HBO's Hear & Now: The Joy of Communication

HBO premiered the documentary film Hear and Now last night. It is a love story of a fascinating, quirky, intelligent, loving couple who happen to be deaf and the parents of three hearing children. One of the children, award winning filmmaker Irene Taylor Brodsky decided to document her parents journey through cochlear implant surgery.

Paul and Sally Taylor have been deaf all their lives - they are well adapted, happy people - successful, good parents. They are about to retire. Still, what are they missing out on, not being able to hear? Paul Taylor is one of the inventors of the TTY - the telecommunications system that revolutionized communications for the hearing impaired. Brodsky captures the vulnerability of the deaf - of anyone with disabilities. She captures the rejection the Taylors felt as teens trying to fit in to an uncaring world. She captures the youthful hope the Taylors feel at 65, wanting to try new things - have a conversation, go to a concert, listen to music. One thing they remind us is that communication is a joy we take for granted.

Their surgeon proclaims that cochlear implants are the #1 medical advance of the 21st century - because hearing is the only sense that can be restored. The filmmaker/daughter makes it obvious that just the thought of being able to hear for the first time is emotionally overwhelming for the 65 year old Sally, but the surgeon seems to have as much difficulty processing her emotional reactions as she seems to have processing sound.

The surgery is successful - both Paul and Sally can hear sounds. Language acquisition and understanding the spoken word is a different matter. I admit to being an emotional person but I was crying like a baby watching this deeply personal story. The technology is still new and maybe counseling and language classes are imperative adjunctive therapies to help recipients adapt to the world of sound.

Hear and Now airs frequently on HBO in English and in Spanish through June 22. Be sure to watch it exclusively on HBO.

Labels: cochlear implants, HBO, Hear and Now

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AUTISM: The Musical Premieres on HBO March 25 at 8PM

HBO rocks. They keep bringing these crazy love stories to TV - and Autism: The Musical is yet another. The movie ends with Stevie Wonder's song As, fitting for this testament of love mothers have for their children. The fathers love their autistic children, too, but not with the passionate vehemence of the mothers. Autism: The Musical, directed by Tricia Regan tells the story of Elaine Hall, her autistic son Neal and the courageous and unconventional approach she took to unlock her son's world. Coach E, as Ms. Hall is called, engages other autistic children and their families in the production of a musical, written by the children themselves. Look for an interview with Coach E later this week.

Half a million children in the US today are diagnosed with an autism spectrum disorder (ASD). ASD's are developmental disabilities, marked by significant impairments in social interaction and communication. Autistic people are, well, different. Society isn't kind to people who are different. We all know autistic people and struggle with how to accommodate their odd behaviors into our world. Autism: The Musical offers new ideas and fresh approachs for people who seem to be locked into a world of their own.

Warning signs of ASD in adults or children:

• lack of "pretend" play
• not pointing at items that interest them
• not responding to their name
• repeating words over and over
• repetitive actions

Some children seem to develop normally until 18 - 24 months of age when they stop gaining new skills or losing skills they already have, like language or interaction with others. Watch HBO's Autism: The Musical and step into someone else's world.

Thank you, HBO, for use of Group photo from Autism: The Musical, available on HBO.

Labels: autism, autism spectrum disorders, Elaine Hall, HBO

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Interview with a Hero: Dexter Pitts of HBO's Alive Day Memories: Home From Iraq

Alive Day Memories: Home From Iraq is a documentary film from Executive Producer James Gandolfini featuring interviews with ten injured troops who have returned from Iraq. This quiet, elegant film premiered on HBO Sunday September 9, 2007 at 10:30PM and you can see the entire film on HBO.com through September 16, 2007. Half of the troops returning are suffering from post-traumatic stress disorder or PTSD. Dexter Pitts, featured in Mr. Gandolfini’s film, is one of them. HBO and Mr. Pitts made possible the following interview:

JC: Hi, Mr. Pitts – do you prefer to be called Dexter or Mr. Pitts?

DP: You can call me Dex, ma’am.

JC: OK, Dex thank you, call me JC. So tell me a bit about when you went to Iraq…

DP: In June 2004 I was US Army active duty. I was 20 when I left, 19 when I enlisted. I was married at the time, no kids. I was in Iraq six months and 20 days when I got injured. I was injured January 2, 2005.

JC: What happened?

DP: I was in the driver’s seat of a Humvee and an IED exploded half a meter away from the door – I’m lucky to be here…My left arm was broken in three places, I had a contusion in my brain, shrapnel in my back…I left Iraq January 4, 2005.

JC: And were you transferred to Germany?

DP: Yes, ma’am - I was in Germany 2-3 days and then sent to Walter Reed. I was discharged from there after six months of rehab – in August 2005.

JC: And were you diagnosed with PTSD while you were there?

DP: Well, what happened was, they had regular lunch meetings to check the mental status of the people who were OIF [Operation Iraqi Freedom] and that’s when it came out…

JC: How was the re-entry process for you with your family? I mean, do you mind talking about this stuff? My goal is for people, civilians like myself to understand better what you and all the other veterans returning with PTSD are going through…

DP: No, I don’t mind at all- It was hard, it was real hard. Especially with my wife. I had changed as a person. I didn’t know who I was any more. Little things set me off…My little 12 year old cousin was just a kid fooling around – but in Iraq, kids might kill you…so my cousin hit me in my left arm, my bad arm and I hit him in the chest – I needed help. I couldn’t differentiate between the good and bad…people would try to understand, but they didn’t know where I was coming from…I had changed.

JC: How are things with your family now, after treatment?

DP: I got divorced in October 2005. I’m stronger now. It’s a combination of therapy and the work I did on myself. I had a lot of support from my family even though they didn’t always understand…My dad was in the service 20 years – but he never saw conflict. My experiences there in Iraq are burned into my mind. I’m still in a hyper-arousal state – when you’re in these constant huge crowds, and anyone might be someone who could kill you – we were in the Abu Ghraib housing projects surrounded by all these people who don’t like you – so crowded around you – so today I still have a hard time with crowds.

JC: Where do you live today and what type of work are you doing?

DP: I live in a big town in Kentucky. I’m a full-time college student studying criminal justice. I can’t have a regular job with all I’ve been through – I’d like to be a cop in the Federal system – like the US Marshals. I’m getting into acting some, too.

JC: Wow! That’s incredible…well, you certainly have a great personality and a fantastic attitude to do anything…so can you tell me about your treatment for PTSD?

DP: I have been in small group therapy – Group therapy in Fort Durham. For a while I was on three different medications – Seroquel, Zoloft. I was depressed – I had severe depression. I felt so much guilt about being home while my whole unit – Alpha Company 214 - is facing their third tour over there – they’re all coming home in November and I can’t wait!

JC: There has been a lot of talk in the news about people having trouble getting care for PTSD – did you have that problem?
DP: I never had trouble getting treatment. I was taken care of from the beginning. The trouble is – you have to ask for it, and us men, we have this machismo, we’re in denial. You have to admit you have a problem – you have to fight for what you want. Now me – I was going to get off the bench and get in the game…

JC: That’s an awesome attitude…how about sleep?

DP: I still have trouble sleeping. I can only sleep well when I have people around me I can trust, like my girlfriend. Then I feel I can let my guard down and sleep well. The intrusive memories never go away. You can’t get rid of the memories. You have to control them – not allow them to control you…It’s a part of me…I carry it but I can’t let it take over my dreams and what I want to accomplish. I’m the shot caller…

JC: Why did you enlist in the Army?

DP: I hated the military when I was young – I thought it would ruin my life and I was never going to join. But Hollywood influenced me and my dad really was a part of it. Because he did it I guess I wanted him to be proud, to show him I could do the same and more. He was real old school growing up – we weren’t close – I’m a real mama’s boy. We didn’t show emotion. My dad is a real tough guy – but when he heard I got hurt – he cried. He cried for me…I would give anything to see that…and we are closer today. The whole family is closer. Tragedy brings us together…

Labels: Alive Day, Alpha Company, Dexter Pitts, HBO, Operation Iraqi Freedom, PTSD

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Thank you Dr. Emer for Grand Rounds 50! Remember September 9 10:30 PM HBO: ALIVE DAY MEMORIES: HOME FROM IRAQ

Thank you for including a link to my post Remember September 9 10:30 PM HBO: ALIVE DAY MEMORIES: HOME FROM IRAQ in Grand Rounds 50, a round up of medical writing in this week's blogosphere - on Parallel Universes...

You can preview the promo here: http://www.youtube.com/watch?v=gEZsuuOf3Ao

And a clip from the film as well: http://www.youtube.com/watch?v=1HFjnfMlRqM

Labels: Gandolfini, Grand Rounds, HBO, Iraq, veterans

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US Military Casualities: Amputations at Record Numbers

Last summer a report from the Congressional Research Service based on Department of Defense information was sent to Congress detailing the US military casualty statistics in Operation Iraqi Freedom and Operation Enduring Freedom. Twenty percent of soldiers injured have multiple injuries - and may have traumatic brain injury (TBI) as well as traumatic amputations. All most half of the amputations are caused by IED's. These could be prevented if the transportation vehicles our troops are using had undersides designed to bear the impact of this well known threat. The MRAP is one such vehicle that the Marine Corp is now contracted to produce. It has a V-shaped underbelly desgned to protect against underground devices.

Advances in battlefield medicine have saved many combatants who might have died - but is the rehabilitation they receive up to par? The Center for the Intrepid, a $50M rehabilitation center in opened its doors in San Antonio, Texas in January, 2007 to treat the record number of amputees and troops with severe burns. Amputee rehabilitation programs are run at Brooke Medical Center in Texas, Walter Reed Medical Center and Bethesda Naval Medical Center. Housing has been built at Center of the Intrepid for families of the soldiers in rehab. The Center was funded by private donations from 600,000 US citizens, which means the world to the beneficiaries of the services provided. State-of-the-art technology is provided to military amputees including advanced prosthetics, computerized and video monitoring, biomechanical studies and advanced physical therapy methods.

One of these programs is the art program at the Center, a collaboration between the General Services Administration (GSA) and the Fallen Heroes Fund. The art work was chosen to complement the architecture, to remind visitors of the heroes and the sacrifices they have made for the US, and to support the physical rehabilitation programs and motivate participation in extreme sports. The Intrepid Fallen Heroes Fund and the Wounded Warrior Project has also just made available a publication " A Handbook for Injured Service Members and Their Families". The handbook provides information about what to expect, resources available and issues that will crop up. The handbook is available at www.fallenheroesfund.org.

New generation prosthetic devices are being designed by researchers at Arizona State University's Polytechnic campus and the Military Amputee Research Program at Walter Reed Army Medical Center. The Otto Bock C-Leg has a microprocessor knee and was introduced in 1997. It allows the wearer to go up or down hills and slopes and provides greater freedom of movement. Otto Bock also makes a myoelectric hand that is lightweight, compact and responsive.

If you want to get up close and personal with some of the amputees returning from Iraq, watch HBO's Alive Day Memories: Home From Irag from Executive Producer James Gandolfini. The documentary film premieres on September 9, 2007 at 10:30 PM and continues through September 16, 2007. Don't miss it - I have had a chance to see it and it is very moving. These American heroes have sacrificed their health and well being - they don't want us to forget them.

Labels: amputees, HBO, injuries, Iraq, prostheses, veterans, warrior

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REMEMBER SEPTEMBER 9 10:30 HBO: ALIVE DAY MEMORIES:HOME FROM IRAQ

Beginning Sunday September 9 through September 16, 2007 HBO will be airing the very special documentary by Executive Producer James Gandolfini Alive Day Memories: Home From Iraq. I had the opportunity to see the film this weekend and was struck by how unsentimental it is. Filmed on a black, blank stage, Mr. Gandolfini quietly interviews some truly tough men and women about what lead them to enlist in the service (Army or Marines), what they remember about the day they almost died, and the aftermath. There are no cheap attempts to manipulate our emotions. There are no judgments about the right or wrong of war or this war in particular. There are just ten human beings, aged 21-41, unique, full of life, energy, love, ideas, desires, hopes and dreams sharing their stories with Mr. Gandolfini.

Interspersed with the interviews are videos of the servicemen and women at home or at play or in Iraq before they were injured. There are videos of them in the hospitals and rehab centers or dancing after the injuries. Each has a story to tell.

Some of the facts Alive Day Memories: Home From Iraq educates us about:

• 90% of the wounded of this war survive their injuries
• the majority of the wounded cope with amputations, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD)
• this war is seeing the highest percentage of amputees since the Civil War
• 50% of those wounded suffer from PTSD
• 33% of the injured suffer from TBI
  

Mr. Gandolfini calls them "True American heroes." And as HBO has observed, their fight has just begun. For the 30,000 wounded troops among us, and no doubt many more who will return to our shores, we need to rally round them, and help them with this fight. Watch this movie to gain a better understanding of their struggle.

See previous posts: War of Disabilities: HBO's Alive Day Memories: Home From Iraq Tells the Stories
Home From Iraq: HBO, James Gandolfini Focus on New Veterans

Labels: amputees, Gandolfini, HBO, Iraq, PTSD, TBI, veterans

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War of Disabilities: HBO's Alive Day Memories: Home From Iraq Tells the Stories

Penetrating wounds from improvised explosive devices (IED) create unique patterns of injuries that are challenges for clinicians and rehabilitation professionals. An upward oblique trajectory through the neck region, coupled with chest wall and lung contusions is often seen. Extremity injuries present with extensive comminuted fractures and traumatic brain injury (TBI) due to combat appears to be associated with increased cerebral edema as compared with civilian TBI.

IED's are easily assembled from agricultural and medical supplies. Activated by remote control, they combine blast, fragmentation and armor penetration. Often grouped as "daisy chains ", inflicting damage on the underside of multiple military patrol vehicles and, using time delay, the rescue teams as they rush to help the wounded. IED's then, are an illusive battlefield threat generating deadly blast effect injuries. A wavefront of high pressure spreads out at1600 feet per second from the point of explosions, propelling shrapnel at high velocity. Ballistic trauma injuries, or penetrating brain injuries, are treated conventionally. But blast waves cause invisible brain damage, smashing the soft brain tissues against the hard inner skull. Neither helmets nor body armor can protect against the forces of high pressure wave blasts which can result in loss of consciousness, severe concussion, blindness and other neurological deficits.
1800 US troops are suffering from TBI due to penetrating head injuries but there are concerns that there may be many more suffering TBI due to blast waves from TBI. TBI has become "the signature wound of troops returning from Iraq".

Military records indicate that 60% of military injuries are due to IED's or roadside bombs. According to Defense Update International, Online Defense Magazine, the Iraq war, now in its fifth year, is not a war of death but a war of disabilities. David Eschel states the symbol of the war is not the cemetery, but "...the orthopedic ward, the neurosurgical unit..." Executive Producer James Gandolfini looks at a new generation of war wounded in his upcoming HBO feature documentary, Alive Day Memories: Home From Iraq. The film premieres September 9, 2007 at 10:30 PM and can be streamed beginning Sunday 9/9/07 at 111:30 PM EST through 9/16/07 at 10:30 PM.

Thank you, Google images and mindhacks.com for use of image of Iraq IED.

Labels: blast injury, combat, defense, Gandolfini, HBO, IED, veterans

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Home From Iraq: HBO, James Gandolfini Focus on New Veterans

Depression is a serious problem for returning veterans of the Iraq war and their needs are going unmet. Returning veterans report feelings of alienation from their homes and families. The psychological problems, be they depression or post-traumatic stress disorder (PTSD) are creating havoc in family life, with almost half of veterans reporting family conflict or other relationship troubles upon returning from service.

The Veteran Resources Website has rich resources for family members concerned about loved ones with signs of mental illness or distress. That's just not enough though to prevent the alarming public health crisis that is the high suicide rate found in returning veterans. Mark Kaplan MD of Portland State University, has published a study finding that male veterans are twice as likely to commit suicide as civilian males. Oddly, being overweight seemed to confer protection against suicide by 50%. Dr. Kaplan states that being a veteran is a risk factor for suicide, especially for males.

Last week the Pentagon was forced to acknowledge that the suicide rate among returning veterans is the highest it has been in 26 years. Morale is extremely low, troops report little faith in their commanding officers. Problem relationships, legal and financial problems upon returning home are the reasons cited for suicide. "...there was a significant relationship between number of days deployed...and limited evidence to support the view that multiple deployments are a risk factor for suicide behaviors..."


The biggest threat to troops in Iraq and Afghanistan is improvised explosive devices (IED). Experts describe a mind set needed of constant vigilance - no place is safe. There is no safe haven. There is no down time. Devastating injuries from the war are the focus of a new HBO film by Executive Producer James Gandolfini, Alive Day Memories: Home From Iraq.
In this new documentary which first airs September 9, 10:30 PM exclusively on HBO, Gandolfini interviews 10 veterans about their "alive day" - the day they suffered devastating injuries and lived to tell about it. Healthline will be featuring more posts about this event as we approach the date. We are honored to help HBO promote the important message of the film.

Thank you Cpl. Joseph DiGirolamo for use of photo of Lance Corporal William A. Staley while stationed in Iraq, 5/2006.

Labels: depression, Gandolfini, HBO, IED, PTSD, suicide, veterans

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COMA: Interview with Liz Garbus for HBO Special

Traumatic Brain Injury (TBI) is a major international public health issue. It is estimated that as many as 5 million US citizens may have had TBI and the incidence is higher in Europe and South Africa. Young males (15-24), infants and children under age 5, the elderly over age 75 are all more likely to suffer TBI than the general population. Transporation accidents are the leading cause of injury, followed by falls and violence.

Award winning filmmaker Liz Garbus has done it again with a quiet, restrained film Coma about TBI, which will air on HBO July 3, 2007. I interviewed Liz earlier today and, paraphrasing our conversation (I did not record it):

JC: What sparked your interest in this subject?

LG: Sheila Nevins, President of HBO Documentary Films approached me about the idea when the nation was so polarized over the Terry Schiavo case - persistent vegetative state was not understood by the public. And for me as a parent, as we did the film, it became about the Mothers. Mothers don't ever abandon their children - it cuts across all classes, even people who can't afford to give up their jobs to take care of their kids - they do. Mothers are tireless advocates for their children, no matter what.

JC: I was struck by how understated and low key the film was - could you talk about that please?

LG: It was a long process - we shot 200 hours of film at JFK Johnson Rehab Center
following these four families who allowed us into their lives - it was a very unique and privileged situation that we had. We were observing the emergence of consciousness - a slow, painstaking phenomenon. So the approach is restrained to honor their struggle - to treat it with dignity. These families are living in a twilight zone between life and death - and we witnessed some amazing moments - like Sean [young man in vegetative state] crying...

JC: The neuropsychologist, Dr. Giacino, was the key player of the Rehab Team. I found that to be true in my own TBI work - but most people aren't aware of the role of the neuropsychologist.

LG: Yes, I wasn't familiar with the field beforehand, but I found him to be the Guide to the Brain, the Mystery Explorer, our Guide to Outer Space of Consciousness. He was the one who did a battery of tests and helped the families understand what has happened, what is happening. Although you can't give a prognosis, he provides a road map of what can be expected.

JC: You did an amazing job of showing the willpower of the individual...

LG: It was a great honor last night - we had a screening of the film for HBO and Tom [one of the four amazing patients in the film] and his fiancee came. They are living a happy, loving life now, and that's as much as any of us can ask for, isn't it? Tom's stubborness, anger, drive - with brain injury you are locked inside yourself - but the anger and frustration pushes you to recovery.

JC: I always say that anger is a very underrated emotion - the frustrations brain injured people endure are intense.

LG: Tom was pissed - cognitively he knew he was in Rehab - he knew he had to do some things to improve but he was like, why do you want me to throw these rings on this stick? Some of the therapies struck him as ridiculous. And he had this condition we talk about in the film - anosognosia - so he lacked insight into himself - it was part of the brain damage.

JC: So what are some things you would like people who watch the film to come away with?

LG: There's a larger social argument - funding to keep intensive rehab. Private insurance companies stop paying for aggressive therapies if there is no improvement after 6 weeks - but studies show that people improve for up to a year post injury. So that means people with top potential are languishing in nursing homes due to lack of funding.

JC: So I take it you're going to go see Sicko [Michael Moore's film premieres June 29, 2007]?

LG: Yes, we went to a screening - and I hope this draws attention to an important subject and sparks a lot of debate.

JC: And the other points about your film you want people to come away with?

LG: It's about the power of family, the power of love. Life is fragile. I'm a parent and I went home every day and just hugged my kids and remembered every moment with them is special...For the families involved I hope a community develops from this - a community of support for TBI patients and families.

JC: Thanks for your time and thanks for bringing attention to this important subject.

Thank you Google Images for use of Photo.

For more about TBI see:

CDC Concussion Management Tool from Medicine for the Outdoors written by our Chief Medical Officer, Paul Auerbach, MD

and this 18 minute video clip, on HBO's website.

Labels: Coma, family, HBO, Liz Garbus, mothers, persistent vegetative state, TBI, Terry Schiavo

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Upcoming Events: HBO's COMA, IHI's Shared Quality Agenda & Medicine 2.0

Summer should be a time to kick back and take it easy (I think?) but it's going to be a busy month here at Healthline. First up, HBO is airing a new documentary, Coma, on July 3, 2007. Directed by documentary filmmaker and producer of Ghosts of Abu Ghraib Liz Garbus, the two hour special follows the lives of four families of brain-injured patients at JFK Johnson Rehabilitation Institute Traumatic Brain Injury (TBI) Model System in Edison, NJ. I had the opportunity to preview the film last night and found it refreshingly subtle. As a former neurotrauma ICU RN and TBI/catastrophic case manager, this is another one of those areas I'm passionate about. Garbus delicately teases out the subtle differences between persistent vegetative state (as in the Terry Schiavo case) and minimally conscious state (as in the case of Terry Wallis). Healthline is going to feature some more stories about TBI - Garbus' film triggered a flow of memories of some of my unforgettable patients I should share with readers - and we will update our popular Symptom Search to include more conditions associated with TBI. More about the upcoming show after I interview the director later this week...

The Institute for Healthcare Improvement (IHI) was kind enough to provide me with a press pass to attend the important upcoming conference, Engaging with Physicians in a Shared Quality Agenda here in San Francisico later this month. IHI is a not-for-profit organization dedicated to improving the delivery of health care internationally. They strive to accelerate the continual improvement of health care delivery in areas of safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. There programs are legendary for being demanding, energetic, challenging and smart. Looking forward to sharing their vision and ideas with our readers.

Healthline Connects will be hosting Medicine 2.0 Blog Carnival on July 24, 2007. The brainchild of Bertalan Mesko of Scienceroll, whose professed hobby is the relationship of medicine and Web 2.0. Well, I prefer Health & Web 2.o, but healthcare bloggers, step up to the plate. You're doing the dirty work but start writing about it. What does Web 2.0 mean in your work and what is your vision of the future? I want to hear/read all your best stuff! For the uninitiated, Web 2.0 was coined by tech guru Tim O'Reilly in 2003 (correct me if I'm wrong). He's intriguing in that he studied Classics and his honors thesis "explores the tension between mysticism and logic in Plato's dialogues..." Cool. Check out the Web 2.0 Meme Map developed at one of O'Reilly's brainstorming sessions. Now think about applying it to the delivery of healthcare. Cool...Blogging, RSS, the wisdom of crowds are all Web 2.0 features. How do we square that with Evidence Based Medicine? Do you want the "wisdom of crowds" when you're trying to titrate your amiodarone drip? Didn't think so...

Finally, a group of us are going to see Michael Moore's Sicko this Friday. We'll let you know our reaction.

Thank you richardmasoner for use of photo of US CDC graph.

Labels: Coma, documentary, HBO, Liz Garbus, quality improvement, Sicko, Symptom Search, TBI, Tim O'Reilly, Web 2.0

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