Friday Fireside Chat: Dr. Booker, founder, OnPulse

Today, I’m talking to Dr. Corenthian “Corey” Booker.

Corey Booker, not to be confused with the mayor of Newark, is a physician. He received his undergraduate degree in Neurobiology and Physiology at the University of Maryland College, and his medical degree from Creighton University.

Thanks for talking to MedCrunch. What is OnPulse?

OnPulse is a new healthcare product designed to get you, the patient, on the same page as anyone involved in your healthcare. It’s an online environment allowing providers to communicate to one another and their patients. Not only physicians, but staff members –anyone who owns a piece of patient care. With instant online access through the product’s patient profile, connected health teams can view and share relevant information, no matter what EMR they use, or whether they’re at the office, at home or on the road.

Who should use OnPulse?

Any healthcare provider who is currently communicating by email or any specialist trying to manage a large team with email should love OnPulse. Also, any patient who emails their provider should use OnPulse.

How do patients access OnPulse?

It’s web based now (mobile app will be available this summer), so they would log on at http://www.onpulse.com and enter a username and login. Right now, it is by Invitation Only. You can request an invitation at our website. We will release it to more people next month. It can be accessed on iPads and will eventually be available on mobile phones.

What makes OnPulse different from anything else out there?

What makes OnPulse different is we allow the individuals who have an account to own their information. The difference is whenever you stop receiving care somewhere and close an account, you no longer have access to that information. With OnPulse, if you end a relationship with a doctor or provider, you own your information and you can share it with another provider anywhere or anytime you want or the next time you need to access care you can share it with that provider. As a system, multiple providers from different organizations can communicate. It’s based on 4 things: 1. Simplicity. 2. Access. 3. Peace of Mind. 4. On-line teams communicating in one place.

What regulations exist concerning ownership of patient health information?

Multiple state statutes, regulations, and cases govern the ownership of health information and the information contained in medical records. The classic statement of the rule concerning ownership of medical records is that the provider owns the medical records maintained by the provider, subject to the patient’s rights in the information contained in the record.

 
But,under the federal Health Insurance Portability and Accountability Act (HIPAA), every person “has a right of access to inspect and obtain a copy of protected health information.” The Meaningful Use regulations require that outpatient providers give patients clinical summaries within three business days for at least half of all office visits, if requested. Hospitals have to provide an electronic copy of discharge instructions upon request.

 
The stage two meaningful use places a much greater emphasis on patient engagement and set high standards for making data electronically available to patients. Physicians should think about these requirements as they work to implement a new EHR system. The new rules state that a professional must make electronic records available to 50 percent of their patients. Furthermore, 10 percent of a physician’s patients must actually view and download these records.

Should people be concerned about privacy?


As a patient no one knows you have an OnPulse account unless you tell them. Under HIPPA they allow providers to do what they currently do and allow them to invite other providers to the health team. Everyone on the team knows who has access to information. The system is only transparent to those using it.

When did you develop the idea for OnPulse?
I was exposed to communication in our healthcare system during my first summer of medical school. Writing HEDIS measures for the National Committee for Quality Assurance (NCQA), as a Washington Health Policy Fellow intern, taught me that our system was fragmented.

My understanding of communication in healthcare matured in residency when I became responsible for confused patients, busy consultants and returning phone calls to referring doctors for unreceived faxes, but I didn’t do anything about it until my fellowship. As a resident, you learn to communicate with everyone involved, you manage the communication with among your resident colleagues, consultants, patients and the people who are training you. As a resident, you learn to communicate with everyone involved, you manage the communication with among your resident colleagues, consultants, patients and the people who are training you. As a resident I saw, how our means of communication can fail the provider team and the patient. I didn’t know what to do about it at the time.

Within the first six months of my fellowship, I had a patient who looked at me with tears because she had suffered financially, physically and emotionally –she said, ‘I thought you guys were all communicating.’ That was it. I realized that all the faxes, phone calls and emails had failed her and so did our team, despite our best intentions.

Mostly, I learned even more about communicating in healthcare when I became a patient after I ruptured both of my patellar tendons, which connects your knee cap to your lower legs. I realized how difficult it is to navigate healthcare and to have a choice. I also learned how difficult it was for all of the providers to communicate as they are trying to help you reach a certain outcome, especially when they are not in the same organization. For instance I had an orthopedic surgeon and two physical therapist all in different places. This experience really informed how important the asset a patient was to the health team and really improved the system.

How does a patient get started using it?

The patient can either be invited by their provider or they can open their own account. Adding providers is simple. We recommend they that they invite providers that they have an established relationship with, especially an electronic one. If they have multiple providers helping them on a single issue they can suggest to their primary provider to form a health team in OnPulse. Then, you’re able to exchange messages, create a task and share files. Whenever information is requested by you –you receive a text or email alert that something is available to you.

OnPulse spans the communication needs for across sickness, wellness and fitness . For example, some patients even use it to communicate with their fitness trainer, keeping track of a daily routine, and keeping all their health information in one place.

[click  image below to enlarge]

Are there any costs involved for the patient or the provider?

It is free to an individual patients and individual providers. No fee for individual users either patients or doctors. There are subscription payments as a practice to include your business for independent practices or hospitals.

What are the benefits of using OnPulse?

Medical practices can share vital information with other providers and their mutual patients in an easily accessible, unified place. It gives providers and patients secure access to the entire team of healthcare providers. It gives both peace of mind that what they send is actually received by the right person. It helps streamline communication. And it provides personalized communication with everyone. And it’s free to an individual patient and individual provider to use.

Where do you envision OnPulse in 5 years?

My vision for it is to become the healthcare communication environment of choice for all providers and patients. OnPulse, the new on-line healthcare communication environment for patients and providers.

How did medicine and entrepreneurship meet?

My background is medicine with a consistent thread of entrepreneurship. During my fellowship I completed the masters program in clinical informatics at the Duke University’s Fuqua School of Business to better understand how to apply my ideas to clinical medicine. Prior to this time I dabbled in buying and selling houses, creating an online stationary company for my creative wife Kathy and forming a mobile application development company, but by far (besides my kids) OnPulse is the thing that wakes me up and takes me to bed.

“I believe in better communication in healthcare. That’s why I developed OnPulse, where everyone can easily contribute to the personalized best care for the patient and the patient will own 100 percent of their records, and be able to share them accordingly with their health team of choice.” ~ Corey Booker, MD/founder, OnPulse

[click image above to enlarge]

For More Information visit http://www.onpulse.com

 

If you have any questions for Dr. Booker, feel free to ask them below.

Obesity or Greed Epidemic? by Maria Dorfner

Today, as some docs want to regulate toxic sugar I’m reminded of a blog I wrote on this day in ’05:

June 4, 2005 – Every day we are bombarded with media messages about the “obesity epidemic“.  The AP puts a new story on its wires and TV news writers end up rewriting the wire copy for broadcast, so the propaganda ends up in our living rooms.

Who is distributing the Press Release? What is their motive? What have they got to gain by scaring the public into believing we’ve all got one foot in the grave? Turns out, a lot of folks have a lot of money to gain.

In 1988, the World Health Organization (WHO), officially declared obesity a disease. You can’t declare something a disease unless it’s widespread and statistics back it up. Recently, we have seen how the Centers of Disease Control (CDC) admitted inflating those numbers. The CDC was able to receive about $40 million dollars a year allocated towards obesity based on their previous numbers.

In 1993, a study by McGinnis & William Foege, M.D. published in JAMA estimated that the most prominent contributors to mortality in the U.S. were, in order, tobacco, diet and activity patterns, alcohol, microbial agents, toxic agents and firearms with “dietary patterns and sedentary lifestyle being the most common source of unnecessary death and disease among Americans“.

That was 19 years ago, yet we keep getting told the same information as if it’s new.

 

They want us to believe that obesity has surpassed tobacco deaths. Maybe the people who quit smoking started eating.  Although, the alarming number of deaths due to obesity that Foege quoted back then were the same wrong numbers derived from the CDC. 

Obesity programs are funded primarily by the National Center for Chronic Disease and Prevention. There’s that word “disease” again. The budget? $747,472,000.

Turns out, a lot of folks want to get their hands on that money under the guise of conducting “obesity research”. The Medicaid Obesity Treatment Act of ’01 required medicare prescription drug coverage to cover drugs medically necessary to cover obesity.

By declaring obesity a disease many unhealthy strategies for weight loss (stomach stapling, liposuction, diet pills, body wraps, herbal remedies, etc.) might become warranted. Doctors could justifiably use these treatments and feel confident that they are improving the client’s health simply by decreasing his or her weight.


Pharmaceutical companies would be able to market their quick fix pills and quacks could promote radical diets that promote fast weight loss. It must be emphasized that the effect of these treatments would only be temporary since they don’t address long-term behavior change, such as lifetime physical activity and improved dietary habits. In addition, even if weight loss is achieved and maintained there is no guarantee that it will be accompanied with health benefits.

It’s bureaucracy growing in inverse proportion to its effectiveness. It can justify more government taxing under the guise of “tax policy as a social engineering tool”. There are so many special interest groups that want us to buy into the obesity epidemic under their insatiable search for funding. When the truly obese do not respond to their efforts — then they go after the mainstream. More numbers enables them to justify their perpetual fundraising efforts.

The so-called obesity epidemic brings in revenue. In order for these organizations to keep the money rolling in they have to expand the nationwide guilt trip and falsify numbers. The motive is money. Plain and simple.

Foundations redirect their funding when a new disease pops up. Millions of dollars in grants have been awarded under the “obesity epidemic” war. There’s some obese person out there somewhere who seriously needs help and doesn’t have money, but that person probably never gets help.

If these foundations really want to help people, why not make the grant application open to the obese individuals instead of research institutions and organizations that keep getting grants merely to reinforce that a problem exists. That would cost less and help more.

Long-term diet and exercise modifications are the only effective lifestyle changes that affect obesity. It doesn’t take billions of dollars to make people aware of that. Yes, some people have a genetic predisposition towards obesity, but even they can make changes in their eating and activity level.

Stop lowering the threshold for who is considered obese, so that more and more people fall into a category so companies can sell more drugs to them. So far, adults, children, elderly and even newborn babies have been included in this ever-expanding “Greed” epidemic. 

A lot of wallets expand along with waistlines, and consumers need to be wary of studies and research reports that keep reinforcing the same ol’, same ‘ol with a new twist. The new twist is usually a result of some people sitting in a room saying, “We have to figure out to get more money” from this.

How does telling you you’re fat get them more money? Because then you go to the doctor and ask for help. He recommends drugs or surgery. Fast food? The government puts another “sin tax” on it. What’s next? A “sin tax” for computers and televisions because after all, they do contribute to inactivity. Let’s not forget the lawyers who benefitted from tobacco settlements who would love to go after another big industry as well.

[by Maria Dorfner, NewsMD Communications, originally posted on a blog Saturday, June 04, 2005 @ 7:45 PM

newsmdcommunications.blogspot.com/Cached]
 
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2012 UPDATE – 7 years later.  The headlines as predicted want to include MORE PEOPLE in this “epidemic”. More people. More money.   The headline should be:  Obe$ity Greed Epidemic Much Worse Than Americans Believe.

 

Study: American Obesity Epidemic Much Worse Than CDC Believes

The traditional measures of obesity are inadequate, according to a new report

April 2, 2012 RSS Feed Print

The American obesity epidemic might be much worse than many experts believe because of the limitations of the Body Mass Index, which is the most popular number used to diagnose the condition…

______________________________________________________________________________________________________

Pets are included now. 

Statistics tell us there is no change in this epidemic.

A recent article I read by Pope in the New York Times backs this up.  It’s not because there are a lack of medications.  I begin to wonder if all these pills are merely placebos.  The side effects that kill tells me that’s not the case.  At least not in a few batches.

Here’s a link to all the pharmaceutical drugs available to treat obesity. http://www.drugs.com/condition/obesity.html

There is also an organization called Obesity in America.  The website is www.obesityinamerica.org.  It was created to educate, legislate and reverse obesity. It will also feed information to reporters. That’s enough sugar-coated sweetness to make one obese.

There are people who require medical intervention.  They need to be the focus here.   I cry if I watch The Biggest Loser.  I can feel their pain.  I often wonder why God didn’t create bodies that stayed exactly the same no matter how you eat.  Why do people have to suffer over how their bodies look or how they perceive their bodies to look?  Why is it so hard to lose and so easy to gain?

Being thin doesn’t make you immune to stress and challenges either.  It’s easy to blame extra weight for every problem in your life. When that extra weight is gone –it gets harder because when you discover the problems are still there you begin to feel even worse. Only now you can’t comfort yourself with ring dings.  It’s a vicious cycle.  You absolutely have to have new coping mechanisms and habits to deal with any triggers that made you reach for comfort food in the past. 

On “The Biggest Loser” people are led to believe that once they lose the weight, they will be happy.   Many of these people actually look into the camera and exclaim, “I’m SO happy now!”   Happiness doesn’t work like that.  You could be happy obese.  Obesity doesn’t make you unhappy.   Happiness does not rely on external factors.   Once you attach it to an external factor –it will crash because things do not stay the same. They change. Look at nature if you want to understand how this works.  If you can change, yet stay the same –you will be happy.   Your habits result from your beliefs. 

Establishing good habits from childhood is so important.  Habits are things we do automatically.  When I was a kid, we ran outside to play after school.  They will tell you being poor or being stressed will make you a fat kid. That is baloney. 

Bikeriding was big after school. So was jogging, touch football, tag or stoopball right on the steps. And I played tennis with Rob Bonomolo in grade school. We learned how from watching “Hart to Hart” on television. Jump rope was big after lunch in the lunchroom. Susan Favola, Lorelei Donofrio and I made sure to cover the entire alphabet while jumping.

What belief system did we have then? We associated being outdoors with freedom. Freedom from homework (presumably that was done before you ran outside), freedom from sitting in a stuffy classroom, freedom from work, freedom from carrying heavy books, freedom from wearing a uniform.

We could dump our way too heavy book bags, get into comfortable clothing and run free.

Think about that feeling. Close your eyes. Fresh air. Running. Not a worry in the world. We weren’t sitting staring at screens. We were active outdoors. Flying free. Like birds.

Wrong photo.  Those birds are sedentary.  You get the picture.   Visualize flying ones. 
If the economy were as it is right now when I was growing up and my Dad was out of a job –I would still run outside and play, even more.

You don’t need Big Brother telling you you have a disease and you’re part of an epidemic that is bigger than HIV (it’s not).

Maybe if the government focused on fixing the economy, as much as they focus on fixing your waistline, the stress would go away for the unemployed, underemployed, single mothers, single fathers, uninsured and kids.

It’s not an epidemic.  Thinking that releases the exact kind of stressful hormones  you don’t want in your body.  Remain calm.  It’s your private health. Take care of it one day at a time.  Make good choices.  Stay positive.   You are going to be okay.

15 Things Your Walk Reveals About Your Health

 

Paula Spencer Scott, Caring.com senior editor discovered there really is something to the way he or she moves.  Cue Aerosmith.
 

 
 
The following are 15 walking styles which reveal a whole lot about your health.  If you find one that describes you or someone you know, click on the link below to find out more information about it.
 

1. Walking at a snail’s pace may reveal: Shorter life expectancy

The average speed was 3 feet per second (about two miles an hour). Those who walked slower than 2 feet per second (1.36 miles per hour) had an increased risk of dying.   Walking speed is a reliable marker for longevity, according to a University of Pittsburgh analysis of nine large studies, reported in a January 2011 issue of The Journal of the American Medical Association.

2.  Walking with not too much arm swing may  reveal: Lower back trouble

If someone is walking without much swing to the arm, it’s a red flag that the spine isn’t being supported as well as it could be, because of some kind of limitation in the back’s mobility. Back pain or a vulnerability to damage can follow.

3.  One foot slaps the ground may reveal: Ruptured disk in back, possible stroke

Sometimes experts don’t have to see you walk — they can hear you coming down the hall. A condition called “foot slap” or “drop foot” is when your foot literally slaps the ground as you walk.   A ruptured disk in the back is a common cause, since it can compress a nerve that travels down the leg.

4.  A confident stride in a woman may reveal: Sexual satisfaction

Your stride and gait don’t always indicate bad things.  Women who have a fluid, energetic stride seem to be more likely to easily and often have vaginal orgasms, researchers said.

5.  A short stride may reveal: Knee or hip degeneration

When the heel hits the ground at the beginning of a stride, the knee should be straight. If it’s not, that can indicate a range-of-motion problem in which something is impairing the ability of the knee joint to move appropriately within the kneecap.

6.  Dropping the pelvis or shoulder to one side may reveal: A back problem

Muscles called the abductors on the outside of the hips work to keep the pelvis level with each step we take. So while we’re lifting one leg and swinging it forward, and standing on the other, the abductors keep the body even — unless those muscles aren’t working properly.

7.  Bow legged stride may reveal: Osteoarthritis

Bowlegs (also called genu varum) happen because the body can’t be supported adequately; the knees literally bow out.

8.  Knock-kneed appearance may reveal: Rheumatoid arthritis

In knock-knee (genu valgum, or valgus knee), the lower legs aren’t straight but bend outward.  Sometimes osteoarthritis can also result in knock-knees, depending which joints are affected.

9.  A shortened stride on turns and when maneuvering around things may reveal: Poor physical condition

Balance is a function of coordination between three systems: vision, the inner ear, and what’s called “proprioception,” which is the joints’ ability to tell you their position. The joints can do this because of receptors in the connective tissue around them. But the quality of the receptors is related to how much motion the joint experiences.

10.  A flat step without much lift may reveal: Flat feet, bunions, neuromas

Flat feet are obvious at a glance: There’s almost no visible arch (hence one of the condition’s names, “fallen arches”). But other conditions can also cause a flat walk.

 

11.  Shuffling feet may reveal: Parkinson’s disease

Shuffling — bending forward and having difficulty lifting feet off the ground — isn’t an inevitable aspect of aging. It’s a distinct gait that may indicate that someone has Parkinson’s disease.  The person’s steps may also be short and hesitant

12.  Walking on tiptoes, both feet may reveal: Cerebral palsy or spinal cord trauma

It’s related to overactive muscle tone, caused by stretch receptors that fire incorrectly in the brain. When the toe-walking happens on both sides, it’s almost always because of damage high in the spinal column or brain, such as cerebral palsy or spinal cord trauma.

13.  Walking on tiptoes, one foot may reveal: Stroke

Doctors assessing toe-walking look for symmetry: Is it happening on both sides or only one? When a person toe-walks only on one side, it’s an indicator of stroke, which usually damages one side of the body.

14. A bouncing gait may reveal: Unusually tight calf muscles

Specialists can see the heel-off, the first part of a normal step, happen a bit too quickly, because of tight calf muscles.

15.  One higher arch and/or a pelvis that dips slightly may reveal: One leg is shorter than the other

Limb (or leg) length discrepancy simply means that one leg is shorter than the other. You can be born with limb discrepancy or get it as the result of knee or hip replacements, if limbs don’t line up perfectly after healing.  Shoe inserts usually can make up for a quarter-inch discrepancy; surgery is sometimes recommended for larger differences.

Read the entire article here: http://www.caring.com/articles/things-walk-reveals-about-health

 

This content was originally published by Caring.com: “15 Things Your Walk Reveals About Your Health” and this excerpt reprinted here with permission.

10 Hot iPhone Apps for New Parents

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Parenting in the internet age certainly still has its challenges, but tech-savvy parents have several options in the App Store that can help ease some of the stress. Storing important information, accessing records and even entertaining your newborn can all be done with a tap of the screen; here are ten iPhone apps that all new parents should check out.

1. Baby Tracker: Diapers – If your pediatrician asks you to keep a record of Baby’s diapers, the Baby Tracker: Diapers app is a must-have. The simple interface includes a color swatch and texture options, and even has a Notes feature for in-depth documentation.
2. White Noise Lite – Many parents swear by sound machines to soothe babies and help them sleep soundly; the White Noise Lite app offers several options, including nature sounds and traditional white noise. The best part? It’s free.
3. Baby Tracker: Nursing – The folks at Baby Tracker hit another home run with their Nursing app. Mothers who choose to breastfeed can keep track of nursing times, duration and left/right nursing sides. As an extra bonus, there’s also an option for tracking bottle feedings as well.
4. Baby Brain – Created by a team of experienced OB/GYN nurses and moms, the nap-tracking app Baby Brain helps new parents calculate ideal nap times. Entering the time and duration of baby’s daily naps help the app to analyze the information and provide estimates for when subsequent naps should occur. Parents with multiples can track more than one baby, and the interface allows for easy schedule-sharing via email with caregivers.  This one is TOUGH to find but we love it!
5. Parenting Ages & Stages – Popular magazine PARENTING offers a free app to track developmental milestones from birth to school-age, keeping it relevant for years to come. The high-tech version of the baby book.
6. FeverMeds – Unfortunately, low-grade fevers are part of any new parent’s life. The FeverMeds app calculates age and weight to return the ideal dosage of medication to combat those fevers, and also displays pictures of over-the-counter medication boxes in order to eliminate the possibility of choosing the wrong product. It also tracks dosage time and counts down to the next scheduled dose.  Another tough one to find… Sorry, but it’s great!
7. What to Expect – Baby – Generations of moms-to-be have relied upon the wisdom of What to Expect When You’re Expecting. The beloved line of books also extends into early parenting and development. The What to Expect – Baby app makes carrying the book everywhere a snap, and also includes daily updates and trackers.
8. BabyPhone Deluxe – Instead of packing a baby monitor for trips or carting it from room to room, consider the BabyPhone app. If noise levels in the room exceed a designated level, the app automatically dials a secondary number to alert parents.
9. Infant Visual Stimulation – With one hundred and twenty black and white images designed to stimulate babies vision, the Infant Visual Stimulation app is a great resource for new parents.
10. Baby Rattle 123 – Leaving Baby’s favorite rattle at home is no longer cause for concern with the Baby Rattle 123 app, which transforms your phone into a visually and auditory stimulation tool.

All new parents need some help, so it is a great idea for the iPhone to serve multiple purposes. Check out the App Store for these and other great apps for new parents. You never knew a phone could do so much.

THANK YOU NANNY NET  – Debbie Denard

BEST NEW PARENTING BLOG: NANNY NET –   http://www.nanny.net/blog/10-iphone-apps-for-new-parents

 

RELATED LINKS:

HOW A BABY TAKES SHAPE INSIDE YOUR BODY:  http://www.babycentre.co.uk/video/pregnancy/baby-takes-shape/

WONDERFUL PBS DOCUMENTARY recommended by author, Michael Gonzalez Wallace:  http://topdocumentaryfilms.com/the-secret-life-of-the-brain/

Monitor Babies from iPhone, iPad or IPod

Love this gadget.  BabyPing recently announced the arrival of its new high security Wi-Fi baby monitoring system. The product will allow parents to hear and view their baby utilizing an iPhone, iPad or iPod touch. The system also features double-layer security that alerts parents if their baby cries, if the Wi-Fi connection drops out or if their iOS device is out of range.

 

The BabyPing kit features all the specifications of a regular baby monitor, in the form of a full color video camera with 640×480 resolution and built-in microphone, a free monitoring app for the user’s iDevice, and wireless Wi-Fi connectivity. In addition, BabyPing has developed the Smart Filter which reduces background noise and static, and Constant-Connect technology which instantly notifies the user when the baby is upset or if the connection is lost. BabyPing is also reportedly the only Wi-Fi baby monitor on the market with infrared night vision.

BabyPing will be available from February 2012.

Can an iPhone or iPad Help with Anorexia Nervosa Intervention

Image representing iPhone as depicted in Crunc...
Image via CrunchBase

It’s called “Photo-Therapy” and it may offer a promising intervention

 By Sidney H. Weissman, MD | January 11, 2012
Dr Weissman is on the Faculty at the Chicago Institute for Psychoanalysis and he is Professor of Clinical Psychiatry at the Feinberg School of Medicine of Northwestern University in Chicago.
  ________________________________________________________________________________

We now communicate in ways that are very different from those available just a decade ago. The iPhone, iPad, and similar devices also enable us to observe ourselves as we perform any number of activities. These and other new devices may have an application their designers never considered. I believe we can harness this technology to help us treat some of our patients.

Specifically, I propose that the ability of the iPhone and iPad to ”film” ourselves in real time could serve as an important therapeutic instrument in the treatment of patients with anorexia nervosa (AN).

  • We know patients with AN have a delusional sense that they are overweight and have a distorted body self-perception, even when they are undernourished and near death. To address the distorted self-image, we use various medications and forms of individual, group, and family psychotherapy along with nutritional support administered with the help of dieticians.

These treatments aim to correct the patient’s delusional perception of body image and to establish life sustaining eating patterns that will maintain body weight. Correcting the patient’s delusional self-perception is seen as critical in the patient developing life-sustaining eating patterns. Over time, and for some patients, however, these treatment approaches have limited success.

Mental health professionals typically employ verbal or written communications to address and alter an anorexic patient’s distorted self image. Patients may appear to accept our therapeutic pleadings and go along with varied elements of our treatments. Secretly, however, they often don’t believe what they tell us. Thus, even when we believe our treatment has been successful, seeds of relapse often exist.

If we focus on obtaining a better understanding of how patients with AN distort their body image, perhaps we can enhance our therapeutic approaches?

If a patient with AN sees her reflection in a mirror, she typically perceives herself as overweight. However, if she is shown an iPhone image of herself immediately after it is taken, I have found that she may see herself differently — in fact, as the undernourished person she really is.

When she sees herself in the mirror, the image she sees is instantaniously fused and distorted with her self-perception as overweight. When the same individual holds an iPhone with an image of herself immediately after it is taken, a different cognitive process is involved. First she observes in the iPhone a picture of a woman and that woman’s physical characteristics. She may be able to accurately describe the physicality of the woman in the picture as extremely thin. This may occur because thebrain first registers the physicality of the person. Quickly the patient will realize that she is, in fact, the woman in the iPhone image. At this point, she may or may not continue to be able to report accurately what she now knows is her own picture.

The therapist who treats patients with AN can use the patient’s potential capacity to correctly describe the iPhone images to help her correct distortions of body image.  Let me describe an approach utilizing this knowledge that has successfully worked with some of my patients with AN.

First the patient is asked to observe and then describe her image as seen in a mirror with her therapist present. Then an iPhone image is taken. She is asked by her therapist to describe the iPhone image. If she can correctly describe her physicality in the iPhone image and distinguish it from her distorted view of the mirror image, her therapist can go on to address with the patient her distorted body image.

When a patient persistently describes the woman in the iPhone image in the same terms as she does when observing herself in the mirror, the therapist takes a picture with the patient. The therapist then asks the patient to describe separately their images. If she sees a distorted image of the therapist, the therapist and patient then work to develop a jointly shared description of the therapist. Once this is achieved, both re-examine the image of the other person in the phone image. . .  the patient. They now work together to develop a jointly shared view of the patient.

The therapist does not correct the patient’s misinterpretation of the phone image. If she has correctly described the image of the the therapist but cannot accurately describe her own image, then the therapist may remind her that both agreed on the therapist’s image. At this point, they may again see if they can come to an agreement on a description of the woman in the image. If they now can not, the therapist can explore with the patient why she felt she could not.

The psychotherapeutic  techniques used in this process are described by Frieda Fromm-Reichmann in Principles of Intensive Psychotherapy.1  “The psychiatrist should not argue . . . He should  state quite simply that he does not share the patient’s . . . interpretation or evaluation of facts . . . He should try to interest the patient in the investigation of the following questions. . . why is there a difference in the patient’s interpretation or. . . perception from those of the psychiatrist.”

By reconciling the patient’s perception of herself in the phone image and in the mirror, the patient may actually be able to correct her errors of body image and would — with additional therapeutic interventions to sustain this corrected vision and — eventually be able to maintain her weight with little or no outside help.

The additional treatment would also utilize appropriate  principles and techniques of Cognitive Behavioral Therapy as well as nutritional counseling.

Because of the risk that body image distortion and weight loss will recur, the patient may benefit from learning how to use the selective phone images throughout her life to ensure a reliable body image, regardless of whether she is in therapy.

Conclusion
These therapeutic interactions may be a useful facet of a multifaceted therapeutic approach. They are intended to reduce the power of body distortion in perpetuating AN. CBT and nutritional counseling continue as important elements in the treatment of AN. The technique to address distortion of body image may also be of use in the treatment of patients with body dysmorphic disorder.

Reference
1. Fromm-Reichman F. Principles of Intensive Psychotherapy.  University of Chicago Press, Chicago;1950:175.

The First Comprehensive Biological Treatment for Anorexia Nervosa in Fifty Years Revealed in New Book

One of America’s leading experts in eating disorders and integrative medicine presents a revolutionary new treatment plan for women and men with anorexia

Quote startAnorexia is not the disease we’ve always thought it was. It’s not just a psychiatric disorder. Anorexia is a medical illness of starvation that causes malnutrition in the body and the brain. Treatment needs to focus on correcting this malnutrition.Quote end

The first thing Dr. James M. Greenblatt wants you to know about anorexia nervosa in Answers to Anorexia (Sunrise River Press, softbound, $16.95), his breakthrough new treatment for treating and preventing the disease, is that this is no trivial condition.

“Anorexia nervosa is not just an eating disorder. It’s the most lethal psychiatric disorder on the planet. One of out of every five patients dies within twenty years of diagnosis, predominantly from suicide.”

The second thing Greenblatt, a noted expert in eating disorders and integrative medicine, wants perfectly clear is that the medical profession has failed the millions of young women—and increasingly men—ravaged by the spiral of self-imposed starvation that anorexia unleashes.

“Anorexia is not the disease we’ve always thought it was. It’s not just a psychiatric disorder. Anorexia is a medical illness of starvation that causes malnutrition in the body and the brain. Treatment needs to focus on correcting this malnutrition.”

By treating the underlying medical illness of brain starvation, Greenblatt has had success in helping anorexic patients recover. Armed with the latest research from the frontiers of brain chemistry and nutrition, he even believes that anorexia nervosa may be preventable. That’s the best news we’ve had in fifty years of treating the disease.

Greenblatt’s new nutritional paradigm resulted in his developing a highly accessible treatment regimen incorporating holistic and integrative/nutritional medicine. The nutritional model also enabled Greenblatt to develop a new diagnostic tool for determining the likely effectiveness of individual medications for the treatment of depression and anxiety that often accompany anorexia.

Many of the symptoms anorexics present, including ironically, self-starvation, are themselves expressions of a starving brain. A brain that convinces you it’s a good idea to starve is an insidious adversary. Fortunately, as Greenblatt’s research concludes, you can stop this life- threatening process with targeted nutritional interventions.

“There will always be a role for therapy and medications in the treatment of anorexia,” Greenblatt explains. “But for the first time there’s a treatment that stops the downward spiral of this disease long enough to provide effective treatment and facilitate sustained recovery.”

That will be world-changing news to the millions of families faced with the daily nightmare of “reasoning” with someone intent on starving herself. Greenblatt’s brain research has also led to the aforementioned diagnostic test—referenced electroencephalogram (rEEG)—that has been proven successful in helping doctors know which medications will work for individual patients. “It beats the trial and error method of polypharmacy hands down,” Greenblatt explains. “That’s important. The faster you can treat the symptoms of anorexia—the depression, the obsessive thoughts—the profound malnutrition—the better the chance of survival. Greenblatt has redefined our understanding of Anorexia Nervosa with his description of this life-threatening cycle that he refers to as “Malorexia.”

Answers to Anorexia presents these neurophysiological breakthroughs in language accessible to any layman. It’s a fascinating book for anyone interested in the physical damage and brain dysfunction that result from anorectic malnutrition. And a life-saver for anyone suffering through it.

For more information, visit http://www.jamesgreenblattmd.com

Media contact: Victor Gulotta, Gulotta Communications, Inc.
617-630-9286, victor(at)booktours(dot)com
http://www.booktours.com

Answers to Anorexia: A Breakthrough Nutritional Treatment That Is Saving Lives
By James M. Greenblatt, MD
Sunrise River Press
ISBN: 978-1-934716-07-6; softbound, 6 x 9, 224 pp., $16.95

Biographical Information

A pioneer in the field of integrative medicine, James M. Greenblatt, MD, has treated patients with complex eating disorders since 1988. An acknowledged eating disorder and integrative medicine expert, Dr. Greenblatt has lectured throughout the United States on the scientific evidence for nutritional interventions in psychiatry and eating disorders.

In addition to being the Chief Medical Officer of Walden Behavioral Care, Dr. Greenblatt is the Founder and Medical Director of Comprehensive Psychiatric Resources, a private integrative psychiatric practice. Dr. Greenblatt also serves as an Assistant Clinical Professor at Tufts Medical School. After receiving his medical degree and completing his psychiatry residency at George Washington University, Dr. Greenblatt went on to complete a fellowship in child and adolescent psychiatry at Johns Hopkins Medical School.