By Madeline R Conway
For years, Purell, the hand sanitiser, was Amy Iannuzzi-Tingley’s “best friend.” When she was at her worst, she said, she was taking three “scalding hot” showers a day and washing her hands 50 times. And it was all driven by her obsession with germs.
Amy has obsessive-compulsive disorder. OCD is a mental illness characterised by anxiety and recurring thoughts, or obsessions, that trigger repeated behaviours, called compulsions. For much of her life, Amy’s germ-focused OCD forced her to wash her hands excessively and constantly worry about being contaminated by things around her.
Today, after years of therapy and taking medication, Amy, now 30, keeps a schedule no different than the average speech pathologist. She washes her hands only before cooking and after using the bathroom; she showers just once a day.
And perhaps most symbolic of her recovery, she no longer carries hand sanitiser in her purse.
OCD is one of the most common psychiatric illnesses, according to Robert Hudak, Amy’s doctor and the medical director of the OCD clinic at University of Pittsburgh Medical Center (UPMC). Roughly 1% of American adults, or about 2mn people, have the disorder, according to the National Institute of Mental Health.
Amy’s journey hasn’t been an easy one, but it has inspired her to become an advocate for awareness about the disorder and the options for treating it.
Although she still takes medication, Amy is not in psychotherapy now, and hasn’t been for a few years. But her years of treatment have left her with the tools she needs to keep healthy, she said.
Every day, she makes sure she isn’t washing too much or avoiding things she thinks might be dirty. It’s a far cry from the days before her diagnosis and treatment.
Back then, she said, “I just did everything my OCD wanted me to do. I just washed and cleaned and avoided what I didn’t want to touch, and it took over my life.”
Amy’s OCD was not diagnosed by a medical professional until she was 18, but she knew long before then that she had the disorder. When she was about 11, she said, her behaviours were characteristic of OCD. She had started washing and showering more frequently, and it was a scary point in her life.
“I didn’t know what was going on at first,” she said. It wasn’t until she saw an episode of the Oprah Winfrey Show that she realised what she was suffering from.
The programme featured people with OCD talking about their experiences. When she saw it, Amy said, she “immediately knew, ‘Oh, my God, this is what I have.’”
But Amy did not share her self-diagnosis with family or friends or seek medical help. She kept her OCD a secret through the rest of middle school and high school, hiding compulsive behaviours and making excuses for them when others noticed.
If someone saw her washing her hands at school, she would say she had gotten gum stuck on them from under a desk; if her mother noticed her changing her clothes, she would say she had gotten them dirty or sweaty.
She made it through high school this way. She earned good grades and participated in extracurricular activities, all without medical help. “I thought I could handle it on my own, and I thought I wasn’t bad enough,” Amy said. “I told myself I didn’t need help — that I was fine.”
College was a different story. Amy knew it was time for a change when she moved into her freshman dorm room at the University of Dayton at 18. Her OCD overwhelmed her, and she withdrew after just five weeks.
“I would go to a class, and I couldn’t touch a test they gave me because I thought it would be contaminated,” Amy said. “That was the final straw.”
Now, almost 12 years later, Amy considers herself recovered. She still has OCD — there is no cure for the disorder — but she has gone through treatment consisting of medication and cognitive behavioural therapy, known as exposure and response prevention, that she says has made all the difference.
After she withdrew from college in 2002, she was diagnosed with OCD, started taking medication and entered an intensive outpatient therapy programme at UPMC.
For two months, Amy went to UPMC three days a week. She worked with therapists to expose herself to her fears — objects she thought were contaminated with germs. During her first therapy session, she held the key to the common floor bathroom in her hand, something she normally would have shunned.
The therapy was hard and “very uncomfortable,” she said, but through these exposures, she started to feel better.
“I slowly learned that being contaminated is not going to hurt me,” Amy said. “It was not as bad as I was making it out to be. Slowly, and of course over many sessions and more and more therapy, I started to feel empowered.”
After just a few months, Amy returned to college, this time closer to home. She opted for a single dorm room instead of sharing with a roommate, but she still showered in a hall bathroom. “It was as dorm as dorm could be,” she said.
By the next autumn, she was living in an apartment with friends.
Making such a quick turnaround felt “huge,” Amy said. “It was very empowering to see where I had come in a year, from leaving college to getting better with my OCD and catching back up in school. I just felt normal.”
In the years since, Amy returned to intensive therapy twice and met with a therapist less frequently, once every week or two, for several years. She also has taken regular medication, she currently uses three prescription drugs: Seroquel, Paxil and Cymbalta.
While she has moved away from Pittsburgh, she still sees her doctor at UPMC. Amy said she wasn’t satisfied with the care she received outside of the city. Dr Hudak said many health professionals aren’t taught to diagnose or treat OCD properly.
“It’s very common for medical professionals to misdiagnose you,” Dr Hudak said. “There are a lot of places in the United States — most places in the United States — where expert care isn’t there.”
Amy’s mother, Deborah Iannuzzi, said she decided to get involved with the Obsessive Compulsive Foundation of Western Pennsylvania, a non-profit education and support organisation, because she felt that there weren’t enough therapists qualified to treat OCD in the area. She’s now the chapter’s secretary and previously served as its president.
Today, Amy serves as an advocate for awareness of available treatment options for OCD, and reaches out to others with the disorder. She started a support group in the Pittsburgh area for people with OCD and ran it for a year.
She has also given talks about going to college and having relationships while living with OCD (she has been married to her husband, Andrew, for eight years).
“For a long time there, I would not tell anybody that I had this problem. Now I’m not afraid to tell people,” Amy said. “I want to show (other people with OCD) that there is this therapy and there is hope that you will be normal again.” — Pittsburgh Post-Gazette/MCT
Excess sodium linked to 1.65mn deaths annually
Across the world, the excessive consumption of sodium — hiding in breads, soups and snack foods and beckoning from salt shakers everywhere — is the cause of some 1.65 million deaths by heart disease and strokes yearly, including roughly 667,000 “premature” deaths — those before the age of 70 — says a comprehensive new study.
Globally, new research concludes that one in 10 cardiovascular deaths can be attributed to excessive sodium consumption, and one in five of those among people younger than 70. The study, conducted by an international team led by Dr Dariush Mozaffarian of Harvard University’s School of Public Health, was published in the New England Journal of Medicine (NEJM).
An invited editorial touted the study as a “herculean effort” to glean the effects of excess salt consumption in a broad population. But citing the findings of two studies published alongside the global assessment, University of Alabama vascular expert Dr Suzanne Oparil declared it too early for public health officials to take up the cudgels against dietary sodium.
Daily sodium intake averaged 3.95g per day across the globe, and ranged upward to 5.15g, Mozaffarian’s team found. That level of consumption is well above the range that experts for the Institute of Medicine have concluded is ideal — as little as 1.5g per day for those with high blood pressure (as well as diabetics, African-Americans and those 50 and older) and as much as 2.3g for all others.
Diets high in sodium claimed their highest tolls in a band stretching from the countries of Georgia and the Ukraine and across Central Asia to Russia, Mongolia and China, with slightly lower death rates throughout Asia, the study found. It was lowest in Central America and the Horn of Africa.
The United States, Canada and Europe, where public health campaigns aimed at reducing sodium in foods are already underway, lay roughly at the global midpoint, with just more than 300 deaths per million attributed to high sodium intake.
The study’s seemingly dramatic findings, however, belie continuing controversy over the value of efforts to reduce sodium intake across whole populations.
Among the points of contention is whether diets high in salt cause healthy people to develop high blood pressure or merely exacerbate the condition in those who have it. In contemplating measures to reduce the sodium content in everyday foods, public health officials are also wary of causing harm to patients, including those with heart failure, diabetes or chronic kidney disease, for whom a diet very low in sodium can cause complications and lead to death.
Clinical trials have demonstrated that subjects who reduced their sodium intake lowered their blood pressure. But despite extensive research, debate and efforts at expert consensus, the value of broad sodium-reduction campaigns — as well as the targets such campaigns should aim to reach — remain controversial.
A pair of studies published alongside the global assessment underscore the suspicion that, in broad populations, the relationship between sodium intake, hypertension, cardiovascular disease and death may be quite complicated.
One study found a tenuous connection between sodium intake and hypertension. A second study found that over a roughly 3-and-half year period, those ingesting between 3 and 6g of sodium daily — a span that reflects the global range of sodium intake — were less likely to die or suffer a heart attack or stroke than were those who consumed diets higher or lower in sodium.
In addition, both studies suggested that for some, dietary intake of the mineral potassium may play a role in reducing excessive sodium’s ill effects.
The two studies appearing alongside the global assessment were conducted by researchers at McMaster University’s Population Health Research Institute in Ontario, Canada. Both measured, by indirect means, the sodium-intake levels of more than 100,000 people from at least 17 countries.
In the first of those studies, the link between levels of sodium intake and hypertension was most evident in older subjects, in those who had the highest sodium intake, and in subjects who had hypertension. But in people who fell outside of these groups, researchers found little discernible pattern: a diet that was moderately high in salt — just under 3g a day — was not clearly linked to high blood pressure in this study. And those consuming between 3 and 5g of sodium daily were only slightly more likely to have hypertension.
Those findings led Dr Oparil, writing in the New England Journal of Medicine, to conclude that more study is needed before public health campaigns aimed specifically at reducing sodium intake can be safely launched. — By Melissa Healy, Los Angeles Times, MCT
Eye colour may affect pain tolerance: Study
Pain comes in all shapes and sizes. Whether it arises in the chronic form of arthritis or the sudden squeeze of cardiac arrest, pain is the main motivator for a visit to the hospital.
Doctors may now have to note the eye colour of their patients before choosing a procedure to treat them. New research has shown that women with dark — brown and hazel — eyes respond differently to pain than those with light — blue and green — eyes.
During the 2014 annual meeting of the American Pain Society, Inna Belfer, an associate professor of anesthesiology at the University of Pittsburgh, presented a study possibly linking eye colour to variations in pain tolerance.
The study sample consisted of 58 healthy pregnant women at Magee-Womens Hospital of the University of Pittsburgh Medical Center. Twenty-four women were placed in the dark group, and the remaining 34 were placed in the light group. Dr Belfer and her team measured responses to pain before and after giving birth through a variety of quantitative standard testing, questionnaires and surveys.
The results indicated that women in the dark group experienced more dramatic response to pain with increases in anxiety and sleep disturbances than those in the light group. “This was a small pilot study to start off,” said Dr Belfer. “All we know now is super limited — a hypothesis about why there is a difference at this point would be too optimistic — but this could be a next step in finding a genetic background of pain.”
Identifying eye colour as a genetic biomarker for pain thresholds will be advantageous for the medical community. “Right now we don’t know who is going to feel more severe pain after standard surgery or develop chronic pain,” said Dr Belfer, “This is a problem for both patients who are suffering and society.”
Determining a visible indicator of a genetic signature that predicts pain tolerance will “help to identify those targeted patients, and the earlier you can identify them, you will be in better shape for the future.”
This is not the first research that has related phenotypic differences and pain. Multiple studies have correlated red hair to resistance to pain blockers and requirements for higher doses of anesthesia. Dr Belfer and her team also discovered three studies that link eye colour to physiological activity.
Dr Belfer plans to continue the research on this topic by expanding to studies including men, children and larger, more comprehensive distinctions between groups. — By Campbell North, Pittsburgh Post-Gazette, MCTa
