Cancer fakers

Last week there were headlines in Tennessee about Keele Maynor, who faked having breast cancer for five years, meanwhile collecting thousands of dollars’ worth of sick leave and donations from her coworkers.

Now Maynor, 38, is facing criminal charges for theft and forgery.

It’s a story that’s surprisingly common. Last year an Australian preacher was outed after conning his followers into believing he had cancer. In 2005 a woman in Utah lied about having cancer because she wanted more attention from her husband; she also reaped almost $16,000 in donations.

Cancer fakers also show up in online forums and discussion groups, often in search of sympathy and support and sometimes scamming for money as well.

Why do people do it? The motivation isn’t always entirely clear, but it seems to stem from a desire for personal gain, a wish for sympathy and attention, or some combination of the two. Some fakers are simply manipulative; others seem to have a tenuous hold on their mental health.

In a case from 2007, a 35-year-old woman in Utah claimed to have breast cancer – and even produced a forged letter from a doctor – so she could get leniency in a drug case. A biotech executive in Boston, facing a lawsuit by the Securities and Exchange Commission, used the same tactic last year.

One of the most common reasons for faking cancer is to collect money, as did a former teacher in Massachusetts who received more than $35,000 in donations before being caught and sentenced for fraud and larceny. In yet another case, a social worker pretended to have cancer so she could take time off work.

Some of these people go to great lengths to present a convincing story, as the case of Suzy Bass, who three times faked having cancer, shows:

After spending hours researching cancer on the Internet, Bass learned to draw convincing-looking radiation dots on her neck with a permanent marker (doctors tattoo patients so they know where to line up the radiation machine every day). She would also roll up a bath towel, stretch it between her hands and rub it back and forth against her neck as fast as she could to give herself "radiation burns." She shaved her own head with a razor and made herself throw up from chemotherapy "nausea" in school bathrooms.

Once the truth comes out, the reaction is usually one of outrage. Friends and coworkers feel betrayed. "The cruelest of cons" is how the story of Jennifer Dibble - who shopped and went to tanning salons during times she claimed to have appointments for medical treatment – is described. Said her best friend:

People were sitting around losing sleep thinking that on these days she was suffering, she was going through chemotherapy, throwing up, and meanwhile she was at the tanning salon. At the tanning salon!

 An Australian woman who faked having cancer was forced to move to another town to escape the anger in her community.

Few formal studies exist of people who claim fictitious illness. At least one research paper, published last year in the Psychotherapy and Psychosomatics journal, concluded that there don’t seem to be any effective or successful therapies that have been established yet for these people.

How can you avoid being taken in by a cancer faker? It’s not always easy, acknowledges the ScamBusters Web site. Besides the heartlessness of asking the person to prove it, many scammers are quite sophisticated at forging documents – and they don’t hesitate to manipulate the heartstrings of their friends, relatives and coworkers.

The advice from ScamBusters: Know where your money is going. If you have doubts but still want to help, consider donating to a larger organization instead.

The real casualty, say those who’ve been fooled by a cancer faker, are the people who genuinely have cancer. Not only do the fakers consume valuable time and resources to which they’re not entitled, but they make the public more reluctant to trust or offer support for the next person who comes along.

Ask anyone who’s ever had cancer for real, and most would say they’d willingly forego the attention, the sympathy and the money if they could only regain their health.

Real lives: stories of mental illness

Her name is Amy. She lives in Kentucky and has had major depression since she was 17 years old. She’s also battling anxiety and wonders if her life will ever become better:

I so look forward and yearn for a time in my life when I can find peace of mind. My battle seems to have progressed over the years and I cannot stand what I have become.

Amy’s story is one of almost 200 first-person accounts of living with mental illness that appear on the Web site of Mental Health America, a nonprofit group that advocates for mental wellness. The realLives campaign was launched today to give a voice to the millions of Americans dealing with mental illness and invite them to share their stories. 

Organizers hope that by doing so, it will help reduce the misunderstanding, shame and prejudice that people with mental illness often face.

The stories collected on the Web site feature both personal triumphs and ongoing struggles with mental health disorders such as schizophrenia, bipolar disorder and depression. The stories illustrate various stages of recovery and come from people of all demographics.

The site also includes an art gallery. Poetry will be posted as well.

Whether you’ve been personally affected by mental illness or not, it’s worth a visit. If you have a story of your own to share, it can be submitted online by clicking here.

Understanding heart failure… from soup to nuts V

Millions of Americans have heart disease, of which congestive heart failure can be the most challenging to manage. The topic of heart failure and how to live well with it is being explored in a series of guest columns this month by Aimee TeBrake. Aimee is a cardiovascular nurse specialist with Family Practice Medical Center in Willmar. You can read the rest of her series here: Part I, Part II, Part III, Part IV.

Heart failure may create new concerns and challenges in your life. You can make changes in your daily life that can help you feel better and stay healthy. Sometimes you may feel like you don’t have control over your life or your health, but learning to manage your disease will help you regain some control.

Weigh yourself daily and record. It is best to weigh in the morning after you use the restroom and before you dress, eat, or drink. Report weight gains greater than 2 pounds overnight or 5 pounds in a week to your physician. Weight gain can be a sign that your body is holding on to fluids. This can lead to swelling. It may also be a sign that your heart failure is getting worse.

Stay at a healthy weight. Less body fat and more muscle means less work for your heart. A healthy diet and exercise will help you stay at a healthy weight.

Track your symptoms. If you are having more difficulty breathing, wake up at night short of breath, have more swelling, are getting tired faster, are urinating less frequently, or are feeling light-headed or dizzy, your heart failure may be getting worse. Report these symptoms to your physician.

Manage stress. Emotional stress makes your heart work harder. When under stress, you may have less energy and your symptoms may be worse.

- Keep doing the things you enjoy.

- Spend time with caring friends, family, or a support group.

- Take an active role in your care.

- Don’t overschedule yourself with activities.

- Keep a journal.

- Exercise.

- Talk to your physician if you feel down most days, or are having problems with appetite or sleep. These are signs of depression.

Limit or avoid alcohol. Alcohol decreases the pumping ability of the heart.

Stop smoking. Smoking damages the blood vessels and lowers the oxygen in your blood. It can make heart failure worse. Ask your physician about options to help you quit.

The deadly bite of West Nile virus

Why do some people become deathly ill with West Nile virus, while others emerge with few, if any, symptoms?

Ever since the mosquito-borne virus appeared in North America in the late 1990s, this question has been a puzzler. It’s known that older people and people with compromised immune systems tend to be more susceptible to West Nile virus and are more likely to develop life-threatening neurological complications such as meningitis or encephalitis. But many other people bitten by an infected mosquito have only mild illness or even no symptoms at all.

A study by a team from Yale University might have uncovered some clues about why this is so. Their work appears in the most recent issue of Immunity.

Working with mice, the scientists looked at immune system mechanisms that are supposed to recognize infectious agents and fight them off. Mice with detection and response systems that were compromised were much more vulnerable to West Nile virus, because they were less able to combat the infection.

Although it’s a large leap from mice to humans, the study holds some promise for increasing the understanding of how the West Nile virus works in humans – and might help point the way toward more effective treatment.

In Minnesota, the risk of West Nile virus is higher in the western part of the state, where the environment – open fields edged with trees – favors the Culex tarsalis mosquito species, which is a primary carrier of West Nile virus. Last year in Minnesota, the Minnesota Department of Health recorded 10 confirmed cases of West Nile virus among humans, none of them fatal.

A rainbow of confusion

Yellow means "allergic to latex."

No, wait. It means "do not resuscitate."

Wait, that’s not right either. It means "patient at risk for falling."

For years, hospitals have used color-coded wristbands as a speedy shorthand for signaling important patient information. Unfortunately, however, with no standardization from one hospital to the next, it has been an invitation to disaster – and things got even more complicated with the introduction among the public of the popular "Livestrong" cancer awareness bracelets and the numerous imitations that followed.

It took a close call at a Pennsylvania hospital – a patient whose yellow wristband was mistakenly thought to mean "do not resuscitate" – for the U.S. hospital industry to begin evaluating this practice and taking measures to standardize and reduce the reliance on color-coded wristbands.

In Minnesota, a task force of the patient safety committee of the Minnesota Hospital Association has been working on this issue for almost two years.

Various surveys found that hospitals were using up to 10 different colors to signify "do not resuscitate," and seven colors to denote 29 additional conditions such as allergies or risk of falling. Staff who worked at more than one hospital, or who changed jobs from one hospital to another, almost needed a color chart to do their jobs.

This rainbow of color codes has now been standardized to three: purple means "do not resuscitate," yellow is for patients at risk of falling, and red is a patient allergy alert.

Minnesota has adopted two additional alerts consistent with the color codes in other states: green for patients who are allergic to latex, and pink to denote a restricted extremity, typically an arm, that should not be used for drawing blood or starting an intravenous line.

Not all states are on board yet, but a growing number of them are moving toward uniformity.

Down the road, color-coded wristbands are likely to be seen less often as other methods are implemented – for instance, bar-code technology, computerized medical records and better tools overall for communicating important medical information about patients.

The move toward standardized color-coding has not been without some bumps in the road. Most notably, there has been concern about using "do not resuscitate" bracelets, which can label a patient in unfavorable ways, or broadcast their end-of-life choices to family members and friends who might be unaware of, or disagree with, the patient’s decision. Most hospitals have managed to find a way around this, however, by making the bracelet voluntary rather than mandatory.

What does all of this mean for patients? It should help make their care safer by reducing confusion and allowing doctors, nurses and hospital staff to quickly identify if they have allergies or might be at risk of falling.

Patients can help by keeping their bracelet (or bracelets) on during their hospital stay. If the patient is a child, parents should keep an eye on their child’s wristband to ensure it isn’t removed; there have been some reports of wristband-swapping among children who were unaware of what the colors signified.

As for the yellow "Livestrong" bracelets, the orange Feral Cat Awareness bracelets, the white anti-war bracelets and the rest of the social cause rainbow, patients should leave them at home – or have a family member remove the wristband and bring it home. Doing so can help avoid a potentially serious mix-up.

 

What if the patient really doesn’t want his or her social cause wristband to be removed while in the hospital? In these cases, hospital staff can cover the bracelet with tape or gauze.

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Understanding heart failure… from soup to nuts IV

Millions of Americans have heart disease, of which congestive heart failure can be the most challenging to manage. The topic of heart failure and how to live well with it is being explored in a series of guest columns this month by Aimee TeBrake. Aimee is a cardiovascular nurse specialist with Family Practice Medical Center in Willmar. For the rest of the series, click here for Part I, Part II and Part III.

Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it. – Plato

You may think having heart failure means you should be less active. The truth is if you have heart failure, it’s extra important to stay active. Remember, your heart is a muscle and exercise can strengthen your heart and improve blood flow. Being active will make you feel more energetic, and less tired. People who exercise have fewer symptoms.

- Ask your physician before you start or change an exercise program. Always follow their recommendations and let your body be your guide. Only do what feels right to you.

- Choose an activity that is enjoyable. Walking is a good way to get moving. You can walk outdoors or indoors around the house or at the mall.

- Light gardening, swimming, and water aerobics are other options you might choose.

- A cardiac rehabilitation program may be an option. This is a supervised exercise program. It can help you feel more confident about how much your heart can handle.

- Consult with an exercise physiologist for recommendations and goal setting.

Tips for keeping active

Start slowly. As you gradually become stronger, increase your exercise time.

Wear comfortable walking shoes.

Exercise at the same time every day. This helps establish exercise into your daily routine. Avoid times right after you eat as more blood flow is involved with digestion.

Don’t exercise in extreme temperatures. Try an indoor activity on those days.

Add activities to your day. Even small activities add up. Go shopping. A shopping cart may make it easier for you to walk. Park your car farther from the store. Stretch your arms and legs while watching TV.

Make activity fun! Go for a walk with a friend. Walk your dog. Listen to enjoyable radio, music, books on tape while doing household chores. Read a book while on a stationary exercise bike. Bowl, fish, or golf with friends.

If you can’t finish a sentence while exercising, you are pushing yourself too hard.

If you feel fatigued, short of breath, an irregular pulse, dizziness, chest pain or tightness, pain in your jaw, neck, shoulders, or arms, stop what you’re doing. If the symptoms don’t go away, call 911 for emergency medical care.

Family Practice Medical Center

In distress, and not getting help

Virtually all people who’ve been diagnosed with cancer will, at some point, need some kind of psychosocial intervention, whether it’s help with transportation or a prescription for an anti-depressant or simply a nonjudgmental listening ear.

Yet only a minority of them actually receive any extra help, even though there’s overwhelming evidence that patients with cancer fare better when all their needs - emotional and social as well as physical - are being met.

The oncology community needs to do better than this, urges the Journal of Clinical Oncology in a series of articles in its latest issue.

The articles examine a study on which types of patients are most likely to be referred for psychosocial care during cancer treatment, whether insurance coverage makes a difference in whether cancer patients receive counseling or other behavioral intervention, and some of the barriers that might prevent patients from receiving the psychosocial care they need.

The emotional side of cancer has been receiving long-overdue attention, especially within the past decade or so. When the Lance Armstrong Foundation conducted a poll in 2004, it found that nearly half of adults with cancer felt their non-medical needs were not being met by the health care system. Many said their oncologist did not offer support in dealing with depression, chronic pain, ongoing health challenges, worries about cancer recurrence, or financial or job insecurity.

Fifty-three percent of the respondents said the practical and emotional consequences of cancer were harder to cope with than the medical issues. What’s more, many of them did not have resources available to help with the emotional challenges, and many reported struggling with depression on their own, without outside help.

The Institute of Medicine issued a call to action in 2007 with its report, "Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs":

The failure to address the very real psychosocial health needs of patients and their caregivers is a failure to effectively treat that patient’s cancer, plain and simple. After all, cancer treatment is intended both to extend life and to improve the patients’ quality of life. The health care system should explicitly recognize these needs and find ways to meet them. Patients and caregivers deserve no less.

This has yet to make it into widespread practice, however, the Journal of Clinical Oncology points out. In one of the studies, patients with advanced lung or gastrointestinal cancer were more likely to be referred for psychosocial care if they were younger, single and depressed - but older patients were less likely to get extra help, even when they exhibited fairly high levels of distress. In another finding from the same study, fewer than half of the patients who screened positive for depression were actually referred for psychosocial services.

What were some of the barriers? Sometimes patients are reluctant to seek help, noted the authors of the JCO commentary "Bridging Mind and Body." In other cases, the oncologist might not know what community resources are available, or might lack experience in screening patients for psychosocial distress. The complex treatment of cancer might result in care that’s fragmented or uncoordinated, allowing the patient’s emotional needs to fall through the cracks. Or, in a rural community, there might be a shortage of qualified services that are convenient and accessible for patients.

The authors also saw issues with insurance coverage – either a lack of insurance altogether, or limited coverage for mental health benefits that forces patients to pay more out of pocket and places limits on the amount of care they can receive.

Carol L. Alter, of the department of psychiatry at Georgetown University in Washington, D.C., notes progress. The American Society of Clinical Oncology, the American Psychosocial Oncology Society and others are developing a quality standard for psychosocial care for the cancer patient, she said.

The National Comprehensive Cancer Network also has published a guideline on screening for psychosocial distress, referral, intervention and follow-up, and various advocacy organizations are working on ways to put this into practice. "It now becomes the responsibility of the broader oncology community to assure that the recommendations of the report are implemented," Alter said.

Flu tracker, week 5

What’s happening with influenza during week 5, the week of Feb. 1-7:

Influenza activity continues to increase across the United States, reports the U.S. Centers for Disease Control and Prevention. Sixteen states had widespread flu activity, 16 states had regional activity and 14 states and the District of Columbia had local activity. In four states and in Puerto Rico, flu activity was still local. Type A flu viruses are the predominant strain that has been circulating.

In Minnesota, influenza activity has risen to regional levels, according to the Minnesota Department of Health. Twenty schools reported flu outbreaks during the first week in February.

At the state’s 30 health care provider sentinel sites for monitoring flu, 0.87 percent of patients showed up with influenza-like illnesses the week of Feb. 1-7. Although this number is rising, it’s still lower than for the same week a year ago.

Study finds binge drinking among active military

Binge drinking is common among active-duty military personnel and is strongly associated with many health and social problems, including issues with job performance and alcohol-impaired driving, according to a new study released this past week by the University of Minnesota and the Centers for Disease Control and Prevention.

The study, "Binge Drinking Among U.S. Active-Duty Military Personnel," appears in the March issue of the American Journal of Preventive Medicine.

The study analyzed data from 16,037 active-duty military personnel who participated in a 2005 Department of Defense survey of health-related behaviors among the military. Binge drinking – defined as consuming four or more drinks on a single occasion by a woman or five or more drinks on a single occasion by a man – was reported by 43 percent of active-duty personnel during the past month.

About two-thirds of these episodes were reported by active-duty personnel who were 17 to 25 years old at the time of the survey.

The researchers also found that alcohol-related problems were reported by more than half of all active-duty personnel who reported binge drinking. Compared to those who didn’t engage in binge drinking, the binge drinkers were more than six times more likely to report problems with job performance and five times more likely to report driving after having too much to drink.

Although the data were collected almost four years ago, the researchers said the issue of binge drinking among active-duty military personnel has been documented over the past two decades. Because many people tend to underreport binge drinking and the consequences of drinking, the survey estimates might actually be on the conservative side, the researchers said.

They urge more intervention, such as enforcing the minimum-age drinking law across the military and in military communities, to reduce binge drinking among active-duty personnel.

Allergic to penicillin… or not?

Many people who think they’re allergic to penicillin actually are not – and a quick, inexpensive skin test could help sort out who’s truly allergic, save money and cut down on the use of broad-spectrum antibiotics.

These findings, collected from a study of 150 patients at an urban academic ER in 2007, appear in the latest issue of the Annals of Emergency Medicine.

The 150 patients in the study had all reported an allergy to penicillin. But when a skin test was administered, the results were negative for 137, or 91 percent, of the patients.

Penicillin is the drug of choice for many emergency patients because it’s both effective and inexpensive, but it can’t be given to people who say they’re allergic to it, said the study’s author, Dr. Joseph J. Moellman of the Department of Emergency Medicine at the University of Cincinnati.

"Until now we have had to rely on the patient for this information. This is the first time anyone has done skin testing for penicillin allergy in the emergency department. It is always preferable to give a patient penicillin instead of a more expensive and potentially complicated drug, but unless we can rule out an allergy to it, that’s not an option."

The study found that the cost difference between penicillin and another antibiotic was approximately $71.

Penicillin skin testing in the emergency room could also help decrease the use of broad-spectrum antibiotics, a practice that is thought to contribute to the development of antibiotic resistance, Dr. Moellman said.

To learn more about allergy to penicillin, check out Mayo Clinic.com or WebMD’s information pages on the topic.