Category: Health

Content Warning: This article contains descriptions of sexual assault.

Marissa Hoechstetter knew things weren’t quite right. First, there was the question about orgasms posed by Robert Hadden, the older male doctor who became her OB/GYN. Then, in a follow-up appointment early on in her pregnancy, his “overly-handsy” breast exam. It was Hoechstetter’s first pregnancy. Hadden had been recommended by a trusted friend and she believed he would treat her with care. So she brushed off her discomfort, as women in ambiguous situations so often do.

In a subsequent visit, while she lay on the examination table, Hoechstetter felt Hadden rub her clitoris. “Did that actually happen?” she asked herself. The draping around her protruding abdomen obscured any view of his hand. She was near the end of her pregnancy; delivery of her twins was imminent. She told herself she needed to stay focused on a healthy delivery. And she did. In April of 2011, her beautiful twin daughters were born.

But one year later, during the vaginal exam that was part of her one-year postpartum visit, Hoechstetter did not second-guess. The prickle of Hadden’s beard and tongue on her labia were undeniable. “I knew what happened,” she says. “I knew.” Still, she tried to refocus. “Almost everyone I know has some experience that we’ve tried to accept and move on. So I was like, ‘I’m not in danger. I’m not going to see this person anymore. I’ve got to raise my babies and live my life.’”

But the violations of her body, and of the trust she’d placed in the medical establishment, would not abate. The actions of the man then-acting U.S. Attorney Audrey Strauss would later describe as “a predator in a white coat” led her to shun subsequent doctor’s visits, destroyed memories of her pregnancy, and impacted her relationship with her young children. “There was a long time where I didn’t even want to look at baby pictures, because they reminded me of what happened – of the first person to touch my children.”

In late May, New York Gov. Kathy Hochul signed into law the Adult Survivors Act (ASA). The bill gives people like Hoechstetter an opportunity to hold perpetrators, and the systems that protect and enable them, to account – allowing survivors to file claims that would have otherwise been barred due to the statute of limitations.

New Recourse for Survivors

In 2019, in the wake of the #MeToo movement and increasing accountability for sex crimes, New York extended the statute of limitations from 3 years to 20 years for adults filing civil lawsuits for certain sex crimes, including forcible touching, sexual abuse, and rape. However, the extension only affected new cases and could not be applied retroactively, which is where the ASA comes in.

The bill creates a one-year “look-back window” that allows individuals who were 18 years of age or older when they were harmed in New York state to file a civil lawsuit against the people, or institutions, that caused injury.

The effort is modeled after the Child Victims Act (CVA), legislation passed by the New York state Senate in 2019, that raised the criminal statute of limitations for child sexual abuse crimes by 5 years and raised the civil statute of limitations for someone seeking redress for physical, psychological, or other harm caused by child sexual abuse to age 55. The CVA look-back window was also scheduled to last for 1 year, but was twice extended due to the COVID-19 pandemic. By the time it closed, over 10,000 cases had been filed not only against individuals but against institutions, including the Boy Scouts of America and numerous Catholic Dioceses. Attorneys anticipate a similar spike of cases with the ASA.

While a growing number of states have opened look-back windows for those who are abused as children, justice for adult survivors of sexual assault has been slow, based on the rationale that adults are better equipped to respond to acts of violence within a predictable time frame. Statutes of limitation are intended to discourage unreliable witness accounts, but they belie how insidious and devastating sexual assault can be.

It Takes Years

“It is very different than if you’re a victim of a robbery where someone comes in and steals your TV or takes your jewelry,” explains Sherri Papamihalis, the clinical director at Safe Horizon Counseling Center, the only outpatient mental health clinic specializing in evidence-based trauma treatment for survivors of crime and interpersonal violence. “With assault, the body becomes the crime scene.” The emotional and physical impacts – ranging from fear, depression and anxiety, to impaired cardiovascular function and PTSD – are not linear and can be hard to detect.

Discrete portions of the brain are responsible for the processing of bodily sensations and memory, but when traumatized, Papamihalis says, experiences can become fragmented and memories are suppressed. “It’s as if you threw a glass down and it shattered.”

That’s why trauma can rise to the surface in unexpected ways at unanticipated times. “Take, for example, a rape survivor who was victimized by an uncle who smoked,” Papamihalis says. “They may only remember the smell of the cigarettes or recall a certain sound. Their body will hold the sensations, but they may not have a linear memory of what happened.” This avoidance is one of the symptoms of PTSD. “The brain tries to protect us from painful memories. Someone might remember bits and pieces of an assault, or they may not remember anything at all.”

For Hoechstetter, the impacts of Hadden’s abuse lodged within her body and psyche took years to be fully revealed. She knew what he had done and felt the impacts of the abuse, but still had to hold down a job, take care of her daughters, and get on with her life. It was only when a relative questioned why women who had been assaulted by Bill Cosby took so long to step forward that she realized she, too, needed to speak up and add her voice to the small chorus of those who had already made claims against her former doctor.

Holding Abusers to Account

Hadden was eventually arrested in 2020 and found to have sexually abused dozens of patients between 1993 and 2012. According to the original indictment, the disgraced doctor “used the cover of conducting medical examinations to engage in sexual abuse that he passed off as normal and medically necessary, when it was neither normal nor necessary – it was criminal.”

Although the number of victims eventually swelled to over 200, many were told their cases were too old to prosecute. Hadden eventually received what Hoechstetter describes as a “slap on the wrist” plea deal in which he lost his medical license, but received no prison time. He was required to register as a sex offender, but only at the lowest level, which kept him off the public registry.

The outcome, prosecutors told Hoechstetter, was the best they could have hoped for. To Hoechstetter, this was another violation – and galvanized her to advocacy. “It went beyond the feelings towards this person who had harmed me, and became a much bigger feeling of rage at the institutional failures of people who said they were supporting and protecting me. Once I realized how deep the corruption went, and how many women he’d abused, I knew that there had to be institutional accountability, too.”

The ASA not only opens up possibilities to hold perpetrators like Hadden to account in civil court, it creates an additional path of recourse against hospitals, churches, schools, or other negligent institutions that may have created conditions that allowed the abuse to occur or continue. Hoechstetter is already involved in litigation against Hadden and Columbia University Irving Medical Center New York-Presbyterian Hospital, but is heartened that the ASA will enable the “dozens and dozens of Hadden victims who keep coming forward and have had no recourse” to benefit. “If we don’t name the harm done at the start, we won’t ever move the needle on sexual violence.”

The Power of Speaking Up

In New Jersey, similar legislation instituted in 2019 gave both child and adult sexual assault survivors 2 years to bring civil claims, regardless of when the abuse occurred. Lawsuits skyrocketed as many of those who had suffered in silence had opportunities to seek restitution. But advocates caution lawsuits and legislation should not be considered the final or only measure of healing.

“Healing is deeply personal and deeply individual,” says Robert Baran, managing director of the New Jersey Coalition Against Sexual Assault (NJCASA), “and the look-back window is always going to be an arbitrary number that will seem insufficient to a large portion of survivors.” But what it does do is expand options, allowing survivors greater opportunity to seek their own versions of justice and accountability. Not everyone has the resources – or will – to move forward with a lawsuit in the prescribed windows, Baran says, but knowing they have the chance to do so is impactful in itself.

For those who are able to come forward, the financial damages that could be awarded through a civil lawsuit can help “shift the burden” of the emotional, financial, and life costs from the survivor to the responsible party. That, Baran says, “can feel empowering, liberating, and vindicating.” While he recognizes that “putting what we could call a ‘price tag’ on pain and trauma doesn’t always feel great,” he explains financial relief can enable people to pursue other avenues for healing, including therapy or time off from work. “It can allow for options that might not have otherwise presented themselves.”

More broadly, he says, there is great power in sharing one’s experience, echoed in what survivor and advocate Marissa Hoechstetter describes as her “full circle” experience. On May 24, 2022, she and her 11-year-old daughters were part of a small group who attended the signing of the ASA. Her girls, she says, were the only children there. They got to have their picture taken with the governor, and told their mom how very proud they were of her.

“To have had this happen to me when I was pregnant, and then be at the bill signing with my kids, it was really emotional,” Hoechstetter says. “I hope I’m teaching my daughters that they need to use their voice if someone hurts them or they see harm being done to other people. That this is what it means to use our voice for good.”

Every 68 seconds, an American is sexually assaulted. If you or someone you know has been a victim of sexual assault, you can find resources and 24/7 support at theRape, Abuse & Incest National Network,  1-800-656-HOPE (1-800-656-4673).

The Adult Survivors Act opens a one-year window, during which adult survivors of sexual violence that occurred in New York state can bring their cases in civil court against their abusers or any individuals or institutions that enabled their abuses. The ASA will only set aside the civil statute of limitations for the duration of the one-year window, starting on November 24, 2022, and closing on November 23, 2023. When the window expires, the existing statute of limitations will, once again, take effect.

Aug. 19, 2022 — Among hockey fans, Kevin Stevens is a legend. A member of several teams, including the Boston Bruins and the New York Rangers, the now 57-year-old was especially known for being a Pittsburgh Penguin during the team’s Stanley Cup championships in 1991 and 1992.

But the Bostonian is also a recovering addict whose life changed dramatically when he was 28 years old and made “one bad decision” one night.

“I had never done drugs in my life, but someone stuck cocaine in front of me,” he says. “I didn’t know what it was, but I tried it and that changed my life for the next 24 years.”

Stevens forged a long and often well-publicized battle for sobriety with many challenges along the way, including an opioid addiction due to a massive hockey injury (as well as continuing to use cocaine) and an arrest for dealing oxycodone in 2016.

When he entered a guilty plea in 2017, he vowed to turn his life around. Ever since, he has dedicated his life to help others through Power Forward, a nonprofit he started in 2018 that’s focused on raising awareness about addiction.

Bring on the Dogs

Today, Stevens, who currently works as a National Hockey League (NHL) scout, and one of his board members, Michael Hamrock, MD, a primary care and addiction medicine doctor at St. Elizabeth’s Hospital in Boston, have introduced a unique healing method to the list of offerings for people in recovery.

Called the DOER (Dog Ownership Enhancing Recovery) program, a trained support dog — in this case, a golden retriever named Sawyer — will be sent to live with 12 men living in a sober home in the Boston area, in a program that’s the first of its kind in the U.S.

“For the entirety of my practice, my patients have told me over and over again how much their pet dogs have improved their physical and mental health, so I thought we should add this to one of our offerings,” Hamrock says. “I know this will help.”

The day Sawyer was introduced to the residents as part of a pilot program was a joyful one, Hamrock says.

“We brought Sawyer to the backyard and, while on a leash, he went to each resident individually,” he says. “They started patting him and playing with him. I could see the tremendous delight in their eyes.”

The goal: To add more dogs to the program, over time.

“I believe meetings, medications, spiritual care and having a sponsor help with recovery,” he says. “But dogs can provide safety, prevent loneliness, help you reestablish relationships, help you find purpose and value and offer unconditional love.”

And with overdose deaths in the U.S. reaching record levels last year, Hamrock says the time is now to continuing innovating.

“We know the risk factors for heart disease, but we need a better understanding of the brain disease of addiction,” he says, noting that the acronym GAMES offers a good way to quantify the five risk factors: G (genes), A (age of first drug use), M (treated or untreated mental health issues), E (exposure to opioids as a treatment for, say, chronic pain) and S (stress, especially from adverse childhood events) is a good way to quantify risk factors.

But a well-trained dog can mitigate some of those factors.

“We know dogs can reduce stress and enhance mental health,” he says. “We also know that pet dogs can help with accountability, create a caring environment, and fill the void of nurturing. We can really see a difference.”

Ask Stevens and he’ll tell you he’s excited about how service dogs might play a role in helping addicts stay in recovery.

“I think what Michael is doing is pretty neat,” he says. “When he brought this idea to the table, it made sense. Dogs are so great for people and they’re that bright spot in your day. Offering these residents the chance to take care of something will make all the difference.”

Aug. 19, 2022 – Good news for music lovers and musicians, too: Wind instruments don’t appear to project COVID-19 particles more than talking does, according to a new study.

New research from the University of Pennsylvania, along with members of the Philadelphia Orchestra, found that wind instruments don’t spread COVID-19 particles any farther or faster than a human would during normal speech.

“We are probably one of the first studies to combine flow and aerosol concentration measurements to study aerosol dispersion from wind instruments,” says Paulo Arratia, PhD, a professor of mechanical engineering and applied mechanics at the university, who led the study.

Arratia and colleagues used a particle counter, humidifier, and green laser to visualize and measure how much and how quickly aerosols shot out of wind instruments (think: brass and woodwinds) as orchestra members played their instrument continuously for nearly 2 minutes. They measured the flow from many instruments, including flutes, clarinets, trumpets, and tubas.

The challenge was finding how far apart musicians could be to play their instruments without requiring a plexiglass barrier or risking the spread of COVID-19 to ensemble members or the audience, Arratia says.

The researchers created a fog-like environment near the instrument’s opening using an ultrasonic humidifier. A green laser lighted the artificial fog. With so much moisture in the air and a light source shining through, Arratia and the other researchers were able to measure the abundance and speed of the aerosolized particles.

Most of the particles released were less than a micrometer thick, like what would occur during normal breathing and speech.

The virus particles weren’t ejected from the opening of wind instruments as violently as they are when a person coughs or sneezes, Arratia says. Indeed, the flow was less than 0.1 meters per second, almost 50 times slower than the speed of a cough or sneeze, which ranges between 5 and 10 meters per second, according to the study.

And the particles from most instruments traveled only about 6 feet before decaying to background air draft levels. Only two instruments in the study, the flute and trombone, sent particles farther than 6 feet before the aerosol dropped to undetectable levels. Therefore, keeping woodwind and brass players 6 feet apart may work for reducing the spread and contamination of COVID-19 particles during live performances as well, Arratia says.

“During the pandemic, orchestras spread out their players and used plexiglass barriers to protect each other from aerosols, which was not ideal for sound quality,” he says. Musical pieces had to be adapted to exclude wind and brass instruments, and venues postponed or canceled many concerts.

Smaller community orchestras faced unique challenges as they tried to follow the COVID-19 protocols set in place by larger orchestras without the same financial resources.

“We don’t have the resources that large orchestras had, there was no way to build plexiglass shields around our musicians,” says Ivan Shulman, MD, the music director of the Los Angeles Doctors Symphony Orchestra. “In fact, other than baffling sound, it did nothing but to redisperse the droplets, at least as far as the information we saw.”

To ensure the safest environment for everyone, Shulman, an assistant clinical professor of surgery at the University of California, Los Angeles, picked pieces like Aaron Copland’s Fanfare for the Common Man, a drum and brass composition that allowed players to be spaced far apart. All members except for the wind and brass section wore masks for every rehearsal and concert, and everyone had to be vaccinated.

“Some orchestras tested all the wind players only, before each rehearsal,” Shulman says. “We didn’t have the wherewithal to actually do that, but with the availability of more testing, we were thinking about doing that when we start again in September.”

While Shulman may not have been able to gauge how his instruments spread particles, his orchestra used a carbon dioxide monitor as a proxy for ventilation in the rehearsal space.

“The evidence we saw was that if you kept the CO₂ concentration to less than about 1,100 parts per million, you were safe,” he says. “We never found that we came close to worrisome levels.”

The new findings are reassuring, Shulman says.

“The concern that I have is even with that, in an orchestral setting, how many people want to be near people speaking? Would they rather be further away? We still have to think about people being close.”

Nonetheless, the COVID-19 protocols are worth doing to be able to play again.

“Just the ability to play together was enough to allay people’s fears that it was worth doing,” Shulman says. “We just want to maintain and create a safe space for everybody.”

FRIDAY, Aug. 19, 2022 (HealthDay News) – The death of a child in Nebraska was likely caused by an infection with a “brain-eating amoeba” that occurred after the child swam in a local river, state health officials announced this week.

In a news release, officials said it was the first such death ever reported in the state’s history. Known as Naegleria fowleri, the amoeba can cause primary amebic meningoencephalitis (PAM), a brain infection that is extremely rare, but nearly always fatal.

“Millions of recreational water exposures occur each year, while only 0 to 8 Naegleria fowleri infections are identified each year,” state epidemiologist Dr. Matthew Donahue noted in the news release. “Infections typically occur later in the summer, in warmer water with slower flow, in July, August, and September. Cases are more frequently identified in southern states, but more recently have been identified farther north. Limiting the opportunities for freshwater to get into the nose are the best ways to reduce the risk of infection.”

The U.S. Centers for Disease Control and Prevention is working to confirm the cause of the child’s death through tests, Lindsay Huse, director of the Douglas County Health Department, said during a Wednesday news conference on the child’s death, NBC News reported.

Huse said the child had gone swimming on Aug. 8 in Nebraska’s Elkhorn River, became symptomatic five days later and was hospitalized within 48 hours after symptoms began.

The child, who authorities have not released additional information about out of respect for the family, died on Aug. 18, Dr. Kari Neemann, medical advisor for Douglass County, said during a news conference on the death.

“Right now, we are simply urging the public to be aware and take precautions when they are being exposed to any warm, freshwater sources,” Huse said.

The single-celled organism N. fowleri can be found in soil and in freshwater, such as lakes, streams, hot springs and rivers. It can infect people when contaminated water goes up the nose. The amoeba has been found in Northern states more often as climate change fuels rising air and water temperatures.

The amoeba infects about three people annually in the United States and is typically fatal, according to the CDC. A total of 154 known amebic meningoencephalitis infections happened between 1962 and 2021. Only four of those infected survived.

A Missouri resident also died from infection with the amoeba in July, possibly contracting it while swimming in an Iowa lake.

Swimmers should try to prevent water from entering their noses by plugging their noses if going underwater in freshwater, Huse said. Health officials also suggest not stirring up sediment in shallow warm water. Swallowing water does not cause this infection.

“Make sure that you are not engaging in activities that are causing forceful water up the nose such as water skiing, high speed tubing, those sorts of activities,” Huse said.

More information

The U.S. Centers for Disease Control and Prevention has more on brain-eating amoeba.