Doctor Secrets!

Blog by DR. MD.

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What I Learnt from Batman & Can We Learn Medical Stuff from TV?

June 17th, 2011 · My Raves

File:Joker (DC Comics).jpg

In my mid-teens I orbited away from mutants and Marvel to DC’s world of Gotham and Batman. To this day I have a collectors Two-Face coin on display below my computer monitor. My reason for gravitating to Batman and his arch villains is that they seemed more real to me. Exaggerations of brain lesions we know do occur. Batman is suffering PTSD with narcissism and antisocial personality disorder traits. The Joker is obviously suffering with a frontal lobe lesion causing disinhibition. Scarecrow chemically tickles a victims Amygdala overpowering them with fear. And my favorite, Harvey Dent aka Two-Face, has a traumatic Thalamic lesion making even trivial decisions impossible without his trademark coin.

But this leads me to my question. Can we learn real science, or real medicine from mass media? Take a peek at what Everyday Health turned up: “The 6 Most Powerful Health Plotlines on TV“. Enjoy.

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Kate Middleton’s Royal Wedding Nerves

May 5th, 2011 · Celebrity Health

Like 2 billion other people on earth I watched Kate and Williams wedding over last weekend. Very classy with a puff of magic dust. At some points through the broadcast I really felt for Kate and Pippa. Imagine 2 billion camera eyes on you, and an electrified sea of another million persons standing outside your wedding. Yikes. William I had no worry about – he’s been used to being media swarmed since childhood so plenty of time to develop an immunity.

File:William and Kate wedding.jpg

This led me to thinking… is there a medical way to achieve Kate’s poise. Not saying she did use pharmacological help. But is there something in the Royal Medicine Chest that might help with a nerve racking public appearance like this.

Actually two items come to mind:

  • Propranolol – used by surgeons and golfers to steady their hands, this stuff takes the edge off an adrenaline rush without leaving your head space fuzzy or sleepy.
  • Lorazepam – this sedative is frequently used by insomniacs, phobics, and people with fear of flying. In low doses, it allows you to function without nerves and wears off in about 4hours.

Again, not saying anyone went to the chemist before the wedding… but I just wonder…

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News on Charlie Sheen – Addicted to Drugs or Not?

April 30th, 2011 · Celebrity Health

Can we use news clips to figure out if Charlie Sheen has a drug addiction? Addicts I’ve come across almost never admit a problem before recovery. Charlie Sheen has to date publicly denied return to use. But what does the evidence suggest?

File:Charlie Sheen March 2009.JPG

The American Psychiatric Society provides a fat book of criteria needed for diagnosis of a spectrum of mental disorders. It’s called the DSM-IV and for addiction aka ‘drug dependance’ they require the following:

A maladaptive pattern of substance use, leading to
clinically significant impairment or distress, as manifested by three (or more)
of the following, occurring at any time in the same 12-month period:

(1) tolerance as
defined by either of the following:
(a) a need for markedly increased
amounts of the substance to achieve intoxication (read “get high”) or desired effect
(b) markedly diminished effect with continued use of the
same amount of the substance

(2) Withdrawal, as manifested
by either of the following:
(a) the characteristic withdrawal syndrome for the
substance
(b) the same (or a closely related) substance is
taken to relieve or avoid withdrawal symptoms

(3) the substance is often taken in larger amounts or over a
longer period than was intended

(4) there is a persistent desire or unsuccessful efforts to
cut down or control substance use – such as revolving door rehabs.

(5) a great deal of time is spent in activities necessary to
obtain the substance (e.g., visiting multiple doctors or driving long
distances), use the substance (e.g., chain-smoking), or recover from its
effects

(6) important social, occupational, or recreational
activities are given up or reduced because of substance use – Charlie Sheen reportedly is not welcome on “Two and a Half Men” the hit show where he was reportedly paid a million dollars per episode. His comedy live show since has been described as a bomb. Sounds like severe occupational distress to me.

(7) the substance use is continued despite knowledge of
having a persistent or recurrent physical or psychological problem that is
likely to have been caused or exacerbated by the substance – marital breakdown, losing your job, having your kids stripped from you, and wild rants on television fits this bill to me.

So we can only speculate on areas 1-3 without a smoking gun/bong. But we’ve still got a triple pass for diagnosing a drug addiction especially in someone with a known prior history of drug abuse. Gone are the days of entertainer P.T.Barnum who said “There’s a Sucker born every Minute”. We the public are a lot less gullible than a century ago. And we’ve got our eye you Charlie Sheen. Get help. Get your life back man.

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Avoid Bicep Rupture

April 3rd, 2011 · My Tips

Not sure if it’s a coincidence but the past week I’ve seen yet another bicep rupture. Which is odd because in the past year this makes the fifth person I’ve seen, including my dentist, with a completely torn bicep after having seen none in the previous 5 years. Weird huh.

Biceps

The bicep muscle attaches to the shoulder at the top and into bone just below the elbow crease. That allows it when flexed to pull your forearm up toward your chest. If it’s overloaded it will snap from one or both of its tethers.

In all cases the story was similar: grabbing a heavy object that was falling – a garage door, a motorcycle, a person e.t.c. – a nasty snap felt in the arm, and searing pain. What I would see is a Popeye bicep with flexion weakness, tenderness over the bicep muscle, and in one case warmth over the site.

Bicep ruptures are anecdotally more common in bodybuilders than the general population due to using very heavy weights and steroid water retention softening their tendons.

Not sure why so many weekend warriors this year are sharing this injury but the key thing to avoid it is to catch heavy things slowly. What I mean by that is not trying to reduce momentum of a falling object all at once. When I catch something very heavy I actually fall with it following its path and gradually slow it on the way down. I do not try to completely arrest it in the air. My arms and legs slow its decent and whatever velocity is left over the ground absorbs. I call it a “Grounding Catch” method.

Of course, you also have the option of just letting it drop. In every case I’ve seen, the object turned out not to be worth saving from the wrath of the floor.

More bicep rupture information.

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Michael Douglas Throat Cancer Missed

February 27th, 2011 · Celebrity Health

I recently glanced at a TV interview with Michael Douglas about his throat cancer. He said to the effect that he’d seen several doctors about a dry, hoarse throat and they missed a walnut sized tumor. He said at that point he was undergoing Stage 4 cancer treatment. He also said that he hadn’t yet forgiven his doctors for missing it. And I had seen an article earlier where his wife Catherine Zeta-Jones had said that she was furious that doctors hadn’t detected it earlier.

Michael Douglas throat cancer missed

I walked away from the TV thinking “Wow, what a bunch of quacks Michael saw”. But then I put my figurative white coat on and could see that it wasn’t that simple. I started to think, what would have happened if Michael Douglas had walked into my office. Would I have done something differently?  Nope.

To understand, you first have to enter the probability space we doctors work in. 98% of sore throats and hoarse voices I’ve seen in the past year were either strep throat, viral, or allergy mediated. About 2% were from stomach reflux. And roughly 0.1% had a throat/thyroid nodule or cancer. In other words, I have to see at least a thousand people with a hoarse voice to find a single throat growth, and of that tiny subset most are benign. Now imagine you’re a bouncer at a bar checking for fake ID’s. You see a thousand real IDs and then the thousandth and first visitor flashes a fake one. Do you think you’d catch it?

That’s the reason that we encourage our patients to return to clinic if their symptoms do not clear with therapy. Now I’m not absolving Mr.Douglas’ doctor from any negligence. And I’m not saying that what happened isn’t tragic. But the events must be interpreted within the probability context of reality. If we sent every sore throat to see an ENT specialist right away, pretty soon no one would be able to see one as they’d be utterly swamped.

Another problem not featured in the tabloids is the halo that surrounds stars. It throws people off their game. For this reason when I visit a hospital with family I usually tell them not to tell personel that I’m a doctor as it throws them off their game if they know. They act differently. And by trying harder they shift from unconscious automatic behavior to conscious and actually perform worse than when they weren’t trying at all. Did Michael Douglas blow away his doctor with his halo? Maybe the doctor was trying too hard to rush him through and get him back out to his golf.

Finally. The problem with the media is that all the cameras point at the stars, and few at people qualified to make  judgment calls. This leads to unbalanced commentary. When a star voices an opinion we have to remember that it is an unqualified opinion. Because I act as a President or Doctor or Corporate Raider for a film that does not embue me with the knowledge base or experiences of a real President or Doctor or Corporate Raider. External behaviors are easy to copy. Mental functions are not. To be balanced, the interview I watched should have sought the input of an ENT specialist to hear their opinion. But that wouldn’t have been nearly as sexy for network ratings.

In summary, I wish Mr.Douglas a speedy recovery and I am hopeful his experience reminds us in healthcare to stay alert.

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Preventing, Avoiding Runner Foot Injuries and Sprains

April 27th, 2010 · My Tips

I’ve seen many foot, ankle, and hip injuries in avid runners ranging from sprains to stress fractures. Being a jogger myself I know the biggest pain is not being able to run :(

So I’d like to share my runner secrets that help me to dodge jogger foot, knee and hip injuries:

  1. Sprains and stress injuries are caused by repetitive slamming on hot spot pressure points. So orthotics can help but you can still develop repetitive step injuries while wearing them – my sister fractured her toe during a marathon while wearing orthotics. My solution is simple… rotate your sneakers. Many runners have half a dozen shoes but habitually only wear one pair. Each pair have slightly different pressure points. By switching them with each run hot spot pressure points get a break between runs.  Simple n’est pa.
  2. Go for natural terrain. Pavements are too perfectly flat and hard. I like running on trails with pebbles and gnarly mud and craters because no two steps are the same. That means the shock to my tendons and bones keeps changing reducing my chances repetitive injury. Grass is my number two ’cause the sod absorbs impact.
  3. If you feel soreness in your foot the day after a run wear soft soled Crocs or sandals until it abates. Walking around your  house barefoot on hard tile or wood perpetuates the injury by limiting tendon rest.

And that’s it. Hope it helps :)

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Don’t iPod and Drive

November 4th, 2009 · My Rants

We often hear “alcohol was a factor” when talking about motor vehicle accidents. But you never hear “music was a factor”. But nearly everytime I see somebody screeching off their tires, zig-zagging through traffic, or speeding like their car’s invisible,  I invariably also feel their bass shaking my windows. Do you?

I think the role of music in traffic accidents is sorely understated.

800px-Honda_NSX_red

Three years ago I smashed my car into a pole after cranking Rammstein and slamming the gas ’round a corner. Freaking brilliant. Then there was the torn off side view mirror listening to the Yin Yang Twins and suddenly decided to make a single lane into a double. In fact everytime I’ve had a near miss that I can think of driving, I’ve been slugging down some Rap or Rock. Racy tunes lead to a thready pulse, loosening of the mind, and outright racing.

But I did an experiment. Is it the music? Or is it the volume? My conclusion is that two things have to be in place to create that euphoria to drive wild – the right tune, and thunderous volume. If you just tone down the volume, that maddening song stops yelling and you can drive most righteously with the whisper from the back woofer.

Today my music taste has evolved, ahem gotten older, so my driving’s pretty tame currently. But I can’t help looking out my window and seeing the new pimped out drivers making  old mistakes.

My message: Be careful if you iPod and Drive!

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How Well do TV Shows Portray Real Life Doctors

October 20th, 2009 · Celebrity Health

“What do doctors think of their portrayal by actors on TV?”

I think television portrayal  of doctors has come a long way since General Hospital. Though I don’t religiously follow any of the main series – Grays Anatomy, Private Practice e.t.c. but I do peek at them from the corner of my eye when my wife is watching and actually find them quite entertaining. (I’m so embarrassed).

Los_doctores

For the most part, the dialogue, clothes, and science behind the shows strikes a strong verisimilatude with me. I’ve heard of past TV errors such as pretend docs using the wrong end of the stethoscope, but since about the 80’s doctor shows routinely consult with medical consultants and writers to ensure their dramas don’t become comedies. One thing I do find off is the amount of rare medicine TV doctors find themselves mixed up in. The routine stuff we usually see – coughs and colds, high blood pressure – simply isn’t sexy enough to draw viewers.  I guarantee if you were to watch most of my real days as a doctor you’d probably snore. I doubt my reality show would last a season.

The other oddity played up on TV doctors is the amount of wild clinic romance. Wow. I really must be missing out. Not to say it doesn’t ever happen – doctors are most likely to marry another doctor or nurse than other single job description – but it’s way over the top on TV. In the past decade of being in the doctor biz, all the doctors I know who were married, still are. Medical school is where the hanky panky is as twenty-somethings play musical chairs to pair up before the dreaded too-late-thirties.  By graduation, doctors are too busy to be chasing skirts/suits and are generally in stable relationships.

So my verdict on TV doctor shows: great entertainment, but don’t take notes!

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Preventing Work Injuries

October 20th, 2009 · My Tips

I don’t think a day goes by that I don’t find myself stitching somebody up for a job site cut, abrasion, impaling, burn e.t.c. What’s amazing to me is that EVERY time I’ve inquired, the mishap was predictable and preventable and NOT a freak accident.  EVERYTIME!  e.g. People not wearing gloves with saws and grinders, guys with nail guns wearing painters cotton gloves, gals grabbing hot trays without mitts or using cutting knives without protection, using high speed drills with bare hands, hammering without eye protection. Superman acts by Stupidman? The human hand and eye is no match for a hammer, saw, drill, butcher knife, nail gun, hot glue e.t.c.

Finger_Injury

What I also find interesting, is that these injuries are often by weekend warriors who know better e.g. the carpenter building a doll house on the weekend and figures “ah, why bother wearing gloves to use this table saw… oops!” The most common reasons cited to me for not taking precautions are being in too much of a rush to put on gear, and not wanting to loose sensation. Neither reason makes any sense to me. Being in such a rush that you end up injured and lose more time unable to work while you heal. And needing to feel a plank of wood as it’s skewered on a table saw – what’s so fuzzy that you need to feel?

By my reckon, freak unavoidable accidents are rare. Hand and eye work injuries, can be prevented by wearing appropriate gloves, glasses, and gowns.

This revelation came to me this weekend while I was mowing the lawn. I had in my ear plugs, donned my gloves, and flashed on protective nerdy glasses. Well I was chewing gum, and ran over a seed which spun out the mower, past my mouth, and punched me in the uvula – the little dingley thing at the back of your throat. A freak accident. And I wasn’t hurt. But if it had hit me in the eye, the story would be quit different, predictable, and preventable.

So if you want to be Superman the builder, you’ve got to put on the spandex gown, with gloves and glasses or that “S” on your chest will stand for silly.

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How to Get Rid of Acne – Doctor’s Orders

October 15th, 2009 · My Tips

Acne, also known as: zits, pimples, goobers, the widow maker, pizza-face, bachelor’s buddy e.t.c.  is the scourge of teens and twenties fresh on the relationship scene.  Acne couldn’t come at a worst time.  Just when you’d like your complexion to be perfect for that first date, these ugly red spots pop out like stop signs all over your face.

Acne

So what causes acne? A parental conspiracy? Nope. It’s caused by raging youthful hormones stepping up sticky sebum production which a villainous bacteria on your face called “propionibacterium acnes” feeds on. After gorging itself with this breakfast of champions the critters produce chemicals which irritate your skin.  That’s what turns the oily pimples from simple swellings to red peperroni pustules that shout “stay away!”.

So to get rid of acne we either have to cut off the oil supply, or we gotta run the bacteria outta town.

Birth control pills, Accutane and vit. A analogues work by the first method, and antibiotics, peroxides and sulpha topicals work by the latter. Simple.

As a doctor I tend to start people off with over the counter preparations to try first for a month. It that doesn’t work I’ll try a prescription strength topical – usually a concoction with an antibiotic in it or vitamin A analogue for a month. If that doesn’t work I’ll begrudgingly pull out my pad and write a script for oral antibiotics or accutane, or in some girls, switch or start a birth control pill. I use this as a last resort remedy because tablets invariably have a higher chance of side effects.

It’s

caused by raging youthful hormones stepping up sticky sebum production.  Now there’s a bacteria called procurement which lives on your face and loves eating oils.  After gorging itself with this breakfast of champions the critters produce chemicals which irritate your skin.  That’s what turns the pimple from a swelling to red pustules so disgusting even vampires stay away.

So how do I get rid of acne? I use a

But the good news about acne is that if all else fails, you’ll grow out of it in 5-10 years. So there. The secret’s out.

Doctor Secrets! Clear. Quick. Fun. Try us!.

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