Good news for old coots

Men prefer mates who are younger and women prefer mates older than themselves.
--Fieder, M, Huber S. Biol Lett. 2007 Aug 28.

Old(er) guys who snag young wives appear to have an evolutionary advantage over younger men. According to the anthropological team of Fieder and Huber, "maximum offspring count" occurs if HE is 6 years older than SHE.

This study was based on data from 10,000 Swedish baby boomers. They found that a pairing of younger moms with older dads produced 5% more progeny than same-age couples. Over a large population, this may represent a huge evolutionary advantage to those women who genetically find older guys attractive and vice versa.

Doc-in-a-Van

Some patients are just plain uncomfortable sitting in a doctor's office.
--Randolph Swiller, MD, Ft. Lauderdale, FLA

So if the patient won't come to Dr. Swiller, he comes to them. In fact, that's what he does, all car rounds all of the time. He believes that medicine has become "time-centric and impersonal," and that home visits are "one way physicians can reclaim the high ground in medicine."

My lowdown on his high ground is that it sounds wildly impractical and inefficient. I am sure, however, that there are any number of people right here in Denver so spooked by the very idea of medical care that they would never set foot in a doctor's office. A free-wheeling MD (and Doc Swiller offers sliding scale visits!) could certainly change their lives.

In our culture, it's a difficult thing to talk about.
--Patricia Lenton, University of Minnesota's School of Dentistry, on bad breath

And this is one of my dilemmas--do I, and how do I, talk to people about body odors?

I spend a lot of time with people in the closed quarters of a small exam room. Cigarette smokers who smoke in their cars reek of old smoke. I don't have any trouble discussing their habit with them. People who drink alcohol before their appointment smell strongly of that, and I always initiate discussions with them--especially if they're my first visit of the morning!

But people with B.O. so bad that I have to abandon the room for an hour or two lest future patients think that I smell of old sweat, well I just can't bring myself to mention that. Likewise bad breath.

I feel like it's my duty to do so, but mentioning another person's odor is so taboo, I still can't point this out to my patients.

Gee whiz moments

Spontaneous gut feelings may be the stuff of which great discoveries are made. Consider Archimedes running naked from his bath after discovering the principle of buoyancy. Here's a real-life, up-to-date, Eureka moment from the Center for Marine Science (CMS) at the University of North Carolina.

Marine biologists already knew when there's a red tide in the morning, asthmatics take warning. The microorganism responsible for red tides produces a powerful toxin that constricts airways. If an onshore breeze blows this noxious spray inland, susceptible individuals may experience an asthmatic attack. But these little red buggers, aka Karenia brevis, also make a substance dubbed brevenal that counteracts their pulmonary poisons and reverses bronchial spasm.

CMS investigator Andrea Bourdelais discovered this potentially useful substance while dosing guppies in the lab with K. brevis products. Those guppies that survived the first red blast seemed oddly immune to another dose of red tide toxins. Per Dr. Bourdelais:

I had a spontaneous gut feeling--a gee-whiz moment--that the first material was an antidote to the second one.

Not only does brevenal block red tide brevetoxins, the substance also seems to promote mucous clearance. Airway blockage and sticky mucous are two lethal characteristics of cystic fibrosis, and brevenal seems to counteract these tendencies more potently than amiloride, a drug currently used to alleviate CF symptoms.

Will brevenal effectively work in humans born with this genetic disease? While trials on asthmatic sheep suggest this may be the case, scientists plan to first test brevenal on manatees. This endangered Florida sea mammal is also rendered breathless by red tides. Veterinarians at Lowry Park Zoo in Tampa, Florida have the FDA green light to break out the brevenal for manatees affected by the next red tide.

Never-ending coughs

As the new school year approaches, I face once again the prospect of being shut up in an exam room with someone in thin control of thick secretions. There are days during the cold and flu season where I feel like shouting into the waiting room "Go home, there is nothing I can do for you. Pick up a prescription for codeine cough syrup from the receptionist and call me in two weeks if it hasn't gone away."

Now, courtesy of The American College of Chest Physicians, there's a whole new lexicon in cough diagnoses. No more 'cough due to post nasal drip' as in the gunk slipping down the back of your throat is making you cough. Upper airway cough syndrome sounds more worthy of that pricey visit co-pay anyway, and the new name recognizes that it's not just about the mucous stuck in your throat anymore but also about inflammation of the cough receptors in the upper airway.

What about the never-ending coughs from hell following chest colds? These coughs last more than 2 months here in Denver where the air is dry and filled with dust and automotive schmutz through the winter months. These coughs are now called post-infectious cough secondary to upper airway cough syndrome.

While the chest docs recommend treatment with an antihistamine-decongestant combination drug, I prefer prescription Tessalon Perles (generically available as bezonatate) which specifically quiets those unhappy cough receptors. The new guidelines also tap an inhaler called Atrovent (ipratropium) as useful for post-infectious coughs.

Zelnorm is back

On a limited basis. If you found this drug to be a moving experience for your chronic constipation, the FDA has created a loophole through which you can get back on it.

This is the IND option, or investigational new drug protocol program, which states:

In some instances, patients with a serious or life-threatening disease or condition who are not enrolled in a clinical trial may be treated with a drug not approved by the FDA. Generally, such use is allowed within guidelines called a treatment IND, when no comparable or satisfactory alternative drug or therapy is available.

So while Zelnorm was yanked from the market in March when its use was linked to increased risk of ischemic cardiovascular outcomes, youngoid women under 55 with constipation from IBS or CIC (chronic idiopathic constipation) can apply for a waiver.

Big-time constipation is a real show-stopper. If you miss your Zelnorm, ask your MD to call the manufacturer at 888-669-6682 to open up options for your bowel woes.

Death by caffeine

Despite my dispatches on the health benefits of real deal coffee, I had no less than three patients yesterday admit apologetically that they still drank coffee. No apologies needed, I'm a fan! I don't even trust people who don't drink the stuff.

Imagine then how dear to my heart is Mark Malkoff who visited every Starbucks in Manhattan within a single day. Would you like to watch him do it? Check out 171 Starbucks in 24 Hours. While you're visiting energyfiend.com, you can also determine how much is too much by clicking on "Death by Caffeine." I found that 56 1/2 cups of my morning coffee would do me in.

THE defining moment

Well I've been debating ever since my last posting about whether or not to share this DM with you. I don't want you to think me unprofessional, and, after all, I did sign this Med Blogger Code of Ethics thing. However, if I relay something that happened in the course of practicing my profession in a dispassionate sort of way, how could that be deemed unprofessional?

The schedule noted her visit as Stomach flu. She sat down by my exam room desk and began rummaging in her large bag. After extracting a baggie, she tossed it across the desk to me.

Uh-oh. Close encounters of the turd kind. Thank heavens for Snap n' Seal. This, she declared, is what's coming out of me. What almost came out of me is uncontrollable laughter. The final crowning moment of the quintessential DM? She started to leave the room without her production at the end of the visit. Would you mind, I asked gently, taking that along with you?

Defining moments

I find many of patients get associated in my mind with one 'defining moment,' whether it be some event in their lives that they've described to me or some notable medical problem that they've had. When I see them in the waiting room or even just seeing their name on the day's schedule evokes these strong associations.

One delightful sixty-something African-American woman wished to travel several years ago and went looking for a tour group to join. By some means unremembered, she hooked up with a busload of middle-aged white guys from a poker club in Colorado Springs. This odd pairing of my patient with this bunch of buddies turned out splendidly. While she has not been able to travel much since, the C. Springs men have called her on several occasions to join them on the road or just to see how she's doing.

Another one of my patients exactly my age told me on questioning that she had attended Kent State during her undergraduate years. Immediate goosebumps for me: "So you were there in the spring of '70?" (talk about a defining moment for an entire generation) "My roommate," she says, "died that day in my arms."

One of my favorite layered memories of a patient involves first finding years ago an extensive inflammatory cancer in her breast. On surgery, all lymph nodes found were positive for cancer. That, of course, is not the good part of the memory. What makes me smile is that ten years later she brought me a bottle of wine to celebrate a decade cancer-free. Even better yet, now 16 years have passed and wine or no, I love seeing her for mundane routine check-ups.

Brains join bowels and skin...

as body parts that thrive with daily caffeine.

French researchers studied 7,000 men and women with respect to their drinking habits and their ability to retain their marbles over the course of 4 years. The men, unfortunately, became tongue-tied and befuddled independent of coffee consumption. But the women, particularly the old gal octogenarians, remained nimble in word-finding and spatial orientation by tossing back three cups daily of the real caffeinated deal.

Per Karen Ritchie of the French National Institute of Medical Research:

The more coffee one drank, the better the effects seemed to be on (women's) memory functioning in particular.

Coffee also seems good for the basal ganglia, a part of the brain that regulates movement. Trouble here causes movement disorders such as Parkinson's Disease and also the abnormal muscle spasms known as dystonia. One form of dystonia is blepharospasm or eyelid twitching. Think Chief Inspector Dreyfus in "The Pink Panther." Coffee consumption inversely relates to risk of Parkinson's (the more you drink, the lower your risk of developing the disorder), and now a study from Italy suggests that daily use will also keep your eyelids still(1).
_____
Defazio G, et al. J Neurol Neurosurg Psychiatry. 2007 Aug;78(8):877-9.

Best Advice, Worst Advice

I once asked a patient who had recently completed breast cancer therapy what was the best advice she received and what was the worst. I don't actually remember what the best advice was so shocked was I to hear that I had offered her the worst advice. I counseled her to consider quitting her job to deal with the effects of chemotherapy. Well obviously you can't get chemotherapy if you've quit your job and lost your insurance. Quite an eye-opening lesson to me.

Now as I complete a heart-wrenching week considering nursing home or no for my mother, here's the best advice I got from my friend Ed:

Standing by her is the right thing to do. Whatever the burden on you--
which I know is huge--you are honoring your commitment. And of course you
can't do everything.

I found that very hard, personally...to know that I couldn't really lift
the weight off my mother. Her needs were infinite; my capacity to help was finite. But I offered what I could. You are doing the same.

My mom stays in her home. I continue on as #1 caretaker.

"...no reason to give it up"

Patients continue to tell me with pride that they have given up coffee. Gotta love coffee, however, and indeed I do. You see, what the drink does unto skin cells (see post below) it also does unto colon cells.

Japanese investigators studied the coffee-swigging habits of 96,000 people. While men showed no particular colonic benefit from coffee, women who indulged in 3 or more cups per day over the 12 year course of the study had less than half the risk of invasive colon cancer compared with their uncoffeed peers. Says Manami Inoue of the research team:

Some people cannot tolerate caffeine, so they should not force themselves to drink coffee. But for people who like it, there is no reason to give it up.