The purpose of my opus is self-evident. I seek to enlighten and inform the general public by putting forth issues of paramount medical importance to local communities, the nation at large, and perhaps even a wider audience. Now, I could impress you with an in-depth, clinical and investigative approach to the subject matter, but that might not only bore you, the reader, but also jeopardize the few tenuous friendships I continue to cultivate. So, I have opted for a simple, concise view of things, based on the current medical literature. Little room has been left for dialectics, as the scope of my endeavor in its purest sense is to inform, to entertain, and perhaps to elicit a chuckle or two.
When the dust settles, however, jocularity must cede the day to keen awareness of the fact that there is, indeed, a health care crisis in the United States. In the State of Texas, for example, only 28 percent of an estimated 83,437 small businesses offered health insurance to employees in 1997, according to the Texas Department of Insurance. Furthermore, national average annual premiums for employer-sponsored health maintenance organization, or HMO, plans are $1,920 for single coverage and $5,280 for family coverage. With 1 out of 10 children in depressed and inner-city urban areas of the U.S. having some sort of disability, the writing, whether it be graffiti or the most elegant cursive, is clearly on the proverbial wall.
If the following excerpts from my medical writings interest you, please be sure to e-mail me for the full versions.
Supercalafragilistichemochromatosis
�. . . . . . . Even though the sound of it is something quite atrocious, occurring in the virile sex it is more precocious, supercalafragilistichemochromatosis.� In this, the Hemochromatosis Screening Awareness Month, that little ditty seems all the more apropos. I can assure you, however, that for 0.5 percent, or one million plus, of the U.S. population, it is no laughing matter. Even the treatment of hemochromatosis would make Bram Stoker�s Count Dracula proud, as phlebotomy (bloodletting), to reduce and maintain body iron at normal or near-normal levels, is the treatment of choice.
Eye-atollah
Like a desert sheik stealing through the night in search of a fertile bed, a welcome crumb, and a drop to quench his thirst, cataracts stealthily infiltrate the tranquility of our aging population. But where do they come from, and what is their grand design?
Simply put, a cataract is nothing more than a painless, cloudy area in the lens of the eye, which blocks the passage of light from the lens to the nerve layer of the retina. Unlike a sultan�s harem, which at the least has vigilant, muscularly well-endowed eunuchs to halt the march of an unholy infidel, the retina is defenseless to the onslaught. In fact, some cataracts grow larger or denser over time, causing severe vision changes leading to blindness, glaucoma, or a loss of independence in older adults.
Elder-bury Whine
�Crabbing,� complaining, aches, pains, groans! All constant companions of a dear friend called �Old Age.� When you�re up, he brings you down. Our bodies are both friends and traitors, to be taken for granted in health and then turning their backs on us when we need them most. Can we do something about this, or should we drown ourselves in Tylenol, Celebrex, Kaopectate, and stool softeners?
Over the next 3 decades, the number of individuals over 65 years old will almost double, going from 29 million to over 51 million in the year 2020. This group will represent 17% of the total population. Currently, over 21% of all first admissions to state and county mental health facilities in the U.S. are over 65 years old. Furthermore, depression is particularly prominent in the geriatric population, with those over 65 committing suicide at a rate higher than any other group in the U.S.
Staying Abreast
What you don�t know can actually kill you! Those of us who find the idea of being palpated, patted, poked, or prodded abhorrent, or uncomfortable at best, had better reconsider. In the United States alone, there are 39,600 women who will die from breast cancer this year, and an additional 203,500 women will be diagnosed with it. As many as 50% of the women in the U.S. will have benign breast lesions, with breast cancer itself being the most common malignancy in women in our country.
While two thirds of the tumors in reproductive age women are benign, the majority of lesions in postmenopausal women are malignant. Routine monthly self-examination and yearly physician evaluation are recommended for all women over age 20. Self-examination should be performed approximately 5 days after menses, when the breast is least engorged and tender.
Mr. Trouble
Daily Dilemma of Diabetic Decay
Another rotten day! I just hate to get up in the morning. I didn�t sleep well last night, and the fact that sensation in my feet is at a premium, makes that long walk to the bathroom fraught with unimaginable peril. An unnoticed pin or needle on the floor can mean long-term trials and tribulations for me if I happen to step on it. As it is, I am constantly slave to those horrendous foot ulcers that I must clean, disinfect, and dress on a regular basis. Not to mention those ugly shoes, three sizes too big, that I must wear to protect my feet.
First things first. Time for a �pit stop.� It seems like I live in the bathroom. I urinate a lot, and thirst is a constant companion, too. I�m always reaching for that �mythical nectar,� which will finally calm the fires raging in my mouth and tame my insatiable hunger. They say that breakfast is the most important meal of the day, and I often eat it like there�s no tomorrow. Then the praying begins. I try to relieve myself with the day�s �number two� before I leave for work. My bowel is lazy, however, and the color, smell, and sheer number of Trojans extruded from this horse are enough to make a man sick. My digestive powers are basically defunct.
Motor Madness
�Rev it up,� �blow the engine,� �pole position,� and �four to the floor,� calls to arms of despondent youths who equate manhood and testosterone levels with the length of a rubber trail, rather than with what lies beneath the left side of a rib cage. Now, �boys will be boys,� but a six-pack, racing tires, and a pretty copilot can transform the �apple of a mother�s eye� into something far more terrifying than the imagination of Mary Shelley or Bram Stoker. A new cultural phenomenon or simply a right of passage?
Motor-vehicle crashes are the leading cause of death in the United States for persons ages 1-34, according to the National Center for Health Statistics. Thirty-eight percent (15,794) of U.S. traffic fatalities in 1999 were alcohol-related; on average, drinking and driving killed a human being every 31 minutes. Furthermore, about 3 in every 10 Americans will be involved in an alcohol-related crash at some time in their lives. If that were not enough, from 1995 to 1996, alcohol-related traffic fatalities among youths ages 15-20 increased by nearly 10%, from 1,473 to 1,617.
Cupid�s Conceit
Whether it be a broken heart of a wide-eyed adolescent, or the chest-crushing pain and anxiety of an attack on middle age, an organ the size of a human fist has no business causing so much grief. All of us are affected in some way by our pulsating companion beneath the rib cage, who we take for granted until faced with a record-breaking race to the emergency room, to the tune of flashing lights and screeching sirens. So, let us take a brief, �heartfelt� look at three issues of concern.
At the top of our list is the subject of depression, which can be triggered by the onset of heart disease. That finding may, indeed, account for the increase in depression afflicting those of us 45 years of age and older. High cholesterol and coronary artery disease have been linked to inflammation of the immune system, which, in turn, is related to the neurotransmitter serotonin. As brain serotonin levels are known to affect mood, it takes no stretch of imagination to deduce the logical connection between a sick heart and a sick mind.
Vege-toll
Taxes, death, and vegetables exact a �toll� on our bittersweet journey on the road of life. While the former drain both coin and vital juices from an organism already wracked by quotidian deceit, exploitation, and malfeasance, vegetables try to even the score. They comfort, fortify, and replenish, although through no fault of their own they sometimes taste bad in their haste to be good. Those �red, green, and yellow, save-the-day fellows� are the king�s champions and our heroes. They do battle with those recalcitrant bacteria, viruses, oxidants, pollutants, poisons, and cancer cells that invade portals and illegally homestead on prize property. Shortcuts, misinformation, and slights of hand, however, like too many cooks in the kitchen, will desecrate a desired result.
Do we heat our vegetables or eat them raw? Nutritionists agree that eating fruits and vegetables raw is a healthy way to get water, fiber, and vitamins. Nonetheless, that should not be a blanket statement, as there are others who are convinced that some foods are healthier cooked. Cases in point are the examples that follow.
The Al and Joe Medicine Show
�Come and get it. You want it. We�ve got it. Welcome to Al and Joe�s �Kitchen of Forbidden Delights,� where the customer is always right, and where your pocketbook guarantees you limitless access. Come and choose from a vast array of vitamins, elixirs, and potions. Let your palate be the judge. If they taste bad, they certainly must be good for you. Imbibe the waters, go easy on the wine, and partake of our quintessential fountain of youth. What�s that you say? Charlatans? Quacks? Come on, Joe, it�s time to move on. Maybe the folks in Las Cruces will appreciate us.�
From north to south and east to west, in circus sideshows, medical literature, and the hallowed halls of prestigious research institutions, hawking medicinal wares has become a quotidian way of life. �Take this pill for gas, that one to make a baby, and a drop of Kaopectate to prevent those nasty squirts.� Damn the long clinical trials, turning back the hands of time has become big business. In an epoch where the good die young and the old die miserably, edges and hedged bets are desperately sought.
March 2004, as National Nutrition Month, beckons us all, as captains of our protoplasmic ships, to throw Al and Joe overboard and set a course that will take us the long way around. Living longer, more productive lives, with an emphasis on quality of life, and freeing children from the ethical and financial handcuffs of caring for aging, �baby-boomer� parents in frail health is our destination.
Forty Winks or Forty Wives?
As I tossed and turned on still another sleepless night, strange voices admonished me for not living up to expectations. I was told to mow the lawn, take out the garbage, pick up my dirty socks, and get off the couch. Cold beer and Sunday afternoon football were �Verboten!,� and I was at my wits� end. My forty wives were a literal pain in the ass. All I needed were forty winks.
I was like the 70 million other problem sleepers in this country. I just couldn�t get my act together. I might as well have climbed Mount Everest or won the Texas Lottery. My complaints were not singular either. They ran the gamut from restless legs syndrome, advanced sleep phase syndrome (ASPS), and delayed sleep phase syndrome (DSPS) to even sleep apnea.
Medical Technology: Midas Touch or Dr. Frankenstein?
In what seems like ages ago, but was only 1993, feats of magic, otherwise known as mini-invasive surgery, were being performed on a somewhat regular basis. At that time, such surgery was considered a medical marvel, with one-day hospital stays, relative lack of postoperative pain, and absence of unsightly scarring all welcomed by the general public. Laparoscopic cholecystectomies, appendectomies, nephrectomies, and bowel resections became the talk of cocktail parties, and the bravura of the men and women in white appeared limitless. What would come next, a cure for cancer, bionic limbs, robotic surgery? Fast forward to the present, and surgery through a couple of half-inch slits, PET scanner imaging of people�s brains, oscilloscope-guided placement of electrodes in the brains of patients with Parkinson�s disease, and tiny cuffs on the fingertips of newborns to monitor dozens of different parameters have become a reality, not science fiction. In fact, it now appears that both doctors and patients have been caught up in the power of technology, to the point that perhaps we have lost sight of its proper role. Have we gotten to the point that anything less than the frontiers of technology connotes bad practice? Perhaps a return to the basics is called for. After all, 85 percent of the information required to make a typical diagnosis comes from a good old-fashioned patient history.
Stem Cells: You Can�t Live With �Em, You Can�t Live Without �Em!
Why so much controversy over something as small as a stem cell? What did they ever do to anyone? Why can�t we pick on someone our own size? The 40 or so cells of a four-day embryo, when stained and slipped under a low-power microscope, are really not much to look at. That view hardly merits the hair raised and passions engendered by the little fellas. Depending on which side of the fence you�re on, that roundish sphere of hollow balls, known as an embryo�s blastocyst, might represent an incipient human life, to be accorded all the rights, respect, and dignity owed to any other human, if you are a right-to-life activist. On the other hand, if you suffer from the likes of Parkinson�s disease, Alzheimer�s disease, Huntington�s disease, stroke, spinal-cord injury, diabetes, or muscular dystrophy, or, if you know or love someone who does, then those �microscopic balls of hope� represent something entirely different, a possible miracle and perhaps the light at the end of the tunnel.
Mine is Bigger than Yours!
The Truth about Fertility
These days young women are quite caught up in their careers. And why not? Advances in fertility treatment have given them a great deal of hope. They can now balance both job and family-planning in a calmer manner. There is no rush. But is this false hope? After all, women�s biology has not changed one bit. Statistics show that the rate of first births for women in their 30s and 40s has surged in this country - quadrupling since 1970. At the same time, rates for women in their early 20s have dropped by a third. So, the tendency to have �cake� now and children later has become pervasive in a capitalistic and technologically advanced society like our own. One thing couples fail to realize, however, is the bottom line: advancing age still decreases a woman�s ability to have children. �Mine is bigger than yours� has no validity or substance whatsoever, when the tick-tock of the biological clock is tossed into the mix.
TB or not To Be
A play on Shakespeare�s words does little to detract from the seriousness of tuberculosis (TB). In recent years, in fact, there has been a resurgence of this age-old malady in the United States and here on the border. Although the epicenter of TB in the U.S. continues to be New York, it must be acknowledged, realistically, that TB is reentering the mainstream of medicine and the delivery of health care everywhere. Alarmists, vested interests, and others have decried the decline in still-needed programs and warn that case rates will rise.
As you know, tuberculosis is a disease that, because of its airborne transmission, has great public health significance, sometimes pitting the concerns and desires of the diseased individual against the public good. The goals of public health are threefold and include prompt diagnosis and treatment, prevention of transmission to others in the community, and identification of those infected with Mycobacterium tuberculosis who are at high risk for developing disease, and therefore candidates for preventive treatment.
Physician Roulette: Come on like Thunder to Prevent Medical Blunder
Pain and dread of the unknown are terrible things. When �an ounce of prevention� cedes the day to �a pound of cure,� we�d just as soon sell our souls to the devil as make a mortal choice. We pick up the Yellow Pages and pray to The Almighty that the healer we choose has his or her proverbial cards in order. �Physician roulette� is the name of the game, and let the buyer beware; one false move spells no tomorrow.
With 196,000 people dying each year in hospitals from medical errors, careful scrutiny of the diplomas on a wall is just a first step. Common medical errors run the gamut from adverse drug reactions and dispensing blunders, to dirty hands, medical equipment, and catheters, serving as foci of infection. And let�s not forget wrong-site surgery either.
Bugged!
Anthrax, plague, botulinum, brucellosis, cholera, and smallpox: a small cadre of bacteria, viruses, and toxins that could spell big trouble, though excessive fear of contagion might be as unfounded and unwarranted as a child�s disproportionate mental �knee-jerk� to imaginary Halloween gargoyles, ghosts, goblins, or the boogie-man. Let�s debunk, or �debug,� some of the more common misconceptions associated with infectious disease, transmissible human pathogens and their vectors, biological weapons, and the microbes themselves by taking aim at anthrax.
Historical perspective on the �measles experience� in the United States from 1912 to 1963 gives us a point of departure. The incidence of measles during that period never dropped below 100,000 cases per year, and epidemics were quite common. After the introduction of the first vaccine in 1963, the number of cases fell to very low levels. We are now faced, however, with an entirely new scenario that risks taking us back to square one.
Flat Tired
Like a nightmare that never ends, you fill up the tank in the morning, shift into drive, and cruise the straight and narrow all day, only to find yourself on the side of the road, �flat tired.� Sound familiar? Well, take solace in the fact that you�re not alone. It is estimated that at least 500,000 people in the United States, and most likely many more, find themselves on the proverbial shoulder of the road with chronic fatigue syndrome (CFS) or a CFS-like condition.
Although its cause remains a mystery, like a sudden pneumatic blowout, its effects are evident. One�s normal activities begin to stagnate, and good sleep, whatever that is, simply is no match for the strong and noticeable fatigue that takes over our daily existence. Pedal to the metal, in the form of caffeine and psychostimulants, is no match for the sputter of depressed physiologic machines of all ages and social and economic classes. Women are diagnosed with the malady two to four times more often, and Shakespeare�s �rose� or chronic fatigue syndrome would smell as sweet, whether it be called myalgic encephalomyelitis, postviral fatigue syndrome, or chronic fatigue and immune dysfunction syndrome.
Vaccimum
Sell your body. Sell your soul. Is that what it�s come to, for a dose of vaccine? Leaving politics to those most inept at governance, the politicians, let us turn our �vaccimum� attention to the scientific side of the crisis at hand. Is there, indeed, a flu vaccine shortage? Is it important? Who is most at risk? What are the ramifications of influenza in an unprotected populace? What can we do about it?
Certainly, the fact that 56 million Americans, not to mention our legions of friends north and south of the borders, are prey to influenza each year. That, in itself, would not be alarming, if �Jewish penicillin� (chicken soup), comfortable pajamas, a soft, warm blanket, and a few days� bed rest fueled rapid recovery of our physiologic machines. What grinds the cogs to a halt is the realization that influenza is responsible for 200,000 hospitalizations and 36,000 deaths in the U.S. each year. And that is in no way comparable to tax credits for the rich and privileged, but rather something far more serious: a potential bombshell in the laps of the poor, the sick, the elderly, and the cancer-ridden, those most likely to reap the catastrophic harvest of a flu epidemic.
Hocus-pocus Meningococcus
Life is beautiful for young people in their primes, with everything to live for. Then, �hocus-pocus,� sudden headaches, fever, malaise, confusion, eye discomfort to light, and a literal pain in the neck, and all that changes. Hearing loss, neurologic deficits, and the ultimate �disappearing act� leave no doubt that this was black magic.
From schoolyards to college campuses, masters of deception levitate in the air, infiltrate large groups of people, and finally decimate central nervous systems with sleight of hand. Bacteria, mycobacteria, fungi, spirochetes, protozoa, helminths, and viruses are their names, but on their marquees is emblazoned a simple, �MENINGITIS.� As beguiling as Houdini, they often seek instant gratification, presenting acutely to a virtually limitless audience within hours to 1-2 days after the appearance of nonspecific cold or flu symptoms. On a whim, they may prolong their tours, performing less frequently, with hiatuses of weeks to months of general symptoms. Let there be no mistake, however, what they are selling is not pure entertainment, but medical emergency.
