The Body Odd

More than a headache: Surviving a hole in the head

2008-07-24T02:10:00Z

By Dr. Billy Goldberg

We see a great deal of severe head trauma in the ER. Amazing survival stories, however, are few and far between.

For every headline-making tale of survival you hear about – a man is fine after being accidentally shot in the head with a nail gun or a boy completely recovers after a butter knife is lodged in his skull – most cases of head injury don’t have happy endings.

The recent tragedy of welterweight Oscar Diaz is typical. The 25-year-old boxer is in a coma after collapsing in the ring on July 16. According to news reports, there was no sign that anything was wrong with Diaz until he grabbed his head and cried out just before the 11th round. Doctors think he will survive after surgery for bleeding on the brain, but whether he’ll have a normal life is unclear.

When it comes to head trauma there’s a weird phenomenon we often see in the ER — nothing turns out like you'd expect. Some people will suffer a simple fall and conk on the head and have horrendous injuries while others suffer brutal blows and come away unscathed.

Sure, there was the gang member shot four times in the face who didn't even lose a tooth. But on the other side is the innocent bystander hit by the bullet who dies instantly, or the grandma who trips going to the market to buy cat food and experiences life-threatening bleeding in her brain.

You can’t talk about surviving a traumatic brain injury without mentioning the most celebrated head trauma patient of all time, Phineas P. Gage. In 1848, near Cavendish, Vt., an explosion blew a 3-foot iron rod through the head of Gage, a railway construction foreman. It entered his left cheekbone, passed through his skull, and exited out the top of his head.

Despite a few convulsions immediately following the accident, Gage remained alert and lucid, and recovered completely. There was one problem, though. Once an extremely polite, hard-working, compassionate man, Gage became a foul-mouthed, selfish, erratic, lying hooligan. Gage’s accident helped provide science with insights into how the prefrontal cortex controls decision-making and personality.

According to the Brain Injury Association of America, 1.4 million Americans will sustain a traumatic brain injury each year. Of those cases, 50,000 die and 235,000 are hospitalized. The Centers for Disease Control and Prevention reports that there are approximately 5.3 million U. S. citizens with a disabling brain injury. The costs of caring for the traumatized totaled $60 billion in 2000.

What determines whether someone walks away from a head injury and ends up on the TODAY show or ends up in a coma, or worse? There is a cynical ER saying that the key to is to be a drunk with a seizure disorder.

Seriously, it’s all about which structures in the brain are injured and how severe the damage. Damage to the frontal lobes can cause changes in mood and personality or emotional instability. Injury to the area of the brain responsible for motor control can cause weakness. Temporal lobe damage can cause difficulty with language and trauma to the occipital lobe can cause blindness.

Another interesting result of head trauma can be anosmia, or the loss of smell. Approximately 5 percent of all head trauma patients exhibit total anosmia and around 30 percent of patients experience some decreased smell. Anosmia is usually due to shearing of the olfactory filaments at an area at the base of the skull.

Yamilet Leon, 7, is one of the lucky ones. The young girl was playing near a park in Sacramento, Calif., on July 3 when her brother heard gunshots. Yamilet complained of pain and doctors found the cause: a .22 caliber bullet just beneath the skin just above her temple. She’s now recovering from surgery to remove the bullet.

Then again, how lucky are you if a bullet hits you in the head?

Black and white twins: Brothers from the same mother

2008-07-17T20:43:00Z

By Linda Dahlstrom

Some things aren’t always black and white. Then again, sometimes they are – like the twin sons born July 11 to a German couple.

The first baby that was born, Ryan, has light skin and blue eyes. His brother, Leo, is dark-skinned with brown eyes.

"None of us could believe it," the maternity ward's head doctor, Birgit Weber, told one news source. "Both kids have definitely the same father."

Stephan Gerth is German and white. His wife, Florence Addo-Gerth, is from Ghana and has dark skin.

It was “a real surprise,” Gerth told the German newspaper Die Welt, adding that the most important thing to him isn’t color, but that everyone is healthy.

The odds are one in a million, say doctors, but it can happen with fraternal twins due the genetic soup in our backgrounds. Peter Propping, former director of the Institute for Human Genetics at Bonn University, told Die Welt that the black mother may have had some white ancestors, or that the white father may have had black ones. Very occasionally, the roll of the DNA die may cause the baby of biracial parents to inherit only the genetic coding for one color.

Rare though they are, the German twins do have some company. In the past few years, at least three mixed race couples have welcomed twins who were also black and white.

In 2005, British couple Kylie Hodgson and Remi Horder, both born to mixed-race parents, had twin girls – one who is blond and fair-skinned and one who has dark coloring.
In 2006, Kerry Richardson, who is of Nigerian and English descent, and her partner, who is white, gave birth to twins who were both born light-skinned. But as they got older, one got darker while the other got lighter.
Natasha Knight, of Australia, welcomed a blue-eyed blond baby girl and her sister, who has brown hair, eyes and dark skin in 2006. Knight’s older daughter has blond hair, blue eyes and light olive skin. Knight is of Jamaican and English descent; the father is German.

In 1993, another set of black and white twins was born to the Dutch couple, Wilma and Willem Stuart, but it turned out to be a case of an in-vitro mix-up. The parents, who are both Caucasian, were mystified when the twins were born, but fell deeply in love with both of them. However, after about a year, genetic tests revealed that while one of the twins was biologically related to both parents, the other twin was not.

The hospital called it a “deeply regrettable mistake.” It soon became apparent that a device similar to a large eyedropper had been used twice, causing another man’s sperm to be mixed with Willem’s. The couple remembers two other couples in the waiting room the day of the procedure. One of them was black.

Being of different races and coming from different fathers hasn’t stopped the Stuart boys from closely bonding. While the dark-skinned boy did eventually meet the man who was his biological father, the brothers consider themselves full twins. In 2005, they attended a twins festival and proudly won the “Least alike twins” award.”

“For the two boys, being celebrated for their differences finally answered all the questioning looks, nasty teasing, and outright expressions of disbelief they've endured all these years,” Wilma Stuart told Dateline, which has been following the family since 1993.

Stephan Gerth and Florence Addo-Gerth, the parents of the newest set of “black and white” twins, know they’ll face some incredulous stares.

"I imagine sitting in a playground where the other mothers will call me crazy when I tell them the boys are twins," Florence told www.peacefmonline.com.

Like all siblings, their differences are more than skin deep. The twins also have distinctly different personalities, say their parents. Leo, the dark-skinned baby, is quieter; Ryan, his light-skinned brother, is temperamental. "When he's hungry, he's hard to stop,” said the mother.

She says her children were born looking exactly as they should. "God has decided that my children should have different skin colors," she says.

Allergic to exercise?

2008-07-16T19:32:00Z

By Melissa Dahl

Does all that exertion on the elliptical machine make you nauseous? Have you ever been convinced that if you spend even one more minute on the treadmill, you will actually die? Maybe it’s not all in your head.

A few people are actually allergic to exercise, and in very rare cases, a sweaty workout could be enough to kill them.

Exercise-induced anaphylaxis is a fairly rare condition which can cause hives, fainting, vomiting and difficulty breathing during a workout, and the symptoms can last up to four hours after it. In some cases, it can be triggered by certain foods eaten before exercise, like peanuts, shellfish, eggs or even, in two reported cases, celery. But this isn't just your average food allergy, an expert explains.

"These are people who will not have this reaction unless they exercise right after eating this food," says Dr. Jacqueline Eghrari-Sabet, an allergist in private practice in Montgomery Village, Md., and a spokeswoman for the American Academy of Allergy, Asthma and Immunology. "Eating shellfish and sitting there? Nothing. But eating shellfish and exercising? For these people, it's bad news."

As you exercise and your heart rate speeds up, your blood starts whizzing through organs much faster, and therefore more frequently, than it normally does. With every trip your blood takes to your stomach, it's picking up more, say, celery bits. For those with exercise-induced anaphylaxis, the normal amount of celery antigens picked up by the blood isn't enough to bother them. But while exercising, the extra celery bits their blood is picking up causes an allergic reaction.

Running and jogging are the most likely to trigger an attack, but other strenuous activities like dancing, volleyball, skiing and even yard work can also cause a reaction.

Since the 1970s, only 1,000 cases of exercise-induced anaphylaxis have been documented – and among those cases, one death. Experts believe that’s because many people with this condition are able to recognize the symptoms quickly and keep it under control by waiting a couple hours after they eat to work out and bookending their workouts with a slow warm-up and cool-down.

"It'll usually happen when you're really exercising," says Eghrari-Sabet. "I don't think you're going to get it when you're bowling. But if you're doing cardio or a hip hop class, then, yes."

Others suffer from the less serious exercise allergy cholinergic urticaria, a common type of heat rash, which differs from anaphylaxis in that it starts and ends with the skin reaction – no nausea or difficulty breathing for these folks. Ten to 20 percent of the population will experience some form of it during their lives. Besides exercise, sun exposure, spicy foods or even getting too emotionally worked up can cause an itch attack.

The condition can strike spontaneously, so even if you’ve been exercising all your life with nary a rash, you can unexpectedly break out in hives. Even some marathon runners have suddenly come down with a bad case of the itches after jogging, explains Eghrari-Sabet. Women are most susceptible to the condition, and the average age for its first appearance is 16. (A handy way to get out of gym class?)

Unfortunately for people seeking an excuse not to break a sweat, most dermatologists and allergists send their patients with exercise-related allergies right back to the locker room.

“If they come to me, I’m not going to tell them not to exercise,” says Dr. Bruce Robinson, a Manhattan dermatologist. Instead he advises patients to pick a less strenuous regimen or a cooler place to work out.

Because the itchy sensation happens when body temperature suddenly rises, it can be eased by warming up and cooling down slowly, before and after every workout. Or try swimming for your normal cardio routine, which will keep the body temperature cool. If a food allergy is the culprit, don’t eat for a couple of hours before your workout.

Although serious side effects are rare, some experts believe, that exercise-induced anaphylaxis often goes undiagnosed. So if you start to feel itchy while working out, watch out. It’s probably best to avoid death by treadmill at all costs.

For more on exercise allergies and other workout quandries, read our Smart Fitness column.

What's stuck where?!

2008-07-09T17:57:00Z

By Mark Leyner and Dr. Billy Goldberg

No matter how careful we think we are, we’re all prone to doing some pretty stupid things to our bodies. Some of us take responsibility for our own actions. Others blame their defective thongs.

Remember Macrida Patterson? She’s the Los Angeles traffic cop who sued Victoria’s Secret for an eye injury that occurred when a heart-shaped metal fastener in her underwear snapped, popped into her eye and injured her cornea.

The case of the hazardous thong got us talking about the fact that people typically look for some excuse or someone else to blame when they get hurt. Nowhere is this more evident than in the emergency room.

Just this past week, Billy was working in the ER and he saw a classic example of a poor decision gone haywire. It was a busy Monday evening and the ER was filled with your usual assortment of injured, infirmed and intoxicated. Alcohol is usually involved in most of the ER’s most brilliantly dumb accidents. In fact, from 1992 through 2000, researchers found that there were an estimated 68.6 million emergency department visits related to alcohol, almost 8 percent of the total ER visits during that time period.

We have to assume that some intoxicant was involved in this particular case, but by the time Billy got involved, it was too late for questions. A middle-aged man had apparently needed to urinate and used a nearby plastic bottle. After inserting his penis in the hole, he found himself unable to extricate his now swollen member from the grasp of this plastic vise. It is unclear what attempts he made on his own, but by the time he arrived he was trapped and had been unable to relieve himself. After a hefty dose of morphine, two young residents and a junior attending physician unsuccessfully tried to free him from captivity. By the time Billy arrived, he was screaming in pain.

Doctors refer to objects that are swallowed or inserted as “foreign bodies.” There are countless stories of various things removed from patients’ stomachs, noses, ears, rectums and vaginas. The bottle doesn’t quite qualify as a foreign body (as it’s the entrapper not the entrapped), but a search of medical literature revealed similar cases of “penile entrapment in a plastic bottle.” In these situations, the danger is that prolonged strangulation of the penis can lead to gangrene and even result in the amputation of the affected part.

Watching reruns of MacGyver would probably be more useful than medical school in a case like this. A ring cutter that ER doctors use to cut through metal was slowly making its way through the hard plastic, but the patient kept struggling and howling.

After a heavy dose of sedation, a carefully placed metal blade between the bottle and the penis provided the leverage needed to cut through the plastic. As the bottle was being removed, the patient was finally able to urinate and, unfortunately, sprayed all over poor Dr. Billy.

In the ER, no good deed goes unpunished.

As the patient was sleeping off the sedation, the ER staff went back to their routine business. We never found out the precise details of how this occurred, but keep your eyes on the local papers. You may come across a story about a certain gentleman suing a bottle manufacturer.

Why her skin was crawling with body critters

2008-07-01T18:47:00Z

By Diane Mapes

We’ve all had that creepy feeling that something is crawling on our skin, scurrying across our scalp, scuttling around the base of our neck. Usually, it’s our imagination, but for a woman in Levittown, N.Y., that creepy feeling was all too real.

Nina Bradica, 45, was quarantined June 6 after she became infested with bird mites, tiny insect-like parasites that normally live on birds.

The mites entered Bradica’s home through a wild bird’s nest in her bathroom vent. The nearly-invisible bloodsuckers took over her bathroom and swarmed onto Bradica when she took a shower. Before long, her body was covered with red bumps and welts from their bites. The bugs crawled into her nose, her ears, her mouth and “other places,” according to her daughter.

While bird mite infestations in humans are rare, they do happen, says Dr. Richard Zack, associate professor and chair of the department of entomology at Washington State University. The most common infestations occur in people who work in the bird and poultry industry, but the creatures will flock to anybody if the circumstances are right.

“Nesting birds or small mammals carry their own set of parasites and although those parasites don’t normally feed or interfere with humans, if something happens to the mice or the birds that are nesting in your house, the parasites will look for an alternative food source,” he says. Unfortunately, that alternative food source can be you.”

When it comes to pesty infestations, Zack says humans can play host to chicken mites, northern fowl mites, tropical fowl mites, tropical rat mites and house mouse mites. For more information or tips on dealing with mites, contact the Centers for Disease Control and Prevention or visit birdmites.org, bitingmites.org, or buginfo.com.

Dust mites can cause serious problems for those with allergies, although they live in our bedding rather than on our bodies, says Zack. But watch out for the itch mite, Sarcoptes scabei, better known as scabies. Also of note is the face mite, or follicular mite, a microscopic bug that lives at the base of hair follicles – including, shudder, our eyelashes.

“Upwards of 90 percent of all people have these mites living on their body on a permanent basis,” says Zack. “As far as we know, they don’t cause any problems. There’s even speculation that they’re a beneficial parasite.”

Not so beneficial — or easy to ignore — are lice, the scourge of mothers everywhere.

Head lice stick to the head and the nape of the neck, while pubic lice (commonly known as crabs) live anywhere there’s coarse body hair – beards, moustaches, armpits, and, of course, points further south. The body louse is more of a “commuter” bug, says Zack. It feeds on your body but actually lives – and lays its eggs -- in your furniture or carpeting.

Another popular drop-in guest is the bed bug, which crawls out from behind pictures, peeling wallpaper, or wooden molding in order to feast on its favorite midnight snack: human blood.

Ticks and fleas will jump aboard for a quick meal, as well. Chiggers, too, will live on our bodies temporarily, although they don’t feed on our blood, but rather inject us with their spit which liquefies our skin cells which they then suck up through a tube.

All of which itches like no tomorrow.

The creepy crawly contingent doesn’t stop there. Millions of Americans, primarily in Appalachia and the South, are currently infected with worms and parasites, according to a new study.

The most common human worm infection is ascariasis, caused by a parasitic roundworm that lives in the intestine and can grow to a horrifying 12 inches in length. Human infection takes place after the accidental ingestion of ascaris’s egg-infected feces. Once the eggs hit the host’s stomach, they hatch and immature worms are carried to the lungs and then to the throat where they’re swallowed. The larvae travel through the body to the intestines, where they develop into adult worms, lay eggs, and the whole cycle begins anew.

Other “helminth” or parasitic worm infections include toxocariasis, a roundworm parasite which infects between 1.3 and 2.8 million Americans, and strongyloidiasis, a type of threadworm that lives throughout the body and infects 68,000 to 100,000 Americans.

Platyhelminth infections (i.e., flatworms or tapeworms) also love to make themselves at home in the human body.

Although these infections can wreak havoc for many, particularly those living in poverty, the majority of Americans don’t have to worry about the yucky squirmers. However, they may encounter "worm therapy" in the near future. Some scientists now believe worms may actually help the human body fight off allergies and immune diseases. Researchers are conducting tests with various parasites in the hopes of developing alternative treatments.

But that’s a whole different can of worms.

When it comes to drooling – and kisses – the wetter the better

2008-06-25T22:33:00Z

By Dr. Billy Goldberg and Mark Leyner

We hope that those of you who share our insatiable appetite for pungent biomedical fodder heard about a health clinic in Arkansas that was evacuated recently after more than 30 people were sickened. The staffers and some patients were hit with symptoms that included nausea, dizziness and uncontrollable drooling. A hazmat unit from the National Guard ran precautionary tests, and health officials are looking into whether the outbreak might be connected to an exterminator’s visit.

msnbc.com

Uncontrollable drooling?! Surely there’s a disaster film in the making here. Imagine scores of hapless villagers borne away on a tsunami of drool!!

It makes good sense that a hazmat unit was called in because the toxic effects of pesticides – and nerve gasses, for that matter – may include excess salivation with drooling.

But before we tackle the fascinating subject of excessive drooling, which in polite society is more properly known as sialorrhea, how about a quick tutorial about saliva? Drool School.

Spit is one of those disreputable, often reviled bodily fluids that doctors – like chivalrous knights on charging steeds – feel an obligation to rescue from misperception.

Saliva is a clear, viscous fluid secreted from the mucous glands of the mouth. What a magical fluid! The WD-40 of our squeaking bodies.

It contains two major types of protein secretions aiding in digestion and lubrication, as well as several antimicrobial components. Our salivary glands produce about 2 to 4 pints of drool a day.

All babies drool, especially when teething. But as children get older they usually learn to control their saliva and most kids beyond 4 years of age stop their drooling. Children who suffer from disabilities that impair the nerves or muscles in their throats and mouths may continue to drool past this age and may require treatment which can include speech therapy, biofeedback, medication and even surgery.

Pregnant women can also become big-time droolers. Their salivary glands may become swollen, their cheeks puff up and they can have difficulty swallowing and speaking. Sometimes they even have to constantly wipe their mouths to prevent saliva from dribbling down their chins. Ah, the blissful indignities of impending motherhood!

Breathing through the mouth while sleeping also can result in drooling, especially after a few alcoholic drinks.

Not having enough spit can be equally uncomfortable. There are over 1,800 drugs that can make your mouth feel dry. Eighty percent of the top 10 drugs may cause oral dryness, including drugs prescribed for high blood pressure, anxiety, depression, allergies, weight loss or pain.

If a patient complains of sialorrhea – excessive drooling – various associated signs and symptoms need to be explored. Is there also a sore throat, difficulty swallowing, chewing, and speaking? Does the patient have pain or stiffness in the neck or muscle weakness in the face? Has there been any exposure to pesticides? Are there bite marks? (Excessive drooling can result from rabies.)

Why so many questions about too much drool?

In the presence of other symptoms, it can be a sign of trouble. Drooling with fever may indicate abscesses in the head and neck area, tonsillitis, mononucleosis, strep throat or epiglottitis. If accompanied by dysphagia (difficulty swallowing), weight loss or facial weakness, persistent drooling can point to an esophageal tumor, Ludwig’s angina or myotonic dystrophy. With Bell’s Palsy, for instance, drooling often accompanies the gradual onset of facial hemiplegia (partial paralysis). And drooling is a common complication of Parkinson’s disease.

Now that you’re slobber-savvy, you can meditate upon several saliva conundrums. Did you ever wonder where all that excess saliva that’s sucked out of people’s mouths at dentists’ offices around the country ends up? If your suspicion is that tens of billions of barrels of frozen saliva is being stored in top-secret tanks under the Antarctic Ocean, awaiting the development of cars that can run on saliva — thus freeing us from the yoke of foreign oil dependence— you might be on to something.

What about kissing? Isn’t it strange that for all the derisive things people say about spit, sharing it with other people is considered one of the sublime pleasures in life?

A study recently conducted at the State University of New York at Albany found that men prefer wetter kisses. The authors of the study hypothesize that “kissing styles that maximize salivary exchange provide subtle information about a female’s reproductive status since saliva and breath odor changes across the menstrual cycles.” The scientists speculate that “male preference for salivary exchange could function to introduce substances such as hormones or proteins into women’s mouths that may influence their mating psychology, and even make them more sexually receptive.”

So, in the end – as ruthless as it may sound – romance may all boil down to the Saliva of the Fittest.

Amy Winehouse: Faint of hair?

2008-06-18T23:33:00Z

By Diane Mapes

You might not think President George W. Bush and Amy Winehouse have much in common, but they’ve both succumbed to episodes of syncope, a medical term derived from an ancient Greek word that means “to interrupt.”

Evening Standard / Getty Images

In other words, they’ve both fainted.

Bush passed out while eating pretzels and watching TV on his couch back in 2002; Winehouse lost consciousness last Monday after signing autographs for a group of fans outside her home.

According to the experts, fainting isn’t as freakish as you might think. Caused by a decrease in the flow of blood (and oxygen) to the brain, syncope is actually fairly common, says Dr. Blair P. Grubb, professor of cardiovascular medicine and pediatrics at The University of Toledo Medical Center. About 19 percent of all adults will experience at least one episode of it in their life. The tricky part is figuring out why.

“Syncope may be benign and it may be the warning sign of something more serious,” says Grubb, author of “The Fainting Phenomenon: Understanding Why People Faint and What to do About It.” “One of the difficulties is that there are many things that can cause it.”

On the serious end of the scale is cardiovascular syncope, which is often the only warning sign before a sudden death due to some form of heart complication or congenital anomaly. Basketball player Reggie Lewis experienced an episode of cardiovascular syncope before he collapsed and died of hypertrophic cardiomyopathy in 1993.

“You may only have one warning before a tragedy,” says Grubb. “If you faint, it could be due to a serious problem. Whenever there’s a question, it’s best to go ask your doctor.”

Non-cardiac syncope is far more prevalent and far less indicative of a serious illness. But its causes are legion.

Alcohol and certain drugs can cause blood pressure to drop which can then trigger an episode of syncope; starving yourself or becoming dehydrated can have the same effect. High gravitational forces can also cause fainting, which is why the Air Force commonly screens people for the condition. A hot, crowded setting such as a political rally or rock concert can also bring on a black out.

Historically, constraining corsets may have been responsible for fainting spells in women, although Grubb says the practice known as swooning might also be attributed to bad health (tuberculosis and other common diseases of the day), toxic make-up (arsenic and mercury were popular ingredients) or good old-fashioned deceit.

“In those days it was a learned behavior,” he says. “Some people would do it as a put-on; it became the social norm.”

Most people who faint don’t need to fake it, though; they’re predisposed to the condition thanks to their off-kilter autonomic nervous system (ANS), the set-up that controls the body’s involuntary functions -- i.e., the regulation of blood pressure, body temperature, sweating, digestion, etc.

“About 10 percent of the population has poor autonomic tone,” says Grubb. “If given the right set of stresses and strains, they’ll pass out.”

The ANS can short circuit in a variety of ways. In neurocardiogenic or vasovagal syncope (also known as the “common faint”), the heart mistakenly sends a signal to the brain that the body is experiencing an episode of hypertension, even though the blood pressure may be quite low. The brain responds by causing the blood pressure and heart rate to plummet, which then results in a lack of blood to the brain.

Boom. You’re on the floor.

Some folks will pass out when they stand for too long in the same lock-kneed position.

Others will faint at the sight of blood (or even the thought of it).

“People will pass out laughing, coughing, sneezing, and having orgasms,” says Grubb. "If you have an enlarged prostate and you have to strain to urinate, you can pass out from that. If you’re really constipated and you strain really hard, you can faint on the toilet. That’s called defecation syncope.”

While most people are able to take evasive action (i.e., get flat) when they feel a faint coming on (symptoms usually include light-headedness, blurred vision, shakiness, and “spots before your eyes”), those who suffer from refractory recurrent syncope aren’t as fortunate.

“These people have no warning whatsoever,” says Grubb. “They’ll wake up on the floor in a pool of blood with a broken jaw. Their lives are ruined by this.”

According to Grubb, syncope accounts for 3 percent of all emergency room visits and up to 6 percent of all hospital admissions.

The famously bee-hived British singer Amy Winehouse is one of them, although her fainting spell seems connected to a more serious problem. Doctors have determined that she has early stage emphysema and an irregular heartbeat caused by smoking crack cocaine and cigarettes.

Given her love of back-combing, though, it's surprising she hasn't fainted before.

“Some people will pass out when getting their hair done,” says Grubb. “It’s called hair grooming syncope. If you yank on the hair of people who are predisposed to this, they can pass out.”

Just because I'm a hypochondriac doesn't mean I'm not sick

2008-06-11T12:03:00Z

"For each ailment that doctors cure with medications (as I am told they do occasionally succeed in doing) they produce 10 others in healthy individuals by inoculating them with that pathogenic agent 1000 times more virulent than all the microbes - -the idea that they are ill." 
-- Marcel Proust, “The Guermantes Way”

Dr. Billy Goldberg:
This quote came to mind after a particularly grueling weekend in the ER. You see, I am just getting over a brief yet vicious bout of nosophobia. Nosophobia refers to a morbid fear of contracting a disease. In my case, I was terrified of about 37 different ailments that might strike me or one of my family members down. It didn’t help that when I got home from the hospital I had to spend an hour convincing my sister that she didn’t have thyroid disease, liver failure or metastatic cervical cancer. My sister and I both share a genetic predisposition towards worrying that isn’t exactly helped by my practice of medicine.

Surprisingly, most doctors aren’t hypochondriacs. But medical students often go through a phase of thinking they have everything they learn about in school. I can recall sitting in a genetics lecture with a pregnant friend and watching her cringe and rub her belly as we learned about every horrendous ailment that might affect her unborn child. This condition has been called "medical student's disease," "hypochondriasis of medical students" – and best of all, "medical studentitis."

Some studies suggest that as many as 80 percent of med students suffer from unfounded fears of illness. The prevalence of true psychiatric hypochondriasis among regular folks has been estimated to be as high as 10.7 percent. This number strikes me as low, probably because it doesn’t include people like me who have occasional episodes of hyponchondriacal thought.

Most medical students recover from their “medical studentitis” and join the legions of doctors who ignore their own medical illnesses and scoff at their patients who have unfounded fears. Unfortunately, I am prone to relapse. Where does all this leave me? I have no idea, but I sure would like to forget my sister’s fears, that 5-year-old who came into the ER with newly diagnosed leukemia and that funny lump that I have on my own leg.

Mark Leyner:
Hypochondria is a Möbius strip to me. I can’t tell where it begins or ends, or, conceptually, what’s the inside and what’s the outside of it. So, it produces a kind of vertigo. Or maybe I just think I have vertigo.

Isn’t there a profound truth to thinking that we’re sick all the time? The reality is that once we’ve outlived our prime procreative days, we begin to inexorably degrade. Our very bodies become constant reminders of our own mortality.

Isn’t hypochondria, actually and paradoxically, an illness in and of itself? It’s included in the category of somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the reference handbook used by clinicians to guide the diagnosis of mental disorders. Some experts argue that hypochondriasis shares many features with obsessive-compulsive disorder or panic disorder and would be more appropriately classified with the anxiety disorders.

So, thinking you’re sick when you’re not is … sick. Hmm.

Our society’s ingrained hostility to hypochondriacs clearly demonstrates how arbitrary cultural judgments can be. Certain delusions are more disreputable than others. We denigrate hypochondria – the delusion of being ill when one is well. But we laud sick people who think they’re well – it’s evidence of a brave and gritty optimism. Stupid people who maintain the delusion that they are smart tend to be intolerable. But smart people who insist that they are stupid display wonderful humility and charm. And even in the pecking order of bogus invalids, hypochondriacs rank above the malingerers, who knowingly feign illness or other incapacities in order to avoid work.

As a child, I was elaborately schooled in the fine art of hypochondria. Hypochondria was to my family what skiing or folk-dancing was to other families – a traditional pastime that stretched back for generations. Dinner conversation inevitably turned to someone’s bloody sputum or lumpy testicle. It was like a never-ending borscht-belt production of Munchausen syndrome (the epic Wagnerian version of hypochondria).

Here are some of the conditions, diseases and tumors I’ve thought I’ve had just over the past two months: oligodendroglioma, arrhythmia, bladder cancer, skin cancer, cirrhosis of the liver, syphilis, Crimean-Congo hemorrhagic fever, Creutzfeldt-Jakob disease, anaphylactic shock from dust-mite allergies, some teratological malformation of the alveolar ridge, and bronchiolitis obliterans (Popcorn Worker’s Lung Disease).

The consummate achievement in the art of hypochondria goes considerably beyond merely thinking that you’re sick. The ultimate form of hypochondria is thinking you’re dead. A person who thinks he’s dead, but consents to a sort of feigned life is to be enormously admired.

Here we can see how this ultimate hypochondria can be a profound expression of bushido – the traditional code of the Japanese samurai.

This is how Yamamoto Tsunetomo, a 17th-century samurai retainer of the Nabeshima Clan, described the proper attitude of a warrior: "Every day without fail one should consider himself as dead. There is a saying of the elders that goes, 'Step from under the eaves and you're a dead man. Leave the gate and the enemy is waiting.’ This is not a matter of being careful. It is to consider oneself as dead beforehand."

Now there’s an eminently healthy attitude, if I ever heard one.

Are you a hypochondriac? Take our poll.

In hot pursuit of aphrodisiacs

2008-05-28T16:01:00Z

Dr. Billy Goldberg:
What ever happened to good old-fashioned romance? Oysters and champagne are passé as people reach for more exotic aphrodisiacs. The pursuit of a sex boost had a deadly result for one New York man after he ingested an aphrodisiac made from toad venom. This poor soul ate a product meant for the skin, and unfortunately it contained a chemical that had effects similar to the heart drug digitalis, which can cause irregular heart rate, nausea and vomiting.

What a terrible way to go.

Aphrodisiacs are by no means a new invention. The name comes from Aphrodite, the Greek goddess of love and beauty, and throughout history many products have been believed to stimulate sexual desire – from rhino horns to snails to the beetle-derived “Spanish fly.” Viagra is mistakenly thought of as an aphrodisiac, but rather it’s a treatment for ability (impotence), not desire.

Unfortunately modern pharmaceutical companies have yet to find that magic little potion to increase sexual desire. Just this month, a highly touted compound, Bremelanotide, originally known as PT-141, was shelved as an aphrodisiac by its company Palatin Technologies. This nasal spray showed remarkable promise stimulating the desires of both men and women, but it also raised their blood pressure. Don’t give up hope. The company has another compound, PL-6983, that they’re banking will take its place.

In the meantime, you will have to rely on the old standards such as alcohol, chocolate, roses or Barry White music. A search of the word aphrodisiac in my medical database revealed 197 scientific articles. But after reviewing several, I realized that there is very little data demonstrating that many of the herbal preparations available work in humans. I will admit that a variety of things such as Cihuapatli, the Mexican zoapatle (Montanoa tomentosa) or Curculigo orchioides rhizomes (Golden-eye grass) have created some pretty horny lab rats.

Once, in Jamaica, I tried a roots-based tonic, Baba Roots, that claimed to be a “front-end-lifter,” but I can’t say that I felt any “lift.” John Layfield, a former professional wrestler turned Fox News business commentator, is embracing this Caribbean folklore as he peddles Mamajuana Energy, his own version of an herbal elixir from the Dominican Republic.

Don’t bet on it. However, if you are feeling really adventurous, you could travel to Beijing and visit the Guolizhuang restaurant, where chefs specialize in a range of penis and testicle dishes derived from dogs, donkeys, sheep, horses and seals -- all thought to boost libido.

I think I’ll stick to the oysters.

Mark Leyner:
I have to confess that I’m absolutely baffled by this subject. The whole idea of aphrodisiacs is so alien and remote to my life as a man that I wonder if I can conjure up even a single insightful thing to say. Ingesting toad venom to get an erection? I think about sex about 10 trillion times a day. It is mind-boggling to me – as sex-obsessed as I am – that I would ever take something that would cause me to think even more about it.

Who needs toad venom?

There’s not a single part of a woman’s body that doesn’t arouse me. I don’t even need to see or think about the standard erogenous zones. Every inch of a woman is erotic to me, including the internal organs. How many thousands of hours did I squander as a teenager, shuttered up in my room, lecherously ogling my transparent female figurine, with all the incredible libido-inflaming anatomy and viscera visible to my hungry eyes? The lungs, the pancreas, the sigmoid colon, the adrenolumbar vein… Yikes!

I actually think I need some sort of “anaphrodisiac” – something that would actually inhibit my libido.

For most men, thinking about their grandmas – dead or alive – should usually result in an almost instantaneous decrease in tumescence.

But when I think about my grandmother, the image of mah-jongg tiles immediately comes to mind. And along with the memory of those tiles, comes the memory of the fleshy, heavily freckled arms of the buxom women – my grandmother’s friends – shuffling those tiles in the brutal sun in front of their cabana at the swim club… Obviously going down that road will do me no good at a time like this.

I did see a psychiatrist once about all this. More out of curiosity than any alarm. After 45 minutes of regaling him with an anecdotal history of my libido, he concluded that, to an unusual degree, I cathect everything – that is, I inject almost every object in the world with libidinal energy. He ventured the opinion that I might be stuck in some infantile stage of polymorphous perversity.

As he was talking, I was absently fondling a golf ball I’d found on his desk. The ball was inscribed with the word “Effexor.” It was one of those promotional trinkets left behind by some pharmaceutical sales rep. Rolling the ball in my hand, I couldn’t help but picture Jang Jeong or Meena Lee or Shi Hyun Ahn or any one of the many South Korean lady golfers who’ve become such a dominant force in the LPGA.

Even typing the words “dominant force in the LPGA” is highly arousing to me right now.

Toad venom? For me? I don’t think so.

Do you have a favorite aphrodisiac? Vote!

Living for the instant brain fix

2008-05-15T19:55:00Z

By Dr. William Goldberg and Mark Leyner

Is it just us, or does it seem like everyone is either searching for that little something to get a competitive edge or simply struggling to keep up?

Americans are 24-7-365. We are both guilty of swilling espresso as we burn the candle at both ends to finish our new book. But that doesn’t disturb us nearly as much as the overwhelming amount of highly caffeinated “energy” products being marketed to help stimulate our competitive kids. Snack food maker Mars has even released a new “Snickers Charged,” so even candy can now give you an extra nudge.

The pharmaceutical industry is, of course, lurking right there with a whole slew of cognitive enhancers to push our bodies and brains to their max.

As a society, we tend to reflexively deride and often morally condemn the instant fix (while at the same time scrambling for it). But what about drugs that can instantly improve your cognitive functioning? Not good, right? They’re unfair – like steroids for the brain. Until you consider the pilot who’s flying your plane for the next 10 hours or the neurosurgeon operating on your mom. Maybe a hit of Provigil doesn’t sound like such a bad idea.

There’s nothing earth-shattering or radical about the idea of “cognitive enhancers.” Caffeine and nicotine are two old-school boosters. Many studies have proven that both help maintain attention, heighten alertness and, of course, keep people awake. Research has also shown that caffeine possesses cognition-enhancing properties that can enhance higher cognitive functions like short- and long-term memory and perceptual sensitivity.

But a java jolt isn’t enough for those seeking the the new “smart drugs” or “nootropics,” many of which were originally developed to treat neurological or mental disorders such as Parkinson’s disease.

“Two of the drugs which are now being used as cognitive enhancers, donepezil and tacrine were originally approved in the United States for treatment of Alzheimer's . A study published in the journal Neurology found that commercial pilots who took 5 milligrams of donepezil for one month performed better than pilots on a placebo when asked to fly a Cessna 172 on a flight simulator. There was a significant difference between the groups in the effectiveness with which they dealt with emergencies.

“Then there’s Ritalin, the drug of choice on college campuses for sleep-deprived students struggling to pull all-nighters, complete term papers, even boost concentration during exams.
Drugs like Ritalin and Adderall are commonly prescribed to treat attention deficit hyperactivity disorder (ADHD). At recommended doses, these medications can accelerate the central nervous system, heightening concentration and alertness.

“But as a “smart drug,” Ritalin may not be quite so smart. Never mind the fact that sharing prescription medicine is a felony drug offens in most states – taking excessively high doses of Ritalin can increase the risk for neurological and heart-related symptoms.

The current superstar of prescription stimulants is Provigil (Modafinil), first approved as a treatment for narcolepsy. A secondary indication was to treat something called Shift Work Sleep Disorder (SWSD), a sleep disorder that affects people who frequently work schedules that resist the body’s natural Circadian rhythm, such as night shifts or rotating shifts. We both know doctors who regularly use Provigil.

Provigil can keep a person awake and alert for 90 hours straight, with none of the jitteriness, impaired concentration, “rebound effect,” or risk of addiction associated with amphetamines or even coffee.

Not surprisingly, Provigil is reportedly popular with the U.S. Air Force, and has been used more than 150 times this year by bomber crews to ward off fatigue on missions of more than 12 hours.

Barbara Sahakian, professor of neuropsychology at the University of Cambridge, who has conducted extensive research on Provigil has found that it results in greater concentration, faster learning and increased mental agility. "It may be the first real smart drug," she has said. "A lot of people will probably take [it]. I suspect they do already."

Provigil seems to safely bolster alertness for days at a time with few side effects, but its long-term effects have not been sufficiently studied to completely rule out all potential problems.

A couple of final points. We’re both fathers. When conversations turn to cognitive enhancers, the issue of “fairness” invariably comes up. For instance, do you want your kid taking the SATs and competing with a bunch of other kids who are tweaking on Provigil? Hopefully, we will have instilled in them an awareness of the profound difference between the ability to perform well on standardized tests and the capacity for intellectual discovery, innovation and creativity, and humane conduct.

But we may be in the minority. The “customized” man is looming and there may be little we can do about it.