health wednesday

How many times have I told my parents to stop getting their health advice from the 6 o'clock news? Too numerous to count. It's alway sensationalized, completely overstated, misleading at best, and sometimes just plain wrong. So as a public service to them (and anyone else interested in my ramblings), every Wednesday I'm going to post over something related to health that I find interesting. Current dogma says fat=bad. Except the data doesn't back that up too well. If you want a very detailed assessment that knocks so many holes in that theory that it sinks, try Gary Taubes' Good Calories, Bad Calories. It's not written by a doctor or scientist but it is exhaustive in its approach. But I digress...where was I? Oh, yeah. Fat=bad, especially saturated fat (animal fat). A recent publication looked at fat and diet. But the lead researcher says it better than I can, "For 60 years we've been recommending reduced saturated-fat consumption without a focus on what should replace it in the diet," lead investigator Dr Dariush Mozaffarian (Harvard University, Boston, MA) told heartwire. "In practice, what's happened, if you look at trends over the past decade, saturated fat has been replaced by carbohydrates, largely refined carbohydrates. There have been several recent meta-analyses of observational studies showing that if you reduce saturated fat and don't pay attention to the replacement, there is no association with lower heart-disease events." Mozaffarian pointed to a recent meta-analysis of prospective epidemiologic studies showing that there was no significant evidence that dietary saturated fat is associated with an increased risk of coronary heart disease or cardiovascular disease. So essentially, that study saw no effect of saturated fat on heart disease. American Heart Association, are you listening? Hello? Low fat diets don't hold up well in studies. Anyone? Really? Nobody? So these guys wondered, "well, what if instead of replacing saturated fat (animal fat) with carbohydrates, you replaced it with polyunsaturated fats (plant fat)?" So they looked at 8 different clinical trials in humans (not mice or rats), grouped them together by fat amount and type of consumption, and looked to see of who got the pleasure of visiting the hospital because of heart disease. It turns out that for every 5% increase in plant fat consumption, there was a 10% decrease in having a heart attack or just plain keeling over. Long story short, replacing saturated fat with refined carbohydrates (bread, pasta, etc) doesn't do squat to heart disease. Replacing it with plant fat (vegetable oils like soybean oil) improved your odds of bypassing the bypass, so to speak. And this study didn't even make use of the oils from olive oil, nuts, or fish which all have protective evidence by themselves. Perhaps disease would be reduced even more. Take home advice? Eat less grains overall, especially the refined ones. Replacing saturated fat with polyunsaturated fats - not carbs -reduces CHD risk (free subscription required) Mozaffarian D, Micha R, Wallace S. Effects on coronary heart disease of increasing polyunsaturated fat in place of saturated fat: a systematic review and meta-analysis of randomized controlled trials. PLoS Med 2010: DOI:10.1371/journal/pmed.1000252.

prepare the body

My brother starts chemotherapy in less than 48 hours. Prepare the body as one prepares the mind. So off came the hair. This song just seemed so....fitting. We used to play it when my son was a newborn and began losing his hair so it holds a very hopeful and special place in the hearts of me and my wife.

I looked in the mirror today

My eyes just didn't seem so bright

I've lost a few more hairs

I think I'm going bald

I think I'm going bald

Seems like only yesterday

We would sit and talk of dreams all night

Dreams of youth

And simple truths

Now we're so involved

So involved with life

Walk down vanity fair

Memory lane everywhere

Wall Street shuffles there

Dressed in flowing hair

Once we loved the flowers

Now we ask the price of the land

Once we would take water

But now it must be wine

Now we've been

And now we've seen

What price peace of mind

Take a piece of my mind

My life is slipping away

I'm aging every day

But even when I'm grey

I'll still be grey my way....yeah!

words

The authors I relish the most are the ones who are able to get you, the reader, to experience and feel the situation as it really could be.......I am unable to conjure up the appropriate words that are able to get you, the reader, to feel the circumstances as they actually were. Just before seven in the evening on Friday night, I get the call from my brother and the MD Anderson oncologist and shortly into the conversation, the phrase "we can't cure your cancer, but we can treat it" drifted from a cell tower to my phone to my ear to my middle and inner ear to the temporal lobe of my brain. I heard it, I understood it, I comprehended what that meant. But how do I convey that immediate silence afterwards that stretched across time and space holding a silent note that hung interminably? Are there words to describe the anguish? They all seem grossly impotent to me. None strike the visceral blow that was evoked. Words fail me miserably.

the ultimate sacrifice

I've got a drinking engagement this afternoon with my former colleagues and compatriots....and it's on the house from the VP who played the Ace of spades to get me into medical school....And I can't DRINK! I'll be waiting for a conference call with my bro and his oncologist at MD Anderson to go over the latest MRI and CT results and, hopefully, discuss the treatment plans. I hope my brother appreciates the sacrifices we doctors make.....sigh.

(written completely tongue in cheek because if you don't think humor is some of the best medicine when confronted with cancer....well, I'll spare you the verbal tongue lashing that you so richly deserve...)

learn a foreign language

Some advice for future med students? Take some classes in Greek and/or Latin. Much of med school is learning the new language and if you know the derivatives of the word, it makes it a lot easier. Otherwise you're just memorizing strange words. Let's take presbyopia, for example. Presbys is Greek for "elder". Growing up the son of a Presbyterian minister, I knew that the Presbytery was governed by a council of elders. Opia refers to eye. So put them to together and you have "old man's eye". It's when some getting up there in years has to hold the restaurant menu farther and farther away in order to be able to read it. The reason is that with age, the lens of our eye loses its ability to curve. That increase in curvature is what allows us to see things up close. Consequently, our eye can't focus well on things up close but can on things farther away.

pride

The social worker entered the smallish exam room which is packed full with 5 people. She slowly takes it in and after introductions, mutters "what a support group." Indeed. I've never really given much thought about my family from a conceptual part. I had a good family growing up. Not perfect, but certainly no complaints. It was a good upbringing but I never thought it exceptional. It's what I knew, I guess. But after yesterday's visit to MD Anderson, I gotta say that I've never been more proud to be a part of my family. Just check out the picture my sister-in-law took of us while waiting in MD Anderson's waiting room. Everyone is smiling. Even me and I'm not exactly a happy-go-lucky person. And it's not a forced or fake smile to try to put a rosy picture on things. Because it's not rosy. We all know that. But still everyone is smiling. Smiling through the tears, oftentimes. Looking at it I'm struck with the knowledge that all of us would go to the ends of the earth for each other. Without hesitation. That's not exactly a common thing. But then the doc came in the room and I looked at it from his perspective. I can see why a lot of docs would limit the number of people in the room. It can get too emotional, too out of control, too distracted. Up until yesterday, I would've probably been one of those doctors that limits the number of family members for the sake of simplicity. Our doctor did not feel that way. He was fine with it. He just made it very clear that my brother is the captain of the ship and his choice is law. And after yesterday, I've changed my point of view on the matter. Why? In a word, hope. I gotta believe that sometimes it's all a patient has to get them self out of bed in the morning. And if you have a group of people around them supporting them in that endeavour, as a physician, why in the world would I want to come between that? I'll probably do something very similar to what this guy did - lay the ground rules and stand firm by them but allow the family to feel free to support their loved one with dignity.

pain meds

In light of my brother making use of these meds and the recent House passage of the health care monstrosity, this video seems more relevant than ever. I'm so angry at our government right now that I can't see straight.

dental school

There's a bit of antipathy between medical and dental students. Professors will joke, well sort of, that if you don't like it, you can go next door to the dental school After visiting the dental school to get some free work done by a 4th year dental student, I have a bit of insight. Dental students see themselves as oral doctors, which does make sense if you think about it. Med students wouldn't agree. I even heard one med student comment, "I see them on the bus in the morning and they're so....happy. That ain't right." I have a hunch that med students are A) a bit resentful of the claim that dentists are oral doctors and B) a bit jealous of the lifestyle of dentists. It's really quite a sweet gig. Four years of dental school and then they come out and start their private practice (unless they go on to specialization like oral surgery). No residency, no hell, more cash business, and to top it off, a lot of dentists take Friday off. I told the student I really do wish I could've gotten excited about dental school because it really is an appealing lifestyle. Alas, I was drawn inexorably to medicine. Such is the curse of following a call.

awareness

Ever buy a car and then notice how many of those cars magically appear on the road? I'm like that with cancer now. Granted, I live in Houston so it's not real surprising to come across MD Anderson commercials on the local TV or radio but I'm also seeing them on blogs all over the place now.

I'm on a garden forum and a brick wall forces me to stop. Down in the bottom corner is an ad that means more to me now than I could have ever imagined. In a moment, I go from thinking about plants to choking back tears, imagining what it would be like to have my brother's face in that commercial with a beautiful red line drawn through whatever the hell his 'noma turns out to be.

to thine own self, be true

My phone chirps its Simpson's quote, "(ralph's high pitched tone) Hello, I'm doctor stupid. I'm going to take out your liver bone. (thwack) Oops, you're dead..... (mr. burns) I never liked that doctor stupid." I really need to change that. At home and amongst friends, it's hilarious. At MD Anderson - the #1 cancer center in the word - not so much. But I digress. By the tone of my brother's voice, I can tell it's good news. FINALLY. A bullet we can finally dodge. His head CT scan came back clean. And believe you me, I could use some good news because I f*$(#$d up big time. We were trying to get his 2nd biopsy sample sent down to MD Anderson for a second opinion. Through miscommunication that left me with a monstrous pit in my heart, they sent the WHOLE sample down to MD Anderson and kept nothing for themselves. What do you do with that? You really want to be responsible for delaying treatment, especially for your brother? As a physician, I think you've gotta have skin thick as steel. You can't let setbacks get to you. Pick yourself up and dust yourself off. Learn from your mistake and try to make it right. So before visiting MD Anderson to drop his imaging CDs off, I went deep inside my soul. Everyone in my family worries when I do that. Not even my wife is fully comfortable with it. I can still remember early in our marriage when my wife came home from work with all the lights off and me sitting in the dark listening to music. No one seems to trust that as an introvert, while it's immensely painful to visit the dark side, it's also a source of enormous creativity and strength. And so I asked myself - who are you??? And once again, the physician in me stood up and answered. If you are, then suck it up and get back on the horse. And so I did because in the final analysis, what else could I do? I've never wanted to be a doctor more than this moment in my life.

leap of faith

The ball snaps and I rhythmically find the laces as I drop back, eyes downfield reading the free safety whose decision will trigger mine a split second after his. Before it even comes to that, though....crunch. Someone misses a block and I'm pummeled to the ground without even seeing it. The pile roles off and I immediately find the back side tackle who blew his block. Before I can lay into him, the offensive line coach intercedes (it's practice, not a game). "GET YOUR ASS BACK TO THE HUDDLE AND WORRY ABOUT THROWING THE BALL! I'll worry about correcting the missed block." Furious, I walked back to the huddle but that story comes back to me out of the recesses of my memory as if it were yesterday. That lesson learned applies as much as it did then as it does now. I guess now is the calm before the storm. Check that. It's the calm between the storms, plural. Everything is in motion. Tears have been shed. We each try to cope in own way as everyone waits on pins and needles. It's the huddle in between plays. You're waiting for the coach to pass on the next play, hoping that it's not a stupid one that you'll have audible and then get in trouble for second guessing him, but you'll still do it because you know you're right. I'm not sure waiting is the hardest part but it ain't easy. The next week isn't going to be either. Monday morning, my brother gets a CT scan of the head to see if anything is there, too. Meanwhile, I grab every scrap of data they have and head down to Houston to meet with the dean. We then call the oncologist and I don't know what happens next. I am acutely aware that in these trying times, everyone reaches a point where they have to let go and trust someone else. I had to trust that coach would make sure I wouldn't have a defensive end crawling up my back unseen. My brother, I suspect, trusted his doctor. At some point, I convinced him to let go and move that to someone else. So then that trust falls on my shoulders. I needed to find someone and someone fast. And that's not an easy thing to do. To ask someone to second guess someone they trusted. You take a known entity, and ask them to replace it with an unknown on your word. But then it's my turn to pass that burden onward. And that's hard for me given my background as a scientist, as a quarterback. I know when I'm right. But I also know when I'm completely blind and ignorant. And so on Monday, I turn over everything to someone who hopefully is exceptionally competent. I have nothing to go on other than someone's word with whom I interviewed for about 15 minutes (and didn't go well, incidently). A leap of faith in which one trusts that the steps leading to this decision were placed upon the right path. That you didn't miss the blitz that the defense has called. And in a lot of cases, I'm sure that doctors aren't ever 100% sure of the path (at least the honest ones). You make your best educated guess, really. You don't have time to wait. It's a race against a mass of cells that divides ruthlessly and which with no opposition, will in the end destroy itself and the life that it resides within. See why football is nearly a religion down here in Texas?

providence or irony

My dad calls it providence. At times, I call it irony. Let me explain. No, there is too much. Let me sum up. Through contacts and knowing the right people, I scored interviews with both the assistant dean and dean of student affairs when I applied to med school. By some strange streak, the assistant dean is also my advisor. So when I needed a contact at MD Anderson (#1 cancer center in the world) for my brother, she was the recipient of one of the many emails I sent out pleading for help. She forwarded it onto to the dean who gave me the name of a good oncologist. I push a bit more and long story short, I get an emails at 7 and 11pm last night in addition to 7 am this morning. Wow. It's helping to renew my faith in humanity and our medical system when a dean has the inclination to so diligently help out a student's family member. So I'm going to take all the data so far, show it to her come Monday, and then we're going to call the oncologist bypassing all sorts of bureaucratic red tape and probably violating about a hundred HIPAA codes in the process. Hopefully, he's starting his chemo within a week's time.

the longest mile

I love road trips. They've taken me on great vacations, great hikes, and all around good adventures. Yesterday, though, a short 500 miles on the road left my heart torn in ways I would not wish upon anyone. I went up to Dallas to be with my brother and his wife when they met with the oncologist - definitely malignant cancer. I can't even really begin to figure out how I even feel. All I can I do is think of him sitting there in the chair getting the news. It's forever etched in my memory. The doctor delivered the news in the most compassionate way possible given the circumstances but that doesn't lessen the enormous blow. It's like your breath is not merely knocked out of you. It's like it's stolen. You sit there thinking this can't be real as your world spins and collapses in on you. But it is real. And I had truly wondered which part of me would show up to the appointment. Do I become paralyzed in anguish? Do I try to console my brother? I think... no that's not right because it's not a conscious thought. It's an intuition, really. He needs me hear the medical parts right now. And so the part of me that seems to want to become a doctor stood up and the emotion sits down waiting its turn knowing there will be plenty of time on the car ride home. I did realize one thing. I figure that in a very meaningful and tangible way, I became a doctor in every metaphysical sense of the term yesterday. I could not have conjured a worse set of circumstances. I had to call our parents and tell them their son has cancer. It's hard for me to imagine a harder job a doctor could be called upon to do. And so with a grim sense of determination, I will journey many more of those 500 mile trips as we begin the fight...

block II exams

Block II neurology exam was today. What can I say about this class? Hmmmm. I think my classmates said it better. Before the exam, one student remarked, "despite two full blocks, I still can't explain to other people even basic stuff like 'what does the frontal lobe do?' but I can identify some tiny speck of a tissue on a slide." Or, afterwards how about, "is there a designated crying room?" and that was from a man. Another was, "Why is it after this class exam, I always feel pissed?" It's not that it's overally hard, though there are some concepts that require some thinking. It's that it's taught, shall we say less than efficiently. It's not an easy class and so those less than ideal teaching styles compound the problem greatly. Me? I think I bombed the written part. There was crap on there where I just went, "huh?" We'll see. I'll be happy with a 70.