HOW TO CARE FOR GRANNY by Dr. David Hepburn

The day our pint-sized Granny came to live with us, us being my mother and her three teenage brats, was a sweet potato day. We kids loved our nonagenarian Granny given that we had a common enemy, namely Mom. But there was an adjustment or two that had to be made by all of us.

-We learned, by nauseating experience, never to tug at the Kleenex that was stuffed part way up Granny’s sleeve.

-We got to know the sharp, medicinal smell of Noxzema, which mated with every air molecule in every corner of the house, being particularly pungent in the bathroom, bedroom and wet bar.

-Mom had to give me a stern warning that, given Granny’s age, I was no longer to yank the dining room chair from under unsuspecting keysters that were about to alight upon it while I was “helping” to seat those at dinner. (I still remember Father Blair splayed across the carpet letting loose with some scriptural words that he never used in any sermon I recall. Granny laughed ‘till her dentures flew out. I think Mom said grace that night.)

Dr. David Hepburn
Dr. David Hepburn

-I had to enter our only bathroom with my eyes wide shut, just in case.

-Even Ralph, our yellow lab, had to learn not to jump up on folks, given that he had knocked Granny down, petticoats over tea kettle, about 47 times in the first two days. This take down was followed by a Benny Hill type chase through the house that involved Granny throwing, bobby pins, wooden spoons and even the nauseating Kleenex that we feared Mom would make us pick up, before Ralph ate it.

-Nylons that my sisters wore on their legs were now ending up decorating Granny’s head.

-Edgar Winter’s “Free Ride” was often accompanied by the blaring of a rogue hearing aid. Ralph eventually ate the hearing aid, which I think was fine with Granny who had no time for Edgar anyway.

-I always looked twice in a glass before drinking from it to see if there were any signs of Polident, Poligrip, Polyfilla or perhaps a loose molar.

-Grilled cheese sandwiches were made differently than when Mom made them as they now had a special white sauce in them along with a bread and butter pickle. The pickle was a nice addition but to this day I’m not sure if the white sauce was Miracle Whip, Elmer’s Glue, Noxzema or all of the above.

Though conversations took a little… OK, a lot longer and we had to open doors a little more slowly and speak a little louder… I miss it. Miss her and miss the times that we were Granny’s caregiver. Granny died at 96, but she died at our home, now her home, happy. Ralph laid at her door for a month.

Remember the days when your mother changed your diapers, breast fed you, spoon fed you that Gerbers “Squash and Prairie Oyster” slop. Well I do, and now, as my mother ages, it is my turn to do the same for her, though I’m a little sketchy on the breast feeding thing.

Remember when your dad beat you….to the corner. When he really gave it to you…money. Well now it’s your turn.

We would love to remember our parents when they were in their prime but the time comes when we need to care for them while we’re in ours. The role of family caregiver is thrust upon you, sometimes voluntarily and other times because your brother apparently is on the Space Station conducting experiments with Poligrip or whatever, that will take “30 or more years” or until probate court.

These days 80% of the care at home is done by family caregivers, saving our health care system billions. There are over a million family caregivers in my province alone, with, 1 in 4 people taking on that role in their lifetime. Over 70% are also trying to balance caregiving at home with their jobs, hardly an easy task. While it can be a rich experience it can also be very taxing and create a real caregiver burden.

David Hepburn
David Hepburn

Thankfully there is the Family Caregivers Network (www.familycaregiversnetwork.org). This amazing network has expertise in helping with the practical problems associated in caring at home for the elderly, the infirm or both. Experts at finding the specific answer to your unique situation, they are a remarkable resource who can offer respite, support, advice and Bingo on Tuesdays. Without explaining everything they do, I would simply suggest that if you are one of the million who are caring for a loved one or a husband at home and have not used this resource, Granny would slap you upside the head…with her Kleenex.

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Get Petrified By Dr. Dave Hepburn

Are we there yet?

Nope

Are we there yet?

Nope

Are we…?

Nope

…There?

Nope

Dad, why do they call the place we’re going to the Petrified Forest?

Well you remember that dark shadow that snaked across your bedroom wall and then slunk under your bed. You could hear it as it sharpened it’s knife and teeth….

I’m not going!

Fine. You can stay here in the car tonight…by yourself.

I hate you.

Ya…well.

And so another harmonious Hepburn family vacation found us in northern California slinkerfying into the Petrified Forest. Got me to thinking, that as doctors, our job truly is to petrify you, not by wearing my new argyle socks with sandals and Bermuda shorts, which “apparently” isn’t all that attractive, but to petrify you into petrifying yourself.

19th century Luther Burbank was, in California checking out surfer chicks and Johnny Carson when he made a side trip to the Petrified Forest. He figured out that a volcano exploded so violently a kazillion years ago, that it hurled down giant redwoods like matchsticks andworse yet, broke several beer bottles. The ash then covered the trees. As the tree fibres decomposed, water, laden with silicates in that ash, seeped down into the gaps, replacing the wood cell by cell with crystalized silica until the entire tree became stone. If only we could do that with our bones. Your bones need to be rock hard and if we have to petrify you into doing this, so be it. Here, let me petrify you with these osteoporotic facts:

-23% of patients who fracture a hip are dead in less than a year.

-30,000 Canadian hips fracture every year, a hip snaps every 17 minutes

-1 in 4 women and at least 1 in 8 men over 50 have osteoporosis.

-Hip fractures related to osteoporosis end up in death in up to 30% of cases! (Actually 100% of those with hip fractures will eventually die.)

-Osteoporotic hip fractures consume more hospital bed days than stroke, diabetes, or heart attack.

-only 44% of people discharged from hospital for a hip fracture return home

-a 50-year-old woman has a 40% chance of developing hip, vertebral or wrist fractures during her lifetime.

-my son’s hockey bag has been labelled a biohazard

-the lifetime risk of hip fracture is greater (1 in 6) than the 1 in 9 lifetime risk of developing breast cancer.

-1 in 4 women who have a new vertebral fracture will fracture again within one year.

Dr. Dave Hepburn
Dr. Dave Hepburn

Osteoporosis, a pediatric disease with geriatric consequences, the infamous “silent thief”, is a disease so debilitating and common, that pharmaceutical companies focus a forest load of research into fixing it. The latest weapon in the battle of the bones is the discovery of something called a RANK ligand (discovered in my son’s hockey bag)  which turns an immature osteoclast into a mature osteoclast. We’re not crazy about mature osteoclasts as they are the little devils that dissolve bone.

A new medication, Prolia, reduces RANK ligands and hence osteoclasts remain immature, much like my mother’s only son.

I don’t have to remind anyone who has watched family members shrink, hunch over, break their backs, snap their hips and live in pain, that anything that helps in the battle against a horrific and dangerous disease like osteoporosis is a godsend. So, here’s hoping you all get stoned and are petrified.

Osteoporosis - Dr. Dave Hepburn
Osteoporosis – Dr. Dave Hepburn

Are we there yet?

Nope

Are we there yet?

We’re closer.

Every little thing´s…gonna be alright- Dr. David Hepburn

Jamaica is a country where you could survive happily with a three word vocabulary (not unlike my hockey team). “No” “prob” and “lemm” with an occasional “ya ‘mon” thrown in if you’re inclined to run off at the mouth.

Problems in Jamaica? Many. Dealing with them is no problemm.

Marley and me were going to get to know each other a little better as I entered the town of Nine Mile to pay homage to Bobmarley’s “reggae pillow”, a large painted rock from whence he wrote some of his music like “This Is One Hard Friggin’ Pillow ‘Mon.”

Glancing around I noted a hummingbird sitting peacefully on a branch outside Marley’s humble abode. It barely moved at all, having perhaps inhaled a little too deeply of the Marley mountains. But it had absolutely no inclination to behave like our busy backyard hummingbirds back home.

A hummingbird feeder in our backyard serves as an urban hub of activity as competing birds zip about darting in for a quick drink. Busy little birds that never stop to rest, not even to eat as they beat their wee wings 200 times a second. But this mellow marley bird just hung out at the Marley motel… zero beats a second.

A favouriteBobmarley song is Three Little Birds wherein some birds are giving a message to Bobmarley. This apparently is not unheard of when you spend your day smoking reefers the size of the Hindenberg.

“Don’t worry… ‘bout a thing, cause every little thing’s… gonna be alright.”

Stress does crazy things to our health. Where do I start? As we live our lives as frenetic backyard birds spending our time, efforts and thus our health in the thick of thin things, we can really do some damage. Some folks stress constantly about money, which ironically often costs them their greatest wealth…their health.

Dr. David Hepburn
Dr. David Hepburn

Others live their lives stressed about whether they are doing what they should to accommodate an afterlife, but often at the expense of a present life. It’s well recognized that long-term or chronic stress can lead to many serious health problems affecting every system in your body. Cortisol raises blood pressure, increases the risk of heart attack and stroke, suppresses the immune system, speeds up aging, causes you to wear spandex in public, etc.

But here’s one you may not know or if you did it didn’t register because you’re stressed out. Long-term stress can physically change the brain! In a large population-based sample of women

followed for 35 years in Sweden, (there’s a heck of a job for a stalker) those who reported frequent or constant stress in midlife were twice as likely to develop dementia! And isn’t that just what this world needs, more stressed out demented Swedish women.

There are several possible biological explanations. The main hypotheses are related to the effects of cortisol on the brain. Animal studies have reported that increased cortisol and chronic stress may increase those nasty dementia deposits, β-amyloid peptide and tau-proteins in the brain. Another theory is linked to the possible role of stress on inflammatory processes. Stress increases the production of pro-inflammatory cytokines which are suggested to give rise to Alzheimer’s disease changes in the brain. Even amongst those with the genetic predisposition for Alzheimers, the apolipoprotein E genetic mutation, those mutants who had no stress did as well on cognitive tests as non-mutants who lived in stressful situations.

Dr. David Frederick Hepburn
Dr. David Frederick Hepburn

Stress also often leads to overeating, boozing, smoking, and watching Jersey Shore, not exactly a prescription for enhancing brain health.Now, of course, not everyone who has stress goes on to develop dementia, probably because they don’t live long enough to get demented given their early onset heart attacks and strokes.

So if after a life of constant stress you find yourself standing on your pillow in your spandex shorts talking to birds, or singing to the Hindenberg, no problemm. ‘Cause in the long run every little thing’s… gonna be alright.

Cannabis: Marley Barley Dr. David Hepburn

It was a dark and stormless magical, Mary Jane-ish Jamaican morning when we headed off to the lush hill country on a pilgrimage to the small rasta village of Nine Mile. Nine Mile is high, really high.

“What’s he writing about this time Ralph? Jerk?”

“Buffoon.”

“No, I mean maybe he’s writing about the health benefits of Jamaican jerk or rum or something ridiculous, I can’t tell half the time where he’ going with his stupid stories, jerk.”

“Buffoon.”

After a couple of hours our Jeep had climbed to with a few miles of Nine Miles, the birthplace, home and resting place of Bob Marley.  Reggae’s Graceland. We stopped to enjoy the vista when a young Jamaican lass, adorned in lemon rind yellow and Lorne green skipped down the potholed path.(Jamaican drivers all state that they are PhD’s… pot hole dodgers). “G’mornin’ mon” she greeted as she then opened a sac unveiling reefers the size of Gary Coleman. Being a responsible physician and with my wife being there and all, I, of course, refrained from buying any…

Dr. Dave Hepburn
Dr. Dave Hepburn

“Ha! What he probably means is the girl couldn’t break a $50!”

Quit interrupting please…though a couple of others in our Jeep with smaller bills made a donation to the young lass. “We gittin’ closah to Bobmarley” our driver announced, Bobmarley now a one word, one love sort of name. “Ya man, I can sense it in the air.”

Cannabis is grown, apparently illegally, all over Jamaica, but up in the Bobmarley hills, I believe, it is illegal not to partake of a little Marley barley.

“You think he’s telling the truth, Ralph?”

“I never know.”

“Well I don’t care if he is or isn’t, he is such a handsome dog.”

Wha.. haven’t you seen the photo? He’s off his rocker again.

While some doctors are unsure of approving the use of non-approved medical cannabis, but all doctors have patients who, almost conspiratorially, whisper “I have to say, doctor, that I tried a little of my …ah…friend’s marijuana and my pain/nausea/spasms/spouse disappeared.” And while doctors feel a tad awkward advising patients to “smoke two of these and call me in the morning” we are always looking at the best options for treating your painful pains and problematic problems. So even though many of us doctors might hesitate to recommend pot as a potion for your pain some of us will go ahead and fill out the government forms for which of course we will charge you. I knowI charge the standard and then even add a surcharge to help top up my Jamaican vacation fund. I can hear you all now.

“JERK.”

Dave Hepburn
Dave Hepburn

Exhaustion Heating up By Dr. David Hepburn

Dr. Dave Hepburn:

An enduring memory of my time in the Serengeti will be of the dainty Thompson gazelle, named after that renowned explorer Ernie (“Dainty”) Gazelle. Delicate, dainty and divinely delicious these speedsters of the Serengeti sport a nifty black Nike Swoosh on their flank indicating to all that they are amongst the fastest animals alive. Unfortunately, it is not as fast as the cheetah, for whom the Tommy (slang used by us rasta safarians) is the favourite fast food.

As was obviously the case with a cheetah we witnessed sneaking up on ten little Tommies grazing in the grazable grass, oblivious to the danger that slunkered two grassy grass knolls behind them. Then one, one grassy knoll. Suddenly a convulsing covey of guinea hens shot out from the grassy knoll screaming “Cheetah, cheetah, friggin’ freakin’ cheetah!!” The three brave males Tommies with their beautiful racks (not a term often used with reference to males) turned toward the threat.

They steadfastly lowered their heads towards the cheetah and really laid on the horn as if to say in a sort of dainty gazellish way. “Attack if you dare but you will need to pass these knives o’ death first there Charlie.” The cheetah, preferring not to deal with this formidable fortress of forking antlers, slunkerified off in the direction of some distant impalas, cheating us out of a deadly battle of blazing speed.

Now as fast as the gazelle is, I can actually run one down on a hot day. Gazelles, like women, don’t sweat and so when they run they quickly overheat and stop, drop and roll over. I sweat like a artesian well but subsequently I stay cooler and can then run up to the downed gazelle and say “you’re it” or “you’re dinner” depending on my mood.

So what is the difference between heat exhaustion, heat stroke, sun stroke, sun burn, Hepburn, Hepatitis and giraffes. Well, it is all about how well we watch our water. As long as we keep hydrated then we will perspire should our body temperature start to rise. When the external temperature exceeds that of our bodies we should sweat.

Sun heath- Dr. David Hepburn
Sun heath- Dr. David Hepburn

The cause of heat stroke comes not just from the heat but rather comes from not drinking, which will come as a pleasant surprise to my buddies down at the Drunken Scalpel. Lack of water means lack of ability to sweat which is why a heat stroke victim’s skin is actually dry to the touch. They ran out of water and so now are heating up internally, cooking important organs like the brain, kidneys and those rather delicate testicles.

Heat exhaustion refers to being somewhat overheated but still being able to sweat and may be a precursor to the more serious heat stroke, aka sunstroke. Stroke has a more serious connotation and means that as the body temperature climbs up past 40C the brain starts to cook and sizzle and not in a good way. But sweating can also be bad for those beasts who live in areas where there is no water, as sweating can, in fact, lead to dehydration.

Refreshing for the heat - Dr. Dave Hepburn
Refreshing for the heat – Dr. Dave Hepburn

So some of these amazingly adaptable animals like the oryx (yet another antelope, less dainty and no swooshes) can actually raise their internal body temperatures three degrees so that there is no external/internal temperature discrepancy and thus they don’t need to sweat. But we non-oryxes have a hard time doing this as we tend to lack the oryx gene and antlers and stuff, so we must drink fluids to allow us to sweat. “Which is better dad?” is a question I have seemingly been asked my entire parental life “a gazelle or an oryx?” In this case I have  decided that I would much rather be an oryx than a gazelle because an oryx is way cooler even though it is hotter. If only it had a swoosh. I suppose it could try to paint one on but then it would simply be… a cheetah.

Fun Health by Dr. David Hepburn

“In the beginning it was fun. In the end, it was all for fun.                                                                      And in between is where it tickles most.”

Dr. David Hepburn:

-You’re not like other doctors, are you?

-Why not? (No doubt another commentary about my endearing sense of mirth.)

-Well doctors are for the most part intelligent and dignified.

-I see.

-And you don’t usually see doctors act like buffoons…

-Well, maybe what…

-And they usually have their fly done up.

-Oooops and most doctors have a stethoscope around their neck, not a rubber duck necklace. They don’t put on examining gloves that stretch to their shoulders and they don’t go around wearing a ridiculous fake clown nose.

-Umm. This isn’t fake.

-And real doctors would call their mother regularly.

-Sorry Mom.

As doctors, we are expected to put forth an air of decorum, an aura of solemnity, possess a reverence for the painful human condition and never pass gas. Apparently,… I missed that lecture.

Keep Smiling - Dr. David Hepburn
Keep Smiling – Dr. David Hepburn

Our dog, Leo, will suddenly go berserk every so often. He just up and races around the house as if he’s been lapping Red Bull out of the toilet for hours. He flies up the hallway, vaults on to the bed, thrashes a pillow, grabs my underwear, sometimes even when I’m not wearing it. All of this with a huge grin on his doggy puss. We have no idea why, but when this spontaneous spaz out hits him, get out of the way. Scientists who deal with the Leos of the world have come to the realization that sometimes whales breech, dolphins leap, elephants frolic, sharks grab a tourist’s leg etc…all just for the fun of it.

Sometimes having fun is just for the sake of having fun and not for any hidden health benefits. But how does playfulness, indulging in frivolity and enjoying pure unadulterated fun, benefit our health?

I can’t stress all the problems associated with stress. It stresses me out just to think about them. Stress has long been shown to boost disease risk and hasten aging. When you’re stressed, your immune system weakens, increasing your chances of getting sick. To protect your body from disease, de-stressing is a must.

Simply put… fun reduces stress. Those whose lives are bathed in fun have lower blood pressure and lower levels of the health-damaging stress hormone cortisol. Fun mitigates worry and removes some of the tremendous burden that worry puts on the heart. Laughter relaxes blood vessels and increases blood flow, the exact opposite of what your blood vessels do when you are stressed.

Those less stressed sleep better, have lower BMI’s and keep their fly up. As Patch Adams put it, “Fun is one of the greatest antidotes to human pain and suffering.”  It is also an antidote to loneliness, isolation, anxiety, and depression.

Play is actually a source of calmness and relaxation, as well as a source of stimulation for the brain and body. People who play more not only think faster but also have better memories. Fun-loving people are more optimistic and studies show that optimistic people live a whopping 7.5 years longer on average.

It’s hard to be depressed, pessimistic and go all cortisolly when your life is one gigantic play date. Playing together for the fun of it brings joy, vitality, and resilience to all relationships. Yet many of us stop playing.

Friends having fun- Dr. David Hepburn
Friends having fun- Dr. David Hepburn

We exchange play for work and responsibilities. When we do have some leisure time, we’re more likely to zone out in front of a TV or computer screen, than to engage in actual creative, brain-stimulating play. But play isn’t a luxury – it’s a necessity.  So ease up, cut up and play up. I’m dead serious.

Alternative Medicine? By Dr. David Hepburn

On a recent sojourn, my old clunker of a car seized up just outside Costco, likely after inhaling excessive toxic fumes of Polish sausage.  As it wheezed into recovery, our Hepburn herd marched into the big box store in search of mega stuff. With my wife off in search of 95 gallon jars of assorted condiments and my kids busy sampling the oyster ice cream, I moseyed on over to the Costco “books” area intent on finding Pseudohypoparathyroidsim For Dummies.  Instead, to my chagrin, I came across book after book with titles like Revitalize Your Lymph with Rutabaga by “Dr.” Pearl Diamond, and The Alternative Medicine Guide to a Really Really Really Healthy Gallbladder by Autumn Moonglow Johnson-Johnson.

Books seemed to glare at me from all directions, slap me across the face and demand that I Awaken Your Spleen Through Foot Massage, or cleanse my hidden immune system on Nature’s All Natural Naturopathic National Gnat Diet. Virtually nothing by a real doctor. By that I mean the guy who went thru 31 years of post secondary edukayshun studying sciense, disease and nurse behaviour. Flipping through Herbs Herbal Remedies I came across an excerpt of how Larry’s psoriasis cleared right up after an infusion of salamander saliva and ocelot tears, while on his vacation in the Dead Sea, during an El Nino. Subsequently, Herb now recommends salamanders for your ailing serum purple psoriasis cells. What does conventional mainstream medicine think of these alternative claims? I, for one, am somewhat appreciative of alternative medicine’s efforts to search for more effective ways to improve health. But, in this day and age when “evidence-based-medicine” is the battle cry, we need more than Larry’s anecdotes.

Dr. David Hepburn
Dr. David Hepburn

I need to know there is some scientific credibility before I venture onto a 13 week diet of dragonfly knees and petunia nectar just to revitalize my inner magnetic force field. Let’s evaluate the evidence that a certain product really helps and a certain procedure really proceeds. You should be informed, and in some cases concerned, about some far out “alternatives” that may be harmful, useless and expensive, just as in conventional medicine. Does the “if it’s natural it’s safe” logic work? No ma’am.

Prancing naked through a mosquito infested poison oak swamp in Zanzibar, feeding on wild mushrooms feels quite “natural” but … King Cobra venom may help a pimple problem but unless there is an emergency, such as before the grad dance, I would avoid the snake oil. Drinking grapefruit juice can actually cause pregnancy if you’re on the birth control pill (sex also required). Personally, I don’t have a major problem with someone under my care adding extract of beaver hair as an adjunct to medical treatment, as long as it is proven safe and doesn’t really financially exploit the victim… er patient. My major concern, however, is the temptation of self diagnosis.

Before embarking on some Sabu flowerpecker therapy for what you think is diabetes, consult a doc. Playing doctor can be dangerous, I know, I often play one.Any studies done on this stuff? Yes, and based on a recent review in a leading journal I list below some of the more popular products along with a detailed scientific discussion as to whether they were felt to be effective based on current data:

Ginseng- nope                        Saw palmetto-yup

Milk thistle- mebbe               Ginkgo-mebbe
Echinacea-nope                     Bee pollen- nope
Feverfew-OK                           St John’s wort-OK
Kelp-nope                                Royal jelly-nope

Cannabis-absolutelySpirulina-nope

Dr. David Frederick Hepburn
Dr. David Frederick Hepburn

Discouraged after “leafing” through the medical advice from those whose entire medical training consists of a weekend flipping between ER and M*A*S*H (and watching the Golf Channel on Wednesdays), I took my pounding headache and made straight to the Black Forest Cake sample line. Our trip to Costco over, the kids stuffed on marinated albatross wings, we tumbled into the car, me whining about my headache. “It’s OK, dear” consoles my wife, packing away the two quart jugs of flea pheromones. “Take off your left shoe and I’ll rub your 4th toe, just above the knuckle.”