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.

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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.

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.

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.

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.”

Get diagnosed…at the airport By Dr. Dave Hepburn

Dr. Dave Hepburn:

Being a Wisequack means making wisecracks at every opportunity where doing so fulfills some innate need in my soul to prevent me from ever truly maturing. I remain in the chrysalis phase of life and doubt I will ever really metamorphosize into the butterfly or a Sear sucker munching moth that I should be. Fellow Wisequack Rob Sealey is frankly, well…larval.

And so it was that traveling back from Phoenix, I couldn’t resist myself while standing in a full body scanner at airport security with my arms in the air looking like I got my shoulder joints stuck halfway though performing the crowd “wave” at my son’s hockey game.

I turned to the TSA security gal and winked “I feel like I need a smoke. Was it good for you?” But my wife thought that this was pretty lame repartee for me. “What you should have said dear” she suggested “is “Ummm listen, I was just swimming….”” “Babe, that’s a great line!! That’s absolutely hilari…wait a second!”  “…in the Arctic Ocean.”

Gone thru the full body scanner yet? The technique usually involves FM radio waves which, if tuned properly should be playing Barrys White and Manilow, given the intimate experience that awaits. For those who prefer not to go through these scanners, you can opt, as Sealey does, for a pat down. In fact, I heard him once ask for a cavity search believing he could get a cheap dental check up. Should have seen the size of his pupils after his check up, as “they checked up everything except my friggin’ teeth.”

But taking a good look inside our bodies is a huge part of everyday medicine and as technology reveals new technological technologies, diagnostic imaging has improved dramatically. One of the brightest new lights is the PET scan, more commonly known as  positron emission tomography.

Positron Emission Tomography - Dr. David Hepburn
Positron Emission Tomography – Dr. David Hepburn

Getting all the details from the pet shop boys, I am told that PET scans are extremely sensitive scans that allows doctors to see how organs function rather than simply looking at a fuzzy still image of them. It’s like the difference between snapping a still photo of, say a parliamentary debate or actually watching a 3D video of assorted vegetables, clothing accessories, pagers, pages being hurled across those esteemed seats of government. PET scans like to look at the metabolically active areas of our body that use a lot of energy ie. sugar that comes from our diet, our tissues and of course our lovely Snickers Bar organ.

Currently, PET scans are most commonly dealing with detecting and assessing treatment of cancer. When a cancer occurs in our body, the nasty cancer cells are very metabolically active as they multiply like an Osmond family in the spring.  Because those cells are so active, they suck up a lot of sugar, virtually stealing it from the rest of the body and literally starving out our pleasant normal cells.

This starvation is why the symptom of “unexplained weight loss” may be an indication that there is an active cancer. PET scans actually show us where there is this increased metabolic activity in our body. If it locates an area of high metabolic activity then there could well be a cancer present. If during cancer treatment, a PET scan shows no decrease in that metabolic activity, then that particular treatment regime may not be working so well.

Besides the cancer world, PET scans are also very useful in detecting heart problems (such as coronary artery disease and damage to the heart following a heart attack), brain disorders (including brain tumors, memory disorders, seizures) and other central nervous system disorders.

But a Pet peeve that many of us have is that while there is a Pet scanner in every hospital, clinic and Burger King in the US, it is rare to spot a stray pet anywhere in Canada. The only Pet scans in my city are when Tinkymuffin, the family Shih-tsu scans the kitchen table when you take a bathroom break. But should, one day, you decide to get a PET scan, or a body scan of any type… don’t go swimming first.

Useless organs By dr. David Hepburn

Dr. David Hepburn: 

Leo, my Havanese dog (by the way, we Havanese owners are an uppity bunch and always use the word “Havanese” when referring to our “dog” so that you don’t think we are owners of a Shih-tsu or Deputy Dawg) wears his emotions on his butt. Happy, and his tail becomes a weapon of mass destruction. Sad and it wilts like a Viagra failure. Excited and it becomes a merry-go-round game to pursue, Frightened and it somehow makes him look bigger like a fuzzy toy rabbit, albeit a fierce-some one, of course.

But how important is a tail to we bipeds? In fact, what is your most useless organ? (My wife’s response was “What or who?”) Turns out we have several organs and tissue, that are vestigial, just junk in our trunk. Useless, useless, useless, Trump, useless…or are they?

Coccyx

The tailbone, more fun to call coccyx if you’re a ten year old tempting your naughty vocabulary, is a collection of five fused (or sometimes separate) vertebrae. These fused vertebrae are the only vestiges that are left of the tail that other mammals still use for balance (cheetah), communication, (lions) and, for some primates in Africa and DC, as a prehensile limb. However, the coccyx, unlike Washington, isn’t completely useless. It allows ligaments, tendons, and muscles to attach to it that have a few important functions, including the role it plays in enabling us to sit properly. The coccyx used to be removed when people injured them but nowadays it is rarely taken out.

Coccyx Bone - Dr. David Hepburn
Coccyx Bone – Dr. David Hepburn

There are cases of infants born with extra vertebrae, giving them tails. There are no real adverse health effects of such a tail, unless perhaps the child was born in the Dark Ages. In that case, the child and the mother, now considered witches, would’ve been killed instantly, which we usually file under adverse health effects.

Tonsils/adenoids

The tonsils are another useless part of the body that can cause a bit of grief. Open your mouth wide and you’ll see a tonsil on each side of your throat, unless you’ve had them removed, in which case you’re much less likely to see them. Tonsils lurk about the back of your throat while adenoids hang out in the back of your nose. Tonsils and adenoids (T&A) are lymphoid tissues that are prone, in kids, to becoming infected and inflamed and as such were indiscriminate targets of scalpels.

Tonsillectomies would cause kids to miss school and eat way too much ice cream, making them sick yet again. Any child with a decent criminal bent could stretch this surgery-induced holiday to two weeks, particularly if you suggested that your coccyx was also sore. I am proud to say that I missed 136 days in Grade 3, just shy of the record set by Capone. But are they troublesome, evolutionary vestiges or ardent defenders of the body? Both tissues function in antibody production and cell-mediated immunity and might well be important as a lymphoid defense mechanism organ in the upper respiratory tract.

Doctors are now a little more reluctant to remove the tonsils or the adenoids no matter how badly Junior snores, snorts or schnoozles. When studies indicated that there was no decrease in the number of colds, sore throats, and other respiratory infections between children who had them removed, and those who did not, Benny & Jerry stocks completely tanked.

Vermiform Appendix.

The appendix is a narrow, muscular tube that attaches to the large intestine. Its purpose was to digest cellulose back when we were cattle or sheep or dentists. But as we have advanced our diet to one of less prehistoric tree bark and more Snickers Bars, the appendix seems useless, unless you’re a surgeon who spends way too much time playing Blackjack. But recently it was discovered that the appendix actually stores good bacteria that can be used to repopulate the gut in cases of severe diarrhea.

It is a reservoir of probiotics! While not so important in countries not devastated by diarrheal diseases, those who live in nations with poor sanitation may need these in-house probiotics. The vermiform (meaning “worm”like) appendix really did resemble a worm when I was living in the jungles of Vanuatu and took out appendices that were jammed up by the disgustingly large Ascaris worms.

Appendix- Dr. David Hepburn
Appendix- Dr. David Hepburn

OK, enough for today as I have been sitting here way too long typing up this life-saving information and frankly… my coccyx needs some ice cream.