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

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.”

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.

Mosquito Misery By Dr. David Hepburn

Dr. David Hepburn:

I take my Aunt Bertha with me to a lot of functions, specifically outdoor functions.

“Wow she must be cool!”

Well no, not really. She’s 5’3” tall and 5’4” across. She sweats like an artesian well and her dentures have a life of their own. But mosquitoes love her and always select her over me. So I dress her up in a dark muumuu and take her with me to BBQ’s and bonfires. When I go snipe hunting at night, I get her to hold the “flashlight” for me. She is my own personal citronella coil. For those of you who think this is mercenary of me, buzzzzz off. Keep in mind that she gets free burgers and plenty of exercise slapping at her neck and ankles.

Mosquito bite - Dr. Dave Hepburn
Mosquito bite – Dr. Dave Hepburn

Why are some people mosquito magnets while others, like myself, are so completely repulsive? Bertha is among the 20 percent of people who are high attractor types, not to be confused with highly attractive types. Noting that Bertha is rather Rubenesque and tends to give off a pong like a hockey bag in a Phoenix summer, mosquitoes, who typically will hone in on dark, odiferous objects, salivate when she is in the area.

The main smell that attracts these flying syringes is CO2, better known as what my sons like to power their BB guns with, prior to firing them indiscriminately in the direction of the neighbor’s greenhouse. Those with higher metabolic rates produce more carbon dioxide, as do larger people and pregnant women. In addition, other smells, emanating from: estrogen, exercise-induced lactic acid and even acetone from your breath, mark you as a good landing spot. Your body temperature, or warmth can make it worse. Mosquitoes may flock to pregnant women because of their extra body heat.

Here are a few other fascinating facts for dinnertime discussion tonight, should that discussion tend in the direction of mosquitoes, the tax man or other blood sucking pests.

-Some mosquito species are leg and ankle biters; they cue into the stinky smell of bacteria on your feet.

-Other species prefer the head, neck and arms perhaps because of the warmth and closeness to carbon dioxide released by your mouth.

-Mosquitoes are more attracted to women than to men, particularly ovulating women.

-Given the choice, mosquitoes would usually rather bite a blonde. Absolutely true! In fact, my blonde friend, aware of this, bought a large scarf for a recent bonfire. (She returned it later saying that it was too tight.)

-Mosquitoes like to aim for moving targets. The Maple Leafs are bite-free.

-Biting increases 500 times during a full moon so… reduce your full moons under a full moon.

-When female mosquitoes drink blood, they leave a small puddle of urine on their victim’s skin. Adds a little insult to injury.

-Only females make that annoying high pitched sound. Mosquitoes too.

-The more times you get bitten by a particular species of mosquito, the less you’ll react to that species over time. Great? There’s more than 3,000 species worldwide.

-Garlic mosquito repellant is fairly effective. Also significantly reduces vampire attacks.

-Mosquito zappers may be popular, but they very rarely capture mosquitoes.

-Mosquito traps that are most successful are those which emanate the same odors, CO2, octenol, heat as Bertha. Personally I just use Bertha herself, adding “You would look absolutely incredible as a blonde. Trust me, I’m a doctor.”

-Even though they seem to move quickly, the average mosquito can only fly up to 1.5 miles per hour. The one exception is the one, obviously into the Red Bull, that spent the entire night in my tent last week at approximately 1500 mph.

-Most mosquito species can only fly about 300 feet before they need to rest. They leave you, fly 150 feet, turn around and 150 feet later, stop for a rest.

-A mosquito flaps it’s wings between 400 and 700 times per second. Ralph Swanson, the man who counted these flaps will attest to this if you talk to him up at the sanitorium. I stop in and see him when… I go to pick up Bertha.