Tsetse and dikdik – Dr. David Hepburn

Most of you realize that I tend to incorporate useful information in, well, a useless format. My writing reflects an “unusual style” which is consistent with comments I often hear about my sartorial taste and my personal interpretation of the foxtrot. I relate common experiences to medicine and as I have just returned from the dark continent, the heart of East Africa, and as I have run out of stories related to my experiences at Chez Hepburn, you will be regaled with exotic Serengeti-style stories about the dung beetle’s constipation, the dikdik’s ED, the warthog’s condylomataetc for the next 17 years or until I go on on safari to Saskatoon.

But front and center, why do zebras have stripes?

“Sir you can’t wear that shirt today” the guide pointed out as we headed off on our safari de jour. “Why? Does it make me look fat? I’d hate to be the first pick of a pride of starving li…” “No, but it is the first pick for the tsetse fly.” Sure enough, flag-sized swaths of my electric blue and black shirt are spread out between poles in different parts of the savannah by the Masaai tribesmen as tsetse fly trap. These very nasty flyflies of death happen to lovelove this colour, and so gleefully land on this cloth unaware that it has been impregnated with heavy duty tsetse fly insecticide. Actually were they aware of this they likely would still land on it as they are rather stupid flies.

Tsetse Fly - Dr. David Hepburn
Tsetse Fly – Dr. David Hepburn

Buzzing about staring through those compound eyes, something in their less-than-sophisticated brains goes, “Wow, blue and black! That reminds me of, well, I’m not sure of what, but as a tsetse fly I think I really dig that pattern. Perhaps I am unusual and have an unusual sartorial taste and dance a poor…Oh crap!” and they die. But one pattern that they can’t process in their wee frontal lobes is the black and white stripes of the zebra. It confuses them and appears to their compound eyes as a Rorschach inkblot representing their grandmother being squashed by a dikdik.

The tsetse fly carries with it a nasty deadly wee bug that many of you might wish you could catch. I will clarify this because failure to do so will cause many of you to think I am unusual.  Tsetse flies are the vector, host and chief bottle washer for sleeping sickness and I happen to know that many of you wish you could sleep better, or at all.

Insomnia represents no small part of any doctor’s practice, one of the more difficult parts. Insomnia is often due to one of four problems: chronic pain, restless leg syndrome, sleep apnea (for the bed partner more than the snorer) and the huge basket of psychological issues which include: anxiety, depressions, and chronic stress. Some have a problem falling asleep, others staying asleep. Our treatment varies depending on which type of insomnia you have.

Many of you are in that nervous Nelly category of those who lie down and start to ruminate, fretting that “I just can’t shut my brain off, doctor.” Well that would be a good thing because if your brain is turned off you will be having somewhat of a bad day given that you would be dead. But you can control what you choose to think about and/or how long you want to think about that specific thing that is keeping you awake. So should you decide to ruminate incessantly about something that keeps you awake, you are, in fact, participating in your own insomnia. Learn to distract yourself from those thoughts or to mitigate the amount of time spent thinking about them.

A very interesting study showed that those with primary insomnia who placed a cold compress over their foreheads an hour before sleeping, cooled down the niggling frontal lobe of the brain and fell asleep much easier. Cognitive Behavioral Therapy (CBT) has also been shown to be highly effective and even hypnosis works for many worriers.ç

Dr. David Frederick Hepburn
Dr. David Frederick Hepburn

“Sleeping pills” are NOT the answer as they should only be used for a very short term. There’s too much of a dark side of long term use of sleeping pills including memory loss, confusion, and even weakness to say nothing of addiction. Yet many of you are not willing to try anything but sleeping pills even though it means your sleeping sickness really gets no better. So close your eyes, shut down your brains, put away those pills and start counting dikdiks.

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Twitterified By Dr. David Hepburn

“You have to!”

“No, Janelle, we don’t!!”

“Look, you want our advice or not. To play in this century you have to tweet.”

And so we were dragged, kicking and streaming into the 280 keystroke world of twitter. We’ve now got a skookum website and some rockin’ youtubes. We podcast like Orcas and are twittering away on tweeter these days to say nothing of being completely bookfaced most of the time, or whatever.

Dr. Rob Sealey and I now have four good tweets a week and we feel better for it. It’s a load off our minds to be able to bring to you the medical headlines from across the planet and summarize them in 280 strokes, complete with insightful, detailed commentary. Some of them may cause you to change your life, others may cause you to change your Fruit of the Looms.

Twitter - Dave Hepburn
Twitter – Dave Hepburn

-An exciting new vaccine appears to cure prostate cancer in mice! Next step is to test on rats, then lawyers, baboons and finally humans.

-Peppermint is superb for gut aches and spasms but can aggravate anal itchiness. Thinking of branding a peppermint drug. “Scratch and Wind.”

-New study shows men with ED have very high incidence of sleep apnea. Guess the only breath their taking away these days… is their own.

-Latest medical news reveals that drinking coffee may reduce prostate cancer risk…apparently Starbucks is already marketing the Prostalatte

-Recent medical journal headline “Heavy cell phone use might raise risk of brain tumours.” Glad my cell phone only weighs 3 ounces.

-Study shows that exercising only one hour per week reduces the incidence of colonic polyps. Get a runner’s high, avoid a high colonic.

-A new study reveals that motivational text messages will help smokers to quit…especially if they’re from the coroner.

-Those with rheumatoid arthritis found to be predisposed to have COPD(emphysema/bronchitis) proving smoking joints does cause lung disease.

-Study shows that hard short interval exercise is much healthier than endurance exercise. Doesn’t mean an interval of every three years.

-A recent study revealed that too much sex could cause a cerebral hemorrhage…another good reason to get married.

-Actual headline in April Archives of Surgery. “Hungover Surgeons (redundant?) Make More Mistakes.” What’s next? Life found to be terminal?

-Talking about parasites and worms on our appetizing radio show. On a similar note there is a election debate in my town today…

-Research shows survival of a heart attack is highest in a gym than anywhere else. Maybe the fear of being seen dead in Spandex?

-Canadian researchers show that pregnancy is safe for women with MS. Safer for women with MRS.

-Study shows that gambling on computers is leading to some serious addiction problems. I gambled on a PC and lost.

Tweet - Dr. Dave Hepburn
Tweet – Dr. Dave Hepburn

-As doctors, we always have to attend courses to update our skills…today’s course is Bear Mountain Golf Resort.

-10 grams of soluble fibre/day is the key to trimming bad internal (visceral) fat. Bad fat is the key to trimming longevity problems.

-Had a great interview today with the remarkable Bif Naked and like the mature MDs we are we resisted all naked jokes. We focused on Biffys.

-More and more conditions are proving to be genetic. Even the ability to have kids is hereditary; if your parents didn’t, you probably won’t.

-Recent study shows that flossing a mouth full of teeth actually prevents the nasty pancreatic cancer! Well, there goes my hockey team.

WHY HOSPITALS CAN ACTUALLY MAKE YOU SICKER By Dr. David Hepburn

LOGIC 101

  1. I have spent no shortage of time in hospitals.
  2. Readers say to me, “Dave, I’ve read your columns and frankly, you are sick.”

Ergo, hospitals make you sick? Here are ten reasons that could be true.

NOSOCOMIAL INFECTIONS are infections picked up in the hospital. Institutions like hospitals, prisons, Charlie Sheen can be bug brewing factories. MRSA(superbug), scabies, viruses and the evil C. difficile. “Welcome to Ward 3, Bloggins. Here are your dinner choices and over here you can pick your nosocomials.”

MEDICATION ERRORS. Whether by a nurse or a doctor, I should point out that if there is any question, then it is preferable to blame the nurse. Doctors write beautifully and legibly as any pharmacist will attest. I once ordered 6 U of insulin for a patient who was mistakenly “given 60”, as the panicked nurse gasped to me over the phone. “How’s he doing?” I asked. “Shaky.”

SURGICAL ERRORS does not always refer to the surgeon cutting off the wrong leg, testicle or heart, but can also mean accidentally cauterizing the graplihornswaggle artery rather than the intended snorghoplaster vein. And of course there is the occasional object left behind in the patient such as a swab, scissors, scrub nurse.

Dr. David Hepburn
Dr. David Hepburn

ADVERSE DRUG REACTIONS are the 8th leading cause of death in North America, as, until genetic drug screening is available, drug therapy can be a bit of a shotgun approach. Be alert, aware and a tad suspect should you be ordered a new drug with names like Widocillin, Nokhel, Kriplex and Urispas (actual names of drugs).

WRONG DIAGNOSIS. Just watch any episode of HOUSE where the staff usually takes the patient to the brink of death before House’s epiphany de jour as a basketball hits him in the left uvula giving him the idea that they’ve been treating the wrong problem all along.

FALLS /TRAUMA. Hospital cleaners seem trained to add extra wax in the rooms of the most frail and confused patients. Sick and often drugged patients have to get up to take a poop and end up performing a triple lutz, ending with an unceremonious splat.

COMPLICATIONS OF INVESTIGATIONS. One apparent abnormality can lead to another to yet another. These so called “incidentalomas” can trigger aggressive or invasive investigations.

“WellDr. Sealey, looks like that zit really was a zit. OK I’ll sew the patient up, you put the catheter in and we’ll send him to ICU.”

BEDSORES. Decubitus ulcers can get infected and very nasty, which is why I write in the orders, “apply turning over the patient like a lamb on a spit.” But, my beautiful penmanship aside, this can get interpreted as “apple turnover the patient until they spit.”

BLOOD CLOT. Anytime a patient is not doing hot yoga and dancing the macarena sixteen minutes after completing surgery, there is a risk that they could develop a blood clot in their legs. This clot can pop off and go to the lungs, uvula or Sudbury. It is vital, post operatively, to move your limbs and shake what your plastic surgeon gave ya’, as we’d hate to have to crack open the Widocillin.

Dave Hepburn
Dave Hepburn

WRONG PATHOLOGY RESULTS. This actually happened to me when I was a patient. I recognized the mistake when my biopsy report said I was expecting twins in six months! But being the astute physician I am, I quickly recognized this as a lab error. I could only hear one heart beat. Yes readers…I might be sick.

Yeast Beast – Dr. Dave Hepburn

I don’t drink. I know it is a major character flaw and I need to fix it but I am weak, though the body is swilling. Damned self-denial. I’ve thought about giving it up, considered joining AA (Abstainers Anonymous) but it’s hard to get away with stuff like that when my mother is always checking on me in my wee corner room deep in the basement abyss where I am kept. But I know some guys who do drink, says it makes the operating room a little livelier. Having a liquid lunch prior to surgery makes removing an aorta or a frontal lobe or inadvertently both, infinitely more amusing.

But one hot summer day, I found myself in a place, which is, oddly enough, home to both the Kokanee beer (Sasquatch’s favourite ale) brewing plant and Canadian polygamy. Truly a town that has either enjoys too much to drink or not enough.

Creston BC, the land of big love, most of it directed towards big foot. So I wanted to know how this beer was made as I am just naturally a curious guy when it comes to things I don’t personally participate in. Incidentally I’m also interested in learning about how to actually pay taxes and Cantonese lip synching.

Anyway, apparently after the malted barley is strained the barley is sent to local cattle. “Hey Bessssssssie babe, after a few of these here bbbarleys you are uddderly a friggin’ fox you old cow.”

Get the mixture all hopped up and then add yeast.

We walked into the yeast room to the pleasant smell of yeast happily churning up the watery ale, immersed in a vat of beer in a sort of Michael Phelps/Homer Simpson way.

Now I am not a yeastologist/naturopath so I don’t know a lot about yeast other than it tends to get a rise out of a lot of the crystal-waving, tulips-in-my-toes gang. Seems the yeast beast gets blamed for a lot of medical conditions ranging from Friday fatigue to pregnancy. “You might think it’s a fetus but really it’s just yeast rising. If you do have a baby it will likely be riddled in yeast unless you buy our yeast-zapping ocean potion.”

Vaginal Thrush -Dr. Dave Hepburn
Vaginal Thrush -Dr. Dave Hepburn

Yeast brews in the vaginal vault in 30% of healthy women usually without causing too much grief. It just sits there dreaming of beer and Birkenstocks. But it is an opportunistic littlebugger and given half a chance it will multiply and start percolating. Antibiotics, taken for any infection, can also kill off the normal bacterial flora of the vagina. When this happens yeast, having been lurking in the shadows, comes forth and claims the vault in the name of yeastkind everywhere.

Other causes of triumphant yeast includes diabetes, pregnancy, high dose estrogen in birth control pills, douches and sprays like Massengill or Raid and just plain good old fashioned bad luck. Yeast infections generally causes itching, burning on urination or intercourse and often a discharge that is described as cottage cheese in nature, much to the chagrin of the folks at Land O’ Lakes.

Men too can get yeast infections on their pride and joys, an itchy condition known as “balanitis” given the close approximation of the infection to the bals.

Balanitis - Dr. Dave Hepburn
Balanitis – Dr. Dave Hepburn

In order to render yeast deceased, treatment can be with creams, suppository ovules and now a simple pill, diflucan, taken once (orally). For those unfortunate gals plagued by recurrent yeast infections take two diflucan pills, 72 hours apart, when beset by an infection. Alternatively to prevent this chronic yeast feast consider taking it once a month when estrogen and progesterone levels swing wildly at mid-cycle (see: male cowering). And even good ol’ Boric acid, 600mg, as a vaginal ovule used during the second half of the cycle might help prevent recurrent yeast.

All this writing of yeast beasts and estrogen and bals and vaginal acid and ultimately death has me exhausted… I need a beer.

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.