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.”

The Big Five By Dr. David Hepburn

Nestled in a bungalow on the Serengeti, deep in the Serengeti-ish part of Tanzania, we were warned not to leave the confines of our bungalow, even to venture the 75 yards to the main lodge, without first contacting security to escort us.

Thinking this a bit overkill, I nonetheless reluctantly called. Nanomoments later, a young man with an old gun appeared on our doorstep, just the ambience you want en route to dinner in the Serengeti. “Sorry to have to bother you.” I commented as we took the first couple of steps out the door. “You must hate doing this.” Suddenly, he swung his flashlight to the left and to my amazement, a few feet way away from where I was wishing I’d brought my Depends, were the intimidating tusks of a friggin’ elephant! Right there!! (African elephants and similar beasts are often officially described as “friggin’” given that they are the size of a friggin’ house or at least a friggin’ condo, and tend to make you sputter out words similar to friggin’, if not “friggin’!” itself, often expressed when you discover one 20 feet from your doorstep.) “Friggin’ thing!” I gasped.

Turns out that elephants, cape buffalo, lions and even leopards often made their way past our front door to get to the swimming pool for a chlorinated drink. And you thought clearing shad flies and ants out of your pool was a hassle. “Thaminiki, can you go grab the elephant net, oh and make sure to clean out any king-of-the-beasts clogging up the filter.”

We literally could’ve sat in our bungalow and witnessed 80% of the sought after African Big 5, the rhino being the only one of the Big 5 not in the vicinity. Why they are referred to as the Big 5 was not always clear to me. It isn’t the “biggest” 5 as the hippo isn’t included. It isn’t the tallest as the giraffe doesn’t make the grade. It isn’t the most dangerous given that hippo attacks are the most deadly in Africa, perhaps due to the fact they got left off the list in the first place. The Big 5 are the Big 5 because they are the most sought after and valuable animals in Africa.

The Big 5 of Africa - Dr. David Hepburn
The Big 5 of Africa – Dr. David Hepburn

Twice a week, I, like Lindsay Lohan, enjoy a drug lunch. This is when well-coiffed and well informed pharmaceutical reps with great teeth and tusks come by the office to provide lunch and chat about what is new in the world of pharmaceuticals. It is a welcome and needed opportunity to discuss the drugs we prescribe you.

“So what’s new Kevin?” I asked one of the reps whose name was Kevin as suggested on his name tag.

“Really Dave, not much. Drug companies continue to focus most of their resources on the Big 5.” Once again, the Big 5 refers to the most sought after and valuable. The Big 5 diseases that pervade our society. Diseases at which Big Pharma aims it’s elephant guns. Big bins of sample drugs addressing the Big 5 fill our big shelves. Listing these diseases tempts me to compare them to the African Big 5, as that is just the way my mind works or perhaps doesn’t work depending on if you’re me or my wife.

Diabetes, often due to diabesity and requiring a trunk full of medications, is the elephant of the group.

Depression. I don’t personally recall ever seeing an overly happy Cape Buffalo. They always look like they’ve woken up on the wrong side of the savannah. They are the grumpiest beast in all of Africa and are constantly complaining to those who would listen, which really would only be other Cape Buffalo and the occasional ox pecker on their backs.

Osteoporosis. Rhino horns are all too often turned into dust and powders in the name of medications, just as the eggshell skeleton of osteoporotics turns into chalk dust… requiring medications.

Asthma/COPD. When lions grab a Zebra, wildebeest or wild tourist, they simply clamp down on the windpipe and slowly wait for the victim to expire. This is exactly the sensation of obstructive lung diseases, though usually without the claws sunk deep into your cranium.

Hypertension. Leopards, due to their stealth, are not easily noticed in the Serengeti, until one suddenly rips you apart. Blood pressure, the silent killer, may not be seen coming until one morning you wake up dead. Leopards tend to go up trees to eat and stroke their fur. As our blood pressure goes up, we tend to stroke too.

Big 5 of Diseases -Dr. David Hepburn
Big 5 of Diseases -Dr. David Hepburn

And so as not to irk the irksome hippo, I would like to give the hippopotamus honorable mention as I would also like to do for cholesterol. Both are chomping at the bit to be part of a Big 6. Both are all about dangerous fat floating around, either in our blood stream or the Zambezi as the case may be. So keep your serum hippos down….friggin’ things.

Erectile Diss-function by Dr. Dave Hepburn

I am not a big curling fan. Not that I don’t like it, I just don’t spend many hours in front of the Toshiba hanging on every “Hurry hard!” But when the Olympics come and Canada is curling, get out of my way. “Sorry Bloggins but we’ll resume those cardiac compressions after this end because we are all tied up with Slovenia.” Yes, every four years I become a hog line hog.

I have also been a Maple Leafs fan forever even though I don’t live in Toronto, never have, don’t want to, dislike the town. But my dad used to sit me on his knee when he wasn’t bending me over it, and we would cheer on Norm Ullman, Dave Keon and Red Kelly. He would yell things like “Shoot it Armstrong!” or “Get up Bower” or “Get off my knee David, you’re 17 years old!”

Toronto, Maple Leafs - Dr. David Hepburn
Toronto, Maple Leafs – Dr. David Hepburn

There are plenty of us jingoistic curling fans and plenty of us wallowing in Leaf Nation. Believe it or not this is actually good for our health. Scientists have shown that fans who feel personally invested in a team or, better yet, who attend games and cheer along with like-minded fans, reap the mental health benefits that come from a feeling of social connectedness. This phenomena is known as “reflected glory.” In the case of the Leafs this phenomena is known amongst scientists as “friggin’ misery loves company.”

Sharing a common allegiance with others, be it the Cubs, Conservatives or Catholics, bonds people together in a special way. We can relate to others who share fanship or churchship and feel a camaraderie with these fellow hooligans. Friends pick a bar or a chapel to meet up in, have a beer and celebrate friendships made because of the sport or doctrine itself.

And being a fanatic fan feels even better when the team wins. Now we’re really reveling in reflected glory. Whether your Canucks lay a licking on the Coyotes or your Methodists lay a licking on the Moonies, your reward system is flooded.

The ‘basking in reflected glory’ notion states that people can elevate their self-esteem in the eyes of themselves and others by their association with successful others. Because the team’s success reflects positively on its fans, sports fans feel better about themselves when their team does well.

In one study ardent fans of Indiana University’s basketball team were shown pictures of attractive members of the opposite sex and asked them to rate their ability to get a date with them. After their team won, both men and women who were devoted fans, even if they looked like Larry Bird, were more optimistic about their likelihood of scoring a date. They also had a higher opinion of their ability to do well at tasks such as throwing darts, shooting free throws, solving word games and even rolling dice.

Another study found testosterone levels in men rise after a victory and fall after a defeat. Researchers took saliva samples from Italian and Brazilian fans in sports bars before and after the two teams played one another in the 1994 World Cup. After the Brazilians won, the testosterone levels of their fans rose more than 20 percent, while the Italian fans’ levels dropped more than 20 percent and their mustaches thinned right out. Same was true of the men. Fans have a strong sense of personal investment in teams they’re following. Sometimes that investment is rewarded and other times it acts like my stock portfolio.

Soccer Fans- Dr. David Hepburn
Fans in a soccer match – Dr. David Hepburn

After a big loss, don’t approach your man looking for a little lovin’ as not only may his libido drop but so too can his manhood. Defeat may lead to ED. (If he yells “Hurry hard!” only every four years, please have him see a doctor.) Though reflected glory explains why the stands are full for winning teams, it doesn’t explain diehard fanship, or people who stick by their team even after lengthy losing streaks aka “The Leaf Experience.” Fans take a pride in their loyalty, and see suffering through failure as a badge of honor. Doing so makes the euphoria of a win even more dopamine rewarding. For many fans, whether it is of the Penguins or the Presbyterians, being a fan is also part of a family’s identity, a tradition passed down from generation to generation. Your great great grandparents may in fact choose your church, foster your fandom and even brainwash your ballot.

So root root root for the home team and flood flood flood your synapses with dopamine, your blood stream with testosterone and your skin with goosebumps. Live and relive those reflected glory days, even if it was a half century ago… Leaf Nation.