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.

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Are you pro probiotics? – By Dr. Dave Hepburn

This column is only for billionaires, which… is all of you. You are rolling in veritable vault-loads of bacteria. You’re a bacterial billionaire. Some of your teenagers are extremely wealthy, as are their hockey bags. In fact, for every single cell in your body you have ten bacteria; on your skin, in your mouth, genital tract, your jockstraps and helmets.

Your colon, you’ll be thrilled to know, is the happy hellish home to most of these billions. But don’t be in a hurry to try and get rid of them courtesy of some primitive cultish practice like voodoo or colon cleansing, the latter which not only does no good whatsoever but may in fact be harmful. (For those gullible colon cleansing folks…you’ve been hosed…so to speak.) Stick to voodoo like my patients do, which may be the reason Dr. Dave bobbleheads are being snapped off the shelves and I have a constant pain in my prostate.

Your bowels are teeming with lovely, yet sensitive, bacteria with names like E.coli and Petunia. However, your bowels also contain a bowlful of nastier, tougher, bacteria with names like Clostridia and Kevin. All of these bowel beauties, good and bad, compete for your pop tarts. Millions of them eagerly waiting in the bowels of your bowels with saliva dripping from their wee bacterial beaks. Sleep well now, Billy.

Bowel Bacterias Dr. Dave Hepburn
Bowel Bacterias – Dr. Dave Hepburn

Normally, the Petunias and those of similar ilk outnumber the nasty fellas significantly, a good thing for keeping your bowel flora and fauna in balance, albeit an uneasy one. The good flora, as mentioned, are a sensitive lot and should they be insulted by say an antibiotic or a foreign invader, they get nervous, can’t eat and often faint. The hardier, evil bugs don’t care and so they take over the pop tart smorgasbord, and in so doing can cause some rather unacceptable symptoms like bloody diarrhea, pain, cramps and death and stuff.

So in this ongoing battle of the gut it makes sense to send in reinforcements from time to time. Welcome probiotics. Yes, you can deliberately add more of these sweet germy gems to that twisting cauldron of poop. That, in fact, is what a probiotic is.

The most famous probiotic is, of course, lactobacillus, found in yogurt. When I first learned of the enormous bacterial count in yogurt I was quite viscerally affected, which may explain the reflexive gagging sounds I make when I spot a roving Yoplait in aisle 6 at the Piggly Wiggly. It also explains why I reach for the soothing Snickers bars to make me feel better as no bacteria could ever survive in my Snickers bars thank you very much. But knowing what I do now about how great probiotics can be, I can almost tolerate a yogurt in the same room, as long as the lid is on and it doesn’t look me directly in the eye.

Lactobacillus - Dr. Hepburn
Lactobacillus – Dr. Hepburn

A live probiotic, taken at the same time that you might have to go on antibiotics, can restore the strength of the good bacteria, preventing the diarrhea often seen in those on antibiotics. Probiotics can also be useful in actually treating good old fashioned infectious diarrhea and possibly even irritable bowel syndrome. In addition to GI problems, probiotics are also considered in the treatment of vaginal, skin and respiratory infections and might even prevent tooth decay and periodontal disease.

Most probiotics are bacteria similar to those naturally found in people’s guts, especially in those of breast fed infants (who have natural protection against many diseases.) Probiotics are available as supplements but are also found in foods like fermented and unfermented milk, miso, tempeh, and some juices and soy beverages. The bacteria may exist in these foods naturally or be added during preparation. Isn’t that a lovely thought? “Bill, add a pinch more salt to that miso and, ummm, do we have any more baby poop left?”

What is important is that not all probiotics are created equal and the correct probiotic, be it bacteria, yeast or Edmonton Oiler, must be chosen for the proper problem or it is a waste of time and bowel, and don’t we all hate bowel waste. If you took the wrong probiotic for a gut problem you might be disappointed to learn that it was the probiotic used for vaginal yeast infections, particularly if your drivers license contains words like Charles or Gordon. So for most of you guys of the male species, it may be better to just inhale deeply… from a hockey bag.

What you can teach your doctor By Dr. David Hepburn

I learn a lot from you patients. Some of you will bring in some esoteric piece of medical information from the internet and I learn that I should spend more time on the internet. Some will have researched, ad nauseum, every possible website, blog, link, forum and tweet about the mating habits of the Eastern Moldavian micro RNA viral particle that, being a physician, I should be an expert on.

Physicians - Dr. David Hepburn
Physicians – Dr. David Hepburn

I’ve even learned about the status of a medication when a patient came in for a renewal on her medications, which included a cholesterol lowering medication called Baycol. As I was writing out the prescriptions and ordering some blood tests she said “Not Baycol, doctor.” “Why not? It appears to be working fine.” “Well, I heard that it was taken off the market, doctor.” “Oh, I’m sure I would have heard that Mrs. Bloggins. Trust me, I’m a doctor. See…” I replied as I reached across the desk and produced a golf ball with the word Baycol right on it. “Regardless of what your balls say, I heard on the radio that Baycol was being recalled.” Sure enough, Baycol had been removed from the market that very morning due to a pesky side effect known as death.

Another patient told me that he had bought my book at Bolen Books. “Well my book hasn’t been released yet, but there are some other stunningly handsome authors out there that you might have confu…” to which he took out a copy of MY book and asked me to sign it.

I learn about cars, trucks, the gospel, RRIFs, riffs, latest Japanese gadgets, latest Japanese research, great books, great bookings, great bookies, stock tips (thanks Martha S.), Chinese cures, Chinese restaurants, clothing sales (with strong encouragement to take advantage of same), movies, movements, a great band, a lap band, and, of course, a plethora of alternative medical stuff, usually involving an exotic sounding fruit endemic to an exotic sounding South Pacific Island. At the end of my day I often have a pile of prescription pad notes scattered across my desk, having scribbled on them “Toy Story 3” or “Bre-X” or “thong” or something completely illegible (which in retrospect I wish had been the Bre-X and thong note) to me or even the pharmacist.

And then I learn some lessons for life. The trusting philanthropist. “I want you to find someone who needs this and give it to them anonymously” said Jean Bilson of 273 Fairlane Ave., 250-379-2345. It was cash. More cash than I would make palpating prostates in a month. So I looked for someone who needed this help, in Maui.

The patient . A 23 year old man had been called in to our clinic regarding the results of a lab test. A test that was positive for herpes. He had to wait three hours. Turns out he never had a test for herpes. It was someone else’s test! Three hours of his life spent in our waiting room amongst the sick, weary and infective, all for nothing. “Hey, at least it’s good news.” he laughed. Wow.

The caring comedian. Opening the door to the exam room, there was a new patient, Jake, fully clothed, lying spread-eagled on the table with his feet in the stirrups and a rather large revealing hole in the crotch of his jeans. “I figure anybody who writes the stuff you do would enjoy a good laugh.” I then learned that he didn’t have a lot to laugh about as dirt poor Jake cared for a severely mentally damaged child, one that was not even his. I learned about compassion…. and sewing kits. Jake, I just happen to have some cash back here.

Dr David Hepburn book
Dr David Hepburn book

So, thanks for the lessons and please…. let me know if I’ve written another book.

Bites from these buggers By Dr. David Hepburn

“What a beauty!” rejoiced the exterminator as he lifted up the fibreglass batting to reveal a steroid soaked spider the size of Saskatoon “We love these guys. A few more of these sweethearts and you’ll have no more problems with carpenter ants in this house!” As thrilled as Mr. Pestilence was to discover that I was breeding Godzillaspiders, I was not particularly placated by the phylum of insect that now dominated my real estate and my frontal lobe. I laid my head on the pillow that night, no longer concerned about my house disintegrating into sawdust but rather plagued with visions of herds of hungry tarantulas burrowing under my silk sheets in search of something tastier than antchops.

It didn’t help when I recalled the fact that the average North American will ingest, while sleeping, three spiders in their lifetime. Since learning of this nocturnal snacking habit, I sleep with one eye open knowing some daredevil spider might pop down my gullet into my stomach where it will spend the night dancing the eight legged cha cha while feasting on jujubes and Denny’s Grand Slam. I’d much prefer that spiders just took a few nibbles at my hide and be done with me.

Black Widow Spider-David-Hepburn
Black Widow Spider -Dr. David Hepburn

SPIDER BITES

Imagine Bernie the Brown Recluse just hanging around the woodpile maybe working on his website or leering over at Black Widow Wanda who has just finished off a nice meal of a beetle or a botfly or a husband. Suddenly a pair of massive human hands reaches in, disturbing this happy arachnid scene and…

“Doc, I think I have a bite of some sort.”

“Looks like a fresh spider bite Bloggins. In fact so fresh that the beast could be on you right now.” At this point a horrified Bloggins usually begins the dance of spider evasion, frantically patting his clothes and hair as he undresses as if his shorts were on fire.

“Will I die?” he pants.

“Yes, one day. But nobody has died of a spider bite in 10 years in North America. So relax. If you were a child and were covered in Black Widow bites then you might have some serious problems requiring antivenim, otherwise just wash the wound well and slap some meat tenderizer on that bite to neutralize the protein.”

Hornet- Dr Dave Hepburn
Hornet- Dr Dave Hepburn

BEES WASPS, HORNETS, YELLOW JACKETS

When Betty Bee is disturbed while cross pollinating her daisies she might get upset and set her stinger deep into your skin. But she that she has a barb attached to her stinger that prevents her from pulling it out of her victim. When she attempts to fly away, the barbed stinger is anchored so solidly to the stingee that it tears Betty Bee’s belly, eviscerating and mortally wounding her. This is why if you listen closely while being stung you will hear “BzzzzOHCRAPbzzz.” Too bad bee, or not to bee.

Wasps on the other hand have no barbs and enjoy stinging you several times. If stung by a bee, carefully scrape off the stinger with a knife or credit card (cost of stingerless sting: priceless). Throw some meat tenderizer and some ice on it. You might also use baking soda and even an aluminum-based deodorant (for perspiration-free bites). A localized swelling at the site of a sting does not mean allergy. But if each sting leads to more intense local reactions, allergies may develop. If a serious allergic reaction occurs it will likely do so within 20 minutes. Eyes and skin will itch, vomiting and labored breathing usually follows. If allergic then carry a dual injection emergency allergy kit at all times or you might be providing the bees with… more daisies.

Do not read this while eating- Dr. David Hepburn

WARNING! You might want to place this article in your “I-Wished-I’d-Dropped-My-iPad-Into-the-Hole-of-One-of-Those-Porta- Potti-Things” file.

I am forever paying attention to the word “transplants.” But this is one time, like accidentally opening Brett Favre’s text message, that I wish I hadn’t paid attention. It isn’t easy to revolt a doctor but this is so utterly repugnant that I really would like you all to share in my nausea, which, frankly, would be a far site better than sharing this particular transplant……feces. Yes, you heard correctly should your wife be reading this to you. She did not misread fleeces or fees please or fleas tease or freeze these or Jersey Shore.

Stool transplant. Not talking about a barstool, though that is probably where your keyster should be drooped over about now having availed yourself of the bar portion at least in order to continue reading about the stool portion.

Clostridium difficile is a bug that we doctors aren’t overly fond of, as opposed to ones we’re more partial to like ladybugs, butterflies and Latoya Jackson. Had we liked this bug we would have named it Clostridium facile or Clostridium Heidi Klum but no, we gave it a name like difficile to reflect the ease of which it is to deal with. A not uncommon colon infection, it has the potential to be diarrhea deadly in those who haven’t got a Prime A immune system. It is an opportunistic bug. Should a prolonged course of antibiotics happen to kill off the “friendly bowel flora” (which btw is a very cool name for a band or a child should you be raised in the wilds of Gabriola), then C. diff can overwhelm the colon kingdom.

C. diff - Dr. Dave Hepburn
C. diff – Dr. Dave Hepburn

Affecting primarily the elderly, this deadly beast is most often caught in hospitals or nursing homes. In fact, the longer your stay in hospital, the higher the risk of developing C. diff.  Cramping diarrhea with recent use of antibiotics (like Cipro), fever, and foul smelling stool (as opposed to the more common lilac/petunia fragrance), is an indication that C. diff has set up shop. Too much of this overgrowth and the body can go into shock. The bowel can even rupture, an event that has been known to ruin lunch at Zellers. Anti-diarrhea drugs can actually make it worse! Currently we treat C diff. with antibiotics, different ones than caused the problem in the first place. But this is not always terribly effective and can be very expensive.

So along comes fecal bacteriotherapy, known in some circles as… kindergarden. It involves infusion of fresh feces from a healthy donor into the hurtin’ bowel in order to reverse the bacterial imbalance responsible for the infection. The best choice for donor is a close relative who has been tested for a wide array of bacterial and parasitic agents and who is excellent at keeping secrets and avoids overindulgence in Lima beans.

Donor stool is collected in the AM and liquefied in your basic orange juice blender. (How about that for a slap chop commercial at a trade show. “ Folks, over here we have umm…well… a blender for your….well…your….poop. Umm…Ok on to the Sham Wow!”) The transplant is done via enemas and/or via an NG tube through the nose, and no… I am not kidding.

A modified form of fecal bacteriotherapy is being developed  which is more effective and easier to administer. A fecal sample, provided by the patient/victim before prolonged antibiotic treatment or hospitalization, is stored in a refrigerator, just behind the Limburger cheese. Should the patient subsequently develop C. difficile the sample is extracted, filtered, freeze dried and then formed into a capsule that can be taken orally with your Fred Flintstones. And just think of how proud if not vindicated the dog will feel as he watches you gulp down a poop pill, the ultimate probiotic.

stool transplant -Dr Dave Hepburn
stool transplant -Dr Dave Hepburn

Now there’s little doubt this treatment has a bit of an image problem, sort of the Kanye West of medicine. But this “transpoosition” may be something that saves your life because even though it is not being done everywhere just yet, it works and it works very well.

And most fascinatingly, some scientists feel that a disturbed gut flora might well be responsible for conditions like Parkinson’s, ulcerative colitis and even obesity. Furthermore, fecal transplant treatment apparently has shown a dramatic improvement in patients with so-called autoimmune disorders like rheumatoid arthritis. Very exciting stuff but it’s 2 AM and I’m poop…er…exhausted. So, before your husband or the dog reads this article….head to the Porta Potti.

Game for Life by Dr. David Hepburn

Got lost once in Boys ‘R Pus toystore. Wandered about until I found myself in the board games section and it occurred to me how much the game names resembled my medical practice. CLUE as in you don’t seem to have one, therefore I am going to smack you with this candlestick holder until you quit inserting the birth control pill and take it by mouth. (Yup, this actually happened.)

RISK (aka “We Used to be Friends”) was a favorite of my sons and I back in the days when we were speaking. Health risk assessments are With the help of Framingham or apps calculating Your 10 year risk of a heart attack or stroke can now be calculated by your doctor along with your risk of being stranded in Kamchatka.

MONOPOLY. This game often begins with “Doctor I know you’re extremely busy and I promise I won’t be long but…” whereupon “the list” is pulled out while the wailing room continues to pile up, overflowing into the neighborhood pub where specialists practice. “Oh and since you’re here can you see George too, his prostate has a rattle and….”

Monolopy game- Dr. David Hepburn
Monolopy game- Dr. David Hepburn

CRANIUM. As in those who should go to the store and purchase this gift because they are obviously in need of one. “Give your cranium a shake Bloggings. What were you thinking when you saw the skull and crossbones on that cigarette package and decided it must be something you ingest deeply into your lungs.”

HUNGRY HIPPOS leads to hurtin’ hips, hefty hams and heart hell.

BACKGAMMON. “OK Bloggins, time for that prostate check.” De test men detest is fast

TRIVIAL PURSUIT. Doc I was reading on the internet about the symptoms of the rare Eastern Moldavian Portobello ovarian cysts and I think I might have them.” “Well, frankly Burt I’d be more concerned about your prostate. Lets play Backgammon.”

PICTIONARY. “Let me draw it for you Bloggins. The pizza goes into this here gastric area and then little boats like these transport cholesterol and other fats directly to your buttocks which now looks like this, ohh… I need a blackboard.”

DARTS. Not really a board game but seeing it reminded me of my mother suggesting a game of darts if I played goalie.

HEADBANDS. “My headache is like a band squeezing around my head,” means you have a muscle contraction headache from stress, neck strain or playing goalie at the family dart tournament.

BATTLESHIPS: “No doctor, I’m not taking that medicine and that’s that.” “But your blood pressure is 190 and you’ll stroke if you…” “My mother never took any medication and she was dancing the can can at 93 and..whoa… I can’t…move my arm.” “Whoops, I think you sunk your ship.”

OPERATION: whereby improperly extracting an organ makes the board buzz and the game goes dead. In my OR improperly extracting an organ makes the lawyers buzz and the game goes dead.

TWISTER: “It started out as an innocent game doc but now I have these, well… lesions.” Scrumpox (seen in rugby players) is one of several transmissible skin on skin diseases contracted when men rub their upper cheeks against the lower cheeks of other men.

Twister - Dr David Hepburn
Twister – Dr David Hepburn

DOMINOES: Pizza paunch leads to metabolic syndrome. Once one thing hits the tipping point the cascade begins and the rest fall soon after. Starts with abdominal fat, then sugars, then blood pressure, then cholesterol… then you.

BALLOON LAGOON: Plastic Surgery reminds you to take care of your sweaters.

SNAKES AND BLADDERS: Urology reminds you to take care of your wetters.

CHECKERS: This in fact is what we as doctors do all freakin’ day. “Doc I think my hornswaggles are affecting my crockinoles. Could you check ‘er out?”

CHINESE CHECKERS: Hen gao xing ren shi ni hornswaggles.

Sorry Sir but you’re going to have leave the store now. And could you please close up all those ….boxes.

Nit picking – Dr. David Hepburn

Whilst strolling about on the Kenya coast just south of Mombasa, my wife and I found ourselves having to constantly negotiate by, if not negotiate with, a large troop of baboons squatting just outside our lodge. Knowing that these boons could get nasty at any moment should we ridicule them or discuss the colour of their keysters, we decided to get to know these boons and, in fact, sort of adopted them, given their uncanny resemblance to my non-adopted sons.

Like all good boon parents we gave them proper Christian names: Debbie Boon, Daniel Boon, Pat Boon and even Barbara “Babs” Boon or just Snooki. Prior to passing the troop I had to jettison any bananas I kept in my pocket (do not extrapolate this) to hand feed the eager Vervets or Sykes monkeys we happened upon. Hand feeding a baboon would likely have meant just that, the banana simply an appetizer. But between demonstrating their fangly fangs and strutting about with their boon butts high in the air, they sat and most patiently and lovingly picked lice and nits off of each other.

Baboons- Dr. Dave Hepburn
Baboons- Dr. Dave Hepburn

This social grooming seemed so genteel that soon my wife was combing through my chest hair looking for something to chew, where, other than remnants of Coco Puffs and an occasional bratwurst, she found very few lice…. and so ordered out. But to many, having lice are a way of life, particularly if you are a louse.

And so, fellow primates, here are the facts of lice.

  • Manual nit picking is a necessary part of any lice treatment program. Pediculocides are not 100% effective so you MUST nit pick with a fine tooth comb or perhaps simply get married where you will be readily nit picked bald as a mole rat embryo.
  • A hatched nit needs a human blood meal within 45 minutes to survive. So should you hear a celebration in the nape of your neck, meaning all the lady lice are enjoying a baby shower, I suggest that you cut off the blood supply to your head, much like the cast of Jersey Shore does.
  • Many schools have a no nit policy meaning that if you have nits you don’t come to school. One of my sons would get little grains of rice and glue them to his hair and so missed Grade 6 entirely and, like the cast of Jersey Shore, most of Grades 7 thru 12 which is why he’s now running in the upcoming election.
  • The pubic or crab louse is a parasitic insect which spends its entire life on human genitals, sort of like the cast of Jersey Shore. They can also be found in hair, on the abdomen and under the armpits as well as on the beard and mustache. Men too can get lice. In children they are usually found in eye-lashes or eyebrows.
  • A pubic louse resembles a miniature crab when viewed through a strong magnifying glass. They look quite a bit different than head lice which look more like Wayne Newton.
Head Infested With Louse- Dr. Dave Hepburn
Head Infested With Louse- Dr. Dave Hepburn
  • A common misbelief is that infestation can be spread by sitting on a toilet seat. This isn’t likely, since lice cannot live long away from a warm human body. Also, lice do not have feet designed to walk or hold onto smooth surfaces such as toilet seats so if they get left on a toilet seat they often fall into the toilet, sort of like Aunt Florence in the middle of the night.
  • You don’t need a doctor to detect crabs. Genital crabs cause intense itching and are very visible to the naked eye so if you notice the nether regions appear to be humming with activity and you just spent a weekend within the vicinity of Charlie Sheen ….
  • Crabs and head lice are not transmissible to or from pets. Fleas and scabies are. So should your dog come to you and say “Hey pal, I got crabs from you” just ignore him unless of course you realize you have a talking dog. No doubt owning $uch a pet would certainly be a boon to your troop.

Acuna matata