If this is happening in England, it is most certainly happening in the U.S. And not only on cell phones, but on shopping carts too. The same shopping carts that little children rub their hands all over and try to put their mouths on. Grocery stores contain hygienic wipes to wipe down a cart when you walk into the store. Use them.
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Tuesday, October 18, 2011
1 of 6 Cell Phones Contaminated with Feces
Monday, October 17, 2011
New ADHD Guidelines and the Omission of Neuropsychology
The fact is that the diagnostic criteria for ADHD have already been in existence in the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (Text-Revision), referred to as DSM from this point forwards. This is the book, published by the American Psychiatric Association, which mental health and medical professionals refer to for making diagnostic decisions in this particular subject area.
While a primary care clinician can easily refer a patient for a sleep apnea study and order other tests to rule out a physical cause of ADHD-like symptoms, what primary care clinician is going to have the time to go over all 18 symptoms, interview teachers and other sources of information, evaluate for a learning disorder, and evaluate for psychological causes of the symptoms? None who I know of. For example, evaluating for a learning disability is going to require time intensive psychological testing and primary care clinicians simply do not administer IQ tests and test of academic achievement.
Saturday, October 15, 2011
Don't Worry, Be Happy
In yesterday’s blog entry, Dr. Allen ended it with the following question: So what are some take-aways on how to increase well-being and happiness? Here are some suggestions.
Friday, October 14, 2011
Guest Blog Entry. The Happiness Hype: What’s All the Buzz About and Is it Worth It?
Thursday, October 13, 2011
Attack of the killer bean sprouts
What many people do not realize, however, is that bean sprouts can be just as dangerous as raw meat. Yes, bean sprouts. Why? Because the sprout seeds can easily become contaminated in the fields where they are grown. Bean sprouts need to be grown in a warm and moist environment. Such environments are the ideal setting for bacteria to grow, including salmonella and E. coli. Some of the sprout seeds can also become contaminated by animal manure where they are grown.
To be safe, it is best to avoid bean sprouts at restaurants because you have no way of knowing how well they were cooked, unlike meat, which you can inspect. If you want to eat bean sprouts at home, health officials suggest immersing the sprouts in boiling water and cooking them thoroughly to kill harmful bacteria.
Tuesday, October 11, 2011
The Chinese Elephant Man
RECOMMENDED BOOK: The Elephant Man
He was mentally and physically tortured by his disease and was keenly aware of how his appearance affected others. He ultimately died when trying to sleep like a normal person but the weight of the tumors in his head, crushed his trachea and caused him to suffocate. An autopsy revealed a broken neck. Here is a picture of Mr. Merrick when he was alive.
I remember watching The Elephant Man movie as a teenager in my basement one evening and being profoundly affected by sadness that someone would ever have to go through such a terrible experience. It has always made me reflect on my life and deal with life stressors much easier by putting things in perspective. There is not much in life we can go through that would be worse than such an experience.
Below is a video of how he appeared before and after surgery, but it is obviously disturbing so be warned before viewing. The case is remarkable, sad, and inspiring all at the same time. If Mr. Chuncai can get through his days and find some positives (see the video) there is no reason that any of us cannot either, even when we hit rock bottom.
Monday, October 10, 2011
Exercise & Eat Fruits & Veggies All You Want: You're Still Going to Die
The reason why so many people need to listen to music on a jog, jog with a partner, watch TV on a treadmill, or read a book while on an exercise bike is because they are trying to distract themselves from an activity that is usually not that fun on it’s own. That being said, there are some people who enjoy running on it’s own due to their body being sensitive to the release of endorphins (pleasure producing chemicals) but this is an experience I have never had, despite doing my fair share of jogging and trying without success to get high from it (i.e., joggers high).
If you are reading this and absolutely love exercising every day and eating nothing but a vegetarian or vegan diet, then that’s great and this blog entry does not apply to you. But if you do not like it or do these activities under the false belief that they are going to cause you to live until you are 100, and/or automatically going prevent you from getting a serious disease such as cancer, then this blog entry does apply to you. The fact is, life is short and no matter how many carrots or apples you eat or laps you run, you are still going to die. What’s worse is that you could die from a cause that has nothing to do with diet or exercise (e.g., a car accident). Also, following a strict diet and exercise routine may do nothing at all to stop a spontaneous cancer from developing or from dying before your natural life expectancy.
Related Blog Entries:
1. When Fruits and Vegetables Kill
2. Michael Clarke Duncan Turns Vegetarian, Loses Weight, and Dies of a Heart Attack
3. How Fruits and Vegetables Killed Steve Jobs
Sunday, October 09, 2011
Ten Alternatives to Corporal Punishment
- Instill a good sense of moral values with your child from a very early age. Teach the Golden Rule (“Treat other people the way you would want to be treated”) as the basic principal underlying personal interactions. Remind children of this whenever they violate the Golden Rule and remind them that they would not like it if someone behaved to them in the way they just behaved to someone else.
- Model positive behaviors when you are upset. Try not to scream, curse, or physically act out in front of the child so you do not model the very behaviors that you do not want the child to do when upset. No one is perfect and you will occasionally slip up, but when you do, admit the mistake. It is frustrating and confusing for a child to see double standards in behavioral expectations and rules.
- If the child makes a mistake in behavior (e.g., does not say thank you) correct it immediately and explain what was wrong and why.
- Teach the child that there will be consequences for undesirable behaviors in the form of privilege withdrawal. Try to use a warning first unless the undesirable behavior is particularly problematic. Many children will tell you that this is actually the worst type of punishment because they do not want their toys taken away from them, do not like being grounded, do not want their phone or ipod taken away, etc.
- Follow through with threats of consequences. If you say you are going to take a privilege away but do not follow-through with this after an undesirable behavior, then the child is not going to believe you and will continue with the behaviors. Ideally, a warning will ultimately suffice to modify behaviors because the child will learn that you mean business when you issue a warning. Do not give in to temper tantrums as the child will only learn that this is an effective way to get out of the punishment.
- Only allow the child to get the privilege back by doing something positive and desirable rather than just giving it back the next day or later in the day.
- Talk with the child about why the privilege was taken away, what he/she did that was wrong, why it was wrong, and how to handle the situation differently next time. Tell the child what they need to do to get the privilege back, to apologize to anyone who was affected by the behavior, and most importantly, always tell them that you still love them and give them a hug at some point. It is important that you have a positive bond with the child to most effectively provide discipline.
- Reward the child for positive and desirable behaviors. This can be spontaneous at times but also consider implementing a system in which the child earns points for positive behaviors. Earn enough points and the child receives an award (e.g., 10 points earns a cookie). The points can be in the form of tangible objects (marbles, tokens stored in a jar) so the child can monitor progress better. Points can be taken away for undesirable behavior and regained with positive behaviors. For more information on this topic, do an internet search for “token economy.”
- Talk with your child from an early age about societal expectations and demands. Teach them from an early age why learning, reading, staying in school, and staying out of trouble are important. Teach them about staying away from drugs, alcohol, cigarettes, other children who get into trouble, and age-inappropriate violent media. Talk with them about the consequences of bad behaviors and/or a poor education in childhood and adulthood (e.g., suspensions, jail, homelessness, low income). The content of these conversations will obviously depend on the child’s age.
- Surround the child with positive role models. This can be real role models such as parents, siblings, other family members, and friends but can also apply to positive fictional role models on television (e.g., He-Man or Franklin as opposed to Jason and Freddy Krueger).
Saturday, October 08, 2011
Why Corporal Punishment Is Wrong
The context of this blog entry is that today, a man in Orlando Florida, was arrested for humiliating a child (that he was not even the parent or legal guardian of) on a video he posted online by shaving off the child’s hair, threatening him with a belt, beating him with a belt, and then making him do push-ups and sprints as a form of boot camp. This was all done because the child got in trouble in school and the man was concerned that the child would go to prison one day. Valid concerns. Invalid approach…which is why he was later arrested. While this man’s behavior may have been considered acceptable 20 years ago, today it is considered a form of child abuse.
- It causes fear in the child towards the parent. “Good,” you may say. “I want the child to fear me so he/she will listen.” But children do not need to suffer physical trauma to induce fear and respect for you. If you have established proper boundaries with the child and he/she knows that you are the boss, simply raising your voice slightly or looking at them wide eyed with a serious look could be enough to send the message that you are not happy and that the child needs to listen and take you seriously.
- It causes anger in the child…towards you. No one likes to be hit and because of that, the child will not like the source of the hitting.
- It will damage the attachment that the child has with you because of points one and two. Some withdrawal from the parent is likely. Think about your own life. Would it be easy for you to have a good relationship with someone who was hitting you and causing discomfort, pain, and/or injuries?
- It teaches the child that it is appropriate to respond to anger with physical violence. Think about it. You are upset at the child. You then model to the child that the way you are going to handle that is by hitting him/her. So, when the child goes to school and another child upsets them, he/she may respond by striking the other child in response.
Friday, October 07, 2011
Inspiration if Diagnosed with a Serious Illness
After the diagnosis, Gould wrote a brief essay that came to be a source of inspiration for many people in similar situations. He lived a productive life for twenty years after the diagnosis. Not bad for someone given eight months to lived. Below, I have reproduced Gould’s essay, entitled “The Median is Not the Message.” Please read it over, share it with friends, and most importantly, pass it on to anyone you know of who was diagnosed with a serious medical illness (particularly cancer).
Consider the standard example of stretching the truth with numbers - a case quite relevant to my story. Statistics recognizes different measures of an "average," or central tendency. The mean is our usual concept of an overall average - add up the items and divide them by the number of sharers (100 candy bars collected for five kids next Halloween will yield 20 for each in a just world).
The median, a different measure of central tendency, is the half-way point. If I line up five kids by height, the median child is shorter than two and taller than the other two (who might have trouble getting their mean share of the candy).
A politician in power might say with pride, "The mean income of our citizens is $15,000 per year." The leader of the opposition might retort, "But half our citizens make less than $10,000 per year." Both are right, but neither cites a statistic with impassive objectivity. The first invokes a mean, the second a median. (Means are higher than medians in such cases because one millionaire may outweigh hundreds of poor people in setting a mean; but he can balance only one mendicant in calculating a median).
The larger issue that creates a common distrust or contempt for statistics is more troubling. Many people make an unfortunate and invalid separation between heart and mind, or feeling and intellect. In some contemporary traditions, abetted by attitudes stereotypically centered on Southern California, feelings are exalted as more "real" and the only proper basis for action - if it feels good, do it - while intellect gets short shrift as a hang-up of outmoded elitism. Statistics, in this absurd dichotomy, often become the symbol of the enemy. As Hilaire Belloc wrote, "Statistics are the triumph of the quantitative method, and the quantitative method is the victory of sterility and death."
This is a personal story of statistics, properly interpreted, as profoundly nurturant and life-giving. It declares holy war on the downgrading of intellect by telling a small story about the utility of dry, academic knowledge about science. Heart and head are focal points of one body, one personality.
In July 1982, I learned that I was suffering from abdominal mesothelioma, a rare and serious cancer usually associated with exposure to asbestos. When I revived after surgery, I asked my first question of my doctor and chemotherapist: "What is the best technical literature about mesothelioma?" She replied, with a touch of diplomacy (the only departure she has ever made from direct frankness), that the medical literature contained nothing really worth reading.
Of course, trying to keep an intellectual away from literature works about as well as recommending chastity to Homo sapiens, the sexiest primate of all. As soon as I could walk, I made a beeline for Harvard's Countway medical library and punched mesothelioma into the computer's bibliographic search program. An hour later, surrounded by the latest literature on abdominal mesothelioma, I realized with a gulp why my doctor had offered that humane advice. The literature couldn't have been more brutally clear: mesothelioma is incurable, with a median mortality of only eight months after discovery. I sat stunned for about fifteen minutes, then smiled and said to myself: so that's why they didn't give me anything to read. Then my mind started to work again, thank goodness.
If a little learning could ever be a dangerous thing, I had encountered a classic example. Attitude clearly matters in fighting cancer. We don't know why (from my old-style materialistic perspective, I suspect that mental states feed back upon the immune system). But match people with the same cancer for age, class, health, socioeconomic status, and, in general, those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say, tend to live longer.
A few months later I asked Sir Peter Medawar, my personal scientific guru and a Nobelist in immunology, what the best prescription for success against cancer might be. "A sanguine personality," he replied. Fortunately (since one can't reconstruct oneself at short notice and for a definite purpose), I am, if anything, even-tempered and confident in just this manner.
Hence the dilemma for humane doctors: since attitude matters so critically,
should such a sombre conclusion be advertised, especially since few people have
sufficient understanding of statistics to evaluate what the statements really
mean? From years of experience with the small-scale evolution of Bahamian land
snails treated quantitatively, I have developed this technical knowledge - and
I am convinced that it played a major role in saving my life. Knowledge is
indeed power, in Bacon's proverb.
The problem may be briefly stated: What does "median mortality of eight
months" signify in our vernacular? I suspect that most people, without
training in statistics, would read such a statement as "I will probably be
dead in eight months" - the very conclusion that must be avoided, since it
isn't so, and since attitude matters so much.
I was not, of course, overjoyed, but I didn't read the statement in this
vernacular way either. My technical training enjoined a different perspective
on "eight months median mortality." The point is a subtle one, but profound
- for it embodies the distinctive way of thinking in my own field of
evolutionary biology and natural history.
We still carry the historical baggage of a Platonic heritage that seeks
sharp essences and definite boundaries. (Thus we hope to find an unambiguous
"beginning of life" or "definition of death," although
nature often comes to us as irreducible continua.) This Platonic heritage, with
its emphasis in clear distinctions and separated immutable entities, leads us
to view statistical measures of central tendency wrongly, indeed opposite to
the appropriate interpretation in our actual world of variation, shadings, and
continua.
In short, we view means and medians as the hard
"realities," and the variation that permits their calculation as a
set of transient and imperfect measurements of this hidden essence. If the
median is the reality and variation around the median just a device for its
calculation, the "I will probably be dead in eight months" may pass
as a reasonable interpretation.
But all evolutionary biologists know that variation itself is nature's only
irreducible essence. Variation is the hard reality, not a set of imperfect
measures for a central tendency. Means and medians are the abstractions.
Therefore, I looked at the mesothelioma statistics quite differently - and not
only because I am an optimist who tends to see the doughnut instead of the
hole, but primarily because I know that variation itself is the reality. I had
to place myself amidst the variation.
When I learned about the eight-month median, my first intellectual reaction
was: fine, half the people will live longer; now what are my chances of being
in that half. I read for a furious and nervous hour and concluded, with relief:
damned good. I possessed every one of the characteristics conferring a
probability of longer life: I was young; my disease had been recognized in a
relatively early stage; I would receive the nation's best medical treatment; I
had the world to live for; I knew how to read the data properly and not despair.
Another technical point then added even more solace. I immediately
recognized that the distribution of variation about the eight-month median
would almost surely be what statisticians call "right skewed." (In a
symmetrical distribution, the profile of variation to the left of the central
tendency is a mirror image of variation to the right. In skewed distributions,
variation to one side of the central tendency is more stretched out - left
skewed if extended to the left, right skewed if stretched out to the right.)
The distribution of variation had to be right skewed, I reasoned. After all,
the left of the distribution contains an irrevocable lower boundary of zero
(since mesothelioma can only be identified at death or before). Thus, there
isn't much room for the distribution's lower (or left) half - it must be
scrunched up between zero and eight months. But the upper (or right) half can
extend out for years and years, even if nobody ultimately survives. The
distribution must be right skewed, and I needed to know how long the extended
tail ran - for I had already concluded that my favorable profile made me a good
candidate for that part of the curve.
The distribution was indeed, strongly right skewed, with a long tail
(however small) that extended for several years above the eight month median. I
saw no reason why I shouldn't be in that small tail, and I breathed a very long
sigh of relief. My technical knowledge had helped. I had read the graph
correctly. I had asked the right question and found the answers. I had
obtained, in all probability, the most precious of all possible gifts in the
circumstances - substantial time. I didn't have to stop and immediately follow
Isaiah's injunction to Hezekiah - set thine house in order for thou shalt die,
and not live. I would have time to think, to plan, and to fight.
One final point about statistical distributions. They apply only to a
prescribed set of circumstances - in this case to survival with mesothelioma
under conventional modes of treatment. If circumstances change, the
distribution may alter. I was placed on an experimental protocol of treatment
and, if fortune holds, will be in the first cohort of a new distribution with
high median and a right tail extending to death by natural causes at advanced
old age.
It has become, in my view, a bit too trendy to regard the acceptance of
death as something tantamount to intrinsic dignity. Of course I agree with the
preacher of Ecclesiastes that there is a time to love and a time to die - and
when my skein runs out I hope to face the end calmly and in my own way. For
most situations, however, I prefer the more martial view that death is the
ultimate enemy - and I find nothing reproachable in those who rage mightily
against the dying of the light.
The swords of battle are numerous, and none more effective than humor. My
death was announced at a meeting of my colleagues in Scotland, and I almost experienced
the delicious pleasure of reading my obituary penned by one of my best friends
(the so-and-so got suspicious and checked; he too is a statistician, and didn't
expect to find me so far out on the right tail). Still, the incident provided
my first good laugh after the diagnosis. Just think, I almost got to repeat
Mark Twain's most famous line of all: the reports of my death are greatly
exaggerated.
Thursday, October 06, 2011
Pale Skin and Vitamin D
Shade is your best friend and many times it is just easier to stay in doors. The benefit about not exposing yourself to more sun is that you reduce exposure to harmful ultraviolet rays that can cause skin cancer. The flipside, however, is that by avoiding the sun, your body will not convert it into vitamin D. While vitamin D is found in some foods such as salmon, milk, and cheese, you may not get as much from your diet than you need. Many people would be surprised to know that there are very few foods in nature that contain vitamin D. So, it probably should not have come as a surprise that when I went for a routine blood test last year, that I had a low vitamin D level. The solution is easy: vitamin D should be available at your local grocery store or pharmacy as a supplement.
So, if you are one of my pale and pasty friends out there, get your vitamin D level checked and if it is low, talk with your doctor about how much of a supplement you need. You do not want to overdo it in the reverse direction and take too much vitamin D because that can be harmful as well. As the Greek philosopher, Plato, once said, do things in moderation.
Suggested reading: Vitamin D For Dummies
Related blog entry: Too Much Calcium Can Hurt Men's Hearts
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Wednesday, October 05, 2011
More EXTREME Body Parts: Part 2
3. LONGEST NOSE:
5. SMALLEST WAIST: This waist belongs to Cathie Jung, coming in at 15 inches. It almost looks unreal, which is what makes it all the more amazing.
6 & 7. LONGEST MALE AND FEMALE FINGERNAILS (EVER): These belong to Melvin Boothe (now deceased) which were 32 feet and 3.8 inches. To the right is Lee Redmond whose nails measured 28 feet and 4.5 inches. I’m guessing they don’t use computers.
8. TALLEST LIVING MAN: This is Sultan Kosey from Turkey. He is 8 feet, 3 inches tall. Here he is with…Al Roker! Guaranteed Al asked him how the weather was up there.
9. TALLEST LIVING WOMAN: This is Yao Defen from China. She is 7 feet, 7 inches tall. I’d like to see her take on Yao Ming in a game of one on one.
10. WIDEST TONGUE: This is Jay Sloot from Australia, who has a 3.1 inch tongue width. One wonders if Gene Simmons is jealous.
Want more? Click for even more and more extreme body parts.
Tuesday, October 04, 2011
When Patient Advocacy Becomes Patient Enabling
Where patient advocacy starts to become problematic and can lead into patient enabling, is when there is: a) a lack of objective biomarkers to indicate the presence of a pathological physical condition and/or b) the patient is pursuing some form of compensation (e.g., disability application, workers compensation claim, no-fault insurance claim, and/or litigation). By objective biomarkers, this means that there are no significant abnormalities on blood tests, x-rays, MRI scans, physical exam, or other objective measures. When a and b are both present, the risk of patient enabling increases significantly.
In sum, health care providers best help patients by using objective data to guide case conceptualization, treatment, and advocacy efforts. Sometimes, you need to be skeptical, sometimes you need to say no, sometimes you need to say something the patient may not want to hear, and sometimes you need to decide and communicate that there is nothing else you can do. This can all be done in a polite, caring, and respectful way. It does not mean that you have failed if all of your patients do not get better. Some will never get better and some do not want to. It’s just the reality of working in the modern day medical system.
Monday, October 03, 2011
Guest Blog Entry: Are You a Helicopter Parent?
Are helicopter parents becoming a thing of the past? I sure hope so. Last spring I received an email from a parent asking about their child’s grade on a test. The parent wanted to know what their child could do to improve their grade. Right now you may be thinking, “That is not so bad.” Well what if I told you that I teach at a major university? Yeah, now you are with me.
I have never heard of a child dying from disappointment and rarely hear my adult friends complain that they had to problem-solve for themselves as children. Being a resilient adult includes facing challenges, dealing with disappointment and “bucking up”.
Sunday, October 02, 2011
And the Top 5 MedFriendly Blog Entries in September Were...
1. Amazing Images of Extreme Bodies and Body Parts: This is the clear winner with 76 page views. People love the visuals. I’ll try to put up more images next month.
2. Guest Blog Entry: Chakras 101: This was the first guest blog entry since the MedFriendly Blog relaunched. It came in a close second with 57 views. Will a follow-up to this entry be in the works? Stay tuned.
3. White blood cells promote cancer: Cancer will always be an interesting topic for readers. But hearing that white blood cells many play a role in the disease? Definitely of interest. Comes in at 43 views.
4. Abandoning Alzheimer’s Disease: My Response to Pat Robertson. This was my response to Pat Robertson’s advice that a husband of an Alzheimer’s patient should divorce her after putting her in custodial care. It was featured on the popular medical blogging site, KevinMD. Comes in at 42 page views.
5. What to do if You Can’t Afford Medications: A helpful primer for patients on this topic. Comes in at 41 page views.
Saturday, October 01, 2011
Is Asbestos in Your Children's Crayons?
Friday, September 30, 2011
The 10 Year Anniversary of MedFriendly.com
I remember the beginnings of the website idea like it was yesterday. I was driving with a friend in Ft.Lauderdale, Florida, where I was attending graduate school. The person I was driving with told me that his girlfriend had a website that she made about psychology.
Tomorrow, to commemorate the 10 year anniversary of MedFriendly, I will unveil a major new detailed entry that has been months in the making on a topic that is medically, legally, and historically fascinating. Come back tomorrow to see what it is. Thanks to the readers and fans of MedFriendly for helping make it a popular healthcare website! Here’s to another 10 years!
Thursday, September 29, 2011
Waking Up with a Live Grenade in Your Face
The next thing you know, you wake up in an ambulance. There is something in the right side of your face. You figure it’s a rock. The doctor examines you. It’s a live grenade fragment that was supposed to explode when it hit you but it did not. You need it removed. But there’s a problem. If people try to remove it and it explodes, everyone within a 32 mile radius will be blown to smithereens.
Wednesday, September 28, 2011
My Take on Michael Jackson's Death, Propofol, and His Doctor
What people need to understand about propofol is that this is not a pill you get from your pharmacist or buy off the street. This is a very powerful medication you get in a surgery room to render you unconscious. It is a white, milky liquid that looks like Milk of Magnesia. It is so mind altering that it is referred to by doctors as Milk of Amnesia. In fact, Jackson reportedly referred to it as his “milk.” I’ve been given this medication many times when I was younger for various surgical procedures. I remember watching the doctor push the medication in and telling myself that I would see how long I could mentally resist its effect. Within 10 seconds, I was out cold…every time.
So, would anyone reading this then order forty more bottles of propofol for Michael Jackson? Well, that is what Dr. Murray is said to have done. He also used non-standard CPR by not doing this on a hard surface and not using both hands for compression. According to testimony today from a bodyguard who was present at the time of Jackson’s death, Dr. Murray asked if anyone knew CPR. How a cardiologist administering propofol does not know CPR has go to be one of the most ridiculous things I have ever heard.
Testimony today was also that Dr. Murray did not call 911 right away but called Jackson’s personal assistant instead, saying he had “a bad reaction.” That may be the understatement of the year. He also tried to get the assistant to remove the propofol from the room, according to testimony today. Thankfully, Dr. Murray’s license to practice medicine has already been suspended in California. However, Dr. Murray has more to worry about now than the judgment of a state licensing board.