HOUSE: Half the facts delay diagnosis

This week's episode of 'House' has a mysterious, anonymous patient being admitted with bronchospasm after surviving a late night robbery.

This new patient behaves oddly, mimicking the expressions and behaviors of others in the room. Next, the patient begins to parrot symptoms of other patients on the ward.

Right away the team suspects some type of factitious illness, meaning the patient is healthy but is claiming to be ill. Factitious illnesses come in many varieties:

• Hypochondriasis: patient suspects every physical finding signals an undiagnosed condition


• Hysteria: patient reports false symptoms but is unaware of the reason for the behavior


• Conversion disorder: faked neurologic deficit (limb weakness, blindness) masks genuine anxiety (can be used interchangeably with hysteria)


• Malingering: patient feigns illness and has a good reason to do so (evade work, arrest, etc.)


• Munchausen's: self-inflicted genuine illness with unresolved deep behavioral issues


• Munchausen syndrome by Proxy: make someone else genuinely ill, more behavioral issues

The doctors at Princeton-Hillsboro Hospital believed this squirrelly patient had a unique kind of conversion disorder they labeled Giovannini's Syndrome, wherein the troubled soul behaved like a chameleon and adapted to whatever he experienced. I couldn't find Giovannini's Syndrome under Index Medicus. I believe House also mentioned "Mirror Syndrome", but that same diagnosis was used last season in an episode involving maternal-fetal medicine. Other bloggers are sticking by Mirror Syndrome but, again, my treasured Index Medicus, only refers to it as a prenatal health concern.

Whatever it's called, the TV doctors violated one of the cardinal rules of medicine: Don't call the patient a crock [read phony baloney] until all possible organic (real) illnesses are excluded. Chase the real diseases first and then consider a psych consult. Wasting valuable time trying to untangle a factitious illness can lead to a fatal outcome. Most fakers (whether sound or crazy) will usually still be around tomorrow, but the genuinely septic patient with bizarre neurologic symptoms could expire quickly without aggressive antibiotic therapy.

Good news for this patient, he rapidly crashed and developed the usual House-worthy constellation of near-death crises that convinced House and posse to expand the search for a legitimate cause.

Did you check out that liver biopsy? They're not really performed that way unless the physician also practices voodoo. I'm not going anywhere near that hot tub upright spinal tap!

Here's the second cardinal rule about factitious illness: Eventually, even crocks die from real illnesses.

Lo and behold, a little reverse psychology tricked the patient into divulging critical missing portions of his past history. It appears that the gentleman sold farm implements and all of his problems were blamed on an infection caused by a blood parasite - a soil bacterium called Eperythrozoon.

It is incumbent on the treating physician to consider all reasonable causes for the patient's physical signs and symptoms. When the pieces don't add-up (as happens often on House) it is appropriate to consider a functional problem. Oftentimes nonconfrontational psychotherapeutic intervention will expose the underlying conflict that is the true cause for the patient's misery.

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DWTS: Will Youth Prevail? Not This Week

Where is Jane Seymour tonight? I was so surprised when she was called safe in the first round, and even more surprised when she wasn't onstage! Our local TV station is teasing up her absence in their commercials by telling us she was taken to the hospital by ambulance, so I decided to hunt around the Internet for the answer. TV Guide says she's sidelined with food poisoning, which is a very nasty thing to have when one is in the middle of a do-or-die dance competition. WebMD's food poisoning guide has some recovery advice for Jane: Stay hydrated, and get plenty of rest.

Speaking of do-or-die, it's a wonder I didn't fall over in a dead faint myself when Sabrina's name was called to go home. What's up with that? Wow, talk about the power of community. Sabrina is probably one of the most talented dancers on the show, but without the community behind her, she's out like a light with no power. Shameless plug (no pun intended) here: The WebMD community is a great place to be -- give it a try.

The other theme this week on DWTS is the question of whether youth has the edge on this show. Jane Seymour is awesome, dancing up a storm at 56 years young and I just have to say that 48-year old Marie Osmond really does a great job, despite having 8 kids. So is youth really an edge on the show? If you were to ask Sabrina, the answer would surely be "No!". Can Jane and Marie stay competitive with the younger and more athletic Mel B and Jennie Garth, or will next week be the round that sends one of them home? I do think the younger ones are able to do the athletic moves well, but true ballroom dancing is not about athletic moves. It's about elegance and grace and timing and showmanship.

Age doesn't mean they're not fit. In fact, midlife fitness is a growing trend. The idea that age means a sedentary lifestyle couldn't be farther from the truth. We¹ work out at the gym, we ride bikes, we swim, we walk, play softball, and do our best to stay fit and healthy. Marie Osmond, by her own admission, was not in top physical shape, but look what seven weeks of intense exercise and training has done for her! She's looking fantastic.

What do you think? Does youth trump on DWTS? Will Marie and Jane hang on for the finals?

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Technorati Tags: Dancing with the Stars, DWTS, Jane Seymour, Marie Osmond, food poisoning, aging, healthy aging, fitness, wellness, health

¹I count myself in the "midlife fitness" group because I am exactly one year older than Marie Osmond

Nip/Tuck: You'll Love LA!

Sean and Christian, relocating to the Los Angeles area have finally hit the big time. Yes, Miami has the stone crabs and long white sandy beaches. And, it's a hotbed of Latin cool where beautiful women strut their stuff on South Beach. Still, South Florida is not Southern California.

The world capital of beautification and cosmetic surgery is the greater Los Angeles area. With Hollywood hype and glamour well-entrenched, it follows that the beauty industry cannot be far. With Beverly Hills at the epicenter and surrounded by the affluent Santa Barbara and Orange Counties, this is where both Americans and foreign visitors look for the latest trends and the superspecialized doctors to deliver them. Over 14 million people are within several hours drive; there's a big taste here for looking good.

Staff Photo

So, former Miami boys, welcome to the center stage. The big top. You'll be pleased to know there are lots more patients interested in your services. And less joyous to realize there are loads more of your colleagues willing to provide it. Here, there are more patients -- and more competition.

Get ready to work hard in surgery and work hard at getting patients willing to have you be their surgeon. It's not like everyone has been sitting around waiting for you. Some of the brightest and most talented cosmetic surgeons are already here. Like you fellows, they migrated here from everywhere because this is where the action is.

Actually, this is healthy. More competition and more experience breeds excellence. That's why the patients know to come to Beverly Hills; the performance level is very high.

Here's a heads-up for you. Be prepared to deliver more breast implants; the female population here thinks no more of inserting those natural-looking charmers than they do spiffing up their act with a new designer outfit. They consider them "bolt-ons"; no big deal. You'll hear young women admonishing others to "Get some breasts". Just another discretionary purchase like purses and shoes. And keep in touch with your trainer because you'll need some big biceps and deltoids to man that liposuction cannula. Southern California woman hate fat as much as they despise cold weather. The SoCal outdoor life puts a big premium on looking swimsuit-great.

If you have the talent, better brush up on nose jobs. Wide noses, noses with bumps and noses that hang down don't make it out here. But, be careful. If you cannot deliver a natural nose that doesn't look done, you'll soon find those expensive nasal instruments rusting. Nose jobs have been done in large volumes here long before liposuction and breast augmentation were devised. Out here, women -- and men -- take their noses as seriously as they do their sushi.

Best of luck, welcome to cosmetic surgery prime time and let's see what you've got!

Robert Kotler, MD, FACS
Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

Editor's Note: Dr. Kotler shares his Beverly Hills secrets on his Cosmetic Surgery blog, too!

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Technorati Tags: Nip/Tuck, FX, cosmetic surgery, LA, TV, entertainment, skin, beauty

Grey's: Letting a Loved One Die

It has to be one of the hardest decisions ever. Doctors tell you that the person you know and love isn't there anymore even though they're lying in front of you breathing -- even if they're on a breathing machine.

In last night's Grey's Anatomy McDreamy had to tell a grieving father that the daughter he knew and loved was no longer there. She had suffered severe brain damage from a senseless accident when a brick was thrown through her car windshield. To make things even more heart wrenching, the father was waiting on a heart transplant.

The father was faced with two almost impossible decisions. First, should he agree to turn off his daughter's life support because his daughter had no chance of recovery or a meaningful life? And if that's not hard enough, he had to decide whether or not to take his daughter's heart to save his own life.

What a great story for Grey's writers to introduce. The truth is that many people die waiting on an organ transplant. Too few of us agree to be organ donors and that relegates many of our perfectly good organs to be buried with the rest of us.

It's a very personal decision, but one I hope you will all think about long and hard. Agreeing to be an organ donor doesn't mean that doctors won't fight as hard to save your life. It has absolutely no effect. It just means should your time come, you could save one or more lives.

It's no surprise that the father's initial gut reaction to taking his daughter's heart was "absolutely not". I'm sure he somehow felt he was taking advantage of his daughter's death for his own good.

But then George comes in and gives one of his best performances ever. He told the father that he would have given up his own heart to save his father's life. Wouldn't we all do whatever we could to save a loved one?

That is one of my favorite Grey's scenes ever. I was mesmerized by both the father and George. Great job guys!


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Technorati Tags: Grey's Anatomy, organ donation, heart transplant, end of life decisions, mental illness

Kid Nation: A New Take on Pork and Beans

"It's not even the place anymore; it's not even the conditions. It's the people that are getting on my nerves...it sucks!"

Rarely has a fourteen year old been so wise.

This week's episode ostensibly centered around garbage; not the vast wasteland of which this show is a decided contributor, but rather a real wasteland - the Bonanza City garbage dump. And it was disgusting. Filled with rats. "Squalor" is the word that comes to mind, and this garbage became the focal point for much of the first half of the show. How to get rid of it? Who would help? Where would they put it? These compelling questions were quickly answered when Zach, the ten year old who just last week unseated the infamous, universally despised brat Taylor, stepped up and organized the "pioneers" to haul the garbage a distance from town and bury it. Taylor and her sidekick Leila were assigned the job of helping, but they refused, citing that ancient and time honored excuse: "beauty queens do not carry garbage." Now there's a revelation!

When the council determined that Taylor should be punished for her refusal to help, she refused to be punished. Instead of carrying water from the well to the empty tank, she kicked over the bucket of water and retreated into her pageant queen defense.

This was really the issue last night: conflict resolution. Managing seemingly unmanageable situations and inhabitants of Bonanza City. And how the Council, for all its supposed authority, really is not equipped to deal with truly difficult situations.

DK, a reasonable and genuinely kind voice amidst the noise and chaos, tried throughout the episode to resolve the issues that continuously arose. But he was unsuccessful. Here again, Kid Nation purports to be offering kids a way to make a better world, but they never give these kids any tools to make a positive change. There was no conflict resolution, only conflict. As for the waterless tank, DK organized everyone to carry a bucket and go to the well, thus relieving Taylor of any responsibility. There were mutterings about pollution and recycling last evening, and even a stray reference to laundry that caught our ear - but they were nothing more than filler.

Pork and Beans, Bonanza Style.

Then came the challenge of the evening, the one after which the districts are assigned their societal roles, determined by winning or losing the task. And once again the kids were pitted against each other in a repulsive, mind-numbing task. Mike said it best:

"We were wading in 1600 gallons of baked beans and at the same time we were in there with thirty pigs in those beans. That is sick!"

Yes, don't adjust your sets. The object was to dive into an enormous vat of baked beans, avoid the nasty swine, and dig through the muck until you retrieved a tin can painted the color of your team. Now isn't that a great challenge? Isn't this the stuff of a better world? A society much greater than our own?

Oh, but it gets better. The reward for the group collectively retrieving 75 cans was, of course, a choice: massive amounts of fruits and vegetables, or two dune buggies and all the gas needed to power them. The kids had been complaining that all they eat are potatoes and biscuits, so the fruits and vegetables looked good. They are, let's remember, malnourished, unclean, unhealthy, and by and large unhappy. The lone adult, who shows up long enough to tease the kids with their weekly choice, put it to them this way: "Will you choose mother nature or fossil fuels?"

Yes, that's right - they chose mother nature. Hmmm...a reality show where kids prefer vegetables to dune buggies - definitely NOT a reality any of us recognize.

Here's the dilemma: at Safety4Kids we try to observe this show from the point of view of the health and safety of the kids. On that score alone, this show fails on many levels. We really are worried about their health, which appears to decline week after week. And when we hear the kids say that all they eat are carbohydrates, that the water is "black", that the area where they dump garbage is rat-infested, their lip sores appear to be permanent, and they are clearly sleep-deprived, we are concerned to say the least. And their emotional health - that's a huge concern for us.

Last night the clear leader of the group, DK, a very sweet fourteen year old boy who missed his family and was "frustrated" with the group dynamics, chose to leave Bonanza City on the cusp of winning the gold star. Guylan, his friend and one of the new Council members, convinced him to stay by telling him what he meant to the group. He stayed, won the star and in a few moments that finally seemed real on the show, DK cried and shared his feelings with his fellow pioneers and then his family, by phone.

But DK's frustration is our frustration: it's really not even the place anymore, although we loathe the conditions and are fearful for the health and well being of these kids; it is the people themselves that are now the problem. And these poor kids do not have the tools to deal with the conflicts, personalities and issues that arise in Bonanza City.

There has not really been one example yet of their success at building a better world; they are barely surviving the one they've got. And when that one adult shows up to present the challenge, he's condescending and annoying. The challenges are humiliating, usually revolting, and always degrading. What exactly are they supposed to be challenging, never mind learning? The group is not getting any better at dealing with each other or with the basic challenges of communal living and group dynamics. So far, Kid Nation is failing those kids. Let's not even discuss how they're failing the audience.

And please, please, can't they vote Taylor off the ranch?

(c) Natalia Kononenko. Image from BigStockPhoto.com

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Technorati Tags: Kid Nation, CBS, reality TV, Safety4Kids

Dancing with the Stars: Marie Osmond Update and Farewell to Mark Cuban

Wow, it looks like Marie Osmond has mild asthma, which could definitely have been a contributing factor to her fainting spell on Monday. From a behind-the scenes account at TV Guide, her partner Jonathan Roberts said:

She'd already gone through a rough week. And she has a little bit of asthma and all the fires in Malibu affected her. She told me earlier today that she was feeling a little light-headed. And I could tell about halfway through the dance because some steps went wrong and her breathing was getting really bad."

And also this, from the same report:

In fact, Osmond had been experiencing breathing difficulties throughout the day. "She said she had been inhaling some of this bad, smoky air [from the wildfires]," said Harris. "And then you have a hot room, hot lights, a sexy dance and bam."

I can give you first-hand confirmation of these facts. I've lived in California all of my life and cannot recall a time where the fires spread as fast and where the smoke was as thick as it's been this past week. Where I live, (north of Los Angeles and east of Malibu) the smoke rolled in Sunday so fast that it was frightening. While we weren't in any danger of being overtaken by fire, we were in clear danger of being overwhelmed by the smoke. Our schools remained open this week, but the students have been kept indoors in air-conditioned comfort away from the still-billowing smoke from two fires -- one of which remains out of control.

If you're in Southern California, read WebMD's article about the smoke danger. I found it to be very helpful. As I write this, the smoke is staying to the east but as the afternoon heat bears down, it tends to billow over the house at about 4:00 PM each day, so I'm taking their advice to stay inside and limit exercise to indoor activities. Let's hope Marie Osmond isn't working too hard and is able to come back next week for round six on DWTS.

I also want to give a big round of applause to Mark Cuban, who was eliminated this week after giving what I consider his sparkiest and most entertaining performance of the season. I've been rooting (and voting) for Mark all season long, and was really sorry to see him go, though I was afraid it was inevitable as the competition heated up. What is remarkable to me about Cuban being there at all is that he has undergone hip replacement surgery on his left hip.

Dancing, particularly competitive dancing, requires that dancers have their toes turned out at least slightly. Mark struggled with this from the first day of the show, writing:

The Samba is more like the Jive. It doesn't have the jumping, but the up and down and hip action means that i have a hard time going to my left. I cant turn my left foot out. Cant thrust my left hip out. I just dont have the muscles or flexibility in my left leg because of my hip replacement. So when you watch our Samba, you may get a little chuckle watching our entire routine go right.

Each week the judges would score him low no matter how hard he worked, or how skillfully his routines were crafted because he physically could not master that toes-out technique. It's a shame, but I can't blame the judges for scoring the dancers based upon established guidelines, either. Still, Mark Cuban is one of the most upbeat, personable guys I've ever seen on that show, and he really set an example for all of us who are baby boomers with a few extra pounds to shed. From his final DWTS post on his blog:

For 8 weeks I got to get up every morning knowing that no matter how sore I was, I had a goal that required me to challenge myself physically and mentally from 2 to 6 hours or more every single day. I did it. I loved doing it, and I lost 30 lbs doing it. Thats a win.

I agree wholeheartedly with him. While I wish I'd had a few more weeks to watch him, the time I did have was really inspiring. My better half had better watch out -- I'm thinking about signing us up for ballroom dancing lessons!

I just have one choice left before me now...who should get my votes for the rest of the season? Who's your favorite? I'm thinking Helio, but I'd also really like one of the women to win. Jane Seymour is definitely on my short list. Even my daughter thinks she's a beautiful dancer, which is high praise coming from a competitive dancer who thinks anyone over 20 is "old".

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Technorati Tags: DWTS, Dancing with the Stars, Mark Cuban, Marie Osmond, asthma, hip replacement, ballroom dance, dancing

HOUSE: This Diagnosis Was Hard to Swallow

A young Ukrainian female experiences hallucinations, delusions, and seizures and is placed under Dr. House's care.

This week's wild goose chase included workplace toxicity, Creutzfeld-Jakob agent (the same prion felt responsible for mad cow disease), porphyria, Parkinson's Disease, and vasculitis.

[Hey! When did the medical terminology Jakob-Creutzfeld get reversed anyway? That's akin to introducing the classic comic team Hardy & Laurel. Was money involved?]

Eventually one of the competing fellowship applicants burps up the correct diagnosis: Ergot poisoning.

Now before I discuss ergot poisoning I have to take issue with House's writers (for a third consecutive episode) for misrepresenting the neurophysiology of vision. Early in the episode retinal vasculitis was considered - inflammation of the retinal vessels. The team's hypothesis was that the starving retina was transmitting visual hallucinations to the brain.

In order to test the retina's ability to communicate with the brain they performed some kind of Hollywood-improvised visual psychometric device that attempted to imitate a cross between VEP (visual evoked potentials) and an ERG (electroretinogram). Nice try, but the patient was not dark adapted, the exam room was illuminated and I saw no flashes of light. Three strikes and you're out! Color testing, pupillary light reflexes and a peek with an ophthalmoscope would have given them all the information they needed! I'm really starting to develop a complex about the recurring ophthalmic misrepresentation in this show.

Don't confuse Ergotism (patient's poisoning) with Egotism (House's poisoning).

Ergot refers to a psychoactive chemical that is naturally occurring in select fungal species. There are prescription medications that contain ergot derivatives. Battlefield chemical weapons rely on ergot poisoning to immobilize enemy forces. Ergot pops up in all kinds of plants, grains and mushrooms. Apparently this culturally attentive Eastern European consumed lots of dark moldy bread just like they did back home on the farm. Ergot poisoning causes a slow heart rate, vasoconstriction, tissue ischemia, hallucinations, tremors, seizures and tiny pupils (What did I tell you?!? Another inadequate eye exam on House!)

Fluids and supportive care works for mild cases. Atropine can be administered as an antidote. US troops carry injectable atropine with them if there is a risk of ergot exposure.

The woman was treated, she quickly recovered, and at discharge the hospital nutritionist switched her to Wonder Bread.

Nah, I made up that last part.

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Technorati Tags: House, tv, ergot poisining

America's Next Top Model: Fear of Heights

Trey Ratcliff

How would you like it if you had a horrible phobia of heights and someone told you that you just needed to get over it?

That's basically what happened on America's Next Top Model last week.

The photo shoot was held on the top of a building. A platform was built up for the models to stand on while they set out to "become" living gargoyles. The makeup was amazing, and I thought the idea was wonderfully creative.

The problem was that Ambreal, a 19-year-old student from Texas, has a debilitating fear of heights.

When the models were led to the roof to take a first look at the site of the shoot, poor Ambreal had to practically be dragged up the stairs. She was shaking and crying.

To her credit, when it came time to shoot, she trooped back up to the roof and climbed onto the platform. But, it was obvious that her fear was making her turn to cardboard in front of the camera. Being afraid of heights myself, I was impressed that she was able to do as well as she did. She's a brave girl!

However, when the time came to face the judges at the end, Ambreal was told that if she wanted to make it in the modeling world she was going to have to get over these types of fears. Maybe that's true. Maybe to be a model you have to learn to work through your fears, but it's not that easy. (About as easy as quitting smoking cold turkey!)

Perhaps Ambreal's fear of heights can be overcome, but she'll probably need a little help with that.

Recently, Patricia Farrell, PhD, WebMD's resident psychologist, wrote a series of posts on her blog about phobias. She included Acrophobia, which is the hoity-toity Latin term for "fear of heights".

Check it out, along with her other phobia posts on her Anxiety and Stress Management blog.

Do you have any phobias? Would you be able to just "get over" them? Tell us about it!

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Technorati Tags: Americas Next Top Model, acrophobia, fear of heights, phobia, fear

Dancing with the Stars: What happened to Marie Osmond?

Oh, now I have to confess my secret: I'm a die-hard Dancing with the Stars fan and have been since the very first season it was on. My daughter and I do not miss an episode, standing at the ready to cast our votes on our cell phones like texting fools.

But last night's DWTS began with a scary shock when Marie Osmond finished a nice, if slow samba and while listening to the judge's comments, passed out cold on the floor with a very hard thump! The excruciatingly long commercial break that followed was agonizing, because we knew that DWTS is recorded live and the commercial length was necessary to get her some treatment and off the stage.

It was a real relief to hear that she was awake and even had a sense of humor, but her explanation seemed weird to me. She said, "You don't plan those things. Once in a while that happens to me when I get winded, and I stop breathing! I'm so sorry."

Here's the thing: If you watch the video (down below), she's breathing hard. She hasn't forgotten to breathe, she's winded and practically gasping for air. So what's the deal?

According to Dr. Michael Smith, "passing out can occur from either holding your breath or from hyperventilating, but neither one is very common." He goes on to say:

Passing out from breath-holding spells is more commonly seen in children. It could certainly occur if an adult holds their breath, particularly during such intense activity as dancing. A condition known as hyperventilation syndrome, which usually leads to someone feeling very lightheaded but not necessarily passing out, is usually seen in someone suffering from anxiety. I would be concerned that something else caused Ms. Osmond to pass out. However, since she has apparently had several similar spells in the past and I would assume has already had it evaluated by a doctor, it may be something to which she's just particularly susceptible.

Unfortunately, Marie was the first to dance this week, and her fainting spell clearly rattled the other competitors, even after she was examined and they were reassured that she would be fine. The judges' scores weren't her best either, so overall it was a difficult night for Marie Osmond. I wish her all good luck tonight with the results show and hope she's feeling better today!

And now that I've confessed my obsession, it's your turn. Who is your favorite couple? Who do you think will win? Post a comment and spill the beans!



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Technorati Tags: Dancing with the Stars, DWTS, Marie Osmond, fainting, ABC, health, wellness

What's Your Grey's IQ?

How well were you paying attention during last night's Grey's Anatomy? I figured I'd have some fun and quiz you guys. My brain is in test mode since my big exam to recertify as an internal medicine physician is 3 weeks from today.

So grab your pencil and let's get started.

Question #1: How common is ovarian cancer in young women?

In last night's episode, the Chief's niece was diagnosed with ovarian cancer at 14 years old. She apparently had "beaten" it twice before but it had come back with a vengeance. And turns out she was tired of fighting and "ready to go home."

Thankfully, ovarian cancer is not at all common in young women, but it can happen. Most women are 55 or older. However, some of the more rare types of ovarian cancer can affect young women.

What's the biggest challenge with ovarian cancer? Finding it early when it can be more easily treated and potentially cured. Ovarian cancer often has no symptoms until it has spread and there are no good tests to reliably detect ovarian cancer.

So is there anything you can do to prevent ovarian cancer? Like for most cancers and many other diseases, your best fight against getting ovarian cancer is making healthy choices. That's no sure bet but it just might help -- and certainly won't hurt.

Here are some things that have been associated with a lower ovarian cancer risk:

• Oral contraceptives
• Getting your tubes tied, known as tubal ligation
• Pregnancy and breastfeeding
• Diet high in vegetables

Question #2: What condition caused the 28-year old woman to crush her ankle?

While you're probably tempted to answer "her boyfriend," the actual answer is osteoporosis. While hers is certainly an extreme case of obvious malnutrition, there is a good message in there for all of us. Get plenty of calcium!

Many women don't get enough calcium because eating dairy, such as milk, cheese, and yogurt, is unfortunately not a staple in many Americans' diets. Not a big dairy fan?

Other foods that pack a healthy calcium punch are:

• Broccoli, kale, and spinach
• Oranges
• Tofu, peanuts, peas, black beans

Many women need calcium supplements to get their full day's worth of calcium.

Question #3: What medication caused her bleeding ulcer?

Well, the same thing that caused mine. I was taking it for ankylosing spondylitis, a form of arthritis that starts in young adulthood. Thankfully mine didn't lead to vomiting blood.

The point is that ibuprofen and other anti-inflammatory drugs may be available over-the-counter, but they can still cause serious problems. Taking the occasional ibuprofen is fine and unlikely to cause problems in most people.

But when you take it daily, especially at high doses, the chance of developing a stomach or intestinal ulcer goes up dramatically. Just be careful.

If you need daily pain medication, or even pop these pills a few days a week, let your doctor know. You may need something to protect your stomach or possibly a different pain medication.

Question #4: Are residents really that mean?

Last night Grey's residents were in rare form. Well, I don't know if it's rare exactly but certainly mean. Residents work long hours and getting cranky comes with the territory.

And let's just say surgical residents aren't necessarily known for being particularly warm and fuzzy -- at least mine weren't. But the "shut up" and "back off" comments last night were a bit much. And the lack of teaching and abuse due to jealousy?! Definitely inappropriate. What is this? Days of Our Lives?

I'd much rather be taking my recertification exam than going through residency again. Paid my dues!

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Technorati Tags: Grey's Anatomy, IQ, ovarian cancer, osteoporosis, ulcers, health and wellness

CSI: Carpe Diem - A New Kind of Fish Story

Frozen feminized fish, a stash of money under the victim's bed, small vials of unidentified liquid, mysterious text messages, and man boobs add up to a great Thursday night on CSI.

***Spoiler Alert -- Stop here if you don't want to know more ***

JE Field

When they finally put all the pieces of this puzzle together (after taking us through some pretty stretchy, twisty passages, I might add), I wondered whether it was really plausible for drinking water to be so tainted with chemical waste from pharmaceutical dumping that it would cause a teenage boy to have gynecomastia, and for that matter, possibly contribute to his mother's breast cancer, or its recurrence.

Dr. Joe Pizzorno, our Integrative Medicine and Wellness expert, says "there are many unregulated toxins in tap water that can certainly cause us harm." In 2005, the Environmental Working Group found 260 toxins present in tap water, and of those, over half are not currently regulated by the EPA. (On the up side, though, they also found over 90% compliance levels with those that ARE regulated). Most of these unregulated toxins are the byproducts of industrial chemical, unregulated pharmaceutical, and personal care products dumped into streams and rivers.

In my California corner of the world, I battle hard water deposits on a daily basis. I think this is the only area I've ever lived where the tap water looks crunchy when it's half-dry on the side of the sink. After reading the EWP report, there was no way I was going to go into the kitchen and pour myself a big glass of anything that came from a faucet. Feeling slimed, I asked Dr. Pizzorno what I should do to avoid those toxins. He suggests the following:

Choose your drinking water carefully, and treat it as an all-important aspect of your diet when it comes to quality. Even if you live in a region where watersheds are fairly clean, you are likely to need some type of home water-filtering system, unless you'd prefer to buy high-quality bottled water. We like solid-block carbon filters (especially the kind that can be installed under the sink). Reverse osmosis filters are also an excellent way to achieve high-quality drinking water.

Carbon filters, here I come. No question about it.

The other exclamation point to the show tonight was their conclusion with regard the cause of death for Brian, the teenage victim. After hypothesizing that he was preparing for sex change surgery (he wasn't), checking to see if he carried an extra X Chromosome (Klinefelter syndrome), they were out of ideas. Ultimately, they concluded that Brian committed suicide after being ridiculed and rejected by co-workers and the women they were with because of his large breasts.

Is it common for men with gynecomastia to struggle with depression or other psychological effects (not to mention the possibility of hormonal reasons for depression)? This time I asked Louanne Cole Weston, PhD, our sex expert, about her experience with men who have enlarged breasts. Here's what she says:

I have treated several men in my practice who have had gynecomastia and had one friend who also had it. From my small sample alone, I can say that this can occur regardless of sexual orientation. No matter what zone of the world a male inhabits, gynecomastia can be a challenge to live with.

Young boys tend to resort to loose fitting clothes and the avoidance of public swimming. For some, it is so upsetting that they try to distract themselves with unhealthy habits like overeating (which can inadvertently add breast tissue) and self-numbing with substances as teens and later. The seeming feminization of the male body can lead to confusion about gender identity and/or orientation -- among other types of psychological discomfort.

Dr. Weston was also emphatic about the emotional damage ridicule can do to teenage boys in Brian's situation. She says "It's entirely possible that a teenage male could consider and carry out suicide because of gynecomastia. They do it over romantic relationships that go awry. Young people can be so terribly cruel when it comes to body image issues. Suicide could seem like an answer to constant ridicule."

I also discovered that breast reduction surgery for males is on the rise, partly because gynecomastia is a common occurrence, particularly in puberty. Although waiting and maintaining a healthy weight seem to be the best option, surgery can be an option for those cases which don't respond to traditional treatments.

The CSI writers get a thumbs-up from me for dealing with some important issues in this episode, and based on the ending, I think there's a possibility we will see some future storylines relating to the fight to hold the polluters accountable.

Finally, a hurrah for Grissom's offhand marriage proposal to Sarah and her equally offhand acceptance, though I'm a bit concerned that the sting of a bee at the moment of Grissom's proposal is an omen of something unpleasant to come. Workplace romances are tricky things. Will it really last? How does this fit with the news that Jorja Fox is leaving the show in November? What do you think?

Related Topics:

• WebMD Video: Male Breast Reduction Surgery
• Depression: His and Hers

Technorati Tags: CSI, body image, depression, gynecomastia, toxic waste, pollution, environment

Kid Nation: A World Without Adults is a World Without Hygiene

As the layers are peeled away each week on Kid Nation, what is revealed is not at all what was promised. And the kids are surely not to blame. The question we find ourselves asking after last evening's episode is:

"How are these kids supposed to create a better world if they are given none of the important tools?"

The centerpiece of last night's show was town council elections. And yes, bossy, obnoxious Taylor was finally ousted (one of her best friends defected to tip the scales) and Zach, a smart boy with a more democratic approach took her place. Seems like that would be good news for Bonanza City. But who knows? Last week: religion. This week: politics. Next week, according to the coming attractions: Rats. Lovely. Which brings us to the most disturbing discovery of last night's viewing: hygiene. Or the lack thereof.

At Safety4Kids, we're vigilant about the aspects of the show that impact a child's health and safety. So the horror came not at the campaigning, poster-tearing, food-fighting, lazy and disrespectful banter; it came when the "reward" for completing a pinata-swatting challenge was a choice between an abundant barbecue or a toothbrush!!! We were stunned. It's not that we thought that off camera these kids went to a day spa. It's just that we thought they at least had the very basic elements of hygiene. And while previous inhabitants of Bonanza City, however fictional, likely did not have "Crest", surely these kids would at least be able to brush their teeth. We admit that after that moment, our viewing was influenced by imagining all those kids, for forty days, without toothpaste, a toothbrush, floss or mouthwash (all part of the reward), and drinking lots of root beer in the saloon. Yuck.

Once again, we find ourselves wondering about the contrived set of circumstances that contribute to this show's odd and disturbing premise. Imagine, if you will, the production meeting:

"Shall we give these kids beds?"
"Nah, let them sleep on the floor."
"How about dental hygiene--all in favor, say aye."
"Ok, let the record show, that's a 'no' vote on hygiene."
"Showers?"
"We'll see, but not at the beginning. Maybe we could have a hose and a bar of soap as a reward later on in the season."
"Great idea!"
"Anyone here feel strongly about protein?"
"Only if they have to catch it first!"
(laughter)
"Remember people, these kids have forty days to make a better world than the one they've got."
"Hey, did anyone check on those child labor laws?"
"What?"
"Huh?"
"We've got those signed consent forms, right?"
"Somebody call legal."

For the record, the council chose the toothbrushes. And at least one of the original council members, Laurel, ran unopposed because her team loves her. And Greg, the older kid with the attitude, who works very hard (he killed the chickens, remember?) and is now a kind of "big brother" to the little ones, finally won the gold star. In one heartfelt, real moment on the show, Greg addressed the group: "You guys have no clue what this is going to do for my life." He's using the money for college.

But here is our dilemma, week after week. If the idea of Kid Nation is to watch an eclectic mix of kids try to build a better society, why is deprivation the central approach?

CBS is not fooling anyone: this is "Survivor: Bonanza City" and it's kids that are being used as the pawns in this ratings game. And we have to ask, again: at what cost?

(c) Brian Kelly. Image from BigStockPhoto.com

Related Topics:

• WebMD Video: New Cavity Fighter
• WebMD Video: Dental Problems in Kids

Technorati Tags: Kid Nation, CBS, reality TV, Safety4Kids

ER: Bulimia and the Teen Boy

I watch ER every week, almost religiously. It was once my favorite show, and still is one of my top picks. When I'm watching I also try to find interesting health stories that will fit for this blog.

On last week's episode "Officer Down", the issue that piqued my interest was Pratt's teen wrestler. The high school wrestling star came into the ER with what his mom thought was a stomach virus. While Pratt is examining him, he says his chest feels funny and then he goes into V-Tach (that's Ventricular Tachycardia for those of you who are interested in what these medical terms they toss around on TV mean). Pratt is able to bring him back around.

After a series of tests, he is diagnosed with an inflamed pancreas. Pratt is having a hard time understanding why a boy so young could have developed pancreatitis. He suspects the boy may be drinking heavily, which could cause the inflammation to the pancreas, but the wrestler swears he doesn't drink.

An ultrasound shows that the young wrestler has a very large cyst which will need to be removed through surgery. However, it turns out they can drain it with another less-invasive procedure.

After draining the cyst, Pratt notices there are lesions or scrapes on the boy's knuckles. (I'm guessing from scraping his teeth as he forced himself to vomit?) He correctly deduces that his young athlete is bulimic and argues with the kid about getting counseling. The boy assures him it isn't a problem and that he HAS to do it to maintain his weight and get a college scholarship.

The whole scenario was disturbing to me, because both my daughters participate in high school sports. Luckily, I know the coach well, and he would NEVER push the kids to lose weight so that they resorted to doing so in an unhealthy manner.

You also don't hear too much about teen boys and bulimia. It's usually stories about girls.

I wondered how common this is for boys, so I asked our WebMD psychologist, Dr. Patricia Farrell, to weigh in.

"For probably the past 20 years, we've been noticing, or rather bringing to the attention of the public, the incidence of eating disorders in male athletes, especially wrestlers and swimmers," Pat says. "Some of these athletes have been pushed to excessive dieting or purging so that they can remain in a lower weight class where their experience and skills will give them an edge over other boys in that weight class. Swimmers and scullers, too, are urged to restrict their weight and this leads to eating disorders, physical problems and later problems in life, such as poor body image, insecurity and depression. So coaches have a great responsibility to insure healthy attitudes about weight and eating in their athletes while they instill the proper attitude about athletic contests and preparation for them."

I think we all would like to think that this couldn't happen to our kids, but they sure are under a lot of pressure to perform these days. And, from reports I've read lately, it's getting harder and harder to get into college.

If you have a teen athlete, boy or girl, keep an eye out for any warning signs. I know I'll be paying a bit more attention, thanks to ER.

Do you know any teens who suffer from bulimia? How did you find out? Tell us about it.

Related Links:

• Understanding Eating Disorders in Teens
• Family Therapy Helps Teens with Bulimia

Technorati Tags: ER, bulimia, eating disorders

America's Next Top Model: Bianca's Hair Anxiety

As a woman, I have always been somewhat obsessed with my hair. When I was a teenager, I would NOT step one toe out of my house if every hair on my head wasn't in it's perfect place. My oldest daughter is the same way.

So, my heart ached for 18-year-old Bianca on last week's America's Next Top Model, who had to have her hair cropped down to less than a quarter of an inch off her scalp. If you watch the show, you know that Bianca is the willowly African American girl who came to the show with her hair dyed pink. Host Tyra Banks has expressed her dislike of the pink hair from the beginning.

Last week was the hair makeover episode, and Tyra seemed thrilled that Bianca would finally get a new look.

But, when it was time to dye the teen's hair another, more flattering color, the stylist found that her hair was damaged beyond repair. He told Tyra that if he colored Bianca's hair it would likely fall out. The only recourse was to start from scratch.

Poor Bianca sat in her chair with tears flowing down her cheeks as she was cut and buzzed. She cried yet again when confronted with her shorn head in the mirror. And, when it was time to go back to the house, she climbed into bed, dejected and mourning the loss of her hair.

"I look like a boy," she said.

It was obvious as the show went on that she was very self-conscious and still upset by her lack of hair.

Now, you might think that she's just being silly and should just get over it. But, here's what our WebMD psychologist, Dr. Patricia Farrell has to say:

"Girls and women have always been told that their 'crowning glory' is one of their most important assets, so when there's a bad hair day, it's a problem. But when someone ruins your hair, it's a disaster, " Dr. Farrell says. "Hair provides a sense of self and defines someone's personality, in some ways, sending a signal to others about self-esteem. Armed forces and certain groups shave the heads of members to remove aspects of individuality. Unfortunately, hair is such a part of our culture with its beliefs about how hair should 'look' on males and females, that it remains a defining issue especially in young girls' lives."

And Dr. Farrell has some advice for Bianca and others:

"Every negative thing does have a positive aspect, if you look for it. For instance, suppose, as in the TV program, your hair is ruined and must be cut off. What's one way to approach this in a positive manner? It is really an opportunity to explore aspects of yourself that you may not have considered before. How do people relate to this new you? How can you see yourself in a new light where you, rather than your appearance, is what interests people?"

Since this show was taped long ago, let's hope that Bianca has already discovered these things for herself. It will be interesting to see how she's liking her new look in this week's show.

Oh, and by the way, I haven't noticed ANY references to a quit plan for the young smokers in the past two shows. Have you? Let me know if I've missed something.


Related Topics:

• Hair Care Tips
• Winterizing Your Hair Care

Technorati Tags: America's Next Top Model, The CW, reality TV, Bianca, hair problems, Tyra Banks

Grey's: Monkey See, Monkey Do

Well, doctors aren't exactly monkeys - at least most of us - but when we're in training we do function that way to some degree.

The actual mantra we follow in learning new procedures and techniques is "See one, do one, teach one." That's exactly what happened in last night's Grey's Anatomy when the intern did an intubation (putting a breathing tube in a patient). We watch another doctor do it, we do it ourselves, and then we're ready to teach it. A bit simplified, but that's basically how it works.

When the intern, Meredith's sister, went to intubate the man that was rushed into the ER, she was obviously extremely nervous. I can definitely relate. I remember the first time I had to stick a large needle in a patient's back to do a lumbar puncture (spinal tap). All kinds of things run through your mind. What if I hit the spinal cord and paralyze him?

Why do you think they always say don't go to the hospital on July 1? That's when all the new interns are eager to start sticking. It's really not as scary as it sounds.

Even though it sounds pretty primitive, it's done under direct supervision. It's not like we're all going crazy sticking needles in anyone we can find. It's the way training has been done for years and has obviously worked pretty well so far.

It was a good idea to let the intern "practice" on a man that was basically dead. Of course, that freaked Meredith's sister out a bit but that was probably based more on her emotions around her mother's death and whether Meredith did everything she could to save her.

But when McSteamy and the Chief decided they were going to try out some new tongue cancer surgical procedure to help save a woman's tongue, that was a bit much. Very commendable that they wanted to save the very chatty woman's tongue, but get someone that knows what they're doing for God's sake!

Not only was there no one there that had done the procedure before, they had not even seen one done. McDreamy was right to go off on them!

Overall, I was pleasantly surprised to see that there was much more to last night's plot than who's sleeping with whom. They certainly didn't abandon those story lines completely, but at least it wasn't about doctors sleeping with anybody and everybody but "Really Old Guy."

Related Topics:

• WebMD Video: Student Doctor Training
• WebMD Video: Human Side of Being a Doctor

Technorati Tags: Greys Anatomy, TV, McDreamy, McSteamy, medical training

Kid Nation: The Religion Edition

The Real Blessing Would Be A Mid-Season Cancellation!

At Safety4Kids, we're vigilant about issues of safety and wellness that impact young children. So when we began to look carefully at "Kid Nation" we were, in a word, shocked. As the weeks go on, and we get used to the rhythm and routine of life in Bonanza City, we are perhaps a little less shocked; but we're still not happy. In fact, we're pretty concerned. The last people deserving of that coveted gold star are the producers at CBS.

Last night's episode dealt with religious differences, in what is clearly becoming a contrived string of weekly issues, "suggested" by the "journal" left for this generation by previous inhabitants of Bonanza City. So you see, there is a lot you have to be willing to believe to even watch this show! The opening scene had two of the children, currently in the "laborers" district, trudging through the cold carrying pails of water, and ruminating on the meaning of life. One of them asked, "Did God put us here for a reason?" Seems insensitive to remind them that actually it was their parents who signed the waiver, and most likely for the instant, albeit fleeting fame, and the hope of those expensive gold stars. Clearly, these kids are given a topic, and then the story is built around their reactions to it, their struggles with it, and their ultimate triumph or failure, which the producers must think makes for great TV. They are wrong on so many counts.

But even we have to admit to...dare we say...a redeeming moment or two in last night's show.

As the kids dealt with their religious differences, spouting familiar yet cringe-inducing chants such as, "Christians Rule!" and "Jew Crew!", they were also trying to resolve these differences and come together to find something spiritual to nourish them. (We're not even going to talk about the apparent lack of any substantive nutritional nourishment--they almost all look unhealthy, under-fed, and what's with those sores on their lips?!) The big debate early in the show was whether to hold a prayer service with everyone in attendance, no matter their religion, or remain separate and steadfast in their beliefs. The prevailing sentiment was that "religion starts wars and everything bad," so there was a good deal of resistance to group prayer.

When the "council" (the four designated [by whom?] leaders) rang a loud bell, insisting that everyone come to a prayer meeting, no one showed up, and these four ultimately walked away in dismay and confusion.

It took Morgan, a much-admired 12 year old, to bring everyone together. Rather than "demand" attendance at an organized service, she went bunk to bunk to "invite" people to join her and a few friends around a campfire, where everyone could express their feelings and say their own prayer and share something about their hopes and desires. And they all came. And they all shared. Zach chanted in Hebrew, others offered prayers for good weather and good food, and most of them seemed genuinely moved by the experience. Morgan went on to win the gold star, for her ability to "make everyone feel loved." She actually deserved it.

But here's where it all seemed to get surreal. After the weekly challenge, this time assembling a large jigsaw puzzle forming what looked like a church facade, the group had a choice of reward: an 18 hole miniature golf course, erected in the center of town, for use anytime, or, door number two: a stack of religious texts. You guessed it, they chose the books!

We're all for spirituality and the nourishment of the soul. But come on! Are we to believe that kids in a dusty town with nothing to do but bat a piece of tin foil with a stick would choose to read the Torah or the Quran to playing miniature golf?! We're not buying it.

What happens when we watch this show is this creeping sense of distrust we feel; the obvious manipulation of the story for dramatic impact. And therefore, we have to wonder again about the ultimate, long-term effects on these children and their emotional well being.

Some good news in Bonanza City is that the children seem really to be coming together more as a cohesive group. The council is inviting a more democratic process--there are more votes than mandates these days. Next week, the group deals with politics, which suggests they are finally getting fed-up with the 10 year old bossy Taylor and her laziness and screeching admonishments.

A truly strange series of moments came at the end of the show. Cody, a 9 year old, chose to leave Bonanza City. He was too homesick; he missed his girlfriend (?!) Ashley, whose letter and photo he kept clutching longingly. His best pal Campbell took him to the town saloon to throw back a few root beer shots. But nothing helped. So he said goodbye.

Root beer shots? Drowning his sorrows in a saloon? 9 year olds with steady girlfriends. This is where they really lose us!

This reality show business, and it's quite a business, really straddles the line and demands that we, the audience, go along for the ride. If "Kid Nation" is reality, then we're living in an alternate universe.

This show, for all the supposed conflicts and resolutions, the coming together and pulling apart, the group dynamics and struggles with p