My Doctor’s Questionnaire

My doctor is one of those incredibly capable health care professionals who is always acquiring information in order to provide the best possible medical advice.  He uses the information obtained from a questionnaire as deftly as surgeons use a scalpel or GPs use a rubber tomahawk on your knee to test reflexes.

Recently, though, I’ve noticed a change in the tenor of the questionnaires I’m getting from my doctor.  No longer are they just focused on allergies, or muscle strains, or my diet, or how much exercise I’m getting.  Now the questions seem a lot more, uh, pointed.  In my most recent visit, the very first page of the questionnaire I was given to complete was the “Duke Activity Status Index.”

img_5859“Can you take care of yourself (eating, dressing, bathing or using the toilet)?”

“Can you walk indoors such as around your house?”

“Can you walk a block or two on level ground?”

Can you climb a flight of stairs or walk up a hill?”

Hey, wait a second!  Exactly what kind of questionnaire is this, anyway?  Why are the busybody nerds at Duke wondering about whether I can walk a single block on level ground, or eat without assistance?

I’m guessing the “Duke Activity Status Index” is not given to 25-year-old patients.

And then the very next page in the questionnaire packet is the “Burns Depression Checklist,” and one of its questions is:  “Poor self-image:  Do you think you’re looking old or unattractive?”

Well, to be honest with you, I really wasn’t focused on the subject until I started to read this questionnaire!

Advertisements

The End Of “Drilling And Filling”

Here’s another example of the miracles of modern medicine:  scientists have discovered a drug that appears to encourage damaged teeth to regenerate — a development that could bring an end to the practice of drilling out cavities and filling them.

normal-tooth_1The drug is called Tideglusib.  It not only is self-evidently unpronounceable, it also has the effect of stimulating and activating stem cells within the pulpy center of teeth, promoting the generation of the hard material that makes up most of our teeth, called the dentin — as anyone who has carefully read the tooth diagrams and tooth charts at the dentist’s office will recall.  Scientists tested the drug on mice, and found that applying the drug to cavities in the teeth of mice, using a biodegradable sponge, caused the tooth being treated to regenerate enough dentin to close the cavity.  (Wait a second:  mice get cavities, too?  They must not be very attentive to brushing and flossing.)

The next step will be to test the drug on humans, but the signs are encouraging that we may be on the verge of a new approach to dentistry.  Speaking as someone who practiced terrible dental hygiene as a callow youth and often found myself sitting in the dentist’s chair, mouth agape, listening to the whine of the drill and hoping it didn’t strike a nerve, I think an approach that lets teeth regenerate naturally would be terrific.  And, for those of us who have dental fillings that date back to the days of Beatlemania, the regeneration of natural teeth would have the advantage of avoiding visits to the dentist because old fillings are finally cracking or breaking and need to be replaced, too.

 

Say Hello To Your New Organ

Scientists have determined that there is officially a new organ in the human body, which now will be enshrined within our starting lineup of stomach, lungs, heart, kidneys, and the other slimy, wriggly bags of glop pulsing along inside our skin suits.

mesentery-0The new organ — called the mesentery — isn’t “new” in the sense that it only popped into the human body in 2016.  It’s always been there, between your intestines and your abdomen, helping to advance the human digestive system.  In fact, Leonardo da Vinci, who found time to weigh in on anatomy between completing paintings and designing machines that never got built, considered it to be an organ, but later medical types decided that the mesentery instead should be viewed as a number of distinct structures.  However, recent tests confirmed that the distinct structures function together, which means that old Leo was right and puts the mesentery squarely into the “organ” category.  Gray’s Anatomy, the ultimate medical textbook, has had to be amended to make sure that the mesentery is properly categorized, and scientists and doctors hope that the changed classification will allow the mesentery to be more fully studied and, perhaps, lead to the development of better surgical approaches and treatments of disease.

The mesentery may be an ugly conglomeration of tissue that looks like something that has washed up on a beach and sat there for a while, but it performs two important functions.  First, it provides a conduit for blood vessels, nerves, and the lymphatic system to reach from the rest of the human body down to the intestines.  And second, it allows the intestines to be linked to the abdominal wall without being directly attached to the wall.

As one doctor noted, in describing this second function:  “It is unlikely that [the intestine] would be able to contract and relax along its entire length if it were directly in contact [with the abdominal wall]. [The mesentery] maintains the intestine in a particular conformation, ‘hitched up,’ so that when you stand up or walk about, it doesn’t collapse into the pelvis and not function.”

An important function?  I’ll say!  Given the role of the intestines, we obviously all should be gratefully thanking the mesentery for allowing us to answer nature’s call without having to “hitch up” and rearrange our innards afterwards.  I’m glad the mesentery is finally getting its just acknowledgement.

Pinfoot

I’ve now got steel pins in the bones of the middle three toes of my left foot. It sounds pretty painful, and it is. In fact, it hurts like hell.

Curiously, I didn’t really focus on this aspect of the surgery before going under the knife. I guess I thought it would be like having a dental implant, or some other painless miracle of modern medicine. It isn’t. When you’re drilling holes in bones and inserting metal rods, it’s going to hurt. The fact that the pins protrude from my toes and have little yellow plastic balls at the tip, like some kind of doll pin, just adds insult to injury. And I’ll probably never use the word “pinpoint” again without an inward shudder.

My painful, pinful experience also helps to explain the back story and motivation of that Pinhead horror movie character from the Hellraiser series. I’ve only got pins in three toes; that poor bastard had pins in every square inch of his head. No wonder the guy was always in such a foul mood! Just imagine how murderous he would have been if he had little yellow balls on the end of each pin, too.

Colonoscopy Number 4

I just got home from my fourth colonoscopy. My father had colon cancer years ago. As a result my primary care physician, who’s a big believer in the power of genetics and preventative medicine, he hustled to get me in for one immediately. I had my first colonoscopy at age 40, and I’ve had one every five years since.

Most medical procedures aren’t pleasant, and a colonoscopy is no different. Nobody wants to lie on a table, their keister flapping in the breeze, while a doctor inserts a flexible camera devices up where the sun don’t shine and then probes around in their intestinal tract looking for evidence of cancer. At least for the procedure, though, you’re knocked out.

The worst part of the process is the preparation, when you drink a foul-smelling concoction and then spend a lot of time sitting in the smallest room in the house, waiting for nature to take its course — again, and again, and again. By the time you get to the surgical center for the procedure, your intestines clean as a whistle but feeling somewhat overexercised, you change into a gown and are whisked into a small operating room at one of those pocket hospitals. You awaken in the recovery room, get a quick report, and head out on your way.

As a veteran of four colonoscopies, I can report that they have gotten easier. The clean-out fluid has improved dramatically. The first time I did it, they gave me a gallon of foul-tasting glop that was mixed with over-the-top pineapple flavoring in an effort to mask the awful taste of the glop. It didn’t work. Instead, the pineapple somehow had a catalytic reaction with the glop and formed the most disgusting, smelly sludge you could possibly imagine in your most disturbing, fevered nightmare. Drinking it was almost impossible. Now you drink less of the fluid, it doesn’t have ridiculous flavorings that would ruin your enjoyment of pineapples or grapes forever, and you split your consumption between the night before and the morning of the procedure. As for the procedure itself, it gets quicker and quicker.

We do a lot of things to try to stay healthy. I’m glad having to drink the appalling faux-pineapply laxative is no longer one of them.

The Value Of Vitamins

This week the Annals of Internal Medicine published an editorial about the growing use of vitamin supplements in America that may come as a surprise to many Americans.

Entitled Enough is Enough:  Stop Wasting Money on Vitamins and Mineral Supplements, the strongly worded editorial summarizes three articles and the results of a number of large scale studies that produced “sobering evidence of no benefit or possible harm.”  The editorial’s concluding paragraph states:  “In conclusion, B-carotene, vitamin E, and possibly high doses of vitamin A supplements are harmful.  Other antioxidants, folic acid and B vitamins, and multivitamin and mineral supplements are ineffective for preventing mortality or morbidity due to major chronic diseases.”

America has become a nation of pill-poppers.  About half of Americans take some kind of dietary supplement, and Americans spend $12 billion a year on vitamins alone and $30 billion for all dietary supplements.  The notion that the vitamin supplements Americans are swallowing in record numbers are ineffective — or even harmful — may shock people. Of course, whether Americans learn of the editorial and the results of the studies, and then whether they stop taking the vitamins and dietary supplements, is anybody’s guess; one vitamin user interviewed by CBS said she would keep slugging down the pills anyway.

Why are Americans so committed to vitamins and supplements?  Some people blame the aggressive marketing of the products, but I think the root cause lies in two other factors.  First, for years Americans have been bombarded with stories about studies that conclude that something is good or bad — be it cyclamates, red dye #2, or something else.  These studies, I think, have conditioned people to believe that taking one substance, or avoiding another, could have significant health benefits.  If a “medical study” shows that avoiding something has a material effect on health, why is it so outlandish to believe that taking another substance — or a combination of substances — might have a similar beneficial effect?  The context created by the onslaught of “medical studies” establishes fertile ground for hawking vitamins and supplements.

Second, people clearly hope that a magic little pill or two can make up for their lack of exercise, poor diet, or other questionable lifestyle choices.  Like Fox Mulder on The X-Files, they want to believe — but unlike Mulder, they lack any true skepticism.  If they skip a walk and eat a quart of ice cream but take a vitamin or “fat-burning” concoction, they can rationalize that they are doing something positive about their health.  They simply don’t want to get the advice offered by one of the authors of the Annals of Internal Medicine articles:  “fruits, vegetables, nuts, beans, low fat dairy, things like that ..exercising would probably be a better use of the money.”

And that’s probably why the Annals of Internal Medicine editorial won’t have much impact.  Believers believe, and hard advice and facts usually don’t get in the way.

Polio And “Superbugs”

In Syria, more than a dozen children have fallen prey to the crippling effects of polio.

“Polio?”, you say.  “That terrible affliction that paralyzed thousands of American children each year?  But polio was eradicated by the development of the Salk vaccine.”  Yes, but a vaccine can only work if the shot is delivered.  In war-torn Syria, some children aren’t receiving their vaccinations — and the polio virus is still out there, lurking and ready to spread its infection that, for some unlucky few, will produce paralysis.

The story of the Syrian children is a reminder of the thin line of defense that protects humans from illness caused by bacteria, microbe, and virus.  It’s a timely reminder, too, because the Centers for Disease Control and Prevention and other world health organizations are increasingly concerned about the development of “superbugs” — bacteria that have developed resistance to treatment because antibiotics are being overused.  The CDC estimates that more than 2 million Americans get antibiotic-resistant infections each year, and at least 23,000 die because drugs no longer stop their infections from spreading.  The two most dangerous “superbugs” in America are CRE bacteria, which produce deadly, raging infections, and Clostridium difficile, which produces diarrhea that kills thousands each year.  The CDC’s European health counterpart is reporting on outbreaks of other antibiotic-resistant illnesses in some European countries.

This is one of those stories that don’t get much attention because it isn’t threatening to most of us — at least, not right now.  But the spread of “superbugs,” and the overuse of antibiotics that often kill “good” bacteria that are found in every human, are an enormously important public health issue.  We need to stop the overuse of antibiotics that have contributed to the development of drug-resistant bacteria and focus on developing new vaccines and forms of treatment to fight the superbugs.  Otherwise, one day we might wake up to find that the stout antibiotic line of defense that has protected humans from all manner of deadly diseases is simply gone.