Tag Archives: health care

What’s Behind Those Winter Blues

'Winter Fishing on Lake McDonald' photo (c) 2011, glaciernps - license: http://creativecommons.org/licenses/by/2.0/
The season got you down? Struggling with the motivation to get moving, even though you know it will help? Do you find the color red mildly depressing?

You may have a serious case of righteous indignation with the superficiality of life, or perhaps just the winter blues. While we don’t specialize in existential funks, we know something about depression and its cousin, colorfully named Seasonal Affective Disorder (SAD).

Our brains are immersed in a neurochemical and hormonal stew that is dauntingly complex, but a lot of work in the last decade has given us understanding of at least the broad strokes. It’s pretty complicated up in the head.

It is completely normal to slow down some in the fall; your body is conserving energy to get you through the cold winter.

For up to 10% of people, this is much more than simply banking the fires; it is a life changing and unwelcome annual ordeal. An affective disorder is a fancy way of saying a mood problem. The namesake symptom of SAD is depression.

Depression is usually associated with varying degrees of fatigue, increased need for food and sleep, weight gain and difficulty concentrating.
This occurring during the holidays is particularly irksome – when the need for energy is greater than normal. The increased appetite when the house is full of Christmas cookies is torture to anyone trying to maintain an ideal body weight.

An additional 10% of people have a milder form of the condition that may only have fatigue as a symptom.

The scientists tell us that the decrease in daylight triggers a decrease in brain serotonin and increase in daytime melatonin levels. You probably remember serotonin; that is the brain chemical that Prozac increases. Serotonin is good.

You would be right in deciding that medications like Prozac would be helpful in Seasonal Affective Disorder.

For those inclined toward more natural cures, we just need to trick your body into thinking it’s summer.

Your body mostly wants a sunbeam, like a cat. That is something we know how to do. Light therapy is essentially a portable sunbeam. The UV light is filtered out so you won’t get skin cancer, or unfortunately, a suntan. Light therapy with the intensity of 10,000 Lux seems to work the best, with 30 minutes every morning commonly recommended. Sitting in your sunbeam after work can also help, but occasionally causes insomnia. This treatment actually can work in as little as a week. That is three times faster than is usually seen with medical pill treatment.

Melatonin is also commonly used to treat Seasonal Affective Disorder. Melatonin is a hormone that is produced by your body in dim light. Taking supplemental melatonin in the afternoon can reset the hormonal clock.

Light therapy isn’t the only unusual treatment for SAD. Use of a negative ion generator in the bedroom at night shows a 50% response in patients with SAD.

Medications of the SSRI class work well but take a few weeks to become effective. Prozac is the best known SSRI, but any of them are effective.

The seasonal nature of Seasonal Affective Disorder favors the non-drug approach to the disorder. In people with SAD it usually returns each winter. Light therapy can be started in the fall before symptoms occur and can be useful in preventing the onset of SAD. Many find this more palatable than starting and stopping medications every year.

Seasonal affective disorder is often the cause of winter blues. A variety of treatments are usually well tolerated and effective. In the meantime, have a Christmas Cookie, can’t hurt.

Take care,

Dr. B


A Tragic Afternoon at the Reno Air Races

Editor’s Note: Exactly two months ago, U.S. HealthWorks doctor Anne Coatney was thrust into a tragic situation at the most unexpected time. Her story and how she handled it follows.

This sun-drenched afternoon in Reno, Nevada, was supposed to be the start of another memorable weekend for Anne Coatney. A big fan of aeronautics, she was back in a familiar place, her eyes transfixed on the sky as she sat in Box 68 at the annual Reno Air Races.

But for Coatney, a doctor for U.S. HealthWorks Medical Group in Seattle, the day turned tragic as a plane crashed into the viewing stands.

That Friday, Sept. 16, as Dr. Coatney attentively gazed up at the sky during the featured Unlimited Race, fear engulfed the tens of thousands of spectators as a vintage World War II-era fighter plane, traveling in excess of 450 mph, careened out of control.

'Taxi' photo (c) 2006, Dylan Ashe - license: http://creativecommons.org/licenses/by-sa/2.0/
For a moment, it appeared to be headed right for the very box that Dr. Coatney occupied with 13 friends and acquaintances.

“Practically everyone hit the deck around me, but I just stood up and watched it,” recalls Dr. Coatney. “I thought, ‘Oh my gosh, I may die!’ Everyone was fearful for their life.”

There was little advance warning when the modified vintage airplane slammed into the tarmac at Reno-Stead Airport, resulting in the worse accident – 11 deaths, 74 injured – in the history of American air race events. Before this year’s disaster, 18 pilots had lost their lives at the Reno Air Races since 1972, but never a spectator.

The plane piloted by Jimmy Leeward crashed near the grandstands around 50 yards away.

A doctor with 19 years of emergency medical treatment experience, Dr. Coatney took a quick look around her immediate area, then sprinted straight for the crash scene.

As she rushed to the accident location, in her path were debris from the plane, and several dead bodies, including a person in a wheel chair, but she remained focused on getting to those she could still help.

“I was running toward the crash. Your adrenaline takes over and you just react on instinct. I didn’t know I could run that fast,” Dr. Coatney said. “I immediately was looking for someone in charge and, luckily, I found him quickly. I told him I was an emergency room doctor and he told me to go to the red zone, where the most critically injured people were being taken.”

The first person Dr. Coatney encountered was a 54-year-old man who was in mild shock. His right arm was severed at the elbow and he had an open skull fracture. Because she had no medical equipment, soothing words and makeshift treatment were all Dr. Coatney could immediately provide.

“All I had were my hands,” she said.

She kept those hands busy, trying to stop the flow of blood while keeping the man calm and taking some vitals with the aid of her watch. For bandages, Coatney used cloth given to her by helpful spectators who were cutting up nearby curtains from the box seats. Eventually she managed to stop the man’s bleeding in several places.

After helping load the man into a helicopter, she was off to the next injured person, a woman who had two fractured legs, open wounds, internal bleeding, and was in Level 2 shock. Dr. Coatney later treated a 29-year-old woman who had problems breathing due to shrapnel sticking out of her chest. Her leg was fractured and she had a collapsed lung.

Exhausted and back at her hotel that evening, Coatney called the hospital and checked on all five patients she had treated.

Dr. Coatney said her three years of residency at an emergency department in downtown Detroit, where caring for 20 gun-shot wound patients a night was not unusual, helped prepare her for Reno.

“I have learned how to remain objective and just do what I was trained to do,” Dr. Coatney said. “I thank God I had such good emergency training from my ER director in Detroit. It helped me be ready for a disaster like this one.”

Dr. Coatney has been coming to the Reno show for 19 straight years. It was quite an ordeal, but Coatney insists that she will be back in Reno next year and sitting in Box 68 once again.

“When you look back on what happened, you just think that you were lucky to live through it,” Dr. Coatney said. “It makes you look at things differently and you think that every day is a gift. It was a life-changing moment. But I’m absolutely coming back. I’ve gotten to know so many people that come to Reno every year and I’m part of the aviation community.”

Medical Marijuana Hits a Speed Bump

After the almost continuous progress of medical marijuana toward legalization by states, the federal government is threatening to use the trump card of federal law to override state laws.

'marijuana joint' photo (c) 2008, Torben Hansen - license: http://creativecommons.org/licenses/by/2.0/
California medical marijuana dispensaries have been told to cease operations within weeks or face federal prosecution. This has always been a possibility and, while many are surprised and yell “unfair,” many more are surprised it has taken so long. Marijuana, for the record, remains an illegal federal schedule 1 drug.

Medical marijuana occupies a curious and singular position as a “quasi pharmaceutical.” Like prescription medications, it has uses in the treatment of certain diseases. Like prescription medications, it has the potential for abuse.

The federal government sees the potential harm from abuse overriding any benefit of medical marijuana. This is not to say there is no benefit, but the therapeutic ratio tilts toward more harm than good.

The unique position of medical marijuana is further demonstrated by the individual state laws that regulate the prescription and dispensing of marijuana. For the rest of the pharmacopoeia, the DEA regulates all aspects of the medication. The drug manufacturer must make the drug of a certain purity level, it must be free of other harmful chemicals, and must be of a certain strength that is measurable and virtually identical batch to batch. It also must be proven effective for the condition for which it is approved. Those prescribing are highly regulated (medical doctors) as are the pharmacists and pharmacies that dispense medications.

Medical marijuana is also unique in its “sig” (medical language for prescribing instructions). If you look at medication bottles you have had, they give specific directions (i.e., take 1 tablet 3 times per day with food). The instructions for medical marijuana are to essentially use as much as you need, as often as you need, for as long as you need. I can think of no other medication either over the counter or prescription that has that latitude of use.

That being said, marijuana does have some benefit as an appetite stimulant for people with diseases like cancer or HIV who can benefit from that stimulant. It also can benefit patients experiencing nausea from such things as chemotherapy. However, experience has shown us that 90% of patrons of medical marijuana dispensaries don’t have cancer, HIV or what the mainstream medical community sees as serious diseases that cannot be successfully treated with conventional medical treatments.

What it comes down to is the present patchwork solution to marijuana legislation is simply unworkable, requiring a resolution at the federal level. It needs to be either treated like a drug, a medication or classified like alcohol.

Treating marijuana like a medication would involve marijuana being produced by licensed drug companies, in a standardized fashion, with frequent inspection and quality assurance programs. Marijuana, the medication, needs to have standardized levels of THC (Tetrahydrocannabinol), ensuring patients get the same effective dose each time they use it. This would be sold and distributed by pharmacies, with licensed and trained pharmacists. This is unlikely for a number of reasons, not the least of which is that smoking anything causes lung cancer and large pharmaceutical companies or large pharmacies don’t want that liability or damage to their reputation.

Treating marijuana like alcohol at least on the surface appears workable.

This would involve some standardization of product, federal or state inspection and presumably paying state and federal taxes.

Restrictions could be placed on the sale or use of marijuana by underage people.

What we have now is not a solution, but an anti-solution. We should start with a clean slate and appoint a blue-ribbon panel of recognized experts to analyze the risk and benefits of marijuana use. These experts could examine or commission serious scientific research and make reasoned decisions based on fact, not opinion.

Take care,
Dr. B

What is Flu Vaccine Anyway?

We spend a lot of time each fall talking about influenza and flu vaccine. A great deal of hard work by very smart people goes into making this magic fluid each year.

'Flu Vaccination Grippe' photo (c) 2010, Daniel Paquet - license: http://creativecommons.org/licenses/by/2.0/

The first thing you need to make flu vaccine is a flu virus. Those come in many different flavors, some old standbys trying to make a comeback, occasionally some new virus. Because the earth is tilted, our summer is the Southern Hemisphere’s winter. They are having this year’s flu season 6 months before we do. The best place to look for new influenza viruses are poor rural areas in Southeast Asia. In these areas, humans and animals frequently live close together. I’m sure you have noticed all influenza viruses have animal names (swine flu, bird flu…) – that is because the virus jumped from an animal to a person.

The World Heath Organization (WHO) is in charge of collecting flu viruses. They culture a bunch of sick people (nasal swab) to find the new and dominant viruses that season. They get pure cultures of the three worst viruses.

Now the magic begins.

Each virus is combined with a harmless standard lab virus. The result is a new virus that looks like the bad influenza virus on the outside, and like the harmless lab virus on the inside. That is important because the human body generates antibodies to the outside of the virus (it can’t see the inside). Now we have a copy of the virus that can’t make people sick, and grows well in chicken eggs. All this happens at the WHO labs.

Next it’s off to the vaccine manufacturers.

This harmless copy virus is injected into fertilized chicken eggs that are 9 to 12 days old. Three days later there are almost countless copies of the virus in the egg white. The virus is then separated from the egg white. Now it’s time to kill the virus with chemicals as we don’t want anyone being infected by this new virus (even though it is harmless). Now the virus is broken up to get a solution of the surface proteins (those on the outside).

This solution, called antigen, is then diluted to the proper concentration for use.

Next, it’s sterilized and packaged in vials and syringes.

There are hundreds of quality assurance tests done at each step of the process.

So your flu vaccine contains just the proteins from the outside of the original bad virus. It doesn’t have the ability to infect you as there is no living virus in the vaccine.

When you get your flu shot, these proteins (antigens) in the vaccine stimulate your body to make antibodies against this interloper. These antibodies will attach to the original virus and destroy it. In about 9 days you have enough antibodies to fight off an assault by the original virus.

It takes six months from finding a new virus to mass-producing the vaccine. That original virus was found in our spring (the Southern Hemisphere’s fall) and is ready for use by our fall season – just in time for flu season.

Producing the new trivalent (3 viruses) vaccine each year is one of the things the human race does very well; it requires worldwide cooperation to pull it off.

So, when you get your flu shot this year (and do it soon to maximize your protection), appreciate the “magic” that half cc of vaccine represents.

Take care

Dr B

Top Ten Flu Shot Myths: Don’t Fall for Them

It seems most people won’t get a flu shot this year – many turning to what can only be called the Top Ten Flu Myths. Here goes:

'Finally Got A Flu Shot $25.' photo (c) 2010, Jake Metcalf - license: http://creativecommons.org/licenses/by/2.0/
1. The flu shot can give me the flu. No way, no how. Injectable flu vaccine is 100% dead, broken-up virus – it is not infectious.

2. I won’t get the flu. That is Russian roulette. How often this winter will you be in the same room/elevator/auto with someone who is coughing, sneezing and doing their best to infect everyone? You will find yourself trapped like a rat.

3. I’m healthy, so getting the flu is no big deal. Influenza hits even the strong and healthy like a Mack Truck. Think 104 fevers and every muscle in your body screaming at you. Not much a doctor can do after you have the flu.

4. The Flu vaccine is dangerous. This is the old argument regarding the preservative Thimerosal. There is zero scientific evidence that this preservative is harmful. Given the hundreds of millions of flu shots given, even a tiny risk would be found. If you still fear this preservative, the flu vaccine is available in preservative free form (no Thimerosal) and the FluMist nasal spray has none. For the record, my children, wife and I had the regular flu vaccine (with Thimerosal).

5. Flu shots are difficult to find and useless after November. The flu season changes every year. Things like air travel spread viruses quickly to far flung places. It takes 9 days to develop immunity after being vaccinated. You will still get immunity whenever you vaccinate. In terms of finding the vaccine, the vaccine is plentiful even late in the season. If you decide a flu shot is a good idea, why risk getting the disease for months before getting a shot?

6. I get sick even if I get the flu shot. Influenza takes a couple of days to develop after you are infected. So you can also get exposed a couple of days after the vaccine, but before you are immune. Influenza vaccine doesn’t prevent colds. So any of those situations can lead people to think the vaccine didn’t work.

7. I don’t have the money. A Canadian study found an average savings of $43 in healthcare expense for every vaccinated person. Doctor visits and work absence were all significantly reduced in the vaccinated population.

8. Only old people die of flu. In normal years, 90% of flu deaths are 65 years and over. H1N1 had the opposite with almost all the deaths in the young. It is your contribution to the public good to not be passing around flu this winter. We call that herd immunity. The sum is greater than the parts.

9. I am still immune from last year’s shot. The flu vaccine is redesigned every year based on the early emerging virus types in Southeast Asia (they have their winter during our summer). When we measure immunity, flu vaccine gives very strong immunity for six months or longer. You don’t still have high antibody levels the next flu season.

10. Flu shots hurt. In my clinic, we use #30 needles that are the thickness of a human hair. The vaccine is not irritating to the muscle. There is very little pain with a carefully given flu shot. If you are needle-phobic, you can always take the nasal spray (FluMist).

We have plenty of vaccine, what are you waiting for?

Dr. B

10 Reasons Not to Exercise

I was a great exerciser for most of my life. Recently I seem better at making up excuses not to exercise than to actually exercise.

As a motivation tool for myself I have listed all my good reasons for not exercising. You may find a few of your favorites. Hopefully you will see my folly and get back on a program yourself. So after a little reflection, here are my favorites.

1. I am middle aged and don’t need to pretend I’m young.
2. I am too busy to exercise – work, child rearing, keeping the house livable doesn’t leave time for exercise.
3. I don’t get enough sleep as it is without getting up an hour earlier to exercise.
4. My back hurts. You may substitute knees, hips, or your big toe – pick your favorite, or least favorite, body part
5. It’s too hot to exercise (115 F in Phoenix as I write). Of course too cold, humid, windy, rainy or generally inclement works equally well. It could also be too light or too dark for that matter.
6. I have a big meeting tomorrow and I need to be well rested.
7. I’ve been married for 17 years and my wife still likes me (even without exercise).
8. My weight is good and I look like I exercise (I actually stole that one from my wife a decade ago).
9. No matter how much I exercise I still don’t look like Arnold (or Halle).
10. If I can’t do the exercise I want, why bother.

So use one excuse a week and it will be a long time before you exercise.

More seriously, most of these are easily swatted away and I have done that myself many times.

A few to discuss:

No. 10 is a real struggle for many. I had two back surgeries that put a stop to my running and weightlifting. It took some pondering, but rollerblading is easy on the back and aerobic exercise. Aging and injuries do force you to lower the exercise bar, but throwing in the towel is not necessary. If you can only walk, do that. Almost anyone can swim for exercise, the weightlessness makes it joint friendly.

Looking like you exercise is not the point. Living longer and being able to participate is the point. Exercise can make some wheelchair bound people walk again. You can be fat, thin, short, tall, old or young and still make your life better with exercise.

Most studies show exercise helps joint pain. This is true even with relatively advance degenerative joint disease. It also helps you lose weight, lessening pain.

Hopefully, I will think of these counterpoints tomorrow morning when I wake up with an excuse at my lips.

I will recognize it for the excuse it is and move anyway. If doesn’t work, Sheba, my Siberian Husky, will remind me she needs exercise also and doesn’t take excuses.

Take Care.

Dr. Bucklin

Best of Our Blog: A Cup of Joe and Carpal Tunnel Syndrome

We’ve culled through the statistics and pulled together some of our most-read blog items since we launched. Below are two of the favorites.

A Cup of Joe — Stuff of Life or Poison?

In this country, we drink 400 million cups of coffee per day. We consume over 45% of the world’s coffee production. For the record, some of the Scandinavian countries consume three times more coffee per person.

Given all this coffee drinking, it’s no surprise that this is one of the most researched beverages on the planet. And yet there is almost universal confusion on the health consequences of coffee drinking.
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Carpal Tunnel Syndrome Made Clear in 10 Paragraphs

Carpal Tunnel Syndrome (CTS) is an occupational medical diagnosis that often gives employers, patients, and sometimes even medical providers, undue levels of frustration. Like a lot of other things in medicine, reasonably simple concepts are hidden behind Latin words. You just need a basic understanding of how things are put together – in other words, anatomy.

Let’s start with the hands. The hands are absolute miracles of micro-engineering. They are capable of generating tremendous force, while being compact and delicate enough to pay a violin. They pull this off by putting the muscles that work the fingers in the forearm. These muscles are connected by cables, called tendons, to the fingers. Contract a muscle in the forearm, it pulls the cable (tendon) and moves the finger. I never fail to be impressed by the cleverness with which the human body is put together.

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Best of Our Blog: Rusty Nails and Working the Late Shift

We’ve culled through the statistics and pulled together some of our most-read blog items since we launched. Below are two of the favorites.

Rusty Nails, Dirty Wounds and Tetanus

This morning I heard a newscaster lament, “I was cut with rusty metal, and there is a national shortage of tetanus vaccine.”

Despite his concerns, this is not exactly certain death. Growing up in Southern California, I spent most of my youth barefoot, tangled with more than a few rusty nails and was on the tetanus-shot-a-year plan. This experience prompted an interest in the whole rusty nail tetanus connection.Read more

Working the Night Shift and Getting Enough Sleep

The struggle to get adequate daytime sleep when working nights is familiar to many of us. In fact, 15 million workers – or 20% – of the American workforce work other than the typical 9 to 5 shift. Some are swing shift, some graveyard and some even rotate shifts between days and nights. Many people simply do not acclimate to this unnatural pattern of waking and sleep. The resulting sleep deprivation leads to increased short-term illness and long-term medical problems. A much higher incidence of accidents and mistakes are associated with sleep deprivation. The loss of productivity alone is estimated to be in the billions of dollars.
Read more

Update: Head Injuries Remain a Major Concern for Football Players

Head injuries in athletes resulting in concussions occur more frequently than previously thought. We are learning more about the problem and the important consequences.

Each year more than 300,000 athletes in the U.S. suffer some form of traumatic brain injury. High school athletes comprise 60,000 of these injuries. The consequences vary a great deal, occurring both emotionally and intellectually.

Traumatic brain injury can result in short term symptoms as well as problems that are more serious and may not surface until several years later. What kind of problems develop depend on what portion of the brain is affected, the severity of the blow, the number of repeated blows to the head, preexisting conditions of the individual, and personality traits of the injured person.

The more blows to the head that occur – even small ones – increase the risk for mental deficiencies. Significant head trauma to a football player occurs hundreds of times a week during practice and games. Exploring options for protective equipment in contact sports and teaching fundamental techniques in sports that can reduce head trauma are paramount to reducing the number of injuries and the serious consequences.

A study in 2000 surveyed 1,090 former NFL players and found more than sixty percent had suffered at least one concussion in their careers. Twenty six percent had three or more. The survey revealed that players who had concussions reported more problems with memory, concentration, speech impediments, headaches, and other neurological problems than those who had not. Because these professional players had spent many prior years playing football in high school and college, the frequency of head trauma is likely under-reported. Head trauma is a problem for many of the non-contact sports as well.

Other common medical problems are being discovered as we examine concussions more closely. Depression, insomnia, attention deficit and personality changes all occur with similar frequency among high school athletes. These kinds of problems have been found to be more frequent in those who have had even one episode of head trauma.

Long-term problems may take eight years or more to develop or worsen. Immediate symptoms that require removal from sports activities include amnesia, poor balance, headaches, dizziness, or other neurologic deficits, regardless of how quickly they subside on the sidelines. It is widely accepted that concussion symptoms can reappear hours or days after the injury, indicating that the player had not healed properly from the initial blow. This requires strict guidelines that conservatively allow adequate time for healing to occur.

But the question remains – how much healing time is enough? A health care provider should be involved in examining and investigating these head injuries to ensure the best outcome. Even one episode of head trauma makes the athlete more vulnerable to serious consequences for the next episode, which in many contact sports is inevitable.

Both professional and college sports authorities are changing their recommendations regarding contact sports. One recommendation is reducing the numerous head blows by enforcing practices that involve no contact. Research has shown the number of head blows during a college football season totals in the thousands for an individual player. Many football collisions have forces comparable to driving a car into a concrete wall at 40 miles per hour.

Teaching better techniques to reduce the head leading contact in tackling and blocking and providing better equipment can help reduce the negative effects. Football helmet manufacturing and testing are not closely regulated. New helmet technology and better monitoring of equipment after repeated impact can reduce the consequences of head impact.

Repeated head trauma resulting in serious consequences of traumatic brain injury should be no surprise. We can do more to protect athletes of all ages. Athletes themselves should be encouraged to seek medical attention for head injures – even if they seem mild and there is no loss of consciousness. Severity of symptoms and initial imaging studies can detect serious problems early, and be the basis for ongoing treatment and peace of mind.

Dr. Bruce Kaler

Acne, Chocolate, Shaving and Hair – Medical Truth Behind the Myths

One of the small joys of medical school is finding out a bunch of the stuff you’ve been told is wrong.

That may not be the noblest of intentions, but joy nonetheless. My first startling discovery of this type was on the health of your eyeballs and the illumination of your reading material. Who doesn’t have memories of Mom turning on lights with the exclamation: “Quit reading in the dark; you’ll ruin your eyes!” Few of us questioned the wisdom of the advice, even if the lesson didn’t seem to stick.

I still remember cheerfully calling home and explaining to my parents the workings of the eye and the complete lack of damage from reading in poor light. Just like a camera, poor light gives bad pictures, but it doesn’t damage the camera. Yes, these were the same parents that were paying for medical school.

Another bit of mistaken medical folklore involves swimming after eating.

I remember dutifully waiting a good 30 minutes, which seemed like three hours, before swimming after eating, as advised by all sensible adults.

Living in California I heard countless stories of careless people going for a dip too soon after eating, only to be incapacitated by a cramp, and sinking like a stone into the murky depths – that would be the 8-foot end of the pool. I spent months going through every last organ in my cadaver specimen and assure you there is no cramp organ. Swim 10 seconds after your last bite, and use pool water to wash it down and you still won’t get a cramp.

Moving on to teenage years there were lots of well intentioned dietary advice for a teenager with pimples. Chocolate was the favorite food to blame for acne. This myth is so pervasive in society that one of my medical school professors specifically addressed this mistaken notion.

She told us to please find some chocolate that really caused acne (good luck, there isn’t any). She theorized that if it could be found, with a little analysis we could find the specific culprit, and remove it. That would allow us to make acne free chocolate. Think of the sales, I could pay off medical school. This perhaps takes some of the guilty pleasure out of chocolate, even more so now that we know a little dark chocolate is good for you.

About the time we were getting over the worst of our acne, we were giving our young livers a work-out with the new found joys of alcohol. I have vague memories of getting drunk on the most ridiculous beverages, cheap wine, sloe gin or anything else we could get our hands on.

Who has not poured coffee into a drunk friend expecting to sober him up enough to not be killed by his parents? Perhaps you have tried the coffee cure on yourself. Alas, coffee will not speed up the metabolism of alcohol even a little bit. You are just as drunk after 5 cups of coffee – and you have to go to the bathroom even more. The caffeine might wake you up enough to do something stupid, like drink more, or call your ex.

Getting a little older, arthritis seems more like reality, and colds are not shrugged off with the vigor of youth.

If you do get some hand arthritis, don’t blame it on cracking knuckles. Cracking knuckles causes zero joint damage, and produces no increased risk of arthritis. It’s harmless, although quite irritating to most of the people around you, which may be the point.

What about wet hair and colds? Colds are caused by viruses and not cold air or a wet scalp. Wet hair doesn’t even weaken your immune system and make you more susceptible to the first germ that passes by. The dangers of wet hair are clearly overstated.

Shaving causes hair to grow back thicker and darker. Everybody knows that. This also is medical fantasy. Bunches of studies have been done on this very subject. Shave or grow a beard, the whiskers stay the same. Same goes for legs.

How about the healthy glow from 8 glasses of water a day? Another medical myth. The origins of this belief are obscure, but the evidence is clear. Drink when you are thirsty, a little more if you are exercising.

Medical myths are common in society, and always have been. Partly it’s magical thinking, partly American pragmatism. We have only recently started making decisions based on evidence. As that gathers speed, it may spell the end for sewer dwelling alligators, or maybe not.

Take care,

Dr B (aka Dr Don Bucklin)