The Myth of Morning Coffee

You might want to sit down for this caffeine story. No, this is not about the entrepreneur in India who is trying to steal the name of Starbucks for his own chain of coffee shops. This is a serious story! LOL.

Question: How many people out there in blogland swear by their first cup of coffee in the morning? You absolutely cannot live without your first cup of coffee (or cappuccino or espresso or latte or whatever). For me, my caffeine of choice is above.

Researchers at the University of Bristol are reporting that coffee does NOT boost you in the morning. (BBC News) Actually, coffee in the morning helps ease caffeine withdrawl symptoms. Withdrawl? Coffee is a drug? Pshaw!

Professor Peter Rogers, a biological psychologist who led the research, told the BBC: "We do feel a boost from caffeine in the morning, but that's probably due to a reversal of the withdrawal symptoms. That alertness you feel is you getting back to normal, rather than to an above normal level.

First off, a "biological psychologist?" What's up with that? Second, what you feel is "getting back to normal?" What's normal? Call me in denial, but I believe that this study is complete bunk. Caffeine rules! Long live Diet Coke and caffeine. I'm with the pro-coffee activist group on this one.

Zoe Wheeldon, of the British Coffee Association, said the research was interesting. But she added: "There are two sides to the debate and a wealth of scientific evidence suggests that moderate coffee consumption of four to five cups per day is perfectly safe for the general population and does have a beneficial effect on alertness and performance even in regular coffee drinkers."

Yeah! You tell 'em, Zoe. Finally, there are other people out there who see a different use of caffeine - Specifically the combination of Diet Coke, Mentos, and David Letterman.

I Won the Mega Millions Jackpot!

Cha-Ching, baby! I'm on easy street. I'm quitting my job and moving to Hawaii to live my dream of becoming a Magnum P.I. wannabe! Gimme a Ferrari. Gimme a private jet. Gimme my own Dr. A private golf course. Yes!

Actually, not. To be honest, I didn't even play. There was a huge collection at the office today. Sometimes, I wonder, what if the office staff did win? Would everyone quit their jobs tomorrow? Maybe for a piece of the record $370 million dollars, they would. Who knows?

I always remember those stories about a group from work somewhere who hit it big, only to just spend it all. Or, the greed degenerates into eventual lawsuits among "friends." Or, the winners being driven into solitude because the winner's private life disappears. You never know who comes out of the woodwork to claim that they are your relative and/or friend, "Where's my piece of your $370 million!"

So, the waiting game begins. With a record jackpot like this, it's unlikely that it will be one person. It's usually a group of co-workers who grouped their money together to buy a bazillion tickets. These people will become instantly famous, and we'll see how they handle their fame and fortune.

Charmed Heart

Too often, we hear about climbers who are lost as they try to reach the top of a mountain somewhere. Here's a story where a climber not only found the summit, but also is living out a dream.

Last week, this AP story reported that Kelly Perkins and her husband Craig, recently scaled a peak in the Andes mountains. Her other conquests include the Matterhorn, Mount Fuji and Mount Kilimanjaro. What's so unusual about these feats? She did it with another person's heart beating in her chest.

Perkins grew up around Lake Tahoe, Calif., acquiring a love for the outdoors that led to annual backpacking trips with friends. Her zeal for mountain trekking and climbing only increased after her transplant on Nov. 20, 1995. Any fears about stressing her new heart were overwhelmed by a desire to rebuild her strength.

Some 3 1/2 years earlier, she had been diagnosed with cardiomyopathy — a disease in which heart muscle becomes inflamed — which doctors blamed on a virus. For more than three years, she and her husband shuttled in and out of hospitals seeking a donor heart.

I was also able to find their website simply titled craigandkelly.com. The site shares the stories about their climbs and has amazing pictures, like the one above. Let tell you, this is very inspirational stuff.

The Andes adventure was all free climbing, using ropes and protective gear only for safety's sake as she moved up the rock under her own power, using only hands and feet to find natural holds in the crevices of the rock.

She dubbed the route the "Charmed Heart" as she led her team up one of several unnamed peaks in the remote Cajon de Arenales region near Argentina's border with Chile, more than 650 miles west of Buenos Aires.

Craig Perkins, who has given his wife a gold charm for every major mountain climbed since her transplant, gave her another atop the "Charmed Heart" route — this one of a woman mountaineer leaping for a peak and grabbing it by one hand. A tiny sparkling ruby represents her heart.

Thanks Kelly and Craig for sharing your story. I know a lot of my patients and friends who will love to hear your story. Keep climbing as many mountains as you can! I'm glad that you didn't let anyone or anything get in the way of your dream.

What flu epidemic?

"Hey Doc, how's that flu thing going on this time of year," a patient asked me this week. "I mean, you practically made me get a flu shot last fall," he continued in a joking manner. I smiled (kind of).

The press really hasn't said anything about the human flu season. There are countless stories about bird flu, like, how it's in other parts of the world, or, how the United States is no way near ready for a bird flu pandemic.

So, being curious, I checked out the CDC (human) flu website. In case you didn't know, they have a week by week report during the flu season. And, I was surprised from their latest data which is from the week of February 17.

From a epidemiology standpoint, stating there is an "epidemic" occurring is misleading (but makes for a great post title). A small map is above, and in the nation's midsection, where the color is red, there is "widespread" influenza occurring. Here is the summary from the CDC flu website:

During week 7 (February 11 - February 17, 2007), influenza activity continued to increase in the United States... Twenty-four states reported widespread influenza activity; 14 states and New York City reported regional influenza activity; 10 states and the District of Columbia reported local influenza activity; and two states reported sporadic influenza activity. The reporting of widespread or regional influenza activity increased from 33 states for week 6 to 38 states for week 7. The percent of deaths due to pneumonia and influenza remained below baseline level.

The last sentence above is probably why there has been no press coverage on this story, yet. My state is in the "local activity" category, but almost surrounded by the widespread states. So, we'll have to see what happens.

My prediction is that when and if the "weather" story starts to be less newsworthy, then the press will start to pick up on the "widespread flu" story. By the way, as I tell all my patients, it's never too late to get that flu shot. That is, if you can still find one in March.

Pain Management Dilemma

The Washington Post came out with an article on Tuesday with the attention grabbing headline, "Doctors Warned About Common Drugs For Pain: NSAIDS Tied To Risk Of Heart Attack And Stroke." The American Heart Association came out with a statement discouraging use of Cox-2 inhibitors because of it's association with heart attacks and stroke.

"In the past, many physicians would prescribe the Cox-2 drugs first," said Elliott Antman, a professor at Harvard Medical School who led a group of experts assembled by the heart association to study the issue. "We are specifically recommending that they should be used as a last resort."

"This is a very firm statement we are making," he added. "It is our belief, hope and desire that physicians will take our advice, and by doing so it is our belief and hope that we will reduce the number of patients who suffer heart attacks and strokes."

Now, I have no problem with this. My patients have been scared off from these drugs with all the press coverage that has been surrounding these drugs, that the mere mention of these drugs during an office appointment sends the patient running away.

Here's where I start to have a problem with the AHA statement....

Patients should be treated first with nonmedicinal measures such as physical therapy, hot or cold packs, exercise, weight loss, and orthotics before doctors even consider medication, said the AHA scientific statement published in the journal Circulation.

Patients who get no relief after those measures have been exhausted can be considered for drug therapy, but doctors should try drugs only in a certain order, the statement said:

"In general, the least risky medication should be tried first, with escalation only if the first medication is ineffective. In practice, this usually means starting with acetaminophen or aspirin at the lowest efficacious dose, especially for short-term needs."

While most patients are likely to be helped by those drugs, a smaller number may need to try a drug such as naproxen. Patients who require additional help should be given other nonprescription painkillers such as ibuprofen, and only after that option has been exhausted should physicians consider Cox-2 inhibitors, Antman said in an interview.

I can tell you as a primary care physician, most of our patients already do the non medication therapies even before seeing me. In addition, they have already tried a number of over the counter antiinflamatory therapies. When they come to me, they are usually looking for the next step up in therapy. Then, when I introduce the idea of the Cox-2 inhibitor, they balk. So, now what? Hold that thought....

In doing more research on this topic, I ran into an article entitled, "The Poor Management of Pain." It talks about how physicians do a poor job at managing chronic pain, especially with the reluctance in using opioid/narcotic medicines.

It is seemingly a no-win situation. On the one hand, the more you treat pain with opioids, the more likely you will be investigated by state or federal authorities. But, on the other hand, the less you treat pain with opioids, the greater your chances of being sued for civil damages on the grounds of undertreatment.

“Lawyers are lining up right now...looking for cases of poor pain management,” according to remarks given by Bill McCarberg, MD, director of the Chronic Pain Management Program at Kaiser Permanente in San Diego and an assistant clinical professor at the University of California, San Diego, who also serves on the board of the American Pain Society. “Whenever you encounter litigation against doctors for pain management, it is never because...we do not allow the patient to get a muscle relaxant...It is always about opioid management. We get sued because we’re not using opioids.”

So, on a daily basis, I'm constantly challenged on how to adequately treat my patient's pain. On the one hand, there are antiinflamatory medications which have the dangers of heart attack and stroke - News Headline: Doctors Warned About Common Drugs For Pain. On the other hand, there is the use of narcotic pain mediciations which have the dangers of addiction and tolerance - News Headline: Doctors Do A Poor Job At Pain Management. I apologize for the whining, but sometimes all this stuff really makes my head spin.

Obesity = Child Abuse?

Connor McCreaddie, pictured with his mother above, is a pleasant 8-year-old boy who lives north of London. British authorities are so concerned about Connor's 218 pound weight that they are considering taking the child into protective custody unless mom "improves his diet." (FoxNews.com)

An unnamed health official was quoted as telling The Sunday Times that taking custody of Connor would be a last resort, but said the family had repeatedly failed to attend appointments with nurses, nutritionists and social workers.

"Child abuse is not just about hitting your children or sexually abusing them, it is also about neglect," the official was quoted as saying.

Child abuse? Now, I admit, I don't know all the details on this case (other than what is in this article). But, child abuse? I know that this boy is overweight. I would even agree with classifying him as clinically obese, but characterizing this as child abuse? I think that's a little of a stretch, don't you think?

Dr. Colin Waine, the director of the National Obesity Forum in Nottingham, England, called Connor's lifestyle "extremely dangerous," adding he is at risk of developing diabetes in his early teens, and cardiovascular and nervous system problems in his twenties. "He's really at risk of dying by the time he's 30," Waine said.

Pediatrician Dr. Michael Markiewicz agreed. "I'm not saying they can't care for him, but what they are doing is through the way they are treating him and feeding him, they are slowly killing him," he said.

Now, don't get me wrong. I am not endorsing this style of parenting (or lack of parenting). And, again, I have to give the disclaimer that I am not a parent myself. But, if childhood obesity equals child abuse leading to taking a child away from a parent, can you imagine the volume and amount of protective custody cases that would take place in the United States?

According to the Institute of Medicine, NINE MILLION children in the United States over six years old are considered obese. From what I understand, the foster care system is overloaded right now. To add another nine million children would add chaos to chaos.

One more thing to think about. What if childhood obesity was changed to childhood asthma? And, the childhood asthma was caused by secondhand smoke, say, from the parents? According to the American Lung Association, "An estimated 400,000 to one million asthmatic children have their condition worsened by exposure to secondhand smoke." Would you consider this child abuse? Are parents "slowly killing" their children as the pediatrician suggests above?

Sorry for the diatribe, but here's my point. Yes, this is an unfortunate situation for this young man. But, for the government to get involved in this situation is riduclous. There has to be another way to solve this other than to separate a mother from her son.

Update (3pm eastern time): Apparently British authorities have backed away from their position to try to remove Conner from his mother - For now...

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I also posted a video blog on this same commentary. Check out my sidebar and click on the link to my livevideo site. Videoblogging is still tough, but a new challenge that I'm working on.

Original Wendy's To Close Friday

It's the end of an era. The picture above is Dave Thomas, founder of the Wendy's restaurant, standing in front of the original Wendy's in downtown Columbus, Ohio. On Friday, this first Wendy's restaurant will close its doors for the last time. (Columbus Dispatch)

"This was a painful decision," Denny Lynch, a spokesman at Wendy’s headquarters in Dublin, said yesterday after confirming the move. "The store is a walking history of the company."

Wendy’s had put off the decision to close the restaurant at 257 E. Broad St. for years, and acted only after determining that the building would require a costly upgrade.

As you probably know, I've lived in Ohio most of my life. And, I've been to Columbus lots of times. Unfortunately, I had no idea the first and original Wendy's was in downtown Columbus. If I did, then I would have visited there often.

Dave Thomas, who died in 2002, opened the restaurant Nov. 15, 1969, as Wendy’s Old Fashioned Hamburgers. It was named for his 8-year-old daughter, Melinda Lou, whose nickname was Wendy. The chain now has 6,600 stores.

In many cities across the United States, many businesses are fleeing from the downtown area. Columbus is no different. There used to be a science center right across the street from this particular Wendy's, and then they moved as well.

The restaurant had its own set of problems. It lacked a drive-through, had limited parking and was not open in the evening because of the lack of dinner traffic.

The flagship store’s closing will have far more sentimental impact than any financial effect on Columbus or on Wendy’s, said Richard Steckel, economics professor at Ohio State University.

"A lot of people had their first dates there, and the people who work for the company are definitely attached to it," he said. "It’s always sad to see a landmark like that go, but it’s the nature of capitalism."

I definitely have mixed feelings about this. When people want to keep something just for a sense of tradition or sentimentality, I'm pretty harsh on them. "Sometimes you have to let go of the past and embrace the present and look to the future," I sometimes say to people.

Even when people say that Dave Thomas himself would have agreed with this move, it doesn't make me feel any better. Maybe a new restaurant will be built and all the memorabilia will be placed there? Of course, the restaurant would be built in the suburbs and not in downtown, because that's probably what Dave would want anyway - For better business...

Girl Scout Cookie Rant

For the love of pete, please say it ain't so! What the heck is this world coming to? How do you define America - Baseball, Mom, Apple Pie, and the Girl Scout cookie (Thin mints, thank you very much).

Yes, it's that time of year again, ladies and gentleman. It's the time of year where all is right with the world. Yes, there's a war on terror going on. Yes, there is poverty and hunger taking place across the world. But, to escape this reality, what do we have? We have the Girl Scout cookie.

People think I'm nuts - and they may be right. But, if you want to properly participate in binge eating (as I do sometimes), then you need the Girl Scout cookie (Thin mints, thank you very much).

But, alas, friends and neighbors. As I was scanning the news today, I ran across a story which stopped me in my tracks. A story which made me cry out, "Oh no! The Girl Scouts caved in, too!"

Beginning this year, ALL Girl Scout cookies will be trans fat free. (Apparently, some GS brands are already trans fat free.) According to this AP article, the scouts want "to add an element of health consciousness to their annual bake sale."

Initial feedback has been positive, said Anna Ho, who organizes sales for Troop 805 in Parsippany, N.J.

"People are saying, 'It's about time,' said Ho. "Everybody is conscious of the trans-fat issue ... My own sister used to rub me in the ribs sometimes and say, 'When are you going to go healthy?'"

Uh, excuse me? But, if I was going to choose something healthy, I would not choose GS cookies. I would choose something like fruits and veggies to snack on.

This is an appeal to the Girl Scout leadership. Please, please, please leave in the trans fats in your products. How could I ever live without those darn trans fats in my favorite Girl Scout cookies? (Thin mints, Thank you very much!)

Serbian Surgeons Gone Wild

While this story may sound like a television show, this is a real deal. Sometimes, you can't make this stuff up. I cannot add any more comedy to this, so I'll quote it verbatim below.

BELGRADE (Reuters) -- A routine appendix operation in Belgrade went badly wrong when two surgeons started fighting and stormed from the operating theater to settle their dispute outside, the daily Politika reported Wednesday.

Surgeon Spasoje Radulovic was operating when his colleague Dragan Vukanic entered and made a remark that started a quarrel, said the anesthesiologist on duty.

"At one moment Vukanic pulled the ear of the operating doctor, slapped him in the face and walked out," she said.

Radulovic followed and an all-out fight ensued, resulting in bruises, a split lip, loose teeth and a fractured finger.

The operation was completed successfully by the attending assistant doctor.

Now, the Doctor Anonymous blog has just received the exclusive footage of this altercation from Belgrade, Serbia. The video is pretty grainy. I guess it's from a security camera in the operating room. What's a security camera doing there? Who knows?

But, because I'll do anything for all of my readers, and I'll do just about anything for ratings, here is the Doctor Anonymous exclusive footage of the fighting video. Enjoy!

Ash Wednesday

With this being the first day of lent, this day already has a type of reflective flavor. But, for me, it's an especially reflective day. I remember it like it was yesterday.

It was the day that the above movie opened, and it was on Ash Wednesday. I was looking forward to seeing The Passion, and then, that afternoon, I received a letter. It was a letter from an attorney. It was a letter requesting medical records regarding a case that I was involved with 12 months prior.

It was a letter which sometimes starts the process which ends up in a court room. The accusation? Malpractice... Beginning that day, I could not sleep for months as that case went through my head again and again. I learned more about the legal system than I ever wanted to know.

Of course, I cannot talk about the particulars because of patient privacy laws. But, suffice to say that this day changed my professional and personal life forever. So, that's why Ash Wednesday is especially reflective for me....