The wisdom of Sir William Osler MD

Dr. Victor Sierpina

Dr. Victor Sierpina

Sir William Osler was one of the founding fathers of modern medical education. His life and work is a role model for every physician. Though he humbly admitted that he started in life “with just an ordinary stock of brains,” his lifelong discipline and system of study and research made him one of the finest physicians of his time and of all times.

In addition to deep knowledge of the subject of medicine allowing him to write the first comprehensive textbook of internal medicine, he was a gifted and innovative teacher. He personally performed over a thousand autopsies, barehanded as they did in those days, to deepen current knowledge of the pathology and physiology of disease. While at Johns Hopkins Medical School, he helped found the structure of contemporary medical education that has endured for nearly a century after his death. He prompted students to develop a consistent system of regular study to digest usable amounts of knowledge and likened cramming before examinations to trying to eat more than you can absorb.

In addition to his astute clinical, observational, and diagnostic reasoning skills, he emphasized the humanistic side of medicine. He taught students that the core of empathy with the patient is, “putting yourself in his place” and attempting to enter the mental space of the patient while offering “a kindly word, a cheerful greeting, the sympathetic look.”

He sometimes shocked contemporaries by his casual, playful nature and was well known for his affection for children with whom he was known to get down on the floor and play. He honored and trusted his medical students and gave them a key to his home so they could browse his extensive library. That would be like giving someone your email password these days. Continue reading

Magic of the neti pot

Dr. Victor Sierpina

Dr. Victor Sierpina

I want to tell you about the Aladdin’s lamp of nasal health, the neti pot. Shaped like a little lamp or teapot, it is a simple and perfectly designed way of delivering salt water into irritated nasal passages. You put a 1/2 teaspoon of salt, more or less, in the neti pot, dissolve it with warm, clean water, then with your head over the sink and turned to the side, simply pour the solution into each nostril. This flushes out mucus, debris, pollen, and inflammatory cells and molecules.

The sinuses are like little side closets off the nasal passages, with tiny openings called ostia.This little door into a bigger room can easily be blocked by inflammation, swelling and infection. The nasal saline wash can help open these portals and facilitate drainage from the sinuses. A buildup in the sinus of mucus, fluid, and pus can lead to the excruciating pain and facial pressure of sinusitis. While antibiotics can occasionally be useful in this condition, establishing drainage is a first principle. Continue reading

One clue to the sole HIV ‘cured’ patient

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Millions of people around the world are infected with HIV, the virus that causes AIDS, but only one has ever been cured. Known as the “Berlin Patient,” Timothy Ray Brown is a 48-year-old American living in Germany. Scientists and physicians have wondered how he was cured, and some recently published studies in monkeys have provided one clue.

Brown had been HIV positive since 1995. When HIV infects the body’s cells, it integrates its genetic information into cells, making the virus a permanent part of the host’s genetic information. Brown’s HIV was held at bay by antiretroviral drugs that have made this infection survivable. However, in 2006 he was diagnosed with acute myeloid leukemia (AML), a cancer unrelated to HIV. AML affects a group of blood cells in bone marrow called the myeloid cells. Brown underwent grueling chemotherapy that failed. In the hope of saving his life, he received two bone marrow transplants. The year of his first transplant, he stopped taking the antiretrovirals, which would normally cause a patient’s HIV levels to skyrocket.

Yet, years later, there is no sign of the virus returning. Only traces of HIV’s genetic material have been found in his blood, and those pieces are unable to replicate. The big question now is: how was this accomplished? Continue reading

FAST facts on dementia

Dr. Victor Sierpina

Dr. Victor Sierpina

Once upon a time, people didn’t live so long. Elders, if they survived into old age, were revered in society for their long term memories. They could tell the village or tribe when to plant and when to reap, when the buffalo would return or the salmon run, predict the cycle of the seasons, and anticipate a hard winter when extra wood must be cut and stored. In short, they served as kind of a living Farmer’s Almanac for their community. It was their long term memories, their recollections of history and tradition that were most valuable and helped the people survive and thrive. Short term memory didn’t matter as much then.

Times have changed. People are living longer. Society is faster and ever changing. These factors accentuate the problems with loss of function in the aging person. Perhaps no other condition is so feared in our minds as dementia, which includes Alzheimer’s and other types. It is estimated that over five million Americans over 65 suffer from Alzheimer’s and more than 60 percent are women. Short term memory is affected early and most severely though, while long term memory may be preserved a surprisingly long time.

Many age-related changes in memory and cognition can be entirely normal and benign. In my practice, patients often come in alone or with a loved one highly concerned about a sense of “slipping.” They can’t remember words, names, why they went into a room, find the keys and other minor inconveniences. They worry excessively that these occurrences are part of an inevitable slide into Alzheimer’s. Continue reading

Study links changes in DNA to C-section deliveries

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

In the climax of William Shakespeare’s “Macbeth,” the title character is sword fighting and believes himself invincible because he was given a prophecy that said “no man born of woman shall harm thee.” Yet, that is how he was tricked, for his rival, Macduff, was “from his mother’s womb untimely ripped.” This and other historical references show that cesarean sections have been used for centuries, but today the high success rate has made them more common than ever.

The origin of the term Caesarean is popularly and probably falsely attributed to the birth of Julius Caesar. This is unlikely, since C-sections at this time almost always resulted in the death of the mother, and historical records mention Caesar’s mother later in his life. However, the origin may still be linked to Caesar as a law enacted during Caesar’s reign stated that a dead or dying pregnant woman was to be cut open and the child removed from her womb to save the child. Widespread use of this procedure began after anesthetics and antimicrobial therapies became available in the 20th century.

In 1965, 4.5 percent of America’s babies were delivered via C-section. Today that figure has risen to almost one in three, and is on the rise worldwide as well. There are plenty of medical and nonmedical reasons for this shift from vaginal childbirth. Both come with side effects and consequences, some lasting longer than others. For example, C-sections have been linked to increased rates of diabetes and obesity, although we’re not sure why. In a recent study, birth by C-section lead to epigenetic changes in the child’s DNA. Continue reading

Hand washing: A key to good health

Dr. Victor Sierpina

Dr. Victor Sierpina

‘Out, damned spot. Out, I say!” Thus, spake Lady MacBeth in the fifth act of the famous Shakespearean play. And she wasn’t chasing her dog named Spot out of the castle. This quote from Lady MacBeth came as she compulsively washed her hands, to cleanse them of the blood of someone she helped to murder. She would wash her hands repeatedly, up to a quarter of an hour at a time, only to mutter, “will these hands ne’er be clean?”

Hand washing has had somewhat of a bad rap over the centuries. Pontius Pilate famously cleansed his hands in a bowl of water, to absolve himself of his role in Jesus’ condemnation and death. Some religious persuasions won’t eat with the same hand they use for their bathroom hygiene. Perhaps historic experience with infectious diarrhea and maybe lack of sanitary facilities, and clean water, for hand washing in dry areas, led to this practice.

Dr. Ignaz Semmelweis was hounded into insanity and poverty, and ultimately death in an asylum, when he introduced hand washing into the medical profession. He noted, correctly as it turned out, that childbed fever was killing many women who had just given birth. The hospital he worked at in Vienna had among the highest mortality rates anywhere. The delivering doctors often hurried over from the cadaver room where they were dissecting human remains and went with unwashed hands to the obstetric clinic or delivery room. Continue reading

Groups petition to ban baby walkers

Drs. Sally Robinson & Keith Bly

Drs. Sally Robinson & Keith Bly

The American Academy of Pediatrics, joined by other children’s advocacy groups, has petitioned the U.S. Consumer Product Safety Commission to prohibit the manufacture and sale of baby walkers.

This petition is the result of the large number of injuries to children caused by baby walkers.

While considering the recommendation of the AAP to ban walkers, the CPSC suggest the following safety precautions for parents who chose to purchase a walker. Continue reading

No-calorie soft drinks, weight and your gut bacteria

Dr. Victor Sierpina

Dr. Victor Sierpina

Do you know anyone who drinks a lot of diet sodas and just cannot seem to lose weight? It has been known for some time that these artificial, no-calorie sweeteners not only do not encourage weight loss but may actually promote weight gain and even diabetes by continuously stimulating our desire to taste sweetness. When they were invented by the food industry, these new-to-nature molecules promised to offer a positive option to sugar. They seemed to be a healthier alternative that promised to change our habits and health risks from drinking the high fructose, sugary soft drinks that have defined American billboard culture since the 1950s. However, there are issues.

Sweet foods, it turns out, activate a set of digestive processes, enzymes and hormones like insulin that promote weight gain and diabetes. No-calorie sweet drinks do the same. This is very different from the gut and endocrine response to more bitter or alkaline foods such as vegetables, grains, legumes and other plant-based foods. So despite no calories, these sweeteners have not been so helpful in weight loss as a substitute for the sugary soft drinks. They also are not helpful to diabetics for these same reasons. There is now another reason to suspect that there are other problems with these beverages. It turns out that no-calorie soft drinks change the profile of bacteria in our gut, part of the so-called microbiome. These bacteria, which may in aggregate weigh three to six pounds, constitute one of the largest “organs” in the body. They actually contain about 150 times as much DNA as our human genome. The key issue for our diet is that they are essential to the process of healthy digestion. Many foods, especially plant materials, cannot be adequately metabolized and absorbed without a healthy gut bacterial population. When artificial sweeteners alter this profile, our ability to utilize our food effectively is impaired. We still feel hungry. Continue reading

The irresistible rise of genomic medicine

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

It’s only been 150 years since scientists discovered what we now call DNA. Today, it’s a household word, the basis for the field genomics, and an integral part to multitudes of scientific studies. It’s remarkable how relatively quickly our understanding of genes has progressed.

DNA was first thought to represent the genetic material of living organisms in the 1940s. Doctors Francis Crick and James Watson revealed the double helix structure of DNA in 1953, which is widely considered to be the first revolution in modern biology. In 1977, we first decoded the entire genome of a living organism, a tiny virus that infects bacteria called ?X174. This was the first time we understood all the DNA required to produce a life-form. The term genomics was first coined in 1987 to describe the structure and functions of an organism’s entire genetic blueprint. In 1995, we determined the genome of a free-living organism, a bacterium called Haemophilus influenza, for the first time. The genome of a eukaryotic organism, Baker’s yeast, was first completed in 1996. These early studies provided the novel approaches and advanced technologies that were later used to sequence the human genome, which consists of 3 billion base pairs. The human genome project, the second revolution in modern biology, began in 1990, and was completed in 2003. Since then, the genomes of more than 4,000 other organisms, including the ancient human species Neanderthal and the coffee plant, have been completely determined. Continue reading

Find your inner peace

Dr. Victor Sierpina

Dr. Victor Sierpina

Chinese philosopher Lao Tsu once said, “Stillness and tranquillity set things in order in the Universe.”

The Danish sage Søren Kierkegaard likewise encouraged us to times of quietude: “Far from idleness being the root of all evil, it is rather the only true good.”

This is a remarkable attitude in our very busy, constantly moving world where activity, productivity and busyness are equated with our value as a human being. Is this really true?

Perhaps the things we busy ourselves with are not all that important, taking too much time and effort while accomplishing little or nothing in service of others or in helping us achieve our major life goals.

In my daily medical practice, I often encounter people who are busy, very busy. They attest to being too busy to exercise, to shop for and cook healthy meals at home, to attend to important relationships — and too busy, for sure, to center their minds by relaxation or meditation. In other words … too busy. Continue reading