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

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

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

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

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

Enjoy veggies in a nice smoothie

Dr. Victor Sierpina

Dr. Victor Sierpina

When a recent freezing cold front blew in, I decided to get out and harvest my winter garden.

Besides mustard greens, lettuce, herbs, and Swiss chard, I had some beautiful lancinate blue-green kale. Well, right away I made a nice kale salad, described in another article on this website. However, the gift of a fresh turmeric root from my chief resident inspired me to use some of the kale to make a smoothie.

I had seen these before and even tasted a kale or spinach smoothie a time or two. It turns out to be a great way to start your day and getting on your way to getting the recommended five to 10 servings of fruits and vegetables (shoot for 30 percent fruits, 70 percent vegetables) we ought consume daily for optimal health. Continue reading

Zzzzz on snoring

Dr. Victor Sierpina

Dr. Victor Sierpina

Do you snore or know somebody who does?

Snoring is usually a benign process caused by vibration of tissue in the back of the throat. While it can be associated with serious problems like obstructive sleep apnea that require medical or surgical intervention, most of the time the causes are more straightforward.

Chances are if you snore, you might not even be aware of it unless you have a bed partner, roommate or grandchild that you are keeping up and who can tell you.

I did see a recent app for those who live alone that can record your snoring patterns and help identify if you have a problem. If you have a lot of daytime drowsiness and don’t seem to get restful sleep, it might be worth checking out.

I saw a TV commercial for a removable mouth device that reduces snoring. In this ad, a hapless guy is kicked out of bed by his wife who is suffering from lack of sleep due to his loud snoring. He is sad faced and gets to sleep on the couch until he gets the mouthpiece. Ouch! After that, of course all is well again. This kind of mouthpiece sometimes works and has the benefit of being inexpensive and safe. Continue reading

The cough that won’t go away

Dr. Victor Sierpina

Dr. Victor Sierpina

Still coughing? A few days ago I was swapping home remedies with a lively Italian grandmother on how coughs were treated in our families. Her favorite was a mix of honey, lemon juice and a splash of bourbon.

During a recent hospitalization for a bronchial infection, her cough was unremitting so she asked the nurses for her favorite cough syrup. Our professional and patient-centered nurses agreed to bring the honey and the lemon juice. The rest of the recipe would be fine if someone brought it in and they just didn’t know about it. Wink, wink!

Well, she was in the office a couple weeks later and though a powerful opiate laced cough syrup helped, she still was up at night and fatigued from a persistent cough.

I recommended the lemon-honey-whiskey mixture at bedtime along with an expectorant and an inhaler. We got along well, I think, and I expect she and her cough will improve. Continue reading

Beat deafness extremely rare, but actually exists

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Have you ever noticed when someone in the audience can’t clap along with a beat at a concert? Well, it turns out that beat deafness actually exists. The first case was documented nearly five years ago, identified in a 26-year-old man who could not follow the beat at all when listening to music. Chances are, you don’t have it, though. Beat deafness is a form of a musical brain disorder that is extremely rare. Sometimes audience members get so off beat that performers stop in an effort to get back on track. That in part inspired a group of neuroscientists in Montreal to look for people who felt they had no sense of the beat. After screening dozens of people, only one, Mathieu, was found to have true beat deafness.

Mathieu loves music, studies guitar and once had a job as an amusement park mascot that involved dancing, which by his own admission did not go so well. “I just can’t figure out what’s rhythm, in fact,” Mathieu said. “I just can’t hear it, or I just can’t feel it.” However, he can follow the beat if he watches someone else. He could also follow the beat of a metronome, indicating that he did not have a movement disorder. In one test, Mathieu was asked to bounce or bend his knees to the beat of different kinds of music while holding a Wii controller that logged his movements. His results were compared to normal people who could identify the beat. After being tested with merengue, pop, rock, belly dancing and techno music, he was only able to follow the distinct and obvious beats of techno music. Continue reading