You ain’t from here

Dr. Victor Sierpina

Dr. Victor Sierpina

Today, I finally met and had a nice conversation with ole John Dundee, whose father’s family has been in Galveston since long before the Storm. Not Ike, the 1900 one. Oh, that big one. It is fascinating what draws people to a place and how some just settle in for generations while others move on to happier hunting grounds.

Galveston seems to be a magnet for both the lifers and the gypsies and we are all richer for it. My talk with John and his mom, who is a relative newbie to the Island, only having lived here since 1942, reminded me of Cecil, a 93-year-old patient I took care of in Colorado.Sometime in the 1930s, during the Great Depression, Cecil and his family were traversing the U.S. looking for a better life. Their Model T pickup broke down in the high country San Luis Valley of Colorado. Their only possessions were a bag of potatoes and a bag of beans, so they decided to light there and became contributing members of the community, teachers, farmers, small business owners, and so on. Continue reading

Ebola — you won’t get it from shaking hands

Dr. Victor Sierpina

Dr. Victor Sierpina

A strange thing happened to me last Monday when I went to the clinic.

With the report of a man in Texas with Ebola who had been discharged from a Dallas hospital, then readmitted very sick a couple days later, I realized that any patient I came in contact with that day, or any day, might have this deadly virus.

Now we don’t usually think of work in health care as inherently a hazardous profession — say like being a soldier, firefighter or policeman. Yet it has actually always been so. From doctors and nurses who cared for patients with leprosy and bubonic plague in medieval times to those caring for the Ebola epidemic in Africa today, our colleagues in white coats put their lives on the line caring for those who have no other recourse for help.

Emergency workers, ambulance crews, and paramedics are often called into dangerous settings after shootings, bombings, and other catastrophes where the sites are not always secure or safe. They transport people with unknown diseases and unknown risk.

Of course, we have developed methods of reducing risk. Part of annual training at UTMB for all clinical staff includes reviewing universal precautions, which include several levels of infectious disease control. These range from basic hand washing and use of rubber globes to advanced personal protective equipment, including specialized gowns, masks, and in some cases like the Galveston National Laboratory, even hazmat type suits and respirators. Continue reading

Single change in one letter makes you a natural blond

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Out of the 3 billion letters contained in the human genetic code, all it takes to be born a blond is a single change in a certain place from an A to a G.

With the sheer complexity of the human genome, this new discovery shows how remarkably simple it is to be a natural blond. Especially when you consider the lengths people go to become one artificially.

This discovery actually came from research on the evolution of Sticklebacks, small fish that emerged from the oceans and colonized streams, rivers and lakes at the end of the last Ice Age.

Scientists at Stanford University have been studying how Sticklebacks have adapted to different habitats around the world, and particularly how different populations acquired their skin colors.

They discovered that changes in a single gene determined the pigmentation of fish throughout the world. The gene responsible, the Kit ligand gene, is also in the human genome. Different versions of it have evolved around the world and are associated with differences in skin color. Continue reading

Low-power laser treatment works on molecular level for cavities

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

For all those who cringe at the thought of going to the dentist or hearing the word cavity, there is hope.

Apparently, when low-power laser light is focused onto damaged teeth, it stimulates the regrowth of dentin to correct the damage.

The laser light stimulates the stem cells that already are in teeth to differentiate and repair damage from within, so that someday dentists can repair or even regrow teeth without fillings.

Teeth consist of four different tissues; three of these — enamel, dentin and cement — are harder than bone, while one — dental pulp — is soft. Enamel, the hardest material in the body, is the outer surface of the crown of a tooth.

Once enamel has completely formed it cannot be repaired, but it can remineralize. It allows teeth to withstand large amounts of stress, pressure and temperature differences.

Dentin lies beneath enamel and forms the main portion of a tooth through numerous microscopic channels called dentin tubules. Continue reading

New evidence suggests long-term relationships with bacteria begins before we’re born

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

While we know for sure that the microbiome of bacteria living in and on us are key to our own well-being, more evidence suggests that we acquire our microbiomes before we’re even born.

While a baby does acquire bacterial flora from its mother as it moves through the birth canal, scientists now think that our symbiotic, lifelong relationships with bacteria begin in utero long before birth.

They found bacteria living in the placenta, an organ previously thought to be sterile.

They also discovered a baby’s bacteria to be similar to the bacterial flora of the mother’s mouth, making oral hygiene during pregnancy extra important.

An experiment in 2008 by Spanish scientists indicated that bacteria are acquired in some way before birth.

They inoculated pregnant mice with labeled bacteria, which were then found in the meconium, the first bowel movement after birth.


 

This was true even when the babies had been delivered by C-section. So scientists knew then that bacteria are acquired before birth and even without the birth canal, changing what we thought we knew about the womb.

Since then, scientists at Baylor College of Medicine have been studying the inside of the womb and birth canal in both humans and animals.

They discovered that the vaginal microbiome changed during pregnancy, but it did not resemble that of newborns. So where did they get their bacteria from?

Baylor scientists then examined placentas from 320 women immediately after birth. Using DNA sequencing, they identified the individual types of bacteria each placenta contained.

Comparing them to bacteria growing in and on the mothers, they found that the types of bacteria living in the mothers’ mouths most closely resembled those in their own placentas.

Interestingly, the bacteria in the placenta consisted of high proportions of bacteria responsible for synthesizing vitamins and other nutrients, which probably benefits a developing fetus and newborn.

So a fetus is first exposed to bacteria from the placenta, then at birth additional bacteria are introduced, and then again when babies are exposed bacteria on their parent’s skin, in breast milk and in their environment.

Other studies have shown the influence of the microbiome on a mother and her baby. In one experiment, monkeys who ate a high-fat diet while pregnant and lactating produced babies with different proportions of bacteria in their guts than those of monkeys fed a normal diet.

The short- and long-term consequences of abnormal maternal and infant microbiomes are not yet known, but it’s speculated that these changes could influence the metabolism of the infant and the development of metabolic disorders.

Science is increasingly aware of the role and importance the microbiome has in various parts of the body and the part it plays in human health and disease.

Professors Norbert Herzog and David Niesel are biomedical scientists at the University of Texas Medical Branch. Learn more at medicaldiscoverynews.com.

New DEA rules on pain killers are coming soon

Dr. Victor Sierpina

Dr. Victor Sierpina

The US Drug Enforcement Agency, after lengthy debate and public input, has implemented a rescheduling of the most widely prescribed group of drugs in the U.S., the hydrocodone-acetaminophen combinations. These are drugs with brand names of Vicodin, Norco and Lortabs.

There are 135 million prescriptions annually for these hydrocodone combination products (HCPs), much more than for the next most common prescriptions for thyroid, blood pressure, and cholesterol lowering drugs.

Some time ago, government rules reduced the total acetaminophen (trade name Tylenol) content to 325 mg a day per pill as greater than 4,000 mg daily in combination with hydrocodone was placing patients at risk for liver damage.

Those addicted to these meds might have been taking 10, 20 or 30 pills a day, way exceeding the safe amount of acetaminophen the liver can handle.

Now, this HCP group of drugs is moving from a Schedule 3 to a Schedule 2 class, entering the same category as morphine, Dilaudid, oxycodone, Percocet, Demerol, Fentanyl and other powerful and highly addictive pain medicines. Continue reading

There’s hope for sickle cell

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

While sickle cell disease has long been studied, a recent discovery revealed that the disease significantly increases the levels of a molecule called sphingosine-1-phosphate, or S1P, which is generated by an enzyme called sphingosine kinase 1.

Inhibiting this SphK1 enzyme was found to reduce the severity of sickle cell disease in mice, which will hopefully lead to new drugs that target SphK1 in order to treat sickle cell disease in humans.

Sickle cell disease is caused by a change in the gene that is responsible for a type of hemoglobin, the protein molecule in red blood cells that carries oxygen. This tiny change results in hemoglobin clumping together, changing the shape of red blood cells.

The name for sickle cell disease actually comes from misshapen red blood cells. Rather than being shaped like a disk, or a doughnut without a whole, sickle cells are shaped like a crescent, sort of bending over on themselves in a process called sickling. Continue reading

7 steps to improving empathy

Dr. Victor Sierpina

Dr. Victor Sierpina

Last week, we discussed the topic of empathy, how it is different from compassion and how essential empathy is to human relationships.

This matters not only in health care but in families, in business, in friendships.

Based on research from Harvard’s teaching hospital by Dr. Helen Riess and her research coordinator, Gordon Draft-Todd, the following is a an acronym published in the journal Academic Medicine, August 2014. I hope you find it helpful.

The E.M.P.A.T.H.Y. approach to better communication and connection:

E. Eye Contact. This is so essential to connection and engagement, and even the neurobiology of relation, that we need to attend to it. Be aware that some cultures find prolonged eye contact intrusive, seductive or even rude. As a physician, it seems harder to maintain good eye contact throughout an encounter because of the ever-present electronic record which requires us to document, review results, write orders, refills, write work or jury excuses, etc. Early, late, and as often as possible, eye contact is what I recommend to my students and colleagues despite the intrusion of the electronic environment and a busy clinic schedule with short office visits. Also, I recommend patients shut off their phones during visits as the precious time we have can be interrupted by frequent calls and texts. Continue reading

Domestic violence is not just an NFL problem

Dr. Jeff Temple

Dr. Jeff Temple

After an initially weak response by the NFL and victim-blaming by the Baltimore Ravens, pro football player Ray Rice was finally dropped from his team for knocking his wife (then fiancée) unconscious. It has been more than 100 days since the incident, and he was cut loose by his team only after a video clearly showed him knocking her out.

The video of Rice dragging his victim’s body out of the elevator wasn’t enough to warrant this punishment. Apparently, NFL officials needed to see the punch. Some, including Rice, argued that he acted in defense. The Ravens tweeted, “Janay Rice says she deeply regrets the role that she played the night of the incident.”

Sound familiar? That’s because women in abusive relationships have heard this all before

“Why did you marry him?”; “Why do you stay?”; “What did you do to make him so angry?”

And rarely do women in violent relationships have a video to document what happened to them.

While violence perpetrated by pro athletes may demand disproportionate attention, we must be careful not to forget that domestic violence is a very real problem that affects our sisters, daughters, mothers, colleagues and neighbors. Continue reading

Agavin offers more choices to those watching caloric, sugar intake

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Next time you have a bitter pill to swallow, think about reaching for a spoonful of agavin instead of sugar to help the medicine go down.

You might not know what agavin is yet, but you’ve probably noticed that a number of alternative natural sweeteners like Stevia have been added to grocery store shelves next to traditional sugar.

These products sweeten foods but often do not add calories or raise blood sugar levels. Recent research suggests that a sweetener made from agave, the same plant used to make tequila, may lower blood sugar levels and help people maintain a healthy weight.

Agavin is a natural form of sugar, fructose, called fructan. With fructan, individual sugar molecules are linked together in long chains.

The human body cannot use this form of fructose so it is a non-digestible dietary fiber that does not contribute to blood sugar levels. But it can still add sweetness to foods and drinks. Continue reading