Have to … choose to … get to …

Dr. Victor Sierpina

Dr. Victor Sierpina

Do you ever feel overwhelmed with life? So many things simply need doing and you have not enough time to do them.

You might feel like a victim of one more demands on your time and energy.

Try this simple gratitude exercise from the Naikan book mentioned last week. Medical students in UTMB’s Physician Healer track were assigned to create a list of routine daily activities and apply the following to them:

1. I have to …

2. I choose to …

3. I get to …

Such a process helped remove a sense of helplessness, victimhood, or the burdensomeness of daily activities. Once we realize we choose or even get to do the things we do, our whole attitude shifts.

Here are some examples of this process from a student journal: Continue reading

Medieval antibiotic

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Almost every week there is another report about the catastrophe of drug-resistant bacteria, and very few new antibiotics have been developed to treat people who have been infected. But a possible solution to this modern-day problem has been discovered in a 1,000-year-old source: an eye salve, as recorded in a ninth-century text, has effectively killed methicillin-resistant Staphylococcus aureus, or MRSA.

One of the oldest known medical texts, “Bald’s Leechbook” contains instructions for various medicines and treatments. One is a remedy for sty, an infection of the eyelash follicles that is usually caused by the bacterium Staphylococcus aureus. Christina Lee, an expert in the Anglo-Saxon language at the University of Nottingham, translated the instructions for making the eye salve and collaborated with the university’s Centre for Biomolecular Sciences to test its effects on MRSA. The recipe is simple: equal parts of minced garlic and onion or leek are crushed in a mortar for two minutes, then mixed into 25 milliliters of wine from a historic English vineyard. To that, cow bile salts dissolved in distilled water were added, and then the mixture was aged in a brass vessel for nine days at refrigerator temperature. Finally, it was filtered through a cloth to clear it and put into a horn. The instructions said to apply the salve to the eye with a feather. Continue reading

Naikan: Gratitude, grace and the art of self-reflection

Dr. Victor Sierpina

Dr. Victor Sierpina

Gratitude opens untold blessings in our lives. The cultivation of gratitude requires constant discipline in an era often surrounded by a mentality of lack, of ever needing more material goods to believe we can be happy, or when we blame others for not meeting our expectations to make our lives better.

A technique that UTMB students and faculty practice as part of the Physician Healer Track comes from Naikan, a book, by Gregg Krech. You might recall my description that the aim of the healer track is to preserve empathy in physicians in training.

A week after my empathy piece, Time magazine ran a feature article on physician burnout, depression, and suicide. It described a program called The Healer’s Art that is being offered at Stanford University to residents to deter these negative spirals into dysfunction. This long-standing program, developed by holistic physician Dr. Rachel Naomi Remen offers reflection, insight, healing, and opportunities for including gratitude in medical education. It offers many similar skills and practices as does the healer track. Continue reading

Snake bite defense: The Opossum

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

If you live in a rural area, you’ve probably had to deal with snakes. Almost 500,000 people are bitten by snakes and more than 20,000 die from them worldwide each year, although the World Health Organization notes these figures may be closer to 1.8 million incidents and 94,000 deaths. Opossums, on the other hand, never have to worry about that since they are resistant to snake venom. Opossums have a protein in their blood that binds to the toxins in snake venom and neutralizes them. Now scientists are looking into whether this protein could be used to treat human victims of snake bites.

Venomous snakes generally have different combinations of toxins: cytotoxins that kill cells, neurotoxins that affect the nervous system, cardiotoxins that act on the heart, hemotoxins that influence the blood and mycotoxins that are toxic to muscle. Venomous snake bites can cause paralysis that prevents breathing and can cause fatal hemorrhages, irreversible kidney damage and destruction of tissue in and around the bite site, which can lead to amputation. Continue reading

Planting trees whose fruit we will never eat

Dr. Victor Sierpina

Dr. Victor Sierpina

The week before last, I made a house call to Robert, a patient on hospice. He was listless, semi-comatose, with pinpoint pupils from the morphine, and yellow as a gourd from cancer-related liver failure. His devoted wife, along with friends, family, and the hospice care team were keeping him as comfortable as possible as he transitioned from life after a decadelong courageous battle with colon cancer.

Even after spending some time with him talking, examining, reading, praying, I wasn’t quite sure he could hear or understand me. At that point, I started to feel like I had done what I could for him. Now I was there for his family.

This was a special man who had fought his hardest, had created a cancer survivor support group, and who was dying at a prematurely young age. He kept going to his work as a scientist at a local university up until about 2 weeks before his death. Yes, he could only last a few hours at the lab, but his study of sargassum seaweed was his passion and gave his life meaning and purpose until the end. He also played a huge role in the education of the students he mentored. Like his love of planting fruit-bearing trees, he planted seeds of scholarly inquiry, motivated them, and challenged them to achieve more. Continue reading

Drug in clinical trials could help Alzheimer’s

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

More than 5 million Americans are currently living with Alzheimer’s disease, the sixth leading cause of death. Unfortunately, a comprehensive review found that four Alzheimer’s drugs had short-term benefits that are lost after a year and a half of treatment. However, there is some hope in a new drug called aducanumab, which sharply reduced cognitive decline in patients with early symptoms of dementia in a small clinical trial.

Dementia is a neurological condition with a broad range of symptoms that interfere with a person’s ability to perform daily functions. It is diagnosed when there are significant impairments in memory, communication, language, judgment, reasoning, visual perception and the ability to focus or pay attention. It is usually progressive, so patients steadily lose their cognitive abilities and require increasing levels of care. Patients diagnosed with Alzheimer’s, which accounts for about 60-80 percent of dementias, live an average of eight to 10 years after their symptoms begin. Continue reading

Beneficial mutations as sources of new treatment

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

The word mutation doesn’t have the best reputation — most people think of the army of mutants featured in X-Men and other science fiction. There is some basis for the uniformly negative connotation: genetic mutations cause cancer, mutations in bacteria cause antibiotic resistance and many human diseases like cystic fibrosis and sickle cell anemia are the result of mutations in just a single gene. But that doesn’t mean mutations can’t be good for us too.

A mutation is a change in your DNA sequence, altering your genetic code. We are all born with some genetic mutations, which we inherit from our parents. We also acquire genetic mutations from our lifestyles. For example, exposure to UV or other types of radiation can cause changes in your DNA. Some mutations even occur as mistakes during the normal duplication of your DNA as cells divide. Since we have two copies of each of our genes, we can often tolerate one bad or mutated gene — most genetic diseases require two bad copies of the gene to cause symptoms. Continue reading

Healing stories

Dr. Victor Sierpina

Dr. Victor Sierpina

Stories can heal both speaker and listener. Last week, I attended an incredible event at UTMB’s Osher Lifelong Learning Institute in which a roomful of burn survivors met with OLLI lifestory writers who had volunteered to write down the survivors’ stories.

The stories will be collected in a book to describe the survivors’ grief, despair, shame and pain as well as their courage, love, social support, faith and the perseverance that pulled them through. These stories will chronicle the suffering, incredible challenges and how people not only survived, but thrived in their lives after serious burns. The finished anthology will be shared with every Blocker Burn Unit patient new to the trauma of being burned and to whom hearing others’ stories can bring hope.

Conceived by UTMB’s Family Medicine social worker, Amy Barrera-Kovach, who formerly spent 17 years working in the Blocker Burn Unit, it is a joint effort with OLLI at UTMB — Health. It has been funded as a two-year project by UTMB’s President’s Cabinet: “Burn Survivors’ Journeys: Real Stories of Challenges, Strength, and Triumph.” Continue reading

No evidence homeopathy works

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Many families rely on homeopathy, an alternative or complementary form of health care. Until now, there has been little scientific data to support or debunk their use. However, the Australian National Health and Medical Research Council reviewed scientific evidence of the use of homeopathy in treating a variety of clinical conditions, and concluded that there is no reliable evidence that homeopathy is effective.

While conventional medicine is now commonly accepted, complementary and alternative medicines (CAM) have persisted throughout history. Homeopathy is the oldest form of CAM from Europe. It originated with the German physician Samuel Hahnemann, who lived from 1755-1843. He stumbled upon the cinchona, the bark of a South American tree that was used by the indigenous people to treat fevers. Among the active ingredients in the bark is quinine, which is still used to treat malaria. If a healthy person took cinchona, it mimicked malaria with mild, intermittent fevers not associated with any pathology. In 1796 and 1810, Hahnemann published essays on the two theories of homeopathy: substances that cause illnesses or symptoms in people can be used in small doses as treatment, and molecules in a solution can be highly diluted and the solution will retain a “memory” of that molecule. Supporters of homeopathy viewed it as a safe, patient-centered system that was simple and easy to understand. Hahnemann claimed he could cure any and all illnesses using homeopathic principles. Continue reading

The doctor healer track at UTMB

Dr. Victor Sierpina

Dr. Victor Sierpina

Today, I describe an antidote to loss of empathy during medical school, an all too common casualty of medical education. One study showed that up to 70 percent of graduating medical students entering internship met clinical criteria for “burn out.” This results in depersonalization, loss of human connection, and decreases in motivation, compassion, and empathy. It is a catastrophic, unhealthy cascade.

Medical educators strive to prevent such a negative outcome while still being charged with producing highly skilled, qualified, and competent medical graduates.

One approach that is now in its third year of trial at UTMB is the Physician Healer Track. Early student feedback shows it is effective in improving their professional skills and personal lives on multiple levels.

The Physician Healer Track was conceived and developed by UTMB School of Medicine faculty Drs. Cara Geary, Julie McKee, Susie Gerik, Era Buck, and Lee Grumbles. The course is supported by the efforts of a couple dozen other dedicated volunteer physician educators. The focus is to take students starting in year one of medical school into intimate and highly personal experiences that improve empathy, stress resilience, self-compassion, mindfulness, self-awareness, and improved communication skills. Continue reading