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

Tips to help families improve fitness, eating habits

Drs. Sally Robinson & Keith Bly

Drs. Sally Robinson & Keith Bly

In the last two to three decades, the number of overweight children has doubled. Almost one child in five is considered overweight. Obesity can lead to risk factors for heart disease, such as high cholesterol and high blood pressure, sleep apnea, orthopedic problems, liver disease, asthma, as well as low self-esteem and depression. The likely cause of the increase in the amount of overweight children is more than likely the same reason that adult obesity is on the rise: overeating and lack of physical activity.

Because of these findings new guidelines have been developed by the Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents appointed by the National Health, Lung and Blood Institute and endorsed by the American Academy of Pediatrics. The recommendations are regardless of family history all children between the age of 9 and 11 years undergo lipid screening for nonfasting non-HDH-cholesterol levels or a fasting lipid panel. This is to be repeated with another full lipid screen between 18 and 21 years of age. It is unclear in children what the treatment should be when an elevated LDL-cholesterol is found. However there is strong evidence that healthy eating and increased activity is associated with a healthy heart.

The following are a few suggestions to help your family start a program to improve eating habits and increase physical activity. 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

Grasping heart health through sound

Dr. Victor Sierpina

Dr. Victor Sierpina

The stethoscope is maybe one of the most iconic items in medicine and health care. Draped around the neck or tucked into a white coat, this instrument symbolizes the knowledge and authority to heal of those wearing it. Invented less than 200 years ago by a French doctor, Rene Laënnec, it was initially a simple tube of paper. Laënnec found the previous method of applying his ear to the chest, especially that of a buxom lass, a bit uncomfortable for both of them. He solved the problem by rolling up a tube of paper to listen to her heart. He was pleased with the improved sound transmission and eventually went on to use a wooden tube, much like the old ear trumpets in order to hear the sounds of the heart.

Of course, the stethoscope has gone through many upgrades and improvements and is now bi-aural instead of mono-aural, fitting into two ears instead of one. The latex tubing and a specially designed diaphragm at the end allow physicians, nurses, EMT’s and others to listen to the various sounds the heart makes, including murmurs, as well as breath sounds, bowel sounds, and the sounds of blood in the vessels. It can also note the crunch of a broken rib, the wheezing of asthma, the rattle of heart failure, the harsh sounds of pneumonia, the size of an organ, fluid levels and can even be used as a reflex hammer if one isn’t available. It is a highly useful medical device but its days may be numbered as illustrated by the following story. Continue reading

Set healthy goals for children in 2015

Drs. Sally Robinson & Keith Bly

Drs. Sally Robinson & Keith Bly

Now that the magic of Christmas is complete, there’s a new year to look forward to. It’s a new beginning. We can all wipe the slate clean and start over once again!

Your children can be part of that optimistic time of year when we swear off the chocolate, vow to drink more water, and sign up for the gym in droves. And, while as adults, we saddle ourselves with major pressure, the goals you and your child can set are much more manageable.

The goals for your child are totally attainable. For example, (this is the part where you grab your child, curl up on the couch with this column, and have them repeat after you):

1. I will clean up my toys
2. I will brush my teeth at least twice a day
3. I will wash my hands after going to the bathroom and before eating
4. I will share with my sisters, brothers, and friends Continue reading

The spirit of Christmas giving all year long

Dr. Victor Sierpina

Dr. Victor Sierpina

“Find a need and fill it” is a wise saying by a minister I have long admired.

This is definitely the guiding light of the Luke Society that has been filing needs in Galveston for over 30 years for the underserved, homeless, and social outcasts, many with mental health disorders.

Since 1995, they have, under the leadership of internist Dr. Fritz Zaunbrecher, held a street medical ministry to serve those who have little or no other option for health care.

Dispensing supplies of blood pressure medications, antibiotics, asthma inhalers and more to over a hundred people weekly is a major effort and expense. The Moody Methodist Foundation generously supports some of their expenses for medications and supplies. Even local high school students interested in health care contribute time and efforts.

These potentially lifesaving medications have no doubt kept many of the street people out of the emergency room with strokes, heart problems, asthma attacks, systemic infections and more. This is not only a wonderful ministry of health for those served but reduces the unreimbursed costs of care to UTMB and other county emergency facilities for conditions that might have been dealt with earlier, in a less acute stage. Continue reading

Why don’t we bite our tongues?

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Why don’t we normally bite our tongues when we eat? A recent study found that two types of cells in brain, the premotor neurons and motoneurons, work together to coordinate the movements of the jaw and tongue, so that you do not usually bite your own tongue.

We can control chewing consciously, but otherwise it works automatically. Coordination of jaw and tongue muscles during eating is one of the most intricate mechanisms of the motor system in animals and humans. The coordination concerns both the timing and the sequence of muscle activation, in order to achieve the smooth and effective motions required when eating.

Three basic systems must be coordinated when eating. First, activity of the left and right jaw muscles must be symmetrical. Second, the tongue must be coordinated to position food between the teeth while the jaw moves the teeth to break down the food during chewing. Finally, jaw opening and tongue protrusion must be coordinated with jaw closing and tongue retraction to prevent the tongue from getting in between rows of sharp teeth.

Muscles in the jaw and tongue are controlled by brain cells called motoneurons, and those are then controlled by premotor neurons. The previously unsolved mystery was exactly which premotor neurons connect to which motoneurons, which then control muscles. To find the answer, scientists engineered a rabies virus to map the signals that control chewing. The bullet-shaped rabies virus was useful for this study because it infects muscle cells and peripheral neurons and moves rapidly up the nerves to the central nervous system, where it replicates in the brain. Continue reading

Are you ready for participatory medicine?

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

Imagine if public use of social media influenced health care in the United States. The result would be medical care that’s more patient-centric and data-driven.

Luckily, we don’t have to wait for these two platforms to converge because it’s already on the horizon. Called participatory medicine, it’s based on four components termed P4: preventive, predictive, personalized and participatory. This focuses on the patient, not just as a recipient of care, but as an active and contributing part of maintaining health and diagnosing, and treating disease.

Think of participatory medicine as a team sport that includes a patient, patient groups, specialized social networks, the entire care team and clinical researchers. All team members have access to the patient’s data and participate equally in making decisions. Continue reading

Rainforest is a reservoir for new medicines

Dr. Tristi Muir

Dr. Tristi Muir

Our Bodies, Our Lives

On a recent trip to Brazil, I immersed myself in an exploration of the richly diverse Amazonian rain forest. I was awed to learn that so many of the plants that filled this paradise have been used throughout human history to make medicines, poisons, hallucinogens, rubber, building materials and so much more.

While it makes sense that native people use the plants to support their lives, it is astonishing to learn that approximately 70 percent of the new drugs introduced in our country in the past 25 years are derived from nature. Despite the expanding sophistication of bioengineering, Mother Nature retains the crown as the world’s greatest drug engineer.

The indigenous healers in the Northwest Amazon have used more than1,300 species of plants for medicinal purposes. Today, pharmacologists and ethnobotanists work with native shamans to identify potential drugs for further development. Continue reading

Always tired? Here are 5 things to check

Dr. Victor Sierpina

Dr. Victor Sierpina

“Doc, I just feel tired all the time.”

This is the kind of vague complaint, along with dizziness, that challenges every physician. Such patients often show up on a Friday afternoon or mention the fatigue at the end of a visit for other matters. The issue is so common, yet complex, that up to 40 percent of those suffering from chronic fatigue may never receive a specific diagnosis.

Our medical students are trained to make sure a fatigue complaint isn’t caused by anemia or low thyroid. While these certainly can be a factor, it is rare to find the answer to chronic fatigue with a simple blood test.

Many medical conditions can cause fatigue. Loss of organ reserve in vital organs such as the heart, lungs, liver, adrenal glands, and kidney can all lead to fatigue. Chronic infections, cancer, chronic pain, poorly controlled diabetes, obesity, and sleep apnea make up a partial list of well over a hundred identifiable medical causes for fatigue. Continue reading