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Ask Dr Rob: Mama Says Take Yer Vitamins

It's been a while, hasn't it?  Has the absence of "Ask Dr. Rob" posts left you feeling empty inside?  Has it made you feel incomplete?

Or has it been similar to the absence of leprosy?

Either way, I am back to answer the questions that you send me.  Our latest question comes from Sid, who asks the following question:

Dear Dr Rob:

I have such respect for your knowledge as a primary care physician, knowing so much more than those snooty specialists.  You are the smartest person I have ever met...except for my mom.

Speaking of mom, she used to always tell me to take my vitamins.  Was she right about this?

richThanks for the question, as well as the astute observations.  Vitamins are a hot topic that I feel don't get enough attention by the mainstream medical community.  This is probably because they are two busy getting the mud out of their shoes to think about much.  Just as to why they would be in the main stream (and not some tributary) has always mystified even me.  I usually stand in a tributary.  But I suppose you already figured out that I am not quite mainstream.

In answer to your question, Sid, I have to side with your mother on this one.  Vitamins are very important to make you be very strong and healthy, as well as giving you a firm butt and washboard abs (like me) - the guy in the picture kind of looks like Bill Gates, doesn't he?

So which vitamins are most important for you to be taking?  As my mom used to say, Just remember your ABC's.

Vitamin A -  Retinoic Acid

How something called "Retinoic Acid" got to be called "vitamin A" is a sordid tale of the highest scientific intrigue.  You would expect it to be called "Vitamin R," be named after some egotistical scientist (like "Vitamin Ralph"), or at least be called something cool (like "Mega Voltron"). But this did not happen, and the name "Vitamin A" was given this molecule.  This happened through a complex series of political and bureaucratic maneuvering (involving both the Kennedys and Clintons).

MittmanYou may have heard that vitamin A is important to maintain good eyesight.  My mom used to say that if I ate enough carrots I would not have night blindness.  Both of these are true, as it is used in the retina to turn photons into nerve impulses to the brain.  This happens in cells called "Rods" and "Cones."

The picture on the right is an actual picture of the rods and cones taken by a really little guy with a teeny-tiny camera.  I think the rods look more like burritos and the cones like Lava Lamps, but nobody asked me when they were naming them.

george400 It is worth noting that people who eat excess vitamin A can get an orange hue to their skin.  This may seem like a bad thing, causing them to be cruelly mocked and callously discriminated against, but they have the last laugh - as their eyesight is so keen that they actually develop x-ray vision. 

In very large amounts, Vitamin A is actually toxic.  Polar bear liver has such high levels of vitamin A in it that people who eat it actually die from it.  Just why people might be driven to eat polar bear liver is difficult to determine.  Clearly the spleen of the polar bear is far more tasty than the liver.

polar-bear-butler-3

B Vitamins

Once the die was cast and Retinoic Acid was named "Vitamin A," it only seemed a matter of time before some unlucky molecule was named "Vitamin B."  But fate would have it that eight molecules ended up as B vitamins! 

ap_howard_dean_f It seems that the B Vitamins are the Iowa Caucus of the Vitamin world.  Once the bid to be Vitamin B was opened up, multiple molecules threw their hat to become the next vitamin (as did Howard Dean, but he could not keep his temper in check).  The high-stakes scientific run-off ensued and vote after vote ended up in a deadlock.

Finally, at the vitamin convention (which, coincidentally, was held in Denver, CO), a deal was struck for the naming of B Vitamins.  The list is as follows:

  • Vitamin B1 (thiamine)
  • Vitamin B2 (riboflavin)
  • Vitamin B3,(niacin, includes nicotinic acid and nicotinamide)
  • Vitamin B5 (pantothenic acid)
  • Vitamin B6 (pyridoxine)
  • Vitamin B7, also called vitamin H (biotin)
  • Vitamin B9, also vitamin M and vitamin B-c (folic acid)
  • Vitamin B12 (cobalamin)

As is the case in many political fights, there were some very angry molecules when this compromise came out.  Vitamins B 4, 8, 10, and 11 immediately withdrew their bids to be vitamins and instead moved to a commune in Montana.  Howard Dean's lobbying to be written in as B4 was rebuffed as well.

M&M'S DARK CHOCOLATE The best source for the B vitamins is breakfast cereal.  Breakfast cereals contain all of the vitamins and minerals known to man, and some that are known only to animals.  Folic acid is also found in M&M candies.  One bag of M&M's contains 2% of the daily supply of folic acid, so most doctors recommend eating 50 bags of them each day.

Vitamin C - Caffeine

meet_linus_big It is commonly thought that vitamin C is comprised of the molecule ascorbic acid.  This is a myth.  Clearly the word ascorbic begins with an "a" and not a "c."  Vitamin A was taken already by Retinoic acid.  Ascorbic acid is actually not even a real molecule, but instead is a very tangy form of chewable candy made famous by the Nobel Laureate Linus Pauling.

The real Vitamin C is caffeine.  This is not technically a vitamin, but is clearly a nutrient.  It has always been obvious to clinicians that children have high basal caffeine levels.  The energy and vitality of children is witness to these levels.  Anyone who has tried to get their child to go to bed is well aware of endogenous caffeine.

sleepy As a person ages, however, caffeine levels drop.  This necessitates supplementation with caffeinated beverages and/or snacks to get caffeine back to physiological levels.  In ancient times, the availability of caffeine supplements was sometimes poor, resulting in severe caffeine deficiency.  Many have noted that on the ships that explored the new world, vitamin C deficiency was a real problem, resulting in a very sleepy mutiny by the sailors.  Thankfully, with the appearance of Starbucks on every corner in the United states, caffeine deficiency is largely a thing of the past (except in those decaffeinated religious cults).

Conclusions

There are other vitamins I could discuss (D, E, and K), and controversies I haven't mentioned (like the mysterious disappearance of vitamins F-J), but I think you get my point.  Vitamins are necessary in your diet.

Your mother knew best, Sid.  When she served you those carrots with Coke sauce with the M&M garnish, she was taking care of you.  This is the way all moms work - doing whatever they can to do what's best for their little babushkas.  I know my mom did.  I may not have understood it when she insisted on those M&M's, but now I know that Mom really did always know best.

Thanks for the question, Sid.

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Ask Dr Rob: The Sins of the Father

The next question comes from Dr's S and S:

Dear Dr. Rob: We can't figure out how to raise kids properly. Can you give us some tips?

Well guys, I am glad to be able to impart my vast wisdom in the area. There are so many areas, I have actually thought of writing a book on the subject (a novel idea). No, not a novel, a book.

Anyway, let's start with the subject of co-sleeping. Co-sleeping is the practice of parents to share their bed with their children. Recent evidence has shown that this behavior is harmful to children:

Parenting Behavior Plays a Part in Preschoolers' Sleep Problems

MONTREAL, April 8 -- Sleep problems in preschoolers may be partly the result of disturbances earlier in childhood and how parents respond to them, a longitudinal study revealed.

In a study of nearly 1,000 children, sleep disturbances at ages five to 17 months predicted parental behaviors such as the mother being present when the child fell asleep, taking the child out of bed at night, which includes moving the child into the parents' bed (co-sleeping), and giving food or drinks at night, found Valerie Simard, M.Sc., M.Ps., of the University of Montreal, and colleagues.

However, these parental behaviors only explained some of the sleep problems seen through age six years after controlling for earlier sleep disturbances, the investigators reported in the April issue of Archives of Pediatrics & Adolescent Medicine.

"Our findings clarify the long-debated relationship between parental behaviors and childhood sleep disturbances," they said. "They suggest that co-sleeping and other uncommon parental behaviors have negative consequences for future sleep and are thus maladaptive."

From MedPage

I have never been for co-sleeping. Perhaps it is the story in the Bible where the lady rolled on her child and killed it (and then King Solomon showed his wisdom). But I think it is just common sense that says that a child will bug his parent more often when the barrier to do so is reduced. My daughter occasionally sleeps in our bed with us and practices her martial arts skills on me whenever she does.

King-Solomon-Has-to-Decide-Which-of-Two-Women-Claiming-a-Baby-is-the-Rightful-Mother-Giclee-Print-C12366416

As a pediatrician, I try to discourage such behavior for anything other than using it as a form of birth control (proven to be 98% effective). Still, despite my urging, parents will continue co-sleeping, smoking in front of their kids, and using walkers (which has been shown to delay development).

I also discourage this behavior:

Boy blows up 213 balloons with his nose

Otovent-visual-instructions A 13-year-old boy is claiming the world record for blowing balloons with his nose. Using one nostril at a time, Andrew Dahl inflated 213 balloons within an hour Friday in the town's public library. His feat has been submitted for review by Guinness World Records.

His father, Doug Dahl, measured the balloons to make sure each was at least 20 centimeters, about 8 inches, the minimum diameter, and his mother, Wendy Dahl, kept the tally.

At one point he asked, "Does this count as practicing my trumpet?" His mother replied, "Only if you can play that with your nose."

It was his second try. In February he sent a videotape of himself inflating 184 balloons, only to learn that it didn't count because he handed them to his father to tie. This time he tied them off himself.

From Yahoo

med_nose_baloon I am a parent of four children (and now one lobster) and have hopes for their lives. I want them to be happy and well-adjusted. I want them to care for others and contribute to society. I want them to get good grades, not have cavities, and avoid eating at Krystal.

I have not, however, dreamed of them inflating balloons with their nose (or any other unusual part of their body, for that matter). Yet this father not only encouraged the child, but measured the balloons while the mother (the other accomplice) kept the tally. Why? What could possibly be the reason for doing this to their son?

68m59c4

To humiliate him.

There can be no other explanation. Balloons and noses are just not meant to go together. Balloons and modestly-dressed ladies on the beach with bows and arrows? Maybe. But only if they don't use their nose to pull back the string (which it appears the lady in the middle tried to do).

Humiliating your children seems to be a hobby for some people (like my father when he wore the Bermuda shorts and the sandals with colored socks - I was mortified). Perhaps they feel they owe it to them for all the trouble and money it takes to raise them. Whatever the cause, it should stop immediately.

SS1

Another sad story of humiliation comes from the UK:

British schoolboy has scooped a top drawer world record by balancing 16 spoons - on his face.

Nine-year-old Joe Allison beat the previous world record of 15 spoons when he hung the silverware from his forehead, nose, cheeks, chin and ears.

Joe's proud parents, Peter and Fenella Allison, from Totnes, Devon, say they have to buy special British 17.7ml tablespoons after he used up all the ones in the kitchen

I don't recommend this for my patients, but I suppose it is better than steak knives.

So here is Dr. Rob's list of parenting tips:

  1. 50210008 Do not co-sleep with your child. Co-water skiing, co-pole vaulting, and co-bull fighting are also bad ideas.
  2. Sweet tea is not appropriate for children under 6 months (this was actually asked of me by a grandmother).
  3. Do not name your child Peaches Honeyblossom Michelle Charlotte Angel Vanessa, as Bob Geldof and his wife named thiers (or Depressed Cupboard Cheesecake which another couple in the UK named theirs). UK must be a cruel land.
  4. Toddlers should not use flame throwers.
  5. With good care and frequent oil changes, robot children can last for many years.
  6. Consistency in discipline is essential for raising well-adjusted children. The best place to adjust your child is at the base of the neck. It takes great consistency and discipline for you to use a child-adjuster properly.
  7. Do not have your child attempt to set two or more world records simultaneously. The spoons get in the way of the balloons.
  8. Do not use walkers, as they interfere with development. Runners, crawlers, and home-shoppers are discouraged as well.
  9. Keep the ravenous beasts out of your child's bedroom (unless they are teenagers).
  10. Don't worry, everyone psychologically messes up their children. Look what my kids will have to overcome.

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Ask Dr. Rob: Webkinz are Here

So here we are again after a long hiatus (not the hernia kind, just a break of time...although I have been belching a lot lately). There are some serious questions that have piled up (in a cyber-sort of way), so let's get at them. ConstructionPikmin, from South Carolina asks the following:

What's the deal with Webkinz? There are signs all over saying "Webkinz are here." Should I be afraid? They are kind of cute, so I can't imagine they are that bad. What do you think?

Thank you, Pikmin, for asking such a timely question. Nothing could be more serious than the discussion of the Webkinz epidemic. MRSA, Flu, RSV, and other scary infections are nothing compared to the way in which Webkinz have rampaged through our communities.

Now, I am sure there are some readers out there who are unaware of the whole Webkinz phenomenon. Let me catch you up on the facts as I know them. My first sighting of a Webkinz sign was approximately a year ago, when I drove past a Walgreen's pharmacy with the sign "Webkinz are here." From sources that I cannot disclose I have since learned that Webkinz have been around for several years.

yoursign2 On the outside, it looks like Webkinz are cute little fuzzy animals that you pay in the neighborhood of $16 for. Each animal has a tag with a name and number on it which allows you to go the the website (www.webkinz.com) and access various online activities that you can do with a cyber-form of your stuffed animal. It sounds innocent; in fact, it sounds like an incredibly clever marketing scheme, as the more Webkinz you buy, the more stuff online you have access to. Wow. Only in America!

Not so fast. Doing more digging has revealed to me the sinister truth about the whole Webkinz phenomenon: it is a viral infection that is the result of a genetically manipulated form of the Ebola virus (done by Dr. Fred Webb and Dr. Natalie Kinzy). The Webkinz virus causes one of the most contagious and persistent infections known to man.

The reaction to this infection depends greatly on the age of the Victim. Adults infected with the Webkinz virus are prone to do the following:

  • Easily give in to requests of little girls
  • Think that spending $16 on a stuffed animal is reasonable
  • Be oblivious to long hours spent online by children
  • Crave sardines.

For some reason, young boys and teens seem to be immune to this infection, although there have been some reports at irritability and nausea whenever around those infected, so some theorize that the Webkinz infection is just milder in these demographic groups.

yoursign3

Young girls, however, have the most dramatic signs of infection of any group. Symptoms of a Webkinz infection in these patients include the following:

  • Frequent utterances of "awwwww" whenever stuffed animals are nearby
  • An insatiable appetite for any variety of stuffed animals, including dogs, cats, horses, gophers, amebas, sea-cucumbers, unicorns, wraiths, hippos, worms, and fruit flies (to name a few).
  • Ever increasing lapses into the "Webkinz Frenzy," where the patient becomes fixated on a certain stuffed animal (a walrus, for instance) and gives up eating, sleeping, and other important bodily functions while being entranced with the thought of this animal and begging all who can hear for $16 to buy them.
  • Foot odor.

    Word_PuzzleThe astute reader may notice the similarity of this infection to other phenomena in our past, such as the great Cabbage-Patch infection of the 1980's, in which adults would find the sudden urge to buy an extremely ugly doll, being willing to maim and kill anyone who got in their way. This was actually a result of one of a Soviet-made virus, and it nearly succeeded at destroying the culture in the west. Other similar infections in the past thought to be the result of sinister genetic engineering experiments include:

    • Teletubbies Encephalitis (causing severe brain damage)
    • HRPufnstufH. R. Pufnstuf Toxicosis (as pictured on right)
    • The Barney Mutation (Grotesque)
    • The Olsen Twins (Scary one, that one was)
    • Precious Moments (The minions of Satan, as we all know)
    • Milwaukee Brewers Fever
    • Pink Eye

    So is there a cure or treatment for Webkinz? Sadly, there is no known treatment, so the epidemic runs unchecked. Some have suggested that this will fade in the same way as the Cabbage-Patch infection did, but others fear that it may first bankrupt the west. At least 70% of the current credit crisis is felt to be due to money spent on stuffed animals.

    Researchers are looking at a possible immunization against this infection, but unfortunately the research labs have gone broke as the scientists themselves spent all their grant money on stuffed monkeys.

    yoursign

    So, little Pikmin of South Carolina, I suggest you run for your life from this infection. The consequences of not doing so can be devastating. Trust me on this one.

    Gotta run now. I have to go to Walgreen's. Anyone got $16 I can borrow?

    Thanks for the Question! Remember to send your questions to: dr.rob.questions@gmail.com

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    2 Comments

    Ask Dr. Rob: Holey of Holeys

    Medstudentwife (AKA Lala) asks me the following question:

    When I was a kid, Dad would bring home a dozen donuts every now an then as a special treat. When eating them as dessert after dinner, he would ask us to save the "hole" because he could take them back and get another dozen donuts for free. Now in those days, there weren't a zillion types of donuts like we have today, but how come the donuts he always brought back were honey glazed and not something kwel like chocolate coated ? Was there a "hole" rebate restriction or something ?

    Well, Lala, let me first make a few comments about your question before I tackle the tough subject of donut holes.

    It seems odd to me that you find chocolate coated donuts "kwel." KWEL, as I am sure you already know, are the call-letters for AM 1070 - The Talk Station for Odessa and Midland, Texas. This, as we all know, is the home of the Morning show with Craig Anderson, Music with Dorilyn, and the ever famous Citizen Watchdog. I can see how this came to your mind, as most people look up to Craig Anderson as a father-figure.

    It may be, however, that you really meant to refer to the Dutch word kwel, which Wikipedia defines as:

    Kwel is grondwater dat onder druk uit de grond komt.

    In het algemeen ontstaat kwel door een ondergrondse waterstroom van een hoger gelegen gebied naar een lager gelegen gebied. De grootte van het debiet wordt gemodelleerd met de wet van Darcy, waarin de doorlatendheid van de materialen een rol speelt.

    Again, the connection with your father and donuts is obvious...especially the part about doorlatendheid. That part always cracks me up.

    Lies and Shrinks

    So what about the holes and donuts? As most people probably realize, your father was literally pulling your leg. He saw your innocent naivete' and felt, as your father, that he had the right to make bold-faced lies that you would believe without question.

    Fathers are actually required by law to tell these kind of lies to their children. I have my kids convinced that I used to play the accordion for a Finnish punk-rock band. The reason this law exists is because of the incredible power psychiatrists wield with unprecedented impunity. As another astute writer explained to me:

    DO THE SHRINKS RUN THE ENTIRE USA MEDICAL PROFESSION ?

    by Justice Lover

    Last month's alarming news about the appointment of a shrink as the leader of the American Medical Association (AMA) in the USA should not have come as a surprise to any informed person. It certainly did not surprise the APA (American Psychiatric Association) leaders. They have been working on taking control of the AMA for the past 4 years at least, and in the open : with unprecedented impunity !

    Psychiatrists know that the lies we tell our children will give them incredible job-security for years to come. They are bent on using all of the money they make of children crushed by the fact that their father is only a physician (and not an ex-punk rocker Finnish accordion guy) to build an empire of mind-control and take over the medical profession as we know it. I have it on very good authority.

    woa06_korpiklaani_04

    Juho, live in concert (in case you wondered).

    Back to donuts.

    The Dark Truth

    Despite the impossibility of "saving holes" from a donut, your father was looking after you in ways you cannot imagine. Most people do not realize it, but the hole of the donut is far more harmful to the body than the donut itself.

    Astrophysicists have long speculated as to the missing mass of the universe. It seems that the most credible theories of the origins of the universe require a mass that is far more than what is observed empirically, leading to speculation of the existence of dark matter. Some have postulated that black holes are made up of this dark matter, as the mass of a huge star implodes and acquires such gravity that even light will not escape. Yet recent studies by Belgian scientists Duncan and Kreme have determined that donut holes actually contain a large amount of dark matter.

    Why then don't donuts weigh 50,000 Tons as would be expected with all of this dark matter inside of them? That is what makes dark matter so mysterious (as seen in the banner above). The theory is that donuts possess a unique chemical compound that mysteriously decreases the effects of gravity. This has to do with the rotation of the donut, as demonstrated by the following graph:

    Rotation curve of a typical donut: predicted (A) and observed (B). Dark matter can explain the velocity curve having a "flat" appearance out to a large radius

    This can also be expressed as the following formula:

    , where G = 4.31 x 10-6 , and ?M? is the mass contained inside of radius ?R?.

    I am sure this is becoming obvious to you at this point. If you don't understand it, I am sure Orac can explain it to you. He's the smartest guy that I know.

    Dark Matter: Not just for breakfast anymore

    Given these obvious scientific truths connecting dark matter and donuts, the obvious question comes up: so what if your dad had allowed you to eat those holes filled with dark matter? The answer is: it depends. Dark matter (as seen in the equation above) is highly affected by the objects with which it makes contact. If you ate the hole in a donut by itself (without the donut), you would immediately take on the mass of a neutron star, and the earth would be destroyed in a cataclysmic nanosecond.

    300px-Heston On the bright side, that hasn't happened yet. It is extremely fortunate that nobody has ever attempted to eat the hole of a donut without the donut. Yes, people eat things called "donut holes," but they are actually just bite-sized balls made out of the same ingredients as donuts, and contain absolutely no dark matter (although they are apparently chock full of anti-matter, but that is a different story). Some legislators have tried to pass laws that mandated that all donuts be made without holes (like the typical jelly-filled variety), but this was mysteriously opposed by the gun lobby, so it did not have a prayer.

    Eating donut holes along with the donut has several effects. If done in mass quantity, it greatly increases a person's chances of going into law enforcement. In smaller amounts, it just makes you go around all day feeling guilty.

    SI-Clancy-Wiggum

    Other food manufacturers have studied the possible addition of dark matter to their food. Starbucks has successfully perfected the technique of roasting coffee beans with a coating of dark matter. This is what gives their coffee the unique flavor. The effects of this process on human physiology are plain to see: it creates the overwhelming desire to listen to New Age music and somehow causes the consumer to believe it is perfectly fine to drop $4 on a cup of coffee. Just how it affects the neurons in such a profound manner is still being studied.

    Here are some common effects of increased dark matter in the diet:

    • Raising HDL levels (makes RRHDL - really, really high density lipoproteins and YWBHFHDL - you won't believe how friggin' high density lipoproteins)
    • Increases the number of mysterious dark fibers in the muscles
    • Increases pulmonary function by improving alveolar compliance and causing better V/Q matching under stress
    • Shrinks hemorrhoidal swelling

    So Lala, your dad clearly had your best interest in mind. He undoubtedly understood the nuances of astrophysics as it relates to frosted pastries. He clearly grasped the importance of moderating the amount of mysterious things in the diet. I tip my hat to a man with such balance and insight.

    Oh yes, and I think he just preferred the honey glazed donut to the other varieties.

    Thanks for the question!

    Be sure to send me more at dr.rob.questions@gmail.com.

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    Ask Dr. Rob: Animal Magnetism

    Tom asks the following question:

    I recently had an MRI, this is the third or fourth, any time I go though the anti-theft devices at stores. The alarm sounds when I have nothing on me.  What can I do?

    Good question, Tom.

    Before I answer the question, however, I need to address the fact that you are in stores with nothing on you.  While I am sure it gives you a "free feeling," it really is generally not acceptable to be in stores without clothing.  But don't feel ashamed of your love of public nudity.  It is all a part of growing up.

    There was a recent story in the news about a man who is very much like you:

    oldflower1DETROIT — A man who was sentenced to 30 days in jail for taking his daily run while wearing only a stocking cap, gloves and reflective tape said that the nude jogging made him "feel alive," according to police.

    Russell Rotta, 49, told police that he had been running naked since he was a teenager and that he generally woke up each day around 4 a.m. to conceal the activity from his wife.

    Rotta reported running in the nude six miles a day every day, weather permitting.

    "That is the one wild, crazy thing that I do that makes me feel alive," police quoted him as saying.

    Rotta pleaded guilty to a charge of indecent exposure May 22 in Jackson County district court. Judge Joseph Filip sentenced him Tuesday to 24 months probation and $1,500 in fines and court costs.

    Rotta was arrested early April 4 after a caller reported seeing a naked man running in the southbound lane of U.S. Highway 127 in Blackman Township, about 70 miles west of Detroit.

    In the police report, the responding officer wrote that he recalled several reports over the years of a naked man running in the area. The officer said he spotted Rotta by his shoe reflectors as he attempted to cross a road.

    Rotta told police he didn't indulge his habit to disturb anyone or receive sexual gratification. He said he generally confined his running to open fields and wooded areas away from roads.

    He wore reflective tape around his arms, ankles, waist and thighs to avoid being hit when he crossed roads, the police report said.

     

    streakerIf you are wearing reflective tape like Mr Rotta, then this may be setting off the alarm.

    May I also suggest that possibly you are mistaking the alarm for the shouts and screams of the people in the store.  Does the alarm say: "Oh my gosh!  There is a naked man in here!" ?  If it does, then the MRI did not have anything to do with it; you just need to wear clothes.

    How an MRI scan Works

    OK, so what about the MRI scan?  To understand an MRI scan, you have to first understand the nature of the test.  MRI stands for "Magnetic Resonance Imaging."  What happens when you get in an MRI scan is that you are thrust into a tiny hole in a great big magnet.  Then your body is bombarded with radio waves.  The usual choices for these radio waves include many different styles of music, although some newer MRI scanners use Talk Radio shows.  The magnet causes your red blood cells, which contain iron, to all line up in a neat little row, kind of like children in line at school.  The red blood cell (RBC) in the front of the line is known as the "line leader" red blood cell (LLRBC) and is the key to the MRI scan.

    fserie_vie05

    When the LLRBC hears the music, he has a reaction that is specific to the type of music used.  A CWMRI (Country and Western MRI) will generally cause the LLRBC to do the Two-Step, while a DMMRI (Death Metal MRI) causes him to slam dance (this is why this type of MRI is seldom used).  The newer TRMRI (Talk-radio MRI) scanners cause the LLRBC to fall into a trance and have the sudden urge to refinance his mortgage.

    The radiologist then uses a real fancy computer to analyze the resonance of the music through your body.  The resonance will depend on the shape and contour of the inside of your body.  Using Bullion logic, Fourier transforms, and a little bit of magic, it figures out what is wrong with you.

    Older MRI scanners were large and spacious.  But patients enjoyed these too much and this drove the costs of healthcare through the roof. So the FDA mandated that they make them really small so that only the malnourished can fit comfortably in them.  The technician then stands on the outside of the scanner and hits it repeatedly with a hammer to add to the effect.  This has significantly reduced the overall cost of healthcare.

    magnet-manEffects of Magnets on People

    People are not designed to endure strong magnetic fields.  As the old saying goes: If God had meant for man to endure strong magnetic fields, he would have made Wisconsin out of one. 

    That pretty much sums it up.  As stated above, magnetic fields cause the RBC's to line up and for one to seek out the front of the line.  If the LLRBC does not hear music (or talk radio), he goes in search of some form of entertainment.  As desperation mounts, the movement of the line becomes erratic and causes shearing to happen on the inside of blood vessels.  This can lead to internal hemorrhage, or at least a bad case of hemorrhoids.

    There is a subset of people with a condition known as hemochromatosis.    People with this disease store large amounts of extra iron in their body - especially the liver, the pancreas, and the heart.  This can cause significant damage to these organs, leading to diabetes, liver damage, and heart disease.  When people with hemochromatosis are exposed to strong magnetic fields from MRI scanners, it causes them to become polarized, with their head and feet becoming different poles of the magnet. 

    Magnetic Man 01

    You can tell if someone has hemochromatosis by sending them through an MRI scanner and then having them lay down in a swimming pool.  If their head points north or south, then they have hemochromatosis.  Interestingly, if you perform this test on people from Massachusetts, they always turn to the left.

    If you find that you have been magnetized, it can lead to some awkward situations.  Do not, for instance, walk into a cutlery store.  Credit cards and floppy disks are not safe around magnetized people.  There are reports of couples who have both been magnetized only to be tragically found in an eternal embrace.  It is truly a sad situation.

    There are, however, plusses to the magnetic body; for instance, you can take iron filings and make a very handsome beard or a wacky hairdo.

    Owing to the tragic consequences of human magnetization, much research has been done on how to remove the magnetic field from the human body.  Interestingly, some of the most successful therapies come from seemingly outdated modalities.  Leaches can be used to draw the iron out of the human body.  The resultant magnetized leaches then serve quite effectively as refrigerator magnets.  

    magnoanddavey

    Anti-Theft Devices

    So, you ask, how does this all fit in with the problem our dear friend Tom suffers under?  Clearly there is an alteration of the molecular make-up of the human body after being exposed to magnetic fields and radio waves.  Perhaps it is the RBC's lined up that resembles an RFID tag.  Perhaps the anti-theft device thinks he has stolen the magnetism from the MRI scanner.  Perhaps the scanner just doesn't like the easy-listening music that is resonating through his body.

    Or perhaps it is that box of tic-tacs that I slipped into his back pocket.

    Thanks for the question!

    I need more!  Please send your questions to dr.rob.questions@gmail.com.

     

    3 Comments

    Ask Dr. Rob: BLOGGING IN PERSON

    Now we start to get a little personal.  The ever omnipresent Moof asks me:

    Does Dr. Rob come across in the same way IN PERSON as he does in his BLOGGING?

    Before I work to answer this question, I must first address the use of capital letters in this sentence.  Why are the words "IN PERSON" and "BLOGGING" in all caps?  Is there some hidden significance to the fact that Moof wanted to underline by shouting these words at me?  It would be worse (I guess) if she had put it in quotes, because that would imply: 1. That I am not a real person; and 2. That I don't really blog. 

    In case that was what she meant, let me clear the air:

    • terminator I am, in fact a real person.  This has been independently verified by a licensed professional: my dog, Holly.  As you know, Holly's eyes glow whenever she is around a hoax, and her eyes do not glow around me.  Furthermore, if you saw the movie The Terminator, you would remember that dogs can sense a cyborg - even one who looks a lot like a human.  Holly does not violently bark when I am around (unless someone rings the doorbell).
    • I am actually the one doing the blogging.  Some rumors have surfaced that when I write, I am actually temporarily possessed by the spirit of an ancient Viking king; but despite the respect I have for Kevin, MD, this is simply not true (although I do on occasion get a sudden craving for some lutifisk).

     

    Lutefisk-web-hoved

    So what about the question?  My first thought at seeing this question were: is this a good or a bad thing?  Do I come across so badly in my blog that the thought of a real person with such a twisted psyche is horrific?  Or, am I so charming and delightful that upon meeting me there would be the strong desire to petition to make me the king of a Scandinavian country? 

    large_25067

    I really don't know what Moof meant by this, but to study this question I must know the answer to two questions: How do I come across on my blog?  The second, and equally important part of this question is: how do I come across in person? Once I can get an answer to these questions, I can then perform a meta-analysis (publishing it in the New England Journal of Medicine, of course), and give a reasonable answer to this question.

    Question 1: How do I come across IN PERSON?

    Given that I am stuck in my own perspective and can't really "come across" to myself, I had to do some research on the subject.  It made most sense to me to ask the first person who ever experienced me IN PERSON: my Mother.

    Me:  Mom, when you first met me, how did I come across?

    Mom:  Well, Rob, You were kind of slimy and covered with goop.  You were screaming really loud, and then you peed on the doctor.

    Me:  Did I make a good impression?

    Mom:  Not on the doctor, but right after you were born an ancient-appearing old man rushed into the room, grabbed you, and held you over his head.  He then prophesied that you would be the greatest accordion player the world had ever known.

    Me:  Wow.  Then what happened?

    Mom:  The police came and arrested him for unauthorized prophesy.  Still, we knew you would be special.  By the way, have you played your accordion much recently?

    Me:  Shhh!  Not now, Mom!  Other people are reading!

    94309_cd127-accordion

    To get a more representative view of how I come across IN PERSON, I went to the local Wal-Mart and asked people at random how I came across to them.  Here is what they had to say:

      • "Y'all seem real nice to me.  Did you say I'd get a dollar?"
      • "A breath mint would help."
      • "I think you came across aisle 10 in lawn and garden.  Is that what you mean?"
      • "You're the best father any child could ever have."
      • "You're the spittin' image of Colonel Klink."
      • 211sml "I am serious.  A breath mint would REALLY help."
      • "My mom said to stay away from your type."
      • "I don't care how you come across, the total of your order is $17.61."
      • "Are you the guy who plays the accordion?"
      • "Why did you shout the words: IN PERSON?"

     

    From this it is very hard for me to paint a coherent picture of how I come across IN PERSON.  I guess you can say I am a lot of things to a lot of people.  Whatever the case may be, I have started using breath mints.

    Question 2:  How do I come across in my BLOGGING?

     

    klempererThat is kind of a strange question to ask me, since you are the ones reading this and can answer the question far better than me.  Yet my duty in this "Ask Dr. Rob" column is to answer any question, regardless of difficulty.

    So I went to our neighborhood Shaman, and got him to transfer my soul into cyberspace so I could see just how I came across in an objective sort of way.  Here is what I discovered:

    1. I often use sentence. Fragments.
    2. I use too many lists.
    3. I like to use self-referential sentences (like this one).
    4. I prey on the weak-minded masses, asserting my opinion as fact, in hope that I may achieve world domination.  No wait, that is Michael Moore.
    5. Mixed metaphors really burn my goat (literally).
    6. I may be laughing on the outside, but on the inside I'm nauseated.
    7. I have infuriated the Latvian parliament with my antics.
    8. Oprah is jealous of me.

    Conclusion

     

    I am nothing like myself IN PERSON while BLOGGING.  I think it is pretty clear that I have the entire world of the Internet completely duped into thinking I resemble the person I am not while I blog IN PERSON.   Personally, I think my BLOGGING persona never blogs as a person, but rather as a llama.

    This seems pretty obvious to me.

    Thanks for the question.

    PLEASE don't for get to send your questions to dr.rob.questions@gmail.com.

    Ask Dr. Rob: Doctor Tricks

    Our next question comes from PJ, who asks:

    Why do you always measure the patient's blood pressure at the beginning of the visit, instead of halfway through or at the end?

    llama-OBEY First off, I would ask how you know what I do in my office. Have you been spying on me? Are you the one who put the listening devices and webcams secretly in my office? Are you the one who put the GPS device on my stethoscope? Are you the one who posted the video of me on YouTube? Are you the one who put those voices in my head that constantly tell me to move to Idaho and open a llama ranch?

    Oh wait, those all went away with the medication adjustment. Sorry.

    Anyhow, this raises an interesting fact that most people don't know about doctors: we have tricks that perpetuate our business and ensure job security.

    scales The checking of blood pressures at the start of a visit is a prime example of this. We purposefully get scales that read approximately 10 lbs higher than normal scales and force a patient to sit in front of this scale while they get their blood pressure taken. If their blood pressure is not already high from the terror of the prospect of being weighed, we weigh the patient (proclaiming the weight loudly), and then their blood pressure is undoubtedly at least 20 points higher than it is normally.

    The effect of stress on the blood pressure is a well-documented phenomenon known as white coat hypertension. This comes from the fact that often when people faced the prospect of standing on the scale in the doctors office, some of them would not only get high blood pressure, but also have a nervous breakdown, necessitating a call to the "men in the white coats" to bring the patient to the psychiatric hospital.

    Then there is the whole process of taking a person's blood pressure. Did you know that a blood pressure cuff is called a sphygmomanometer? It is a documented fact that nearly 10% of medical and nursing students failed to get their degree simply because they could not pronounce this word. Simply hearing the word sphygmomanometer is good for raising the blood pressure by at least 10 mm Hg in the general population. I am actually at a substantially increased risk of stroke because I have written the word sphygmomanometer in this paragraph. If I don't move on from this subject, I may actually start losing readers to blood pressure related fatalities.

    To take a blood pressure reading, the healthcare worker takes out an inflatable fabric cuff and puts it on the patient's arm. If it is a woman, the worker is instructed to say: "Oh, we need to get a bigger cuff because your arm is too...uh...the size is not right." This is sure to raise the pressure. For men, the opposite tactic is employed, implying that the lack of any significant muscles in the arm necessitates the use of the child-sized cuff (usually a pastel color).

    02542_BloodPressure_PP_med

    money-joke-doctor-copyright3As you see, PJ, these tactics enable physicians to have far more patients labeled as having high blood pressure and requiring many more visits and a higher visit charge. I have not even mentioned the tactic of putting fake patients in the waiting room and calling them to see the doctor before real patients who have been waiting far longer. The possibilities are endless.

    There are several other techniques commonly employed by physicians to ensure job security:

    • When examining a patient's abdomen, it is common to push down and utter the words "does it hurt when I push here?" If a patient says it does not, then you simply push harder. Once you have pushed hard enough to cause pain, you can charge more for the visit.
    • Keep exam rooms cold and then ask about chills or keep them hot and note fevers. Both of these are common ways of necessitating return visits.
    • Keep the patient in the exam room for extended periods and force them to read 10-20 year-old magazines. Or you can stock the room with only Highlights for Children and Rod and Gun magazines. This causes headache and nausea in a significant number of people.Wonder Cover
    • Tell a person to fast before a visit and then schedule the appointment late in the afternoon.
    • If someone calls for an appointment, tell them that the first available appointment is sometime in 2008. This way the minor problems become major ones.
    • Pediatricians commonly teach infants how to pull on their ears while parents are not watching, raising the number of visits by nearly 50%.
    • a the dentist cover Some children can be paid to act terribly sick while at home, and then be perfectly well when they come in to the doctor's office. This not only increases office volume, it provides hours of entertainment for the office staff.
    • My dentist had a trick when I was a kid. The hygienist would check my teeth and they would be perfect. Then the dentist would go at my teeth with a pointy metal device. He would poke and dig and then proclaim he found a hole in one of my teeth that needed filling. I knew good and well that he had just dug that hole.

    So there you have it. Now you know the "trade secrets" of physicians. Hopefully I haven't dashed your faith in our noble profession. Yes, we do some questionable things, but we do help people in many ways. If you doubt me, then you are invited to make an appointment at my office. I am sure I can work you in to my schedule sometime in the next 16 months.

    Don't forget to send me more questions to dr.rob.questions@gmail.com.

    Ask Dr. Rob: Love/Hate and Spit

    From Amanda, I got the fascinating question:

    Why do I insist on having three cats even though I'm allergic to the wee beasties?

    rose,w_cat_people1942 Thanks for the thoughtful question. I am always happy to do whatever I can to mend fences between species. Clearly you have a love/hate relationship with the feline type. Your reference to them as "beasties" betrays an ambivalence that probably runs quite deep. I would suggest a visit to either Dr. Deb or to Shrink Rap - two psychiatry blogs - to sort out these issues. They may help you discover your "inner cat."

    But what of this insatiable desire to be with them, and what of the allergies? You would be interested to know that it is actually not the wee of these beasties you are allergic to, it is the spit. Yes, cat allergy is actually from an allergen present in their saliva. Since cats are fastidious about grooming themselves by licking their fur, the antigen is transferred to the hair and dander, and then shed out for all to enjoy.

    So why have cats developed spit with antigens? To understand this, we must first explain the subject of allergies.

    Your body likes to pick a fight with things, and rightly so because there are many things that would love to take over and make you their personal incubator. Viruses and bacteria are constantly trying to find places to reproduce and spread their DNA throughout the world, and the warm cozy environment of your body fits the bill quite well.

    Jackie Chan So at the annual virus convention, they try to decide just where the next convention will happen and so send scouts to check out different venues. A virus comes to your body and gets checked in at the front desk. When they get in a room (cells of your body) and start acting like a classic Rock 'n Roll band, throwing couches out the window and disturbing other guests, the hotel security (White Blood Cell) is called. Security does its best to throw out the unruly guest, but generally causes damage as apprehending the virus often involves a chase and fight scene like something out of a Jackie Chan movie. Many of the symptoms you get from a virus or bacteria is actually caused by the spin-kick stunts of the white blood cells as it tries to rid your body of the unruly guests.

    The next time a virus tries to check in at the front desk, the front desk staff (or Antibodies) recognizes the virus as the same one that caused the fourth floor to be closed for several weeks and so calls security again. This way, the virus gets escorted off before it can cause any serious problems.

    7391660Now, for some reason, some people's bodies are really bothered by antigens from cat spit. Even though the dander from cats acts as a very good guest in the hotel, the front desk gets really upset and calls in security, causing all sorts of damage.

    Scientists are unsure why cat spit became "public enemy number one" for some people. One theory is that our ancestors were simply grossed out by cat spit and demanded an immune response. Others postulate that the ancestors of the modern-day cat could spit very long distances, much like spitting cobras. Support for this latter theory comes from the existence of a small sect of "cat charmers" in southern Pakistan. The theory goes that the current "hiss" that cats make when they were angry was accompanied by a spit that would cause its victim to have the sudden urge to chase after strings and small shiny things.

    So why, despite your immunological aversion to cats (and psychological, as previously discussed) do you continue to surround yourself with them? There are a few questions I must first ask you:

    1. Are you nuts?
    2. Do you surround yourself with trained assassins, bent on killing you at first opportunity?
    3. Do you collect Precious Moments figurines?
    4. Have you ever gone to the musical "Cats?"
    5. Do you often play music from the group "ABBA?"

    photo7

    It seems to me that you are the type of person who says: "I deserve all of the bad things that happen to me." Just the fact that you are a regular reader of this blog makes that point painfully obvious. You have it in for yourself, and regularly engage in activities that make your life harder.

    My suggestion? Get a goat. They are very soothing (just ask any feisty race horse) and can scare away any "beasties" that come your way.

    Thanks for the question.

    I am starting to run out of questions to answer, so please send your interesting questions to me at dr.rob.questions@gmail.com.

    2 Comments

    Ask Dr. Rob: 9 Months of Speed

    A skeptical reader from Houston asks:

    "What are the effects of speedboats on a fetus?"

    28_week_36364_7 Now, I have to start out by addressing the purists out there who would point out that a child does not become a fetus officially until the 9th week of gestation, meaning that the title of this blog should actually be "7 Months of Speed."  There is one of you in every crowd, and I can honestly say that you bug the rest of us.  Here I am, just blogging away happily, exercising my poetic license and I get a cold fish whacked across my face in the form of a "well, actually" response.  Not this time, bucko!  I made sure of that!  Ha!

    Besides, I think addressing the effects of speedboat on embryonic development is entirely appropriate.  After all, fetuses (or foetuses, as Shinga would say) are greatly effected by any psychological trauma from their past; as we know from developmental psychiatry many a fetus has had to has through embryonic issues such as stem-cell envy and pleuropotent procrastination.  It just makes sense to me.

    The question is somewhat vague, so I will address it from every possible angle.

    • Fetuses should not eat speedboats.  Even a fully-developed digestive tract would have difficulty with the metal and fiberglass of a speedboat.  I generally warn parents about allowing children to eat any form of aquamarine transportation.  Even something as small as a Jet Ski can cause serious injury to the proximal digestive tract.  The heavy metals in the motor as well as the hydrocarbons used as fuel and lubricants are generally toxic to children and adults and may end up being shown to be a cause of autism.

      Speedboat2

    • Fetuses should not drive speedboats.  A speedboat could harm the mother if introduced to the intrauterine environment.  Once out of the intrauterine environment, the fetus is no longer a fetus, so the only way for a fetus to drive a speedboat is for the boat to be surgically introduced into the uterus of the mother.  While many advances have been made in the area of intrauterine surgery (some of it quite exciting), introduction of forms of water transportation has been reported nowhere in the medical literature.  Besides, a fetus is significantly under the legal age to drive motorized water transportation.
    • Proximity to a speedboat has no clear effect on a fetus.  A speedboatmother standing near or on a speedboat has no obvious effect on a fetus.  Exposure to ionizing radiation, such as x-rays or gamma-rays can be harmful to a fetus, but most manufacturers of speedboats stopped making boats that emit this type of radiation in the early 50's.  The passage of the Evenrude Act of 1952 (HR 2234) required that all manufacturers either remove radiation-emitting parts from their boats or cover the boats in lead.  Since the latter resulted in less-than-seaworthy boats, most took the former course.  So rest assured, your unborn children are safe around speedboats.
    • Speedboats do not come from fetuses.  Research into the origins of speedboats seems to indicate that there is no embryonic or fetal form of a speedboat.  Instead of coming from a female speedboat, scientists believe that speedboats come from a factory just outside of Milwaukee. 
    • shuttle Riding on speedboats makes fetuses go very fast.  Compared to controls (fetuses not on speedboats), fetuses who ride on speedboats go quite a bit faster.  The only exceptions to this are those who are compared with fetuses riding in fighter jets or space shuttles.  In that case, speedboat-riding fetuses are comparatively very slow.

     

    There is one more important point I would like to make.  Speedboat Balloon spearing is not an appropriate activity for fetuses.  As a pediatrician, I only can say what is in the best interest of the child, and this activity uses a very sharp object which could cause serious injury.  Furthermore, the lead-tipped cords on which the balloons are suspended could cause lead poisoning. 

    med_speedboat

    Thank you, Skeptical.  I hope this addresses your question.

    Don't forget to mail your questions to me at dr.rob.questions@gmail.com.

    2 Comments

    Ask Dr. Rob: Poverty and Medicine

    Obviously, many of the letters sent to me since my inaugural "Ask Dr. Rob" post have been a bit on the silly side.  I will go that route fairly soon.  But one of the questions was actually quite serious.

    Mario, who works over at the Huffington Post writes:

    How does a scientific report about skin cancer get spun to focus on the rich while ignoring the poor?  

    He then referred me to an article by Deborah Blum which describes the media spin in regard to a scientific report on skin cancer.

    I'd like to tell you a story of skin cancer, wealth, poverty and, I'm afraid, journalism done badly.

    My morality tale starts this Monday with the announcement of a study in this month's British Journal of Dermatology: a report by scientists in Belfast, who had tracked and analyzed skin cancer rates in Northern Ireland over 12 years.

    Their primary finding, based on data from 1993 to 2004, echoed what many researchers have been saying: melanoma and other skin cancers are increasing alarmingly fast worldwide. Even in Ireland -- hardly a sun-blistered climate -- doctors report a 62 percent increase in skin cancer samples sent to laboratories and a 20 percent increase in patients.

    There has been much speculation about the global rise in skin cancer, ranging from heavy use of tanning salons, to overexposure on beaches, to thinning of the planet's ozone layer, which famously blocks the worst of the ultraviolet radiation that bombards our atmosphere.

    But news coverage of this study didn't look for answers to such questions. Rather, they focused on a fact highlighted in the press release -- that the sharpest increase, at least among the largely fair-skinned people of Northern Ireland, is among those who live in affluence. Melanoma is two-and-a-half times more common in people who live in moneyed neighborhoods, according to the analysis, and the less lethal skin cancers, such as basal cell carcinoma, were 41 percent more likely to occur.

    What separates the excellent journalists from the rest is that they notice things that nobody else notices.  Was this simply a story about wealthy people basking in the sun and getting the just deserts for affluent lifestyle?  That is how the press reported it.  But Ms. Blum read beyond this report:

    But as opposed to the news coverage, the report is not particularly obsessed with the wealthy. In fact, if you read the study, rather than the press release, there's a sense of genuine concern about the poorer patients. The researchers real focus is on underestimating skin cancer among the poor. Or to quote directly, "It is possible that patients from lower socioeconomic groups do not present for medical care," leading to under-reporting of skin cancers, emphasizing an underlying worry that the numbers are missing some very sick people.

    This is far from just politically correct angst. Study after study, in country after country, shows exactly that disparity. In the United States, it happens to be a worsening problem. A 2003 report by the National Cancer Institute analyzed "socioeconomic variations in U.S. cancer incidence" between 1975 and 1999. It found that people in poor neighborhoods are far more likely to have their cancers diagnosed late rather than early. Which means, not surprisingly, that they're far more likely to be killed by those cancers.

    How could the media have missed that?  How could we all have missed that?  The problem is not simply that rich people get cancer, it is that poor people don't get diagnosed.  Somehow, however, we get lazy, not reading the original article but focusing on the headlines in the news.  The news organizations are doing what they are designed to do: write stories that will attract attention.  The image of ladies basking on the beach is far easier to sell than the image of poor people with undiagnosed cancers.

    At the end of the month, one of the physicians in my practice will leave us and start a practice among the indigent people in our city.  He worked in a similar practice in Memphis, where he trained, and has always had a heart to serve those who are normally neglected.  While he will be missed, he leaves us with a strong message: don't neglect the poor.

    I have re-written the end of this article a number of times, as it always seems to come off sounding preachy.  The bottom line is that there are many uncomfortable truths in this world: people are sick, in pain, dying, and neglected.  As healthcare workers these truths are harder to ignore than for most.  Yet as a society we can't  afford to forget about these people, or worse yet, ignore them. 

    Thanks for the question!

    I promise the next one will be more along the lines of the first.