After a patient has waited the customary 27 minutes in an exam room, preceded by the customary 52 minutes in the waiting room (hence the term “patient”), I am curious to see how they’ve bided their time in the exam room, especially when kids are involved. In a room replete with scientific discovery, kids are often found reflexing with the reflex hammer, jamming tongue depressors into various orifices their teddy bear didn’t realize he even had, or giving injections to a wailing sister. Mom, meanwhile, is deeply engrossed in the office’s latest TIME magazine (ie. the annexation of Alaska). But the kids’ single greatest source of entertainment is the blood pressure cuff, commonly known of course as the sphyngomanometer. They just love to get that thing wrapped around their mother’s forearm or their brother’s neck, pumping the wee bulb as vigorously as their meaty little paws can pump.

Why is it that every MD’s office has a blood pressure cuff? A doctor may lack rubber gloves, matching socks or a medical degree, but he never lacks for a BP cuff. Is blood pressure all that important to doctors? Indeed it is.

Also known as the silent killer, high blood pressure is so insidious that you may go to bed feeling perfectly perky but wake to discover you are dead. Are you one of the estimated 20 million North Americans who are hypertensive but unaware of it? Will you find out you were hypertensive after you’ve suffered your first stroke? Perhaps it will be a heart attack, heart failure or kidney failure that will alert you to the fact that you should’ve checked your BP every year. As high blood pressure percolates over the years it doesn’t turn your ears red, bulge out your eyes or cause any pain. Then suddenly, it hurts a lot.

The most common cause of hypertension is called “essential hypertension”, meaning essentially we don’t know what causes it. We are, however, aware of some predisposing risk factors including:

• Obesity and lack of exercise. Exercising 50 minutes 4 times a week is the equivalent of taking one whole blood pressure-lowering pill!
• High salt intake, 80% of which comes from salty foods like pickles, chips and saltlicks.
• Stress. One study showed that young adults who were stressed were 7.5 times more likely to develop hypertension 10 years later!
• Smoking. No doubt all the smokers who read health books are shocked to realize this.
• Alcohol, keep to a maximumbmum of one day per glass, bub.
• Age. Systolic blood pressure tends to rise with age, but diastolic pressure tends to drop.

The systolic pressure (the first number) is the pressure in your system when the pump (your heart) is fully contracted. The higher the systolic, the higher the risk of stroke. We like to see this number below 140, REGARDLESS OF AGE!! Some doctors do not treat the systolic pressure adequately in the elderly because they feel that the diastolic number is fine or even low. Whoops.

The diastolic (second number) is the pressure in your system when the heart relaxes between beats. If it is too high then the risk of heart disease, kidney failure and stroke increases. Reducing diastolic pressure by as little as 5 points can mean a 40% reduction in stroke risk and a 50% reduction in heart failure.

One problem in determining blood pressure is that the doctor’s office may not be the most appropriate place to take a reading. Whitecoat hypertension is a very common entity that can cause a BP to read 30 points higher in a doctor’s office than it would be at home. The patient finds himself in the office of the purveyor of pain, deliverer of doom and bearer of bad breath. The preceding patient has just left the office, screaming in pain and carrying an ear. The walls seem to yell, “Quick, get out of here!” This is hardly conducive to a normal pressure. I am therefore, a proponent of home monitors or community blood pressure programs. It’s much more effective, both fiscally and medically to put our effort into detecting and treating the blood pressure problem than trying to treat the consequences of neglect. Hypertension is the third leading cause of death worldwide, behind malnutrition and tobacco. So please, go and get your pressure taken somewhere. If you refuse, I’ll send the kids by to check you over.

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Walter, a wiry and robust 52 year old who bops through life as if his diet consists purely of Jolt, dill pickles and lemon juice, bounced out to the farmhouse, intent on whitewashing the cellar of the old place. Suddenly his head began to throb. He’d been plagued with headaches most of his life but nothing like this. Alarmed, he headed back home and tried to explain what was happening, but words failed him like a Nortel stock. Have you guessed what Walter’s problem was? Fortunately his family recognized that healthy Walter was having a stroke and they rushed him to the hospital. His type of stroke required emergency surgery if he were to stand a chance of surviving, an outcome his family was warned likely would not happen. But he did survive. When he awoke, however, Walter had no memory of the past 20 years including the fact that his son Wayne was the greatest hockey player in the world. Walter Gretzky now devotes no small part of the borrowed time he’s been lent travelling about Canada warning us all to be aware of the symptoms of stroke. Will you be one of the 17,000 Canadians UNDER age 65 or one of the 33,000 older than 65 who will have a stroke this year? Risk factors include all the usual suspects we’ve come to hate: obesity, smoking, high cholesterol, high blood pressure, diabetes, dancing the Macarena, etc.

Know the five signs of a stroke! Pin these to your fridge, furniture or forehead.

• Speech difficulties, finding a word or articulatering it
• Disturbance of vision, as in sudden loss or doubling of
• Headache, sudden, severe and an unusual headache that you don’t recognize
• Weakness or numbess/tingling, usually only on one side of your body
• Dizziness leading to a sudden fall or unsteadiness

Memorize these five symptoms. The mnemonic SDHWD helps, as in Send Dave Hepburn Wads of Dough. Repeat this mantra until it becomes a part of your very being.

15% of all strokes are a result of a brain artery bursting, most often as a result of high blood pressure. 85% of strokes are caused by the clogging of a brain artery, either through Big Mac plaque build up or from wee clots being shot off from an irregularly beating heart. If you can get a stroke victim to a proper stroke facility quickly and the clot is busted within 3 hours, about a third of these patients will recover with no disability. But the longer brain tissue is deprived of blood the more apt a patient is to end up writing newspaper columns. TIME IS BRAIN.

For years not much could be done for stroke victims, but now many new and exciting treatment options exist. The greatest success is with the new clot busters including tPa and even ANCROD, the venom of the Malaysian pit viper. The snake simply latches onto your arm and injects its clot busting venom (just kidding, it actually latches onto your neck) A TIA (transient ischaemic attack) is a warning that you are about to have a stroke in the next few days or weeks. Lasting generally less than one hour, TIA’s may consist of any of the above five symptoms which by now you have memorized using the mnemonic I taught you (please repeat this SDHWD every time you head off to the bank). Get seen immediately, even if these symptoms clear up, as TIA’s are precursors to a stroke. Remember that dying at age 95 is OK, but living at age 55 after having been felled by a disabling stroke is rough. As for Walter Gretzky, though he has recovered, I note that he has been left with some serious memory deficits. Try as he might, he just can’t seem to recall that Wayne and I were separated at birth.

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“If you don’t have it, flaunt it.” Mr. Reynolds

Mr. Reynolds was an unusual and frightening physics teacher. I was enrolled in his Hi School class, Unusual and Frightening Physics 101. To teach us the finer principles of physics he would bring in radioactive material for us to play with, boil plastic flamingos and even shoot off a gun (long before it was routine recess recreation.) But what made him even more unusual was that he was completely bald. Not a speck of hair on his 29-year-old head, eyelashes included. Made Yul Brenner look like a hippie. Compared to Mr.Reynolds, Kojak was a chia pet. Yoda. It was as though some experiment involving liquid nitrogen and Nair had gone wrong. Though I loved his class, I lost my composure one day when he brought in a bowling ball to demonstrate inertia and friction (think Senate). It sent me into a massive giggling spasm, the type where to keep from blurting out, you bite the inside of your cheek so hard you bleed. “What’s so funny, Hepburn?” “Well to be honest sir I was just picturing your eyeglasses on that ball and...” Later that day, while in detention, I finally screwed up the courage to ask, “Sir, how did you get to be so bald?” “Well” he responded with a sigh “I was a hairy guy once, then suddenly, “POOF” it was gone, in one week. The doctor called it Alopecia Areata Totalis. I call it the solar panel to my brain.”

Alopecia areata

One day out of the blue, your immune system, like your parents, might get sick and tired of your hairdo. It will attack the hair follicles and suddenly, over a period of one to two weeks, round bald patches will develop over the scalp. While this usually resolves spontaneously in three to six months, sometimes these bald patches coalesce, like that freaky mercurial cop in Terminator that just would not die. The patches can merge to the point that the entire head becomes bare, a condition called alopecia totalis. Sometimes, as in the case of Mr. Reynolds, the immune system takes out all body hair including eyelashes and facial hair. I recall a patient who had this same alopecia universalis at age 16 only to have all of her hair suddenly grow back at age 41! “Honey, do you remember where I put that Lady Gillette thing.”

Male pattern baldness

Roughly 50% of men will develop a “really wide part”, often decorated by three exceedingly long hairs stretched across the scalp for warmth. These Friar Tucks of hairdom usually hail from families with a genetic predisposition to baldness. Even women who are from families that have a history heavy in chrome domes may develop male pattern baldness. Like most of the world’s problems, we can blame this comb-free living on testosterone. Genetics determine how much testosterone will be converted to its nastier form, DHEAS, in hair follicles. Testosterone and hair follicles don’t get along. Testosterone, being tougher, wins. Men who are eunuchs or who have had their testicles removed for other reasons (see Clinton) STOP losing their hair! Hey, some guys hate being bald. While most of North America’s 80 million balding men just say no to drugs, rugs and plugs, the rest spend a slick seven billion dollars a year on hair loss treatment. One drug, finasteride, taken orally, will prevent testosterone from torturing hair follicles. Minoxidil lotion also helps to reseed the recede, though it must be taken continuously as hair loss resumes when the medication is stopped.

Trichotillomania

The deliberate compulsive pulling out of one’s own hair is a bizarre yet fairly common cause of unexplained bald spots. This may range from mild twisting and yanking of a few strands to a more severe grab and hauling out of massive clumps. Prior to age six it is primarily boys who engage in such behaviour, often perfecting this talent by practicing on their sister. After age six girl trichotillomaniacs outnumber boys 10:1. Treatment involves medications to treat compulsive behaviour disorders or else cutting off the hair completely which may seem harsh but hey, it beats what has to get cut off to treat male pattern baldness.

If you are thinning or losing your hair for no apparent reason you should make sure your doctor does a blood test that includes: TSH, ANA, testosterone, DHEAS, iron, B12.

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Not having a TV in my family has its pros and cons. While we spend less mind-numbing and obesity-inducing time with our noses glued to some senseless sitcom spew, there are those days when we'd be thrilled to watch even the test pattern on channel 2. TV shows become a treat rather than a habit and so, whenever we have the occasion to watch TV, we sit spellbound, staring at commercials with slack-jawed intent as if we were watching the Queen of England belly dancing for a herd of Klingons. And so it was that I found myself in a hotel room with my son watching with utter fascination a documentary on badgers. Were you aware, for example, that these resourceful excavators can sense where underground dungballs are hidden? What's a dungball? Well if you'd watch more TV you'd know. As any amateur dung beetleologist knows, dung beetles zip about collecting great wads of dung which they then fashion into a large croquet-sized ball. As if rolling up a snowman, these dung beetles don wee scarves and go outside to frolic in the dung, making assorted dung angels, dung forts and dungballs. But instead of sticking carrots or coal in the ball, they lay their larvae in the dungball, assuming they will be safe from any self-respecting animal with half a nose. They didn't count on the disgusting badger. As we watched, the TV's larva-cam caught a badger clawing open a large ball of dung and then sticking its tongue into the center of it with great relish. As it slurped up a vile mix of large juicy larva and dung, I found it necessary to put down my pizza. In fact, I closed the box.

How could anything be interested in digging through such a nasty ball of poop? Yet as physicians, or at least lab techs, we relish the opportunity to do much the same, minus the tongue and the larvae. The most sought after information in a stool specimen is the presence of hidden blood. Last year 60,000 North Americans died of a largely preventable disease, colorectal cancer (CRC). Another 150,000 got the news that they have contracted this second deadliest of all cancers, lung cancer being the first. If you are a non-smoker, CRC is the cancer most likely to do you in. The good news is that CRC is generally a slow-growing beast that gives hints that it is about to turn nasty by leaking very small amounts of blood into the stool. CRC begins its life as an easily removable polyp. While most colonic polyps are small and pose no threat, larger polyps, which take five to ten years to grow, are precursors to cancer. For this reason, every man, woman and child over age 50 should have an annual Fecal Occult Blood Test (FOBT). See a doctor who will give you three test cards to take home. Eat a high fibre diet for two days, avoiding broccoli, cauliflower, Vitamin C and red meat, all of which can affect the test reagents. On three separate days take a small stick and (retch, gag) apply stool to these cards, then fold them back up. These cards look like scratch and win cards but please advise the kids or any lotto players in the house that these would become scratch and lose cards should they open the card and enthusiastically rub. Discard the stick far away from coffee stir sticks. Return the card lovingly back to your doctor accompanied by a card of appreciation for what he has go through just to insure your good health. Alternatively, to the chagrin of the Cliff Clavins of the world, you can mail the sample in, hoping that the mailman doesn't have a pet badger accompany him on his route. Through the miracle of modern medical magic the doctor can instantly detect the presence of blood in the stool. While blood does not always mean cancer, it does mean that further investigation, in the form of a colonoscopy, is warranted.

As screening tests go, FOBT has proven to save lives through early detection of a cancer that is usually not bothersome to its victim until it has spread ominously beyond the bowel wall. Since 1984 death by CRC has decreased by 2% per year due to enhanced screening and better mail service.

So please, screen yourself. Though it may sound less than palatable, go and see your doctor and have this simple test done every year. In addition to keeping us all humble it may save your life. Please don't make us badger you.

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“Travel is fatal to prejudice, bigotry, and narrow-mindedness. Broad, wholesome, charitable views of men and things cannot be acquired by vegetating in one little corner of the earth all one's lifetime.”  
-Mark Twain

Economic downturn. Response of one patient. “I will not let this recession session or depression session affect my obsession with two things; good food and good travel. I will never be this age again and years from now I will regret what I didn’t do rather than what I did.”

The problem with we North Americans is the two week vacation, known to the rest of the world as the too weak vacation. While Australians enjoy taking a six month walkabout and wanderlust Germans seem to be on a never ending hinterlands hike, we would rather work ourselves into the grave and then wonder why we never got out and experienced wonder. When I am on my doctorly death bed, looking back over my life I won’t be relishing the time spent with my finger in unmentionable places but rather my time spent with my finger pointing at unforgettable places. I won’t remember lying on the couch watching hour after hour of The View but I will remember watching the view hour after hour.

Q: “Dr Dave, are those who take vacations healthier?”
Dr. D: “I’m writing a health column so what do you think?”
Q: “You know what I think because you in fact are Q as well, aren’t you.”
Dr D/Q: “I knew it...I must be nuts.”

Five health benefits of travel

1. Men at high risk for coronary heart disease who take frequent annual vacations are 21% less likely to die of any cause and 32% less likely  to die of coronary heart disease.

• Unless the vacation involves phrases such as  “ ...and these Great White’s seldom chew through. Just don’t sweat, it  makes them way more aggressive.”

2. Lose weight!

• Most people overeat from boredom, not hunger. Those who experience new places, palates and people are too bored to eat the cardboard aisle of Costco.
• Traveling gets the blood flowing because it means activity. Whether laying on the beach pretending not to ogle, splashing about in the surf or walking the streets of Hanoi, Hamburg or Hades - you will be doing something! You'll turn the television off, shut down the computer, and get moving.
• Even cruises, where people used to go on as passenger and come off as freight, have become more selective and less seductive in their seductive selections.

3. Relax!

• More than half feel more rested, invigorated, stress-free and relaxed when they return from vacation (52%), and almost as many state they sleep later on vacation (49%).
• Improved sleeping habits continue well after the vacation.
• Sleeping pills are often dumped down the drain where they are eaten by fish who become way easier to catch on my next vacation.

4. Blood pressure, heart rate, and levels of epinephrine – a stress hormone – decline on vacations.

• Decline occurs after only one or two days assuming it lacks “I think the trick to get Mummy to start liking you is to rub both feet hard simultaneously and knock off some of that thick yellow scale.”

4. At least 4 out of 10 travelers feel more romantic on vacation.

• Nearly one-third admit to making love more often on vacation (31%). Of course this is not always a healthy thing, especially if Q shows up.
  
  

Join hosts Dr. David Hepburn and Dr. Rob Sealy on a
14 day Grand European River Voyage, offering health
and wellness lectures to enrich the on board experience.
Find out more online or call toll-free! 1-866-341-1777.

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Along with his and her towels, his and her cars, his and her razors, his and her negligees, please add his and her cancers. The prostate and the breast, both capable of harboring hormone-sensitive cancers, possess some intriguing similarities.

At birth, the prostate gland is about the size of a pea, while a newborn brain is the size of a ripe avocado. By adulthood, the prostate resembles more the avocado, while the male brain (as I'm repeatedly reminded by numerous females in my life) apparently tends to resemble the pea.

The prostate's job is to provide a fluid that nourishes sperm. Eighteen nanoseconds after nourishment, the well-fed sperm will cheerfully head off to work on an egg hunt, never to return. The breast's job is to provide a fluid that nourishes children. Eighteen years later the well-nourished child will reluctantly be egged on to find work, always to return.

STATS
Perhaps the most unfortunate similarity between the breast and the prostate is the fact that this year 200,000 women and 200,000 men in North America will be diagnosed with breast and prostate cancer respectively. Of these, 44,000 women will succumb to their disease while 37,000 men with prostate cancer will not survive their illness. Prostate cancer is now the most commonly diagnosed cancer in men. It is the second leading cause of cancer death in males, trailing only lung cancer for that dubious distinction. Breast cancer is the most commonly diagnosed cancer in women. One woman in eight will develop breast cancer in their lifetime. Both cancers can be made more aggressive by our so-called sex hormones. Testosterone can speed up the spread of prostate cancer and a select group of breast cancers are made worse by estrogen. Both cancers are more apt to occur in relatives of those who have had the cancer. Oddly, both prostate and breast cancers are a rarity in Japan.

CLINICAL PRESENTATION
Both cancers present with PAINLESS lumps in their respective gland. When a woman presents to the office with a sore breast, my first job is to reassure her that breast cancer generally is not painful until the very later stages. Most painful breast lumps are cysts or teeth left by a weaning child. Similarly, when a man presents to the office stating his prostate is sore, my first job is to reassure him that he probably has no idea where his prostate is.

DIAGNOSIS
Here the similarities tend to diverge. Women are encouraged to conduct Breast Self Exams. Rubber gloves are not necessary. A Prostate Self Exam, on the other hand, tends to be a tad awkward and is frowned upon in most social circles. A prostate exam, called a DRE (Digital Rectal Exam), should be performed only by a trained pro. Attempt this at home and even your dog will likely leave home. Current recommendations are for men to have an annual DRE after the age of 45.

The Breast Self Exam (BSE) should be performed monthly, about a week after a period. The best method for BSE involves moving the fingers up and down rapidly on the breast while moving the hand up and down the breast. This is called the lawnmower. Men could also attempt the lawnmower, but only on lawns. After age 40, a woman should have a screening mammogram every 1-2 years and annually after the age of 50. The mammogram is a diagnostic test wherein the breast in placed between two paddles and squeezed and squished flat. (Realizing that this is a column focussing on similarities between prostates and breasts, most men, by now, have recoiled in horror, tossing the newspaper across the room should any comparable test exist for the prostate.) Fear not brave lads, the prostate will not be squished flat in any machine. Instead, if a suspicious prostate lump is detected on DRE, a really sharp needle is jammed into the prostate, and a piece of it is torn out for a biopsy. Feel better?

signing off: Dr. Dave Hepburn, M.D.

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Motto for hypochondriacs "There is no such thing as JUST a mole!" Fran Lebowitz

If you could be a doctor for a day, what kind of doctor would you be? Surgeon, GP, cardiologist, George Clooney, Dr. Hook? What if you had to decide on the type of doctoring you would malpractice every day for the rest of your life? Such a decision is one that all medical students must make as they edge closer to actually obtaining their MD (Masters of Deception). Those who don't mind spending a total of 47 seconds per week with their family choose surgery. Those who feel sleep is a waste of time go into obstetrics. Those who enjoy working for $1.67/hour become GP's. But the smart ones become dermatologists, the rare breed of doctor who enjoys a 9-5 lifestyle, big beautiful bodacious sports cars and pustular acne. A ruptured pimple, even at 3AM on the night before an audition for say, Survivor-Winnipeg, seldom carries with it the same degree of urgency as a ruptured aorta. Extricating excess lint from a belly button is seldom as critical as extricating a harpoon from a carotid. A raging wart doesn't isn't the same fear as an outbreak of purulent PMS.

Yet abdominal pain and rashes tend to be the toughest problems for most GP's to solve. A patient can often be panic stricken about an intense rash, one that I might not recognize. Adding, "Wow, I have never seen one that colour before, at least not on a live patient!" tends to convert their panic into frenzied terror. So I call up a helpful dermatologist, the nicest of all specialists (something to do with eight hours sleep), who calmly solves the carcass conundrum. They are expert rashologists, toenailologists and bleebieologists. Knowing about a few common bleebies may save you unnecessary panic. So, while I close my eyes, remove all of your clothes, get out a mirror and check for:

Seborrheic Keratosis
Commonly mistaken for moles or warts, SK's are, next to moles, the most common skin lesion. Seen in the aging population (ie. those whose actions creak louder than their words) SK's are found primarily on the trunk, back, face and hands. They have a tan colour and a stuck-on appearance, meaning that they are part of the outer layer of skin (epidermis). Those with several SK's look as though they have rolled naked in a field of light brown gum. An SK might be a large thick hard wad of gum, or a small thin piece. And like gum, SK's can virtually be scraped off the skin with a dinner knife and flicked across the table for a little dining fun. If you consider scraping them off to be uncouth then try gnawing them off with your teeth (for those hard to reach SK's, remove denture and start champing). Should you be blessed with a more refined upbringing than my own, see a doctor who will freeze them off with liquid nitrogen or scrape them off with a cheese grater.

Skin Tags
Do not turn into cancer. 50% of these wee cauliflawers are found in the armpits, 35% on the neck and the rest in the groin. Tags typically hang on a stalk like a floppy little mushroom and get caught on clothing or necklaces, camera straps, purse straps, Right Guard, backpacks, fingernails, the cat, pony tails, Ban roll-on, tree branches, ZZ top beards, mink stoles and the like. A good-sized tag can tear into grandma's pearl necklace like it was silly string. Have those tags snipped or frozen off.

Basal Cell Cancer
I recall a dermatologist taking me for a stroll and pointing out numerous people walking about sporting BCC's on their mugs. This most common of the skin cancers has a pearly white border and occurs only in the white population. They are sun-sensitive tumors, 85% of which occur on the face, 30% on the nose alone. Not an aggressive cancer that can metastasize, this basal cell cancer invades the skin eating away at the nose, like Michael's plastic surgeon.

But if at all in doubt about a bleebie or any mysterious lumps or bumps be sure to have it checked out by a professional such as George Clooney. He can be reached at www.drdavelookalike.com.

signing off: Dr. Dave Hepburn, M.D.

I caught the Perseid meteor showers last summer, or at least I watched them, or at least I tried to. August's celestial showcase, performed on the northeast stage of heaven's amphitheatre, is an exercise in aggravation to many of us who would actually like to see this shooting star spectacle.

Lying flat on the long grass with my young son, while dew, dirt and various vile invertebrates violated my ear canals, he would point quickly "See that one, Dad!" Yeah! Well, almost. More like "not really but I think I just got bit". By the time I directed my gaze to the streak that I thought I saw in my peripheral vision, the show would be over. Travelling at 60 km per second, or just slightly slower than my eldest son's pickup truck and pickup lines, these streaking stars are not always easy for these old degenerate eyes to track.

To 10% of those older than 65 years of age and to 30% of those beyond 75, peripheral vision may be all that actually works anymore. The macula, a small area in the back of the eye (the retina) responsible for central vision, can degenerate all too easily. In fact, far too many of the Edsel/Eisenhower/Elvis generation are now in a general state of de-generation. Bones, joints, memory, muscles, hearing, vision and other organs of various size and function all begin to shrivel as we begin our free fall into the world of senescence, one we all too often have not prepared properly for. Even the invincible Britney generation needs to prepare now to eventually join the degenerate generation.

Macular Degeneration (MD), (also known as "smackular” degeneration given the many times that foreheads become intimately acquainted with telephone poles, baseballs and oncoming wheelchairs) causes loss of "straight ahead” vision in both eyes. This makes simple tasks like reading, driving and ogling intolerable. The macula can be wrecked in two ways. It may be invaded by a horde of leaky blood vessels that destroy the macula, the so-called "wet” macular degeneration. Or, in "dry” degeneration, which accounts for 90% of MD, the macula may just start to shrivel and break down, slowly causing vision to blur and dark patches to emerge in the middle of a sentence.

For example, if this health column were juxtaposed to a gardening column there might be large gaps in the center of your vision, leading to sentences like:

to prevent nose bleeds · · · · · · · · don't pick too early and always check for beetles the eye surgeon might· · · · · · · · · · · · · · · · use a large-toothed 22 horsepower rototiller if not circumcised, a boy might discover · · · · · · · · an aggressive Venus fly trap side effects include · · · · · · · · spreading a large amount of manure and worms about the bed

Wet MD causes a more profound blindness and is actually responsible for 80% of legally blind eyes. But caught early, there is a chance that thermal laser treatment, and hours of fervent prayer may be able to slow wet destruction of the macula. Macular degeneration may not always render its victims blind but it might reduce them from fully sighted to partially sighted. Still, loss of central vision can lead to loss of driver's license, loss of autonomy and loss of joie de vive. Although sun exposure, high blood pressure and lack of Zinc have all been named as suspects as a possible cause of MD, the only proven risk factor is our old friend, smoking. After smoke gets in your eyes, don't it make your brown eyes blue.

For this reason it is recommended you should:

1. Not ignore any blind spots, blurriness, wavy lines or decrease in color vision. See a doctor who will test your central vision with an Amsler grid. You can easily find an Amsler grid on the internet and test your central vision at home.
2. Have an eye exam (both eyes) every two years if you are over age 65, every year if you smoke.
3. Don't sit in the foul ball section as you begin to age.

But most importantly, remember that you will invariably go blind unless you ask your doctor to ........ clip your begonias each fall.

signing off: Dr. Dave Hepburn, M.D.

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Nuts in your diet or Health benefits of Brazil Nuts, Almonds, Cashews, Walnuts, Filberts Peanuts etc. for reducing cholesterol, cardiovascular disease, prostate cancer, diabetes.... , by: Dr. Dave Hepburn, M.D.

"...Nut snackers actually eat less, lose weight and have less diabetes."

On rare occasions, when I find that my pantry is low on the essential food groups such as Cocoa Puffs, Snickers and Dr.Pepper, I go grocery shopping. Not one to linger too long in the tofu and wheat germ aisle I slink over to the bulk food section, salivating fondly over these massive barrels of massive calories. When it comes to the cases of nuts, admittedly, I am a bit of a nutcase. I scoop up a large mixture of nuts, flick aside the ugly Brazil nuts, flick in a few more cashews and make for my pantry. But I happen to have two teenage sons/squirrels nesting in my home. By the time I get around to treating myself I notice that all of the cashews have mysteriously fallen out of the bag. My "Keep your hands off my nuts!" command does nothing but garner snickers, which as I mentioned is, in fact, one of the more essential and lovely food groups. Returning later, the almonds have been selectively extricated and are gone. Finally the walnuts are freed from the mix, leaving me with nothing but a bag of filberts and salt. This drives me...exactly. Nuts, though unquestionably chockfull of fat, just might be the healthiest snack in your cupboard.

ALMONDS
A handful of almonds a day will keep the cardiovascular surgeon away. The lowering of LDL cholesterol, known as the mother of all evil cholesterol, is essential for routine heart pump maintenance. In fact, in those who are at risk of heart disease, the aggressive lowering of LDL cholesterol is necessary. According to the nutty professors at Harvard who study these things, a daily handful of almonds can lower LDL cholesterol enough to reduce cardiovascular disease by a whopping 20%! In some cases a handful of almonds may be used instead of cholesterol-lowering medication. Almonds are also rich in folate, a vitamin important in keeping hearts, fetuses, bone and brain healthy.

CASHEWS
Gesundheit. These luxurious nuts are nothing to sneeze at. Cashews are rich in selenium, a mineral shown to protect against prostate cancer. (This being the case my sons should have the healthiest prostates south of Spitzbergen.) Cashews, like most nuts are best eaten unsalted and raw while the oil is fresh. Like almonds, these nuts are loaded in monounsaturated fats, which is good fat. If "good fat" makes as much sense as "slumber party or "cat owner," realize that, like good cholesterol, unsaturated fat acts biochemically to reduce the risk of cancers and coronaries.

WALNUTS
Rich in omega 3 fatty acids, walnuts are, like fish, beneficial in lowering cholesterol. They are also rich in arginine, an amino acid important in the synthesis of nitric oxide, which helps relax tense blood vessels.

PISTACHIOS
These nuts have been known to cause an unfortunate disease known in the medical field as Pistachio nail. Wrestling vigorously to get at a pistachio may cause scrapes under the tender thumbnail skin, which when further irritated with salt will cause its victim to insert the injured thumb deep into the mouth. Sucking vigorously at the thumb, the victim is often seen simultaneously sifting through the bag for easier pistachios.

PEANUTS
Peanuts are not your normal nut. In fact, peanuts are no more a nut case than Michael Jackson isn't. They are legumes. But as we can salt them, roast them and sell them in the bulk food containers, let's consider them nuts. The average child will eat 1500 peanut butter sandwiches by the time they graduate from high school. This is not necessarily bad as peanuts are high in fiber, niacin and a powerful antioxidant called reservatol, the same flavenol that gives red wine its reputation as a protector of hearts. Same benefit, less hangover at recess.

So as I sit here with my bag of filberts and salt, my everlasting-prostate sons are fully sated. While a corn doodle or other empty carb snack leaves the snacker hungry again in 30 minutes, a handful of nuts satisfies hunger pangs for several hours. Nut snackers actually eat less, lose weight and have less diabetes. Satisfying, fat, tasty and highly nut----ricious.

signing off: Dr. Dave Hepburn, M.D.

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"SMELL YOU LATER!" The Power of the Sense of Smell, by: Dr. Dave Hepburn

My grandfather's name was Dah. His real name, I'm told, was George, but to his grandkids he was good ol' Dah. As a wee lad I would spend hours sitting on Dah's lap, watching the oft-resurrected Wyle E. Coyote [cartoon character] rocket through another Acme disaster, while the burning embers from ol' Dah's cigar would fall into his snowy white chest hair or directly onto my cornea. Finally he would say, "David, you're 15 years old. Get off my lap and give me back the cigar." I loved ol' Dah and when he passed away it was for me a cruel joke.

Thirty years after his passing I received an unexpected phone call. "Hi, my name is Bugsy and I fought alongside your grandfather George in Italy.” "You knew Dah?” I exclaimed, thrilled at being reminded of my childhood pal.

As Bugsy went on to relate some of Dah's legendary military feats, which usually featured greased pigs, five aces or stolen jeeps, I began to notice a strange odor at my desk, stranger than normal. I glared at the dog who glared back with a stupid yet innocent grin on his mug, but it wasn't him. Suddenly this strange yet familiar smell twanged the memory cells of my brain. It was Dah's cigar. So clearly could I smell that smoke that I had to look around the room twice to insure that no such cigar was smoldering. Smelling a man dead thirty years may seem a tad Beetlejuicy and perverse, but in the part of my mind responsible for smell he was very much fresh and alive. Such is the power of the sense of smell.

"Doc, I don't smell too good."

"Well Bloggins, I've got a cold so I really didn't notice..."

"No I mean I can't smell anything anymore. On occasion it's a blessing but for the most part it drives me nuts. And when I eat I can't tell if I'm eating the pizza or the cardboard box. I'm about as interested in food as I am vacationing in Chechnya. Worse yet, it's really getting me down. Life seems to have lost its zest for me lately."

At the roof of our nose, in a happy little bone called the cribriform plate, sits the olfactory bulb, an organ that is lined by kazillions of glomeruli. These amazing specific smell files can detect, differentiate and process 10,000 different smells.

While taste buds have four basic tastes: salty, sweet, sour and Snickers, it is the sense of smell that allows us to identify exactly what it is that we have just placed in our mouth.

When an odor, nice or nasty, wafts into our nostrils, past assorted hairs, chalk and peas, the glomeruli processes the odor, packs up the information and fires it along the olfactory nerve to some place in the brain right next to the It-Wasn't-Me! denial center.

Anosmia refers to the complete loss of smell. The commonest causes of anosmia include:

1. 1. Sinus disease (either allergic or infectious)
2. Upper respiratory infections, which is why normally evil tasting beasts such as Buckley's or Fisherman's Friend can actually be tolerated when we have a cold.
3. Head trauma, which can disrupt the cribriform plate in the nose.

Age Factors & Smell

Half of those over age 60 have some olfactory dysfunction not necessarily related to any disease, unless you term aging as a disease. As we age, our sense of smell joins the vision and hearing in a gradual decline. Rather than young vibrant cells working hard in the olfactory center, old factory workers now go on strike. Smoking helps to wear down the old factory workers even further. A lack of smell is associated with increased depression and a lower quality of life. Thus it can be concluded that smoking contributes to depression. Astonishingly, loss of smell can also be an early marker for certain neurodegenerative diseases such as Parkinsons, Alzheimers and even Multiple Sclerosis. In fact, anosmia may be the first symptom to signal the onset of these diseases.

As for you Dah, thanks for knocking some "sense” back into me. Smell ya' later.

signing off: your grandson, David.

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Fish Oil Supplements and Your Health OR Salmon is drenched in omega-3 fatty acids

• by: Dr. Dave Hepburn, M.D., Wise Quack's Sturgeon-Surgeon-Fisherman
  
  

  It came out of nowhere. A 100 foot grey ocean behemoth lunged out of the fog right toward the boat I was perched on some 23 miles out into the Pacific Ocean.

  "Shut off your engine and reel in your rod!” barked the orders from the intimidating grey hull of a police ocean cruiser. "You in the bright white shirt, you are fishing in a NO FISH ZONE”.

  "But... but officer I’m not wearing a bright white shirt.”

  "Well then put a shirt on before we go blind and lets take a look at your catch.”

  "OK, throw me something (snicker). As you can see, I have NO fish in this NO FISH ZONE so why don’t …”

  "But you were, in fact, fishing. We saw your flasher, and that’s all we need to see to give you this $250 ticket.”

  "Hold on a second Cap’n Hiliner. How was I supposed to know that I drifted into a no fishing zone, I don’t see any signs?”

  "Check your GPS guppy. Have a good Friday.”

  Busted by fish fuzz, carp cops, pickerel police. And I hadn't even caught any salmon. But the day was not to be a total loss. I cruised over into the FISH-YOUR-BRAINS-OUT ZONE and reeled in a lovely large spring salmon which weighed approximately 36.476 pounds by my guesstimate though the broken scale at the marina had it pegged at 23. (I know it was broken because many of the other experienced fishermen had also noticed that the scales were weighing much differently from what they actually were in their experienced hands.) But my fish was expensive, an extra $250 tagged onto the usual fishing expenses of gas, seasickness pills, 17 lost lures, 1 lost lunch, 1 lost watch, multiple large surgical bandages, skin hook extractor, 3 bribes and the requisite purchase of the market’s salmon special on the way home.

  Was it worth it? Depends on how much value you put into your health.

  Most of you within the sound of this column will die of either a stroke, a heart attack, cancer or as an investigator in the Silverback Gorilla Prostate Study. Several studies have now confirmed that Omega-3 fatty acids lessen the risk factors for stroke and heart attacks but do very little for cancer or gorillas. The American Heart Association studies indicate that Omega 3’s decrease the growth of artery-clogging plaques, thin the blood, lower the level of those dangerous serum triglycerides and appears to even lower blood pressure a little. Salmon is drenched in omega-3 fatty acids, something we get little or none of in the typical North American diet.

  Q: What about fish being contaminated with ocean residue?
  Answer: Farmed fish do have more contaminants than wild salmon. They are fed fish pellets which may have concentrated PCB’s, dioxins and heavy metal contaminants like mercury and Black Sabbath. Any salmon labeled as "Atlantic” is actually farmed. Wild salmon tends to be safer to eat but tougher to catch than farmed. Cooked properly however, 50% of contaminants can be removed from any fish, farmed, wild or pets.

  Q. What about fish oil supplements?
  Answer: Fish oil is considered safe as any contaminants are usually removed during processing. However they lack some of the other beneficial ingredients contained in real fish including several nutrients and many of my most expensive lures.

  Q. So what do you recommend?
  Answer: Two servings of fish per week is the current recommendation but if you are at high risk for cardiovascular disease you might consider supplements as well, after consulting with your doctor. Fish oils, for example, can mess up Coumadin, a common heart drug used to thin the blood. Osteoporosis clinics will often take patients off of fish oil that is high in Vitamin A, a compound that adversely affects bone density. And most importantly I recommend never expose your flasher to the fish fuzz on Friday.

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