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Why Tuesday?

The Girlfriend's Guide to Health will be updated every Tuesday.... Stay tuned dear readers and let me rock your world.

Tuesday, November 26, 2013

Breaking Bread

(I stole this Photo from Mike Bickerton - he's a creative genius)

It has come to my attention sweet sisters of mercy that the war on gluten is upon us. It started off slow, insidious almost. First there was a shelf at the supermarket, then a small area in the frozen food section. Slowly but surely gluten free items were popping up all around the world.

The world (well, the New World- North America seems to be hardest hit) is now officially GLUTEN SENSITIVE.

A recent poll of Americans shows that 30% are afraid of gluten. Seventy percent are afraid of public speaking and 60% are afraid of death. This of course brings a whole new thought to the bagels and shmear served at funerals these days.

Let's be clear... I'm not a hater. I love gluten; and by gluten I mean bread, pasta, all of it. Anytime you take a wheat kernel and turn it into something magical, I'm a fan.

I must admit that when this whole "Gluten sensitivity" experience descended upon us, I was indeed a skeptic. How could something that had literally been a part of civilizations "daily bread" be Satan? Was it not just a fad? Gwenyth (Paltrow) went gluten free so should the masses follow? To be clear, girlfriend names her kid Apple.... her judgement is questionable.

But could 30% of American be wrong? Sure they had some lapse in judgements in the past (George Bush?) but when 1/3 of a nation cites a food sensitivity I stand up and take notice.

And so like any good cybersister.... I went searching for the science behind our culture's fear of all things pizza dough.

Gluten, my sisters is indeed Latin for "glue". It is composed of two proteins Glutenin and Gliadin and when you combine these two proteins together and with water you get something truly magical. I should say, I'm a woman who loves to make bread. I love the tactile experience of kneading the bread and watching it become smoother and springier in my hands. This very act is indeed gluten in action. Mix flour and yeast with sugar and water and sure enough you activate the proteins in the granules- Gliadin and Glutenin which come together to form gluten. The yeast ferments to form carbon dioxide which aerates the dough. The dough rises and when you bake it these bubbles expand even further and stiffen. When the bread is fully baked, the bubbles stiffen and the starch solidifies. Gluten keeps these bubbles intact as air pockets in the dough. Without it they would flatten and just dissipate (insert sad face here).

As beautiful as gluten is- it has an ugly side. On the extreme side there is celiac disease. This is a disorder that has a significant genetic predisposition. Celiac is an autoimmune disorder where the immune system of the small intestine reacts to gluten. As a results the immune system indeed attacks the small intestine causing erosion of the lining over time. Symptoms of celiac include abdominal bloating, pain, diarrhea. Other systems can also be involved in celiac. Patients can experience skin rashes and irritations and even neurological involvement.

Patients with celiac indeed have autoantibodies towards gluten that can be measured. They also have genetic markers of celiac. These can be measured by one or more blood tests.

Howvere, only 1% of the population in North America suffers from celiac.

So what's with all the gluten sensitivity? Well here's where the lines indeed blur. The scientific literature has well documented cases of patitents with gluten sensitivity. These are patients who lack the autoimmune component of celiac but who have significant symptoms ranging from malabsoprtion to abdominal pain to memory dysfuction when eating gluten. In other words- there really is no blood test for these patients. They do however report a wide variety of symptoms that respond when gluten is taken out of their diets.

I'm not disputing the existence of gluten sensitivity.

What about gluten free for weight loss? This one is a tough one, my sisters. Studies actually show that patients who are diagnosed with celiac often gain weight after switching to gluten free diets.

A study published in 2012 looked at weight gain in 1018 patients with documented celiac. The study showed that 30% of the patients were overweight or obese (less than nonceliac patietns). After switching to a gluten free diet patients gained a significant amount of weight (4kg on average). This is thought to be due to the fact that celiac patients on gluten suffer from malabsorption and after switching to a gluten free diet, their gut heals and absorption improves.

In real life people who do not have a gluten sensitivity who go off gluten have variations in their weight. This depends not so much on whether they give up gluten products but indeed what they replace them with. If you give up cookies for gluten free cookies- we have a problem If you give up gluten for vegetables and fruit.... bingo. Weight loss.

Sweet sisters... clearly this topic is a complex one. I suspect there be many a post in the future about this bread of affliction.

TO some it up as any good sister should?

Steering clear of gluten won't kill anyone. It;'s actually not that difficult. meat, fish, chicken and seafood are all gluten free. Vegetable and fruits are all gluten free as are milk, cream anything you can make from them (cheese glorious cheese).

Benign grains such as quinoa and corn and rice are gluten free. Chickpeas, amaranth and soy are all gluten free. Hell, check the Internet my sisters.... the web is full of all rules gluten.

Are you indeed gluten sensitive? Yes? No? Maybe so. Celiac is real and then there is this medical grey area called gluten sensitivity that I would argue the medical community will take years to figure out..... in the meantime my sisters? Eat bread or abstain. Take your pick and pick your side. Should you come to my house you may not want to partake in my home made bread or award winning pies.... but I promise to win you over with my stunning conversation and impeccable table manners.

I Am a Doctor.... I don't play one on TV

I graduated from medical school in 1996. The television show E.R. had been on the air for more than two years. IN fact I can remember my medical school class convening on a local pub in September of 1994 to watch this "brand new MEDICAL show"!! The show would speak to us. The show would guide us to through the maze of future inadequacies and insecurities and emotional landmines that would lay ahead. When we were feeling sad and lonely and just not good enough, NBC and the cast of ER would help us make it through.

And so we huddled around the pub television in Hamilton, Ontario and awaited our prime time salvation. Fortunately he appeared as he did every Thursday for years after in the form of George Clooney. Now, I have been in medicine since 1993 and it is safe to say that there are thousands of doctors nurses, pharmacists and support staff who have come into my life. It is safe to say that there has only been one George Clooney and we have yet to meet.

In fact I mean no disrespect to any of my medical colleagues past, present or future when I claim that no one in medicine looks like George Clooney. Now one could make an argument that things have changed in the television hospitals since the 1990's.

Let's take Grey's Anatomy for example. It is a show on ABC about surgical residents in a Seattle hospital. Examine the evidence please.... Meredith Grey is a babe. Lexi Grey is a hottie and Christina Yang has phenomenal hair. They are all surgical residents at Seattle Grace hospital with impeccable skin and all the right answers. They have a ton of friends and all get along famously. They drink like functional alcoholics and look remarkably fresh and stunning after 36 hours of sleepless call. One of the show's male leads could easily be considered the George Clooney of the 21st century. Dr. Derek Sheppard aka Dr. McDreamy is played by Patrick Dempsey.

The closest I have ever been to someone of Patrick Dempsey's hot-ness in any academic setting is that I had a tiger beat poster of him up in my junior high locker in 1983. Enough said.

I am not saying that doctors are not a good looking group of professional. Okay, I am. No seriously, it makes perfect sense that there must be some division of talent. Intelligent quotients of 140 and above do not usually come in genetically gorgeous packages. As a rule, God, or Buddha or Alla or whoever DIVIDES. Great skin; bad hair. Big eyes; big thighs. Big brain; small boobs. Nobel Prize winner for Medicine and a runway model..... not likely. The world works better when we all are allotted a certain amount of fabulous and are not too greedy in this regard. Well, at least MY world.

The other day, my dear friend emailed me that he is 3/4 of the way through season one of Nurse Jackie, a cable television show starring Edie Falco about an Emergency room nurse addicted to bad choices and Percodan. I find the show amusing and a revelation in character studies. He is finding it a bit too unbelievable and frustrating. In Nurse Jackie there is a character called Dr. O'Hara who is played by Eve Best. She is brash and stylish and I suspect her role in the show is to be a reality anchor for the lead character as well as a bit of comic relief. Dr. O'Hara wears Manolo Blahniks and has no verbal filter. She is enraged when blood spills on her $500 dollar shoes. In TV speak... her character is brilliant. Yes her footwear is fabulous, even in an Emergency setting, she smokes too much, drinks too much and her bedside manner is crap. In the real world, she is not the doctor I want to be.

So when my dear friend tells me that I remind him of Dr. O'Hara, I can't help but put up my defenses and say..... "It's the shoes". On the one hand, I should be somewhat flattered that I am compared to a woman of gumption and style who wears chanel nail polish beneath her latex gloves and can swim with the sharks in Prada Scuba wear so to speak. But on the other hand was I being reduced to a single image in a cable TV show? Was my entire career a parallel to a character on Showtime? Was it just a number game where 12 years of school and 10 years of practice been reduced to 13 episodes so easily?

And then it hit me. When people ask me what kind of doctor I am, I tell them,
"I'm a specialist in Internal medicine"
"what's that?" They say.
"You know the show HOUSE?"
"Yes. "
"He's in Internal Medicine"

And for some reason that does it. No I am not a crotchety, damaged, lonely man with a fondness for Vicodin. okay, maybe damaged, but the rest.... no resemblance what so ever! It was then that I realized that television is our reference library for life. It allows us to get the headlines without delving into details. Of course if Life really is in the Details.... then as far as my Sony goes... I am missing out.

Research argues that glamorizing the profession on medical dramas is a contributing factor to increases in applications to medical resident programs, which increased from 4% in 1994 (the year ER began) to 5.2% in 1997 According to one study published in 1998 by Dr. M. O'Connor in the Journal of the American Medical Association. In essence, O'Connor argued that students watching weekly episodes of ER over 4 years is comparable to a medical student's time spent in a typical emergency medicine rotation. Taking into account television depictions of physicians along with physicians' and public perceptions of physicians, a similar study found that television portrayals and public perceptions of doctors' interpersonal style and physical attractiveness were more favorable than physician perceptions. Interestingly, network television depictions and public perceptions toward doctors' character and power were more negative than physician perceptions. These studies suggest that viewing medical dramas can impact perceptions.

And so like it or not, we all reach for archetypes. My lawyer friends have Law and Order to contend with. My Chef friends have Top Chef. Housewives have Desperate Housewives. Canadians have Corner Gas and we all have Sex and the City. My accountant has no show. Are these accurate comparisons of the lives that we lead and the jobs that we do or are they a sexy, compelling "sum-up-manship" that fails to capture our true vocational essence? I submit the latter but know that despite my protests I can thank all things Prime Time for at least some of the misperceptions the public holds when it comes to the nature of my work.

Let's clear it up people here and now. Medicine is not sexy. My graduating class was of average looks. I have yet to meet a doctor who looks like Eric Dane or Patrick Dempsey or George Clooney. We do NOT have sex in call rooms and I have never seen the boiler room of any hospital I have worked in. And after a long day of saving life after life after life every 15 to 20 seconds,we do not crowd into the same bar where everyone knows us to drink into the wee hours of the night.

The truth? Yah, it's hard work, yes people die. Yes, some of us are jerks and other try their best not to be. Yes, we make mistakes and yes sometimes we do not clean up after them. It's lonely and long and somewhat isolating but the value of the work is there and undeniably there is a commitment that can not be measured.

As for me? My hair could easily rival Dr. Christina Yangs and I do not have her stylist. I look like hell in scrubs and never wear a white coat (not my colour). I don't have nearly the friends in medicine as they do in Grey's Anatomy. I like my job, but I love my life outside of it more.

I'd like to think I am as honest as Dr. O'Hara but that my bedside manner is far superior. I try to treat each patient I see with kindness and respect, regardless of the hour. And as for my shoes? Blood stained or not... they are in a word.... fabulous

Tuesday, November 19, 2013

How Does God Take Her Coffee?

Here is a thought… Wouldn’t more people attend church/synagogue/mosque regularly if their local house of worship served coffee? There I was in a card carrying agnostic sitting in a synagogue last Saturday morning. It was 9:45 in the morning and brunch was nowhere in sight. My mother stood up on the “bima” (the stage) where she was being honoured in front of her community for celebrating her 70th birthday. The rabbi was saying some lovely words about this woman of valour and all I could think of was “why can’t I drink a coffee in here?” Wouldn’t religion be much better served if they had a little late cart just outside by the prayer books and skullcaps? You could help yourself or even order up the perfect Americano... all while you sat in a lovely comfy pew. While worshiping the God of your choice can't you drink from the nectar of another?

Admit it, the thought is somewhat unconventional, perhaps even disquieting but quite frankly I AM ON TO SOMETHING. In fact, I think the problem with prayer is their marketing. Bookshops have adopted cafes, as have movie theatres, airports and luxury retail outlets; should churches be far behind? You can have your late while you buy your Louboutins. Why not mix a macchiato with Mass or Musaf or Mosque?

All this sitting in a house of worship made me wonder about the scientific evidence was for prayer. Now let us pause for a moment, as I understand that I am now entering the unholiest of unholy. I am about to find scientific evidence to support or refute FAITH. I am aware that by definition FAITH does not need science, in fact it is by its very nature a pure leap away from scientific dogma. By our very beings that which we cannot prove, we believe. This is my disclaimer should I be banished to hell for writing this or worse… should my mother be reading my blog.

According to the scientific data there are three different types of studies involving prayer. The first is known as first person prayer, where one prays for oneself. It is widely accepted that prayer can aid in recovery, not due to divine influence but due to psychological and physical benefits. Many studies have suggested that prayer can reduce physical stress, regardless of the god or gods a person prays to, and this may be true for many worldly reasons. A study published in Gerontology in 2001 looked at 256 patients aged 65 and over awaiting cardiac surgery. The study prospectively examined outcomes post surgery and one of the variables they looked at we if the patients prayed for themselves. Although there was no correlate with outcomes, patients who prayed were deemed to be more optimistic going into surgery.

The second type of prayer is when someone prays over you (think “DEMON BE GONE!!”) in a sort of “heeling hands” type of method. A 2005 study published by The Journal of Alternative and Complementary Medicine alleges evidence that eleven healers sent thoughts at a distance and were able to remotely influence the MRI-measurable brain activity in chosen partners who were physically and electrically isolated. Unfortunately this study has never been reproduced.

The third type of prayer studied is the most common and is called Third Party Prayer. This is where people pray for another person’s well being. Regardless of religious denomination, everyone has this. From Catholics to Buddhist, from Mormon Prayer circles to Mecca we all have some way to hope for someone’s well being. Even the best atheist among us has hope for her fellow sister’s health and welfare. Third party prayer has evidence on both sides.

The largest trial to look at Third Party prayer was The STEP trial (Study of the Therapeutic Effects of Intercessory Prayer in patients undergoing coronary Bypass Grafting) published in the American heart Journal in April 2006. The study involved over 1800 patients having Coronary Bypass Surgery and randomized them into three groups.
Groups one were patients who were being prayed for by others but the patients were told that there was no certainty that they were being prayed for.

Yes, doctors are assholes.

Group two were patients who were NOT being prayed for by others and were told that there was no certainty that they would be prayed for.

Group three were patients who WERE being prayed for and were told that they WOULD be prayed for.
In other words, the study looked at both the power of prayer and the power of knowing if you were being prayed for.

Unfortunately, the group that were prayed for and were told as such did the worst in terms of 30-day mortality and complications. In terms of any kind of complications anything from an infection to death the rates were 52.5% for group 1, 50.9% for group 2 and 58.6% for group 3.

The study showed that prayer itself had no effect on whether complications occurred after bypass surgery. Furthermore patients who were certain that people would pray for them had a higher rate of complications than patients who were uncertain but did receive prayer.

Yah, Science sucks.

But my dear girlfriends, ever the optimist (I have to be…. Skinny jeans are back in style) I will leave you with one thought….

In 15 years in medicine I have seen two patients literally come back from death after receiving “last rights”. One was on Christmas Eve 2002; the other time was Easter 2010. On this last occasion, I had told the family that their loved one had a catastrophic stroke and would never recover. The CAT scan confirmed my worse belief and the patient was in a comma. His family prepared for their ultimate nightmare and the priest came in and administered last rights.

Two hours later while we were moving the man to the bed in the ICU he woke up and asked for a drink of water. Hand to heaven… no word of a lie.

Make no mistake, I’m as good a cynic as the best of them, but both of those occasions made me believe for a fraction of a second; not in a god with a name… but in something more than science and myself.

Now if only I could get a good latte in a house of worship I might REALLY join the flock…

Tuesday, November 12, 2013

You Make it a Marathon

I know my sisters. I have been remiss. I have let my duties slack and for that I am truly sorry. I blame my right hip. You see I had the best intentions last week of filling the interweb with stories of my New York state of mind but indeed the pain and the recovery got the best of me.

Good news? I am indeed human after all.

Allow me to elaborate.

As I write this Ladies and gentlemen, let it be known, I am nursing my right hip. Not the joint itself but more the muscles and tendons that keep it together. I am sitting in the lobby of some fabulous hotel in my pajamas with an ice back under my right ass cheek so as to elevate it to a point where I can sit still for 2 hours straight and be witty and amusing with words.

Yes dear friends, on Sunday November 3 I crossed the finish line in central park and put a year of longing to bed. I finished the NYC marathon. I had run the dream. I had faced my demons and slapped the shit out of them.

Swiftly with a smile on my face and tears in my eyes I crossed the line, got my medal and 5 minutes later my ass froze. I know this sounds rather dramatic (what me? Dramatic?) But yes indeed my butt went into spasm and it has not let up since.

Ever a warrior I soldiered on. I hobbled to my hotel with medal in tow, poncho on my shoulders smiling to the masses passing by. I was a marathoner, ass be damned.

My race was perfection. The 5 boroughs indeed did deliver as promised. From Staten Island to Manhattan with Brooklyn, Queens and the Bronx in between I ran for glory in what could easily have been the largest parade of my life. For 26.2 miles crowds filled the streets and cheered me (and 50,000 of my closest running friends) on. Indeed, I WAS a parade.

The crowds were incredible. Three deep lining the streets with signs, music, high fives and love. There was no end to this street party. For the first 16 miles I had forgotten that indeed I was running. I soaked in the love and one foot magically followed another.

Where else in the world do you spend the day having complete strangers scream your name with adoration and encouragement. I could not help but wonder what it would be like to go to work every day with the same kind of sentiment.

This indeed must be the way it is for many professional athletes. They get up in the morning and go to work only to have thousands cheering their glory. An Olympian enters the stadium to the roar of the crowd. A Pro-football player calls for quiet to the screaming fans so he can complete his superbowl play.

I ran down 1st avenue with thousands of New Yorkers yelling my name and screaming “You got this, Ali”.

And indeed I did.

I could not help but wonder what this kind of enthusiastic encouragement can do to one’s performance?

I have long maintained in work and in life that people respond so well to kindness.

What kind of day would you have at work if while getting into your car you were greeted by a team of random strangers telling you to have a great day and “you got this.”?

Would I be a better doctor if after every patient, the occupants of my waiting room stood up and cheered?

How would my day begin or end differently if on my ride to work in the morning the bike paths in Stanley Park were lined with random strangers cheering me on?

Could this kind of idea spill over into every task we do? Would I cook better with a cheering section in my kitchen? Would I shop for Canada with a crowd of sisters in the shoe department letting me know that when it came to buying those Manolos I was indeed a superhero?

Yes, I realize that is a bit of a stretch. My cooking is not bad, but when it comes to shoe shopping I am Wonderwoman…. No help needed.

It’s a crazy idea but indeed one to ponder on this Tuesday as the ice and ibuprofen take their effect.

I have not run for 9 days and will likely need another week before my right hip heals completely and gives up the ghost of its glory.

But amidst the pain of this injury I remember the moments- and there were many- of the kindness of strangers who stood on the streets of New York with noisemakers and coffee, signs and bottles of beer all to usher praise and support to 50,000 weary souls with dreams of their own and an inner battle to rage.

Running a marathon is such a personal crusade. Whether you are first across the finish or last to complete 26.2 miles indeed shows you who you are. Each marathoner has a unique and challenging experience regardless of their time. And in the end, win or lose we all realize the sum of our standard and the quality of our character along the way. A marathon is not so much a race but a metaphor for life.

And so in that metaphor I pause to wonder what our lives would be like if along the miles of road ahead of us we had a packed house or even a few sporadic cheerleaders letting us know that we indeed were seen; that our race had value and that in the end the race, win or lose would be glorious.

No evidence this week my sisters- I blame the injury. It has impaired my ability to search for the science behind my blogging ways. Instead, here I sit with ice and ibuprofen safe in the knowledge that I am made of decent stuff. But even safer in the knowledge that in a world filled with unrest there is hope among the strife; there are pockets of light amidst the darkness.

People do indeed respond to kindness and in turn our civilization has its great moments. If you ever doubt the wealth of the human spirit…. Go stand along the route of the marathon and cheer along with the masses. Take a moment and lend your voice to the song that fuels humanity. I promise it will feel your soul. 

Wednesday, November 6, 2013

Sorry sweet sisters but I'm nursing a sore hip and a marathon hangover.... give me 24 hours and I promise to blow your mind..... stay tuned.