Is there a funny side?
Medicine and the practice of it is a very serious
business. Every time a doctor gives an opinion, the medico concerned has to
be ready to back it up with some serious facts. Some parts of medicine can
be downright depressing, they are so serious.
Take for example, that group of doctors who become Forensic Pathologists.
These people do not even get the chance to have a joke with their patients.
No, their consultations are done in the cold sterile environment of the
autopsy room. As a result of all this seriousness at work, most doctors seem
to develop a wicked sense of humor and I was sent some examples of this,
taken from court proceedings. These made me chuckle, especially as there
appears to be a life-long antipathy between doctors and lawyers, although I
must admit I did meet a great lawyer in Australia, I just can’t remember his
Anyway, here’s a few from the records:
Q. Doctor, how many autopsies have you performed on dead people?
A. All my autopsies are performed on dead people.
And the second one,
Q. Do you recall the time you examined the body?
A. The autopsy started around 8.30 p.m.
Q. And Mr. Dennington was dead at the time?
A. No, he was sitting on the table wondering why I was doing an autopsy.
And the last one,
Q. Doctor, before you performed the autopsy, did you check for a pulse?
Q. Did you check for blood pressure.
Q. Did you check for breathing?
Q. So, then it is possible that the patient was alive when you began the
Q. How can you be so sure, Doctor?
A. Because his brain was sitting on my desk in a jar.
Q. But could the patient have still been alive nevertheless?
A. Yes, it is possible that he could have been alive and practising law
Humor is actually a very important part of life and in fact you’re dead
without it. But jokes aside, laughter really is the best medicine. People
who know how to laugh, at themselves as well as at others, do have a better
outcome than those who do not. Even with such death sentences as some forms
of cancer, you will do much better with a happy, positive, laughing approach
One person who really knew this was a chap in Australia who, once he found
he had a terminal illness, held his own wake before he died. In this way he
felt he could say goodbye to all his friends, rather than have them drinking
over his cold corpse after the funeral. Bizarre perhaps, but I can
understand his macabre sense of humor!
No, learn to laugh, read humorous books, watch funny videos, hang around
with people who tell great jokes and suddenly you will find that life just
seems that little bit better. And you’ll live longer too! Now, have you ever
heard the one about the doctor and the actress?
Here’s some more:
In Hospital Waiting Room: Smoking Helps You Lose Weight ...
One Lung At A Time!
The Demon drink:
When I Read About The Evils Of Drinking...
I Gave Up Reading
My Grandfather Is Eighty
And Still Doesn't Need Glasses....
He Drinks Straight Out Of The Bottle.
And for the UFO fans out there:
The Surest Sign
That Intelligent Life Exists Elsewhere In The Universe Is The Fact
That It Has Never Tried To Contact Us.
Abdominal Aortic Aneurysm or AAA
AAA stands for Abdominal Aortic Aneurysm, and as I have
often pointed out, we doctors love acronyms. I am sure that the education
bodies decreed years ago that the medical course should contain three years
of acronyms, as well as another three years of clinical practice.
So what is an abdominal aortic aneurysm (AAA)? First off, what is the aorta?
The aorta is the main artery of the body, directly connected to the heart
and taking the vast majority of the blood from that important central pump
to the abdominal organs and the legs. This artery is around 2 cm in
However, a situation can occur, whereby the artery begins to bulge and can
grow to four or five times the normal diameter. It is this swelling that is
called an ‘aneurysm’. Being of the Abdominal Aorta, then explains the AAA
description. An aorta is considered ‘aneurysmal’ when it grows more than 50
percent over its normal size. By the way, aneurysms may occur in any blood
vessel in the body, but the most common place is in the abdomen below the
renal arteries (the blood vessels that provide the blood to your kidneys).
Interestingly, aneurysms are four times more common in men than women and
occur most often after 55-60 years of age. Elderly males have yet another
aspect to monitor, as well as their prostates!
The danger of the AAA comes from the fact that this can burst, like an
over-inflated balloon, and the patient experiences a catastrophic internal
hemorrhage. This is generally fatal. Aneurysm rupture affects approximately
15,000 people per year making it the 13th leading cause of death in the US.
The incidence of aortic aneurysm increases every decade as the population
ages. Fortunately, early detection and diagnosis is increasingly possible as
more sophisticated medical screening methods become available.
So why does this aneurysm occur? Aneurysms are caused by a weakening or
damage in the wall of a blood vessel. There are many conditions known to
contribute to the weakening of the artery wall including atherosclerosis
(hardening of the arteries), cigarette smoking, high blood pressure and
inflammation or infection.
Atherosclerosis (hardening of the arteries) is the most common cause of
abdominal aortic aneurysms. This occurs when substances such as cholesterol,
minerals, and blood cells build up in the walls of the artery, and thus
damaging it. The muscular wall of the aorta weakens and with the pressure
inside the artery, it begins to bulge. High blood pressure may speed up the
weakening, but it is not the cause. Aneurysms also tend to run in families,
so there is the thought that genetics may play a role in who gets an
aneurysm. (When in doubt, blame your parents - for everything!)
There is a strong link between cigarette smoking and the occurrence of
aneurysms. Smokers die four times more often from ruptured aneurysms than
nonsmokers. Aneurysms in smokers also expand and weaken faster than those in
nonsmokers, making this the one hundred and twenty thousandth good reason to
give up cigarettes.
Unfortunately, until an AAA bursts, there are generally no symptoms to let
you know you have one of these ‘time bombs’ sitting in your belly. The
discovery is then usually during an annual physical, where it can be
palpated by the doctor, but by far more accurate is an ultrasound, which can
give exact dimensions, and thus progressive indication of how rapidly the
swelling is growing.
The answer to this is an operation to replace the swollen, weakened artery,
with a suitable piece of highly expensive ‘garden hose’ of correct length
and diameter. This is a major operation, but once you have had an AAA
detected, there is no other way around the problem. There is also some work
being done on encasing the aorta to contain the swelling, but this is not
the usual method of ‘defusing’ an AAA.
You should be lining up for a routine health check every 12 months, after
you reach 40 years of age. When was your last one?
However, if they do find one, you join the ranks of the famous, as Einstein
had one, but unfortunately died when it ruptured.
Deafening our children
Have you ever wondered just why Thai ladies cannot talk
quietly together? Women’s conversational Thai is a language shouted at full
volume, with everyone talking at the same time. For the western male this is
something of a (noisy) mystery. However, I have unearthed the secret, and it
isn’t a pretty tale, I will tell you now.
What prompted this week’s column was my accidentally stumbling into the 2011
Aerobics championship for schools being held in one of our shopping malls.
Whilst it was good to see so many of the schools having an aerobics group
present, showing all kinds of physical skills, this was done to music
emanating from a bank of huge boom boxes, with MCs shouting into their
microphones, to be amplified to the same levels.
When I was practicing as an Occupational Health Physician, we would monitor
the noise levels in factories, which by the very nature of the type of work
being done, were quite noisy. The upper limit was 90 dB for eight hours. The
local shopping mall was nowhere near 90 dB, but I would suggest it was at
120 dB at least.
Now groups such as OSHA (Occupational Safety and Health Administration) in
the USA have been able to produce world standards for noise exposure. 90 dB
for eight hours, 105 dB for one hour and 15 minutes or less for 115 dB.
Anything over that and irreversible changes occur in your ability to hear.
That’s for adults - children are more sensitive to noise.
The children in the shopping mall were there for around two hours. About 10
minutes on stage and an hour limbering up and probably another hour watching
the other schools. That is far greater than the 15 minutes at 115 dB, and
let me assure you, it was much louder than that. It was at the threshold of
To give you some examples of noise levels:
Normal home or office background is around 40-60 dB.
Normal speaking voice is 65-70 dB.
Orchestral climax at 105 dB.
Live Rock music: 120 dB+.
Pain Threshold: 120-130 dB.
The ear is made up of three different parts, including the outer ear which
is the part you can see. Its shape helps to collect sound waves. A tube,
called the external ear canal, leads inward to the eardrum.
The middle ear is separated from the outer ear by the eardrum. The middle
ear contains three tiny bones called the malleus (hammer bone), the incus
(anvil bone) and the stapes (stirrup bone). These bones amplify the movement
of the eardrum produced by sound waves making the drum move in and out. The
Eustachian tube connects the middle ear to the back of the throat and helps
to equalize air pressure.
The inner ear is where the sound waves are picked up by a tiny spiral-shaped
organ called the cochlear. Hairs on the cochlear sense the vibrations and
pass the message as electrical impulses to the brain via the cochlear nerve.
The whole system is very sensitive.
There is no doubt that the young ears would be damaged by the noise exposure
they suffered last week. If they were very lucky, it would only be a
temporary form of deafness (called a temporary threshold shift), but enough
repeated exposures will result in permanent degrees of deafness.
Now think of any outdoor party or concert you have been to in this country
and cringe at the memory of the loudness of the music. One hour at 105 dB is
the safe limit. That limit would have been exceeded both in time and in
It is improper for me to be too sweeping with statements, but if your Thai
wife has been to enough stage shows, concerts and outdoor karaoke, she will
have permanent hearing damage by this stage. So will her friends. And so
they have to shout louder. And you go to the pub for a bit of piece and
This also goes a long way towards explaining why the local populace does not
hear phones ringing, and why the girl in the next office has her mobile
phone ring tone set on maximum. And I know she has an incoming call before
BPPV - common but often misunderstood
Benign Paroxysmal Positional Vertigo (BPPV) is a very
distressing condition, and much more common than you imagine. If you have
it, after you move in a particular way, you feel that the room spins around
you and you cannot stop it. It is like being so drunk that when you lie down
on the bed the spinning rotation is so bad you grip the edges of the bed to
stop falling off. That is what BPPV is like - but without the hangover the
The symptoms of BPPV include the dizziness (vertigo), lightheadedness,
imbalance, and nausea. Activities that bring on symptoms will vary, but are
almost always produced by a rapid change of position of the head. Getting
out of bed or turning over in bed are common ‘problem’ motions. Because
people with BPPV often feel dizzy and unsteady when they tip their heads
back to look up, BPPV is sometimes called ‘top shelf vertigo.’ Women with
BPPV may find that having a shampoo can bring on the symptoms. It also tends
to be recurrent. So until you read further, don’t look up or get your hair
To understand BPPV, you have to understand the workings of your inner ear.
You have three semi-circular canals aligned in different directions, which
act like spirit levels (the builders type, not the three fingers on the
glass barman type) which have cells with fine hairs bathed with fluid as
your head moves in different directions. The movement of the fine hairs
sends electrical impulses to the brain to tell it (and you) which way is
However, with BPPV, the natural movement inside the semi-circular canals is
disrupted, so the fine hairs send the wrong signals to the brain, and being
unable to work out which way is really “up” the sufferer falls over, totally
unable to save themselves from hitting the floor. Debilitating and
embarrassing! Ask anyone who has had BPPV.
The commonest cause of interruption to the normal ebb and flow in the
semi-circular canals is produced by something we have called “ear rocks”.
These are made up of crystals of calcium carbonate, and we medicos call
these ear rocks “otoconia”. Imagine these rocks to be like sugar crystals in
the bottom of your coffee cup. These now swish around every time you move
your cup, and likewise your “ear rocks” swish around every time you move
However, it is not all that simple (it never is, is it?) as the commonest
cause of BPPV in people under 50 is head injury. In older people, the most
common cause is degeneration in the semi-circular canals of the inner ear.
BPPV becomes much more common with advancing age, but in 50 percent of all
cases, BPPV is called ‘idiopathic’, which is a fancy word we use when we
have no real idea as to the cause!
Viruses can be accused too, such as those causing vestibular neuritis, minor
strokes such as those involving anterior inferior cerebellar artery (AICA)
syndrome, and Meniere’s disease are significant but unusual causes.
Occasionally BPPV follows surgery, where the cause is felt to be from a
prolonged period of lying on the back with the chin raised (for the
anaesthetic tubes to slip down your throat), or ear trauma when the surgery
is to the inner ear. The simple situation is that we can make the diagnosis,
but it van be harder for us to exactly pinpoint the cause. To make it even
harder, an intermittent pattern is common. Your BPPV may be present for a
few weeks, then stop, but then come back again.
Is there any treatment? Yes there is, if ear rocks are the cause. Treatment
usually consists of a series of maneuvers you are put through which are
designed to move the ‘ear rocks’ around till they no longer cause problems.
These are demonstrated by the Ear, Nose and Throat (ENT) specialists and
usually result in around a 90 percent cure rate. The most common is called
the Epley maneuver or the particle repositioning or canalith repositioning
procedure, but have your ENT specialist show you how to do this.
Cancer research - why it is so difficult?
I addressed the Pattaya City Expats Club a couple of
weeks ago on the subject of ‘Living Wills’ (and I hope you have registered
yours), but in the very lively Q&A session afterwards some statements came
up which I feel obliged to answer in the public arena.
A “cancer research” item was spoken about, which was cited as the biggest
and most comprehensive and most expensive study ever conducted.
It was implied that the results of the study were suppressed by the beef
industry and the dairy industry, because the findings implicated meat and
dairy products in the causes of cancer. (The conspiracy theory is alive and
Please consider just ‘how’ the meat and dairy industries can continue to
suppress these research results? Buckets of money? But with cancer research
being done all over the world, by legitimate scientists, they must be very
large buckets, and there must be an army of researchers ready to be on the
take. I’m sorry, but I do not believe that the world’s researchers are all
corrupt. In fact, at the end of all research papers are statements by the
researchers to show whether or not they have any connection with any groups
or manufacturers named in the research.
This highlights one of the weaknesses of the internet - “facts” are not
subject to scrutiny. You can post anything you like, and there is no vetting
of your posting. For example, the email notification that ‘Aspartame’ can
cause Multiple Sclerosis and a whole swag of other conditions. The writer’s
sister stopped her diet soft drinks and made a miraculous recovery. This
tripe has been going round the world for 10 years. You would imagine that if
it were so easy to suppress scientific information, the cola manufacturers
would have had Frank (the Enforcer) round to his home already.
No, science progresses slowly and with a measured tread. Pointing the finger
at potential carcinogens requires much careful study, far beyond a case
study of one.
There are many reasons for this, including the fact that your reaction to
‘carcinogens’ (cancer producing substances) is not necessarily the same as
the reaction of the person sitting next to you. Individual differences do
exist, and may even be reflections of inherited (genetic) influences. This,
in part, goes to explain why your Uncle Jimmy smoked 80 cigarettes a day for
60 years and was shot by a jealous husband when he was 103, while the man
next door died at 45 with lung cancer after smoking only 20 cigarettes a day
for the previous 20 years!
So what is a carcinogen? Cancer is caused by abnormalities in a cell’s DNA
(its genetic blueprint). Abnormalities may be inherited from parents, or
they may be caused by outside exposures to the body such as chemicals,
radiation, or even infectious agents including viruses. Some carcinogens do
not act on DNA directly, but cause cancer in other ways, such as causing
cells to divide at a faster rate. Substances that can cause changes that can
lead to cancer then are called carcinogens.
The difficulties in studying them come from the fact that carcinogens do not
cause cancer in every case, every time. Substances classified as carcinogens
may have different levels of cancer-causing potential. Some may cause cancer
only after prolonged, high levels of exposure (remember the words of
Paracelsus: “Dosage alone determines poisoning”). And for any particular
person, the risk of developing cancer will depend on many factors, including
the length and intensity of exposure and the person’s genetic makeup.
The International Agency for Research on Cancer (IARC), has evaluated the
cancer-causing potential of about 900 likely candidates in the last 30
years, placing them into one of the following groups:
Group 1: Carcinogenic to humans
Group 2A: Probably carcinogenic to humans
Group 2B: Possibly carcinogenic to humans
Group 3: Unclassifiable as to carcinogenicity in humans
Group 4: Probably not carcinogenic to humans
There are around 90 carcinogens in Group 1, with most being referred to by
long chemical names such as
however, there are others like solar radiation, alcoholic beverages,
analgesic mixtures containing phenacetin, salted fish (Chinese-style) and
Now then, has anyone heard from Uncle Jimmy recently?