Mercury and Arsenic Exposures in the Gluten-Free Diet: Finally A Silver Bullet for Unnecessary Use?

February 17th, 2017

Wow.  So I am rusty with blog stuff.  It’s been literally YEARS since I wrote a blog post.  When I started blogging, I wasn’t sure where I’d go with it.  I never pushed myself to make it a huge aspect of my life or career.  I figured if it was something I loved and was motivated to do, then it would organically become a part of my life. Time and interest proved I wasn’t that motivated.  That’s OK.  Tweeting and blogging are truly things I ONLY do if I really want to.  I think that’s the way most of our activities should be–why do something unless you really enjoy it?

That being said, this article came across my email this morning and I felt compelled to respond.  (It helps it’s Friday, my administrative day, where I have dedicated time for research).  The gluten-free diet is so misused, and the downsides of it are rarely highlighted, so anything that brings real pause for concern is truly important.

First off, some statistics.  About 0.7% of the U.S. population, or 1.8 million people, have Celiac Disease.  Celiac Disease is the ONLY real reason to be on a gluten-free diet.  I fully expect rants in comments regarding how “toxic” it is, but the fact is, there is no proof that gluten ingestion in the absence of celiac disease causes measurable long term harm.  Quite the opposite, in fact, are the numerous studies showing the harms of low carb diets and the benefits of whole grains (see below).  Studies showing benefit of low carb diets are almost exclusively limited to short term studies of less than a year’s duration and look at intermediate markers of health (like weight changes or blood tests) not true markers of health (like whether you live longer and get fewer diseases).

I do believe there are people who are gluten sensitive, and for those people, avoiding gluten makes them feel much better and makes sense.  However, in the absence of a proven sensitivity to wheat, there is no reason to be “going gluten free”.

There are many misleading very popular books that talk about how “evil” gluten is, but they are wrong.  They are simply factually inaccurate and misleading.  However, as our current political environment shows, people seem to respond more to drama, exaggeration and propaganda than actual facts.  For a quick, thorough, factual and medically sound rebuttal of the mis-information behind the evils of wheat, read this quick commentary by Dr. John McDougall, a physician who has studied the effects of diet on human health his entire career. https://www.forksoverknives.com/the-smoke-and-mirrors-behind-wheat-belly-and-grain-brain/

Moving on and back to my point about the significant downsides of the gluten-free diet, I know from experience that people don’t really care that the gluten free diet contains more saturated fat and sugar and less vitamins, minerals, and phytonutrients (plant nutrients) than a wheat-containing diet when consumed in the way most Americans are eating.  However, people who ~love~ the gluten-free diet MAY care if it contains more “poisons”, which is why I was really intrigued by this study in the journal Epidemiology published online this month. Here is the link to a media summary of the article: https://consumer.healthday.com/vitamins-and-nutrition-information-27/gluten-975/possible-drawback-to-gluten-free-toxic-metals-719752.html

Contrary to popular myth, the gluten-free diet is more likely to cause weight gain, not the opposite, which is ironic because so many people are “going gluten free” to lose weight.  The caveat is that the ill effects are predominantly seen in people basing most of their diet on processed gluten-free foods that use wheat flour substitutes.  That is, if you eat a lot of gluten-free cereal, cookies, muffins, etc, then you will by necessity ingest a lot of alternative refined grains, and many of those alternative refined grains have less vitamins and minerals *and possibly more toxins* than wheat itself.  Gluten-free eaters fair substantially better if they eat a gluten-free diet full of healthy fruits, vegetables, nuts, WHOLE gluten free grains (the key is WHOLE), and limited meat and dairy.

The researchers in this article were wisely concerned that the reliance on rice flour as a substitute for wheat flour in many gluten-free processed foods could represent a source of inorganic arsenic (the bad kind) and mercury.  We have known for a while that rice, particularly from certain regions like the United States, can contain higher levels of inorganic arsenic.  There is even an FDA advisory out regarding arsenic in rice, particularly in infant rice cereal. http://www.fda.gov/Food/FoodborneIllnessContaminants/Metals/ucm319948.htm

The study referenced in the news article is well done and was conducted by researchers at universities with high integrity in science.  It was not easy to do because of the complicated statistics necessary to make it a valid and reliable study.  It is also important, VERY IMPORTANT, to know this is an OBSERVATIONAL CROSS-SECTIONAL STUDY NOT DESIGNED TO DETERMINE CAUSE AND EFFECT.  Why is that important?  Studies like this can be very helpful in looking for potential problems that need further evaluation.  Cause and effect studies like randomized trials, are EXTREMELY time consuming and expensive, so we can’t just go planning these on a whim.  Observational studies can be done with less resources and usually in a larger group of people to see if the problem is even worth looking into before we commit a lot of time and money getting to the real truth behind the story.

The study results are very simple:  Those who self-identified as eating a gluten free diet had more arsenic of all kinds, including inorganic arsenic, in their blood and urine.  Almost TWICE as much.  They also had higher mercury and cadmium levels (cadmium only in the urine).

Important things this study CANNOT show:

1. It cannot show whether eating a gluten free diet is the CAUSE of the higher levels  (see explanation above for cause/effect).

2. If the diet is causing the levels to be higher, it cannot show which aspect of the diet is the culprit (the assumption is that rice is the exposure, but they can’t know that for sure).

3. It cannot show whether the higher levels are causing or will cause health problems.

To determine those three very crucial points, we need more studies (whah whah, the disappointing but appropriate conclusion of observational research).

What do I take from this?  What I’ve always taken from the gluten-free diet:  The gluten-free diet is NECESSARY for celiac patients and POINTLESS for most everyone else.  Why would anyone choose a diet that has no measurable health benefit but is likely to cause harm?  I also think it is very important for patients with celiac disease to be aware of these issues and try to limit gluten-free processed foods.  Processed foods of all kinds are bad for health (in everyone, not just celiac patients).  Stick to veggies, fruits, nuts, and select healthy gluten-free whole grains.

Guest Post: “A Real Cancer Story: Our Survival”

March 5th, 2013

Dear Readers,

I was honored to be contacted by Cameron whose wife Heather was able to beat a highly aggressive, usually fatal cancer called malignant pleural mesothelioma. He responded to a post I had written earlier that dealt with my personal health fears and taking care of my own health.

Often as physicians, we spend so much effort focusing on patients that we forget a critical component: caring for their caregivers.

Here is Cameron’s story about his experience. Since the position of caregiver is a role most of us will play at some time in our lives, I hope it serves as inspiration for you as it did for me.

-Lena

 

A Real Cancer Story: Our Survival

I often think about the moment in my life when I changed completely. It was in November of 2005 as I sat with my wife in the doctor’s office that I knew everything was going to be different. That was the day that she was diagnosed with cancer, malignant pleural mesothelioma. It was terrifying, and it came out of nowhere. Only three months before we had been celebrating the birth of our daughter Lily, our only child. Our excitement about the future of our new little family was ripped away from us the instant we received the diagnosis.

I became a caregiver as soon as the diagnosis was delivered. There wasn’t any time to waste. The doctor made sure to tell us about treatment options, and laid out several different locations where we could seek treatment. He mentioned a specialist in Boston named Dr. David Sugarbaker who had an excellent recovery rate for mesothelioma. For my wife, I wasn’t going to let anything stop her from receiving the best treatment, and therefore we made the decision to travel to Boston. It was the first decision of many that I had to help make in the midst of doubts and fear after her diagnosis.

Everything is almost a blur after that. Months went by in chaos. Our lives had been turned upside down. I was still working as many hours as I could while I took care of Lily and Heather, and sometimes, I couldn’t help but let my fears get the best of me. I dreaded the thought of being widowed and alone with my daughter Lily. It was something that kept me up until the early hours of the morning, and more than once caused me to break down in tears under the pressure and fear. However, I never allowed Heather to see me in these weak moments, as I knew she needed me to be a rock for her through this difficult time.
Heather’s family was the first to reach out. They knew that we were going through rough times and came through for us in many ways. They provided help for treatment and other financial assistance that we desperately needed. They also helped with Lily’s care during our trips away from home for treatment. Friends were also there for us, offering support in any way that they could. It was the most amazing gift to receive after all of the heartache, and I can’t help but think of what would have happened if I didn’t have these people in my life. My strongest advice for anyone going through a similar situation is to always accept help whenever it is offered. There is no room for pride when a loved one’s life is on the line. Even the smallest bit of help can be a huge weight off your shoulders, and will remind you that you’re not alone in this fight.

After undergoing intense mesothelioma treatment, which included surgery, chemotherapy and radiation, Heather achieved the improbable and beat mesothelioma, a feat accomplished by far too few people. I learned to never give up hope through this whole ordeal. There were many times when I let fear get the best of me, but I always held on to hope and never gave in to despair. Now, seven years later, Heather is healthy and cancer free. We hope that our story of success over cancer can be a source of hope and inspiration to all those currently battling cancer today.

Cameron Von St. James

Mesothelioma Cancer Alliance

http://www.mesothelioma.com/blog/authors/cameron/

 

Quick Blog #DDW12-Benefit to live tweeting?

May 20th, 2012

I had a question.  Does live-tweeting help improve comprehension of a lecture?

I asked this question because I think it does.  I have to focus and process VERY quickly to live tweet.

I was curious to know if it had been studied formally.  I’m currently sitting in a DDW lecture (not listening b/c I”m not interested in this particular abstract).  So I’ll google it briefly

Search string: “does live tweeting improve comprehension”

Limiting to 2 google results pages (hey I’m at a conference here, no boos to my thoroughness)

Page 1:

Blog saying it’s distracting

http://commetrics.com/articles/forrester-conference-and-twitter-does-live-tweeting-help-engage-conference-delegates/

One article about lessons to learn before doing it

Everything else is unrelated

Page 2:

AHA!

http://theactiveclass.com/tag/mobile-technology/

The effect of Twitter on college student engagement and grades

  1. R. Junco1,*,
  2. G. Heiberger2,
  3. E. Loken3

Article first published online: 12 NOV 2010

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2729.2010.00387.x/abstract

Journal of Computer Assisted Learning

Volume 27, Issue 2, pages 119–132, April 2011

 

Abstract

Despite the widespread use of social media by students and its increased use by instructors, very little empirical evidence is available concerning the impact of social media use on student learning and engagement. This paper describes our semester-long experimental study to determine if using Twitter – the microblogging and social networking platform most amenable to ongoing, public dialogue – for educationally relevant purposes can impact college student engagement and grades. A total of 125 students taking a first year seminar course for pre-health professional majors participated in this study (70 in the experimental group and 55 in the control group). With the experimental group, Twitter was used for various types of academic and co-curricular discussions. Engagement was quantified by using a 19-item scale based on the National Survey of Student Engagement. To assess differences in engagement and grades, we used mixed effects analysis of variance (ANOVA) models, with class sections nested within treatment groups. We also conducted content analyses of samples of Twitter exchanges. The ANOVA results showed that the experimental group had a significantly greater increase in engagement than the control group, as well as higher semester grade point averages. Analyses of Twitter communications showed that students and faculty were both highly engaged in the learning process in ways that transcended traditional classroom activities. This study provides experimental evidence that Twitter can be used as an educational tool to help engage students and to mobilize faculty into a more active and participatory role.

 

So at least one study supports my theory.  No time to do a more thorough review–back to the twitter stream . . .

 

Cancer Phobe-A Doc faces her Breast Health Fears

April 2nd, 2012

Today is my second vacation day of the year.  No, i’m not in Bermuda ):

I’m taking two days to do the kind of stuff every human needs to do.  I’m organizing my life and checking off my personal “punch list”.

First on my list is making my yearly trips to the doctor.  Usually I see the dentist twice a year, but since I moved last year I’ve yet to re-establish care in ANYTHING.  Time to take control.

So, first thing this morning (after cereal and coffee of course) I called my own hospital’s scheduling line to find me some new doctors.

Since I plan to have children in the next few years, I’m going to keep my primary care with a generalist OB/Gyn.  I need a pap smear/pelvic and some general pre-(very VERY pre) natal counseling. CHECK! Got it with someone who has clinic on my research day so I can schedule follow ups conveniently.

I also scheduled my dental cleaning.  I hate it, but my teeth are now quite valuable if you count the thousands of dollars in braces, bionators, and veneers that have graced my pearly whites over the years.

Next I faced something I’ve been meaning to do for a few years–a cancer risk assessment clinic.

Let me just say I am a HUGE cancer phobe.  When I was in my fourth year of med school, I sat down in the MICU one day and rubbed my sore neck muscles–only to find a “larger than the upper limit of normal” lymph node.  I had a few in other areas as well, so like a good med student I flipped out and convinced myself I was going to die from lymphoma.  Ten-thousand dollars later (yes m’aam, 10K smackeroos before my co-pay), I had a lymph node biopsy to tell me I was OK.

Years before, I had had another cancer scare.  One that hit a little closer to home.  When I was 17, I found a lump in my breast in the shower.  Of course, I flipped out then as well.  I went to see a surgeon who did a breast ultrasound.  I had the lump removed and was reassured it was benign–a fibroadenoma.  Pretty common, I know now.

It hit close to home because breast cancer is prevalent in my paternal grandmother’s family.  She had a sister who died of it in her thirties, and a niece who developed it in her 40′s.  A few years later, she herself would get breast cancer.

Now, my grandmother was in her 70′s, and it was metastatic mostly because she never went to see doctors and ignored her cancer until it grew to the size of a baseball.

She ignored it probably because she was scared and knew it was cancer. 

Can I blame her?  No, I can’t.  I can’t without being a hypocrite.  I am terrified of breast cancer, and I don’t do breast self exams for that very reason.  As an anxious person anyway, I know I’m going to feel funny lumps and bumps and convince myself it’s cancer.  Again, just like the prior two times.

I’m not without some justification–screening brings a lot of anxiety and false positives.  There was even one large randomized controlled trial of breast self exams in China that didn’t show a benefit of mortality reduction and did show an increase in the diagnosis of benign breast lesions in those who perform BSE’s (“Randomized trial of breast self-examination in Shanghai: Final results,”Journal of the National Cancer Institute, Oct. 2 (vol. 94, issue 19) 2002).

 

But I can’t ignore some facts:  I’m over 30 and childless (increases chances).  My age at menarche also gets me a couple of notches.  The fibroadenoma as a teen moves me up even farther.  Finally there’s my paternal grandmother and her breast cancer clan.   Thank goodness neither of her two daughters, my aunts, have had any problems, and they are approaching their 60′s.

So, I’ve decided to go talk to someone.  I filled out my family tree at family history.hhs.org.  I was unhappy i couldn’t add to my grandmother’s side, though, so I’ll have to hand-write it onto the tree.  I’m sure there are other family history apps that could help out with this.

What I’m hoping to get is an opinion on whether I should begin screening with mammography at the recommended age of 40, or if I should start sooner with a different modality such as ultrasound or MRI.

For all of you out there who fear cancer, you are not alone.  Even us doctors can be illogical about cancer.  Don’t let your fear control you, though.  Take charge, take a deep breath, and talk to your doctor.

Sigh, I just remembered another fear–skin cancer (I have tons of moles).  Time to call Loyola again. This time for the dermatologist . . .

Naps-not just for trainees

March 7th, 2012

During my internal medicine residency, I was one of the “subjects” in my then-attending Vinny Aurora’s (@futuredocs) experiments of residents and sleep.  I wore a little black watch looking thingy for about a month that tracked when (or not) I was sleeping.

I don’t sleep much.  Life is too full for sleep!  I get about 4.5-6 hours during the week.  I make up for it on the weekend; I like to get 8-10 then.

I am chronically sleep deprived.  I know it.  I feel it.  I fade most afternoons.  I usually don’t indulge in the p.m. coffee run, but most days it would be nice (like right now).

One thing I have found, though, is that a quick nap during my mid-week research day is OH, SO, NICE …..

On Wednesdays we have a 7 a.m. conference.  I get up at 5:20 to make it on time.  I usually go to bed between 11 and 12:30 the night before.  I barely stay awake for it, but waiting for me after that hour of knowledge building is a cozy, warm, quiet office.  Very Very Nice.  Very Very sleep inducing.

I know I shouldn’t sleep “on the job”, but isn’t that what some recent studies of work hours are suggesting?  I find my 20-40 minute naps (don’t ask me exactly where/how I take said nap) are excellent revivers.  I feel so much better afterwards, and I truly think it improves my focus and concentration.  It doesn’t impact how long I work, since “work” takes me well past 6 p.m. most nights.

I’m all for naps.  When I had to take them, I didn’t appreciate it.  Now, though, there are days in clinic when I long for a quick trip to my warm, quiet office . . .

Is BPA Bad? Lets find out Part 1

November 30th, 2011

The JAMA article about the large increase in urinary Bisphenol A (BPA) levels after eating canned soup caught my eye because my husband and I eat a lot of canned soup.

[JAMA. 2011 Nov 23;306(20):2218-20. Canned soup consumption and urinary bisphenol A: a randomized crossover trial. Carwile JL, Ye X, Zhou X, Calafat AM, Michels KB. Source: Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA.]

Naturally I was concerned, but my epidemiology background makes me a hearty skeptic when it comes to chemical/toxin “scares” from food.

My motto is “Show Me the Data”.  It is SO DURN HARD to perform a really good study of the isolated effects of isolated chemicals from isolated foods ON HUMANS NOT RATS that I rarely alter my normal food intake to avoid specific compounds unless a strong body of evidence suggests there’s really something to it.

I also know just how easy it is to get a really crappy epidemiologic study published (ahem, Andrew Wakefield?).

So, here’s my project: look into this BPA thing.  People take teams of researchers and spend months doing this.  This is time I do not have. So, I’ll do this in parts. Part I is literature search.

SO PUBMED, SHOW ME THE DATA:

1. Search string #1: BPA w/o limits = Results 2807 

2807 isn’t a manageable #.  I knew it wouldn’t be, but I was curious.  So, I need to refine my search.

2. Search string #2: BPA or Bisphenol A, limits: humans, english, search title only = Results 537

This still isn’t manageable for 1 person, unfortunately.  I.E. it would take about 9 hours to screen all these abstracts.  But, if I refine the search further, my search becomes more specific and less sensitive.  I might miss an important article.  So I’ll limit to full text only next, then screen the titles.

3. Search string #3: Search string #2 but with full text limit = Results 498

That isn’t too helpful.  Limiting to free full text would be very helpful (i.e. 154), but then I know I’ll miss some important things.  Ok, so let’s see how long it will take me to screen titles.

4. Screening titles, using timer to measure time to screen one screen of titles = Results Page 1 = 2 min, Page 2 = 1.30 Page 3 = 1.20 Page 4 = 1 min

So, I can guesstimate that it would take me about 34 minutes at 80 seconds a page to screen the titles. Out of the first 80 I screened, I chose 30 titles to review.  If that is a steady ratio, I’ll pick 187 abstracts.

BUT then I have to read the abstracts to screen them (time estimate = 2 min/abstract = 6 hours), and THEN I’d have to read the actual articles.  Next would be the joy of getting the articles (some I’ll have access to through my job but I am anticipating quite a few I would have to inter-library-loan, ILL).  I don’t think that an estimate of 30%-50% needed through ILL is unreasonable based on my experience with the library so far.   Each ILL costs ~ $15-20.

Let’s recap:

  • 6 hours to read abstracts.
  • If I go on to choose 50% of those abstracts for review = 93
  • Cost to get full text articles if 30% require ILL = $558
  • Time to read 93 articles, [no clue really, big shot in the dark here] ? 10 min? = 15 hours

There’s NO WAY I can take the time or money to do this.

Luckily as I am scrolling, I can pass over the articles on how to measure BPA and the non-human studies that didn’t get weeded out by checking the “humans only” option.

But, perhaps more efficiently I can pick up other recent review articles about the human effects of BPA (and actually read the full JAMA article, which I have not done yet).  The danger in this is knowing whether the people who wrote those review articles have enough knowledge of epidemiology to accurately evaluate the quality of the studies.   Also here’s a WARNING about reading only the discussion section of journal articles: these ARE NOT SYSTEMATIC REVIEWS.  So, if you are “summarizing” the data, it is only natural to bias your summary to support your findings.  Since humans are humans, I don’t want to trust the JAMA article discussion without looking around myself.

See how difficult this can be?  It is SO much easier to glance through someone else’s review article and take their word for it that they evaluated this data objectively.

In the “good old days”, one was supposed to be able to trust the “name” or “reputation” of a journal and the authors.  Well, we know now that even the bastions of medical scientific writing (names like JAMA or NEJM) can let some data slip through that it shouldn’t. [There was an article on screening for lung cancer using CT scans that used historical controls to make comparisons, published in either JAMA or NEJM a few years ago.  While I was in grad school at UNC, one of my epidemiology journal clubs evaluated this article and we had serious issues with the strength and validity of their findings.  Sadly, I cannot find the citation within a a reasonable period of time to write this blog, so I'll have to get back to you.]

Who do you trust?  I don’t know.  I can only tell you what I do, and what I do changes depending on the time I have in which to do it.  Since I don’t intend to write up this exercise for anyone but myself and the readers of this blog, I’ll probably be less rigorous than I would like to be.

5. Search string #4″ Search string #3 with limits to free full text and limited to meta-analysis and review articles only, Results = 19!! Yay!!, kinda (see qualifications about about limiting it to this tight a search).

You know what?  Two of these articles are EXACTLY THE KIND OF STORY I was looking for.  I was amazed the first article ended up Freely Disseminated in Pub Med Central because it is written in 1st person by a mother and a scientist.

PLoS Biol. 2007 Jul;5(7):e200. Epub 2007 Jul 17. Babies, bottles, and bisphenol A: the story of a scientist-mother.  Quitmeyer A, Roberts R. S. Department of Biology, Ursinus College, Collegeville, Pennsylvania, United States of America.

In this article, an undergraduate biology student and her professor (who is also a scientist and mother) discuss the history of BPA, some of the studies of BPA effects, the legislation surrounding BPA (up to the time of publication, 2007).

“Many animal studies focus on the effect of BPA exposure during fetal development . . . A similar correlation to human development is plausible.   Indeed, BPA has been found in the bloodstream, placenta, cord blood, and fetal blood of humans at levels that are within the range studied in many of the animal models [16].”

Be very clear you understand their argument and rationale for their decisions:

  • Studies of animal exposure indicate adverse effects for animal offspring.
  • The same levels that are shown to be bad in rats (and other animals) have been found in humans.
  • Therefore, if I believe that what is bad for a rat is bad for a human, then I believe that BPA is bad for human offspring.

They also discuss the few human studies that exist:

“Of the few human epidemiological studies, one revealed a relationship between BPA exposure and repeated miscarriage [9]. Additionally, BPA causes a human breast cancer cell line to proliferate, indicating that estrogen-sensitive tissues and cells in the body may react similarly [10]“

They decide to apply the effects of animal studies to humans, incorporate the human studies they reviewed, and thus they believe that current human levels of BPA exposure are too high and can be harmful.

I think it is important not to arbitrarily apply rat studies to humans.  I think we should use animal studies to warn us of potential harmful human effects, then try to see if those effects do indeed show up in humans.  Epidemiology allows us to address these questions in humans without subjecting us to trials where we ingest a potentially toxic substance.  The caveat is that good epidemiology studies of chemicals are hard to come by–there is the potential for SO MUCH BIAS that one must be very careful when designing this type of study.  You can get completely wacko results and needlessly scare a lot of people (ahem, Andrew Wakefield?).

Since the above article is now 4 years old, I want to find some more HUMAN reviews to help me form my own opinion.

Next I will turn to an article published in Germany :

Critical evaluation of key evidence on the human health hazards of exposure to bisphenol A. JG Hengstler et al. Crit Rev Toxicol. 2011 Apr;41(4):263-91

Leibniz Research Centre for Working Environment and Human Factors (IfADo), University of Dortmund, Dortmund, Germany, Institute of Environmental Toxicology, University of Halle, Halle/Saale, Germany, Federal Institute for Occupational Safety and Health, Dortmund, German, Research and Development, Merck Serono, Darmstadt, Germany, Dr. Lilienblum Consulting Toxicology LiCoTox, Hemmingen/Han, Germany, Global Early Development, Bayer Schering Pharma AG, Berlin, Germany, Bavarian Health and Food Safety Authority, Munich, Germany, Lower Saxony Governmental Institute of Public Health, Hannover, Germany, Federal Institute for Risk Assessment (BfR), Berlin, Germany

I read the abstract for this, but I haven’t read the paper yet. Basically this was a panel in Germany that was tasked with deciding if BPA is good or bad for you, and if bad, how much is OK.  I’m going to hope that since they were a panel, and that they took dedicated time to address the same question I’m addressing, that their conclusions will be valid.  However, as pointed out in article #1, I will have to decide if politics, lobbying, and business interests play at all into this panel’s decision.

Since I have spent close to two hours on this exercise today and will now have to go back to finishing my clinic notes, working on my presentation for research conference this Friday, re-writing a paper for publication and working on my next research project, it is time to stop my BPA exploration until next time.

Stay tuned . . .

The Violet Hour

April 20th, 2010

April is the cruelest month, breeding

Lilacs out of the dead land, mixing

Memory and desire, stirring . . .

At the violet hour, when the eyes and back

Turn upwards from the desk

At the violet hour, the evening hour that strives

Homeward

T.S. Eliot, The Waste Land

April is the cruelest month.  It is 8 minutes till midnight.

I am on call.

I have 10 clinic notes to type.

I have spent the last 5 hours on my arse triaging hotel crisis betwixt patient and ER calls.

I have a mock presentation tomorrow for my national presentation in two weeks.  For which I am completely unprepared.  I have not read my slides.  I have not timed my slides.  I am not prepared to answer questions about my analysis.  All my mentors are going to EAT ME ALIVE tomorrow at 4:30 pm.

I have the worst clinic of the entire week tomorrow and a three hour required conference tomorrow night.

It is not the violet hour, that perfect hour before night and after sunset.  That hour of magic and mist.

It is the ebony hour, the night hour that stives

Inward

or

Downward

or just down.

I am so tired.  I am going to make coffee now.

When confronted with mortality

April 2nd, 2010

I haven’t written in a long time.  That is because I have been working about 17 hours a day–first it was making wedding invitations.  Next it was actually work, working.

When you work this much, you go into complete survival mode.  Eat whatever you can get your hands on.  Drink to keep yourself awake (i.e. caffeine). Shower. Toileting. Back to work.

So my condo is a tornado.  I have a trail that runs through it so I can walk.  Step off the trail at your own risk.

A few weeks ago, though, the world came to a grinding stop.  One of my good friends in college, one of my sorority little sisters, actually, is fighting for her life in an ICU.

I am seriously concerned she won’t make it, and I pray for her everyday.

She had her first child a month ago, and within a few days, she got very ill from a lung infection that was only minor before the baby was born.

She has something called ARDS.  It is a horrible, long, scary process that doesn’t always end well.  It is a day by day waiting game.

We got some good news first, then 2 days ago I got bad news.

I cannot fathom losing this friend of mine.  She is an angel.  She truly, truly, has no malice.  I so admire that about her.

Her son is one month old and has been held by his mother only a few times.  It makes me physically ill to think of his tiny little self and his father, all alone.

She is a young, beautiful lady with a beautiful baby boy and she honestly, truly might die.

I see death every day.  I prepare people for death and often have to help them learn how to confront their own mortality.  More often, I have to challenge their families to confront their loved-one’s mortality.  I have never had to face the mortality of one of my friends.

I don’t exactly know what to do, and if anyone should know, I should.

Right now I just pray.  It’s been two days, and no word.  I’m really afraid to ask at this point.

I pray for an Easter miracle.

!!SNOW ICE CREAM!!

January 30th, 2010

Today is the day before my birthday and I got the BEST GIFT EVER: an unexpected day off from work! I could not get my car out of my parking lot.  I really did try–it simply could not be done.  We’ve gotten over 6 inches of snow here.  I don’t have salt or a shovel, so there’s no way I’m going anywhere today.

Thank heavens my attending could get in, but that’s only because he’s in walking distance.  He couldn’t get his car out either (:

So, I get an extra day off and I get to make snow ice cream.

I wrote this post on facebook last year. It snowed on inauguration day, and that’s the last time I had snow ice cream.

I take it as a blessed day. On the inauguration of America’s first biracial president, North Carolina was inundated with snow. Children and Adults were allowed to stay home and play in the fresh powder, also getting to see the inauguration on TV. As I write, the rosy sun is setting on about 5 inches of snow in my front yard.

Ironically, I flew in from Chicago last night. Chicagoans have no respect for snow. I cannot blame them–it really screws up their lives for an extended period of time every friggin year.

For a Southerner, snow is a surprise, a blessing, a lagniappe, a treat. Snow means snow ice cream.

When I was a girl, my mom would go out to our great big green table on the back porch and scrape a big bowl o’ snow (clean, fresh powder). Then she made us one of the most treasured southern treats: *Snow* Ice Cream.

Snow Ice Cream is a miracle. It is homemade ice cream in 2 seconds flat (well, maybe 30 seconds). What takes a crank or hand mixer hours, takes less than a minute with snow. And it tastes exactly the same.

It is truly decadent and can only be made on the very special occasion of a Southern Snow (i.e. once in 7-10 years).

Poor Yankees have no appreciation for Snow Ice Cream. They have no idea what it is. When I moved to Chicago, I was so excited–Snow Ice Cream every year! Alas, no one had ever head of snow ice cream, and they all recoiled at my description of it. Eat snow? In Chicago? They were convinced I’d get cancer or some other hideous disease.

I did make it at least once, with my friend Janke. If he thought it was crazy, he didn’t say so at the time. He was too polite, I guess.

Recipe for *Snow* Ice Cream:
One BIG bowl of fresh , clean snow scraped from a clean surface (this is, of course, a key feature of snow ice cream)
(A tip: leave an inch or two at the bottom to ensure clean snow)
One can of sweetened, condensed milk
(ONLY EAGLE BRAND is legit)
One tablespoon of vanilla
(AGAIN, branding: McCormick’s vanilla is all I remember from childhood. Sadly, I used mexican vanilla and it’s . . . . just .. . . not . . . . the . . . same)

Mix. That’s It. I promise.

It can’t be saved. Neither can the snow–it gets too icy. Have a party and celebrate innocence.

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NYE Special: Champagne aint just for drinking

December 31st, 2009

My NYE isn’t the best.  I’m on call, therefore I’m sober, solo, and signing notes at 11 pm.

I may actually be going back to the hospital to stop some bleeding.  We’ll see.  I really hope it stops by itself.

Life throws you a bone sometimes, though:

So, I’m sitting here writing a consult note at home, trying to help make tomorrow be ~slightly~ less excruciating, and as I like to think I’m a good doc I’m doing a PubMed lit search for an unusual condition: spontaneous pneumoperitoneum.  I’m browsing through the results and I come across the following:

“Chemical Peritonitis from Champagne”

It was written in 2004 by MY BOYS in the U of Chicago Emergency Department (a fascinating place in which I spent WAY too much time during residency).

As a friend to a fine graduate of this department, I was proud.

As a gastroenterologist, I was intrigued.

As a drinker of champagne, I was worried.

So I download the full text and read it.  Only to realize it had nothing to do with drinking champagne.

I’ll leave it to your inquiring and inventive minds to figure out just how one can get inflammation of the lining of your abdomen by champagne without actually drinking it.

Think hard, my friends, think hard.

Or do yourselves a New Year’s favor and read the case report.  I guarantee it’s worth it.

    About Me

    Professional Gastroenterology Fellow

    Amateur Martha Stewart/Bob Villa/Julia Child/Collette Peters

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