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Book Review: Colic Solved

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colicsolvedHave you ever been seated next to a screaming infant in an airplane? If so, you know that even short flights can feel like an eternity. But the question is: why is the baby so miserable? Is there something that can be done to ease their discomfort?

According to pediatric gastroenterologist Dr. Bryan Vartabedian, the answer is a resounding “Yes!” In his new book, Colic Solved Dr. Vartabedian (or “Doctor_V” as he is known on Twitter) describes why unexplained fussiness may often be caused by gastroesophageal reflux disease. Doctor V explains that “colic” is an old-fashioned term to describe the behavior of uncomfortable babies. Colic is not a medical diagnosis anymore than “crying” is… and fortunately the underlying cause of “colic” has been discovered so that it can also be treated.

I met Doctor V at a conference in Albuquerque, New Mexico a couple of months ago. Before our introduction I had no idea that he spent all of his clinical time examining and treating screaming babies – but once that fact was revealed, I understood immediately that he was the right guy for the job. Doctor V is a tolerant, affable man with a tremendous sense of humor and a voice made for radio. He is not easily flustered and has a genuine curiosity about others and their life stories. In fact, there’s something soothing about Doctor V – something that makes you feel that everything’s going to be ok.

And so it’s no surprise that Colic Solved is a written expression of Doctor V’s winsome personality. Every chapter is filled with empathy and reassurance, yet with a clear path forward for teasing out the real cause of a baby’s misery. In most cases, “colic” is actually caused by milk protein allergy or infant reflux (a painful burning sensation caused by regurgitating stomach acid). Doctor V carefully explains how to tell the difference, and what to do about it. Interspersed are amusing vignettes called “Tales From The Crib” in which parents with difficult-to-soothe babies navigate their way towards a resolution.

But best of all, Doctor V does not hesitate to do some good old fashioned myth-busting when it comes to exaggerated claims not based on scientific evidence. Infant formula makers, baby bottle makers, and baby product manufacturers are notorious enablers of magical thinking – moms and dads purchase all kinds of products in a desperate attempt to soothe their babies. Unfortunately, most of these solutions do not treat the root cause of the problem – though businesses thrive on colic cures for desperate parents.

Here’s an excerpt of Doctor V’s exposé of a common soy formula myth (p. 117):

Soy Formula – Do You Feel Lucky?

One of the first impulses for parents with a screaming baby is to reach for soy formula. It sounds all natural and easy to digest. But the role of soy formula in the milk-allergic baby is very misunderstood…

The real problem with soy formula comes with the belief that it’s a reasonable cure for the allergic baby. But up to 50% of babies who are allergic to cow’s milk will react to soy protein in a similar way, so if you or your pediatrician chooses to treat your allergic baby with soy formula, you should consider it a gamble…

Colic Solved is a gem of a book. It’s witty, wise, and well written – a must-read for any parent of a chronically fussy baby. I also think that pediatricians and family physicians should strongly consider prescribing this book to parents of unhappy infants. There’s probably no better way to solve colic once and for all.

Book Review: Seductive Delusions – How Everyday People Catch STDs

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file0002I recently met the author (Dr. Jill Grimes) of Seductive Delusions: How Everyday People Catch STDs at the AMA’s 29th Annual Medical Communications Conference in Albuquerque, New Mexico. Jill is a family physician in Austin, Texas, with a kind and down-to-earth demeanor. Jill is the type of doctor you like immediately – she makes you feel at ease because of her unpretentiousness.

Jill told me that she wrote Seductive Delusions out of sadness and frustration with her inability to protect young people from STDs. Jill saw new cases of sexually transmitted diseases in her patients every week, and wanted very badly to reverse this trend. No amount of counseling “after the fact” had a sufficient effect on new cases, so she decided to launch a preemptive strike: an educational book targeting those who never thought they could contract an STD.

Seductive Delusions uses a “case based learning” approach to educating readers about STDs. Each chapter begins with two true life stories about young people who succumb to STDs. Characters are based upon the lives of patients whom Jill has treated over the years, but stories are blended to protect anonymity. The story-telling format (followed by fact-based summaries) makes the content more entertaining and engaging to read. I doubt that a textbook could hold readers’ attention as effectively as Seductive Delusions does.

I chose to read Seductive Delusions cover-to-cover in 2 sittings, and such a concentrated dose of horror stories made me feel hesitant about ever having sex again. I can also say that there was one uncomfortable moment in an airplane (I read the book on the way back from Albuquerque) when the man sitting next to me glanced at the cover and gave me a very shifty look, and spent the rest of the flight leaning noticeably towards the seat on the opposite side.

That being said, I did enjoy the book. Jill’s characters have an innocent quality to them – like the cast from “Leave It To Beaver.” And I think that was exactly her point – you’d never expect the Cleaver family to be touched by STDs, and yet the truth is that they are succumbing to them in record numbers. Part of the danger of being one of those supposedly “low risk” individuals is that sufficient precautions against STDs are not taken due to a false sense of security.

I had assumed from the title of the book that “everyday people” would include a wider range of characters than were presented. I have been concerned about the reemergence of STDs, for example, in the retiree community in Florida, and thought that Seductive Delusions might touch on that unexpected risk group. However, the target demographic for the book is the late teen to thirty-something heterosexual male and female. I agree with Jill that there’s an educational gap there – but I would have enjoyed her casting a wider net.

The other potential short coming of the book is that the narratives describing how the various characters contracted an STD are so engaging that the reader is left disappointed at never hearing about the long-term outcomes for these individuals. I became emotionally invested in the story (for example) of how Evan contracted HIV from his very first girlfriend (a woman who had been with a man who used IV drugs prior to dating Evan). I felt as if I were there with Evan when he received the devastating news about being HIV positive, and then he drifted away from the pages of the book never to be heard from again. The lack of resolution left me with an uneasy feeling – probably the same feeling that Emergency Medicine physicians experience at the end of each shift.

Nonetheless, I would highly recommend this book to all sexually active young people. It is eye-opening and disturbing in the right sort of way. It’s the kind of book that will help people think twice before they become intimate with others, and take stock of the true health risks involved. I can only hope, along with Jill, that this book will reach the right eyeballs at the right time – and reduce the devastating spread of sexually transmitted diseases in America and beyond.

Book Review: Triumph Of The Heart, The Story Of Statins

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Triumph of the Heart, as its name does not suggest, is about science. The book’s author, Jie Jack Li, is a medicinal chemist who meticulously reviews the history relevant to the discovery of lipid-lowering drugs. He spares no details, even recounting the amusing quarrels and quirks of the scientists engaged in the “apocryphal showdowns” leading to the manufacture of cholesterol in a laboratory.

The personalities of the various scientists and Nobel laureates described in the book are highly entertaining. From beating one another with umbrellas, to insisting on wearing blue clothing only, to egos so large and unappealing as to empty an entire academic center of all its promising young recruits, one has the distinct impression that brilliance does not go hand-in-hand with grace.

That being said, each of these scientists did seem to share a common approach to research: carefully testing hypotheses, repeating peer study results to confirm them, and patiently exploring complex biochemical pathways over periods of decades. The physicians, physicists, and chemists showed an incredible ability to doggedly pursue answers to specific questions – understanding that the results might influence human health. But even more importantly, they were each willing to invest their careers in analysis that may never lead to anything more than a dead end. In fact, the book is full of examples of great ideas, developed over decades, that did not lead to a marketable drug. In some cases the research was halted due to lack of efficacy, in others political forces or personal whims influenced the course.

What strikes me about the scientists described in Triumph of the Heart, is how rare it is nowadays for people to have the sort of patience required for laboratory work. In an age where kids suffer from iPhone and video game addictions, young adults expect a relaxed work environment with high salaries and no accountability, and adults are flummoxed by stores that are not open 24 hours… who has time for the hard work of science? Even The Onion, my favorite spoof newspaper, mocks modern attention spans calling science “hard.”

Triumph of the Heart is about much more than the discovery and development of statins. It traces the historical development of the first antibiotics, pain medicines, diuretics, and steroids, the rise, fall and merger of drug companies, patent wars, the unethical conduct of some researchers, and the financial pressures that shaped the industry, both in the U.S. and abroad. Other than Mr. Li’s inability to resist his chemist’s urge to delve into advanced concepts in organic chemistry (around mid-book) as a physician I found Triumph of the Heart to be quite interesting, and well researched.

The most important take away, however, is that science is about hard work, attention to detail, innovative thinking, advanced analytic skills, serendipity, and the patience of Job. Triumph of the Heart reminds us all what good science is about, and how life-saving discoveries are made.

Book Review: Life Disrupted

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Laurie Edwards has an extremely rare disorder called primary ciliary dyskinesia (PCD). The condition causes similar signs and symptoms to cystic fibrosis (CF), including chronic lung infections and difficulty breathing. In her recent book, Life Disrupted: Getting Real About Chronic Illness In Your Twenties And Thirties, Laurie invites readers to experience her life as a chronically ill young woman. She spares no gory details:

I had to wear the probe for forty-eight hours to see if irregularities in my GI tract were contributing to my breathing problems. It was an awkward contraption, and just as I finished speaking, I sneezed. Because of the tubes, I couldn’t control it well and a bloody mess spewed out of my nose and onto my shirt. I looked down at the mess and up at John.

‘Sexy, huh?’ I asked, completely mortified.

But beyond the raw realities of her illness (including the regular disruption in her education, her unfulfilled longings to “fit in,” and her lack of control of her circumstances), is the amazing story of the people who love her. Life Disrupted‘s ironic subtext is the unshakable support of her family and friends.

From her earliest first moments at home, Laurie’s brother “spent hours standing guard at her bassinet, as if to reassure her mother nothing would happen to her.” As she grew older, her brother continued his protective commitment, promising to always be ready to help her in any time of need. Laurie’s parents had a strong and loving marriage, and their patience and kindness were a constant source of security and comfort.

Laurie’s husband shows incredible stoicism and endurance – undeterred by her diagnosis (which she revealed to him unwittingly on their first date), he learns how to give her chest physical therapy by week three of their relationship, and remains calm during a dangerous near-suffocation episode.

He was perfect. He did not get flustered, did not panic, just got me home as quickly as possible, unlocked my door, and ran to set up the nebulizer. He clapped me while I positioned myself with the nebulizer mask and tubing, trying to manually break up the thick mucus that cut off my air supply.

My favorite part of Life Disrupted is its humor. Laurie does an admirable job of capturing the amusing banter that she and her friends used to lighten the mood:

My friends and I refer to my nebulizer and oxygen face mask in the hospital as the “Super Bong.”

And my favorite sentence of the book is this one:

It was a container of honey mustard salad dressing that turned out to be my Waterloo, the moment of my crushing, flabbergasting defeat.

Laurie’s life – disrupted by chronic illness – is charming, vibrant, and rich in affection. The disruption itself is perhaps diminished by the connectedness of her family and friends – a healthy emotional backdrop to the  physical illness at center stage. In the end, Life Disrupted offers compelling evidence that love really can conquer all.

Better Health Is A Finalist For A Health Policy/Ethics Blog Award

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Well this is really exciting! Thanks to the readers and judges at Medgadget.com for acknowledging my blog for a 2008 Blog Award in the category of Health Policy and Ethics. (This blog won the “Best New Medical Blog” of 2007 award last year.) This year’s winner will be determined by popular vote, which begins tomorrow. I know that my chances of winning the majority of votes in this category are pretty slim, thanks to Respectful Insolence. I am a huge fan of Orac’s blog and have no doubt that his contributions in this category far exceed mine. Orac is a devoted crusader against pseudoscience and misleading health information. Good luck, Orac – I’m sure you’ll win this one!

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