Today, the magazine In Touch Weekly published a non-story entitled Will & Kate’s Baby Heartbreak. The article, based on anonymous “royal sources,” claims that stepmother Camilla the Duchess of Cornwall told a friend that “health complications from Kate’s adolescence raised red flags that may have an impact on her ability to conceive.” The article goes on to say that, based on another unnamed “royal insider,” that the Royal Gynecologist Mr. Alan Farthing “can’t work miracles.”

The only confirmed facts in this tabloid story are that there is indeed a Royal Gynaecologist and his name is Alan Farthing. Mr. Farthing was appointed to the job back in September 2008 and, in this role, he will preside over the births of the next generation of royal babies, including those of William and Kate.

According to his professional profile, Mr. Farthing specializes in treating cancers of the female reproductive tract and endometriosis which is a common cause of infertility. Mr. Farthing graduated from St. George Hospital Medical School in London, is a member of the Royal College of Obstetricians and Gynaecologists and is affiliated with The Wellington Hospital. So why is he called “Mr. Farthing” rather than Dr. Farthing?

According to an article in the British Medical Journal the title has a 500 year-old link with hairdressing: “The tradition of addressing surgeons as Mr or Miss is thought to have its origins in the days of the unqualified barber surgeons whose shaving skills with the blade had naturally helped them carve out a career in surgery. King Henry VIII granted a royal charter to the company of barbers and surgeons in 1540.”

• What do you call nurses with PhDs?
• In addition to gynecology, does Mr. Farthing also do Kate’s hair?

UPDATE (05 November 2011)

Kate Middleton triggered pregnancy rumors when she declined to sample peanut paste while touring a UNICEF factory in Copenhagen.

A photo President Barack Obama and other senior officials watching the operation live from the White House situation room has become one of the most striking images of the raid that killed al Qaeda leader Osama bin Laden. In it, Secretary of State Hillary Clinton is shown with her hand over her mouth.  It now seems that this gesture may have a more innocent meaning. When asked about the photo during a visit to Rome, Secretary Clinton reported:

“Those were 38 of the most intense minutes. I have no idea what any of us were looking at that particular millisecond when the picture was taken. I am somewhat sheepishly concerned that it was my preventing one of my early spring allergic coughs. So it may have no great meaning whatsoever.”

If seasonal allergies were the cause of Secretary Clinton’s gesture, she would hardly be alone. According to the Asthma and Allergy Foundation of America:

• An estimated 50 million Americans suffer from all types of allergies (1 in 5 Americans) including indoor/outdoor, food & drug, latex, insect, skin and eye allergies. Allergy prevalence overall has been increasing since the early 1980s across all age, sex and racial groups.
• Allergy is the 5th leading chronic disease in the U.S. among all ages, and the 3rd most common chronic disease among children under 18 years old
• Approximately 40 million Americans have indoor/outdoor allergies as their primary allergy. (Many people with allergies usually have more than one type of allergy.) Approximately 10 million people are allergic to cat dander, the most common pet allergy. The most common indoor/outdoor allergy triggers are:  tree, grass and weed pollen; mold spores; dust mite and cockroach allergen; and, cat, dog and rodent dander.

Allergic rhinitis is a collection of symptoms, mostly in the nose and eyes, which occur when you breathe in something you are allergic to, such as dust, dander, or pollen.

An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen or dust, the body releases chemicals, including histamine. This causes allergy symptoms such as itching, swelling, and mucus production.
The pollens that cause hay fever vary from person to person and from region to region. Tiny, hard to see pollens more often cause hay fever. Examples of plants commonly responsible for hay fever include:

• Trees (deciduous and evergreen)
• Grasses
• Ragweed

The amount of pollen in the air can play a role in whether hay fever symptoms develop. Hot, dry, windy days are more likely to have increased amounts of pollen in the air than cool, damp, rainy days when most pollen is washed to the ground.

Symptoms that occur shortly after you come into contact with the substance you are allergic to may include:

• Itchy nose, mouth, eyes, throat, skin, or any area
• Problems with smell
• Runny nose
• Sneezing
• Tearing eyes

Symptoms that may develop later include:

• Stuffy nose (nasal congestion)
• Coughing
• Clogged ears and decreased sense of smell
• Sore throat
• Dark circles under the eyes
• Puffiness under the eyes
• Fatigue and irritability
• Headache
• Memory problems and slowed thinking

The best treatment is to avoid what causes your allergic symptoms in the first place. It may be impossible to completely avoid all your triggers, but you can often take steps to reduce exposure.
Treatments for allergic rhinitis include:

Antihistamines

Antihistamines work well for treating allergy symptoms, especially when symptoms do not happen very often or do not last very long.

Antihistamines taken by mouth can relieve mild to moderate symptoms, but many can cause sleepiness. Some may be bought over the counter, without a prescription. Talk to your doctor before giving these medicines to a child, as they may affect learning.
Newer antihistamines cause little or no sleepiness. Some are available over the counter. They usually do not interfere with learning. These medications include loratidine (Claritin) and cetirizine (Zyrtec). Other antihistamines are available by prescription. Azelastine (Astelin) is a antihistamine nasal spray that is used to treat allergic rhinitis.

Corticosteroids

Nasal corticosteroid sprays are the most effective treatment for allergic rhinitis. They work best when used nonstop, but they can also be helpful when used for shorter periods of time. They are only available with a prescription from your doctor. They are safe for children and adults.

Decongestants

Decongestants may also be helpful in reducing symptoms such as nasal congestion.
Nasal spray decongestants should not be used for more than 3 days. Overuse of nasal decongestants can cause rebound congestion  and, for some people, a vicious cycle of overuse and dependence that feels like an addiction.
For more information, click here to go to the Resounding Health Casebook on Allergies.

In honor of Presidents’ Day, I thought it would be a good idea to talk briefly about the role that smallpox played in the life of our first president and it’s important role in the American Revolution. For those who would like to learn about this in greater detail, I would highly recommend the book, Pox Americana: The Great Smallpox Epidemic of 1775-82, written by Elizabeth A. Fenn.

In 1751, when George Washington was 19 years old, he and his brother Lawrence traveled to Barbados, a trip intended to help Lawrence’s persistent cough due to tuberculosis. According to Fenn:

On November 3, the day after landing, the two brothers begrudgingly accepted an invitation to dine at the home of Gedney Clarke, a prominent merchant, planter, and slave trader with family ties to the Washingtons. “We went,-myself with some reluctance, as the smallpox was in his family,” George wrote in his diary. His misgivings were justified. ..On November 17, when the incubation period had passed, the infection hit hard. “Was strongly attacked with the small Pox,” Washington wrote. Thereafter, his journal entries stop. Not until December 12, when he was well enough to go out again, did George Washington return to his diary.

Smallpox did not exist in the Americas, until it was brought from Europe where it was endemic (constantly present). Settlement of the east coast of North America in 1633 in Plymouth, Massachusetts was accompanied by devastating outbreaks of smallpox among Native American populations and later among the native-born colonists.

At the time of the Revolutionary War, there were several outbreaks of smallpox. Because survival after the disease confers lifelong immunity, this gave a decided advantage to the British, many of who had been exposed to the disease earlier in life. There were even reports that the British were practicing what we would now term biological warfare, by deliberately spreading the disease within Boston and by sending infected people out of the city to spread the epidemic in the American lines.

There were only two ways of dealing with smallpox at the time- isolation or inoculation. Isolation meant preventing susceptible people from coming in contact with the disease, usually by quarantine for affected individuals.  Inoculation or variolation, as it was called, required taking a bit of matter from one of the pustules of a smallpox victim and introducing it under the skin of someone who had never had the disease. The resulting case of smallpox was much lighter and greatly decreased the chances of death and scarring. The process was not altogether benign- unless isolated, those who had received inoculation would be contagious to others, and some who were inoculated actually died of the disease they were trying to avoid.

George Washington, Commander in Chief of the Continental Army,was initially hesitant to have his Revolutionary War troops inoculated during a smallpox outbreak writing, “should We inoculate generally, the Enemy, knowing it, will certainly take Advantage of our Situation.” However, by 1777, faced with mounting smallpox epidemics,  battle delays caused by illness among the troops, and fear among potential fighters of getting smallpox if enlisting,  Washington devised an elaborate plan to deal with smallpox. Washington ordered mandatory inoculation of all recruits who had not had the disease.

The inoculation campaign had to be conducted with great secrecy. Though it would protect soldiers in the long run and decrease fear of enlistment, it would also incapacitate large numbers for weeks at a time, rendering the Continentals vulnerable to assault. Ultimately, however, it became clear that the spread of smallpox through the ranks presented a graver threat to the army—and would kill more individuals—than the Redcoats. Recruits were quarantined in camps and inoculated before being sent out to fight.

- Garance Franke-Ruta

Medical historians credit this move by Washington as a pivotal one. Smallpox threatened to kill more soldiers than the British, and it was through Washington’s efforts that the Continental Army was able to turn this situation around and fight at full strength.

About Smallpox:

Smallpox is a disfiguring and potentially deadly infectious disease caused by the Variola major virus. Before smallpox was eradicated, there were two forms of the disease worldwide: Variola major, the deadly disease, and Variola minor, a much milder form. According to some health experts, over the centuries smallpox was responsible for more deaths than all other infectious diseases combined.

The last naturally occurring case of smallpox was reported in 1977. In 1980, the World Health Organization declared that smallpox had been eradicated. Currently, there is no evidence of naturally occurring smallpox transmission anywhere in the world. Although a worldwide immunization program eradicated smallpox disease decades ago, small quantities of smallpox virus officially still exist in two research laboratories in Atlanta, Georgia, and in Russia.

Transmission

Smallpox is highly contagious. In most cases, people get smallpox by inhaling droplets of saliva, which are full of virus, during face-to-face contact with an infected person. When someone becomes infected, they do not immediately feel sick or shed virus to their household contacts. In addition, they have no symptoms for 10 to 12 days. After the virus has multiplied and spread throughout the body, a rash and fever develop. This is the “illness” portion of the disease, and it’s when someone is most infectious.

Some risk of transmission lasts, however, until all scabs have fallen off. Contaminated clothing or bed linens also can spread the virus. Those caring for people with smallpox need to use special safety measures to ensure that all bedding and clothing from the infected person are cleaned appropriately with bleach and hot water. Caretakers can use disinfectants such as bleach and ammonia to clean contaminated surfaces.
Symptoms

Symptoms of smallpox infection usually appear within 10 to 12 days after exposure to the virus. The first symptoms of smallpox may be difficult to distinguish from other flu-like illnesses and include

• High fever
• Fatigue
• Malaise
• Headache
• Backache
• Rash

A characteristic rash, most prominent on the face, arms, and legs, follows 2 to 3 days after the first symptoms. The rash starts with flat red lesions (sores) that develop at the same rate. After a few days, the lesions become filled with pus. They begin to crust early in the second week. Scabs develop and then separate and fall off after about 3 weeks.

Treatment

There is no proven treatment for smallpox. People with the disease can benefit from intravenous fluids and medicine to control fever or pain as well as antibiotics for any secondary bacterial infections that may occur. If an infected person gets the smallpox vaccine within 4 days after exposure to the virus, it may lessen the severity of illness or even prevent it. The majority of people with smallpox recover, but death may occur in up to 30 percent of cases. Those who do recover are often left with disfiguring scars.

Source: NIAID

Today we bring you a very interesting article thanks to our colleagues at MedpageToday. We reproduce it here with their permission.

Chopin May Have Had Epilepsy

By Todd Neale, Staff Writer, MedPage Today
Published: January 24, 2011
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine.

The hallucinations of Polish composer and pianist Frédéric Chopin may have been the result of temporal lobe epilepsy, two researchers proposed.

Chopin died in 1849 at age 39 following a life filled with health problems — including respiratory complaints, nasal blockage, lung infections, and recurrent coughing, blood in his sputum, and fever — that would confine him to his bed for long periods of time.

In addition, he developed difficulty breathing, leg swelling, and severe headaches in the years leading up to his death, according to radiologist Manuel Vázquez Caruncho, MD, and neurologist Francisco Brañas Fernández, MD, of Complexo Hospitalario Xeral-Calde in Lugo, Spain.The exact cause of the composer’s death remains unknown, and the results of his autopsy were lost, the Spanish researchers noted online in Medical Humanities.

That uncertainty has fueled speculation about what killed Chopin. A list of proposed diagnoses includes pulmonary tuberculosis, mitral valve stenosis, cystic fibrosis, pulmonary emphysema, Churg-Strauss syndrome, and allergic bronchopulmonary aspergillosis.

According to Vázquez Caruncho and Brañas Fernández, a genetic disease is considered most likely because Chopin’s father and two of his sisters suffered from respiratory complaints throughout their lives as well.

Looking beyond the cause of death, however, the Spanish researchers explored the possible reasons for the hallucinatory episodes Chopin had on several occasions.

One such incident occurred while he played at the home of a wealthy merchant and the musician described it in a letter dated about a year before his death.

“A strange adventure happened to me while I was playing my B flat Sonata for some English friends,” Chopin wrote. “I had played the Allegro and the Scherzo more or less correctly and I was about to play the March when, suddenly, I saw emerging from the half-open case of my piano those cursed creatures that had appeared to me on a lugubrious night at the Carthusian monastery [Majorca]. I had to leave for a while in order to recover myself, and after that I continued playing without saying a word.”

Citing other accounts from Chopin and his contemporaries, Vázquez Caruncho and Brañas Fernández compiled a list of characteristics of the hallucinations:

* Chopin was able to recall the episodes in detail.
* He appears to have experienced some episodes as unreal and seemed to be disconnected from reality.
* The hallucinations occurred mostly at night.
* Some of the episodes accompanied acute infections and fever.
* The idea and images of death were recurrent.
* Chopin had complex visual hallucinations.
* There are no indications that Chopin had neurological deficits.

Although hallucinations are the hallmark of various psychiatric disorders, according to the authors, Chopin’s were generally unlike those associated with psychosis.

The episodes were also likely not the result of toxicity from the drugs he took for his various ailments, such as laudanum.

“Toxic hallucinations can be visual, synesthetic, tactile, or auditory,” Vázquez Caruncho and Brañas Fernández explained. “When they are visual the images are usually abstract and preceded by unformed visual sensations. In addition, Chopin experienced hallucinations before he was on frequent medication.”

Based on the descriptions of Chopin’s episodes, the researchers proposed temporal lobe epilepsy as the underlying cause.

“Temporal lobe epilepsy may produce complex visual hallucinations, but they are usually brief, stereotyped and fragmentary,” they wrote.

The authors noted, too, that psychiatric symptoms — including anxiety, fear, sleeplessness, and depression — can precede epileptic episodes. Chopin complained of all of those symptoms.

Vázquez Caruncho and Brañas Fernández acknowledged that they “know nothing about his physical neurological state, nor have we imaging or electrophysiology tests that could help us establish a definite diagnosis.”

But, they added, “a condition such as that described in this article could easily have been overlooked by Chopin’s doctors.”

They concluded, “We doubt that another diagnosis added [to] the already numerous list will help us understand the artistic world of Frédéric Chopin,” they wrote, “but we do believe that knowing he had this condition could help to separate romanticized legend from reality and shed new light in order to better understand the man and his life.”

It was announced today that Peace Corps founder and director Sargent Shriver has died at the age of 95.  Shriver,  father of Maria Shriver and widower of Kennedy sister Eunice Kennedy Shriver, was also an unsuccessful Vice-Presidential candidate who ran with George McGovern in 1972. Shriver had suffered from Alzheimer’s Disease for the past 8 years, which sparked  an intensive advocacy campaign  by his daughter and her husband, former Gov. Arnold Schwarzenegger. In a statement by President Obama he stressed that “Sarge came to embody the idea of public service.” This is evident in many of the public roles he held: as head of the War on Poverty for President Lyndon B. Johnson, and as a leading force in Head Start, VISTA, the Job Corps, Community Action, Upward Bound, Foster Grandparents, Neighborhood Health Services and the Special Olympics.

It is somewhat bittersweet that Shriver should die so shortly after a major piece of legislation to support the efforts against Alzheimer’s Disease was passed into law. The law, called  The National Alzheimer’s Project Act,  will create a coordinated national plan to overcome the Alzheimer crisis and will ensure the coordination and evaluation of all national efforts in Alzheimer research, clinical care, institutional, and home- and community-based programs and their outcomes. President Obama signed the bill into law on January 4th, 2011.

According to the Alzheimer’s Association:

Alzheimer’s is a national crisis, affecting Americans across all walks of life and across all regions of the country.

• 5.3 million people – 5.1 million aged 65 and older – have Alzheimer’s disease, and another American develops Alzheimer’s every 70 seconds.

• Caring for those with Alzheimer’s and other dementias costs society a total of $172 billion, including $122 billion in costs to Medicare and Medicaid.

• Nearly 11 million caregivers provide care for people with Alzheimer’s disease or other dementias – unpaid care valued at $144 billion.

The Alzheimer’s crisis is only going to get worse.

• In 2050, 13.5 million Americans aged 65 and older will have Alzheimer’s disease, and someone will develop Alzheimer’s every 33 seconds.

• Caring for people with Alzheimer’s and other dementias in 2050 will cost Medicare and Medicaid over $800 billion (in today’s dollars).

Today there is no one government entity whose sole purpose is to mount a full campaign against Alzheimer’s disease. Based on the
recommendations offered by the Alzheimer’s Study Group (ASG),  an independent, bipartisan panel created to evaluate the government’s current efforts to combat the disease, this legislation creates a National Alzheimer’s Project Office at the Department of Health and Human Services and an inter-agency Advisory Council that is responsible for creating a national plan to confront the escalating crisis.

The National Alzheimer’s Project Act will:

• Launch a campaign within the federal government to overcome Alzheimer’s disease.
• Create a National Alzheimer’s Disease Plan.
• Update and report the National Plan to Congress annually.
• Establish an inter-agency Advisory Council that will coordinate and evaluate all federal efforts on Alzheimer’s research, care, institutional services, and home- and community-based programs.
• Accelerate the development of treatments that would prevent, halt, or reverse the course of Alzheimer’s disease.
• Ensure the inclusion of racial populations at higher risk for developing the disease.

What do the mother of Prince William’s fiancée and The Price is Right host Drew Carey have in common? Carole Middleton and Drew are both on no carb/low carb diets. The so-called Dukan Diet, named for its inventor Dr. Pierre Dukan, seems like Atkins with a French accent or now, perhaps, South Beach on the Thames.

Dukan’s book will not be available until May 2011 (too late, perhaps, for June weddings but in plenty of time to prepare for bikini season). In the meantime, we’ll find out as much as we can about Dr. Dukan’s “new” approach to carbohydrate restriction and report back to you in an updated post.

In the meantime, you might find some of our related stories helpful:

• Diets That Work!
• Food Fight Over Whether Hitler Made Us Fat
• Food Addiction: Cheesecake-Eating Rats and Obesity as a Mental Illness
• Drew Carey loses 80 pounds and “cures” Type 2 Diabetes

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Dan Olds from Beaverton, Oregon has characterized those of us who are interested in popular culture as “slack-jawed yokels”  in a recent interview with Sharon Gaudin of Computerworld. Olds’ characterization was based on the fact that, in 2010, eight of the top 10 searches on Yahoo! were about celebrities or “pseudo celebs” such as Lady Gaga, Miley Cyrus, Justin Bieber, Megan Fox, Britney Spears and Kim Kardashian. Only two of the top 10 searches were about other news, namely the BP oil spill and the World Cup.

Mr. Olds concluded that the internet is not a serious tool for information dissemination because the Yahoo! top 10 list did not include searches about the global economic crisis, the earthquake in Haiti or the mid-term elections in the U.S. Could it be that us yokels simply get our “hard news” from going directly to sites that specialize in this information (e.g. CNN, The New York Times, Wall Street Journal, The Economist, etc.?) rather than using search engines to find it?

The phenomenon of celebrity has been shown by Prof. Graeme Turner, Director of the Center for Cultural & Critical Studies, University of Queensland, to perform important social functions:

• in the formation of cultural identity,
• as a mode of discourse that results in pleasurable social exchange, and
• in the construction of community.

Hamish Pringle, in his book Celebrity Sells, further explains “…that the role celebrities play in people’s lives goes beyond a voyeuristic form of entertainment, but actually fulfills an extremely important research and development function for them as individuals and for society at large. People use celebrities as role models and guides.”

By analyzing 12 case studies between 1938 and 1992, Prof. Barron Lerner has shown how celebrities have influenced public attitudes toward diseases and their treatments. He describes how celebrity cases can educate the public, create advocates for research and patient care on behalf of other people with the same disease, and have even influenced aspects of the professional training of physicians.

An intriguing aspect of Dr. Lerner’s work is the important observation that the public increased their knowledge of medical topics and conditions, not because they were seeking health information but rather as a consequence of their primary interest in celebrities’ lives.

Photo: Cletus Delroy Spuckler character from The Simpsons

Steve McQueen (1930-1980) was the “king of cool,” academy award-winning, A-list actor of the 1960s and 1970s and, at one point, was the highest paid movie star in the world. Mr. McQueen got sick in 1979 while acting in and directing his the movie Tom Horn and was diagnosed with mesothioma. He died a year later in Mexico while seeking unorthodox cancer treatments that were not available in the United States. McQueen’s quest to cure his tumor was avidly followed by the press. The extensive publicity surrounding McQueen’s unconventional treatments led thousands of cancer patients to enter Mexico in the hope of escaping the “death sentences” pronounced on them by U.S. doctors providing conventional treatments. This one story encapsulates many aspects of  health care that remain prominent and controversial today. These include complementary and alternative medicine (CAM), participatory medicine and medical tourism.

We have written about mesothelioma before and refer you to our posts on Army Archer, Merlin Olson and Malcolm McLaren. The definitive account of Steve McQueen’s unconventional healing and Mexican journey can be found in Dr. Barron Lerner’s excellent book When Illness Goes Public. Traveling to countries outside the U.S. to obtain unconventional treatments characterized the cancer journeys of both Farrah Fawcett (1947-2009) and Brett Hudson (1953- ) both of whom traveled to the same German Klinik to have their tumors treated. These cases might all be considered examples of participatory medicine, a grassroots  patient movement toward more active engagement in managing their medical conditions in partnership with their professional healthcare providers. For a specific example, see our post on “ePatient Dave” who has just come out with his new book Laugh, Sing, and East Like a Pig: How an Empowered Patient Beat Stage IV Cancer.”

Fox News’ Hollie McKay claims that it was Elvis’ constipated colon that caused his last curtain to fall. McKay reports that, according to Elvis Presley’s now-retired personal physician, Dr. “Nick” Nichopoulos, The King’s autopsy revealed that his large intestine was twice the diameter and twice the length of a normal colon. The article speculates that something called “Hershberger’s disease” could have been the underlying cause (This is just a careless mistake because what Dr. Nick is referring to is Hirschsprung’s Disease, an unlikely explanation of Elvis’ constipation because this disease — also known as aganglionic megacolon — is a congenital disease of newborn children who, if untreated with surgery, die within a few weeks).

People seem to be very interested in, even obsessed with, their bowel habits and advertisers take advantage of this. How many radio commercials have you heard about treatments to remove pounds of poop plastered  “on the colon wall like spackle or paste.”  And how many celebrities have you heard about using “cleanses” (sometimes just a nice word for enemas) to address any of a number of health problems caused by “toxins” in the body? In part 2 of this story, we’ll review how solid waste is formed and eliminated and some of the causes and cures for commons causes of constipation.

When Illness Goes Public: Celebrity Patients and How We Look at Medicine, Dr. Barron H. Lerner explores how celebrity patients have influenced public attitudes toward diseases and their treatments by analyzing 12 case studies between 1938 and 1992 (see below). Dr. Lerner describes how celebrity cases can educate the public, create advocates for research and patient care on behalf of other people with the same disease, and have even influenced aspects of doctors’ professional training.

Dr. Lerner points out that sick celebrities are important to other sick people, in part, because we assume that celebrities have access to the best medical advice and care and other sick people would like to have the same opportunities. For instance, Lance Armstrong says that people wrote to him asking about everything he did and ate while fighting testicular cancer. Another example is that of actor Steve McQueen. During his battle with mesothelioma in the 1980s, there was a belief that he had extended his life by obtaining treatment not available in the U.S. — an early example of medical tourism. Following this news, thousands of cancer patients traveled to Mexico in search of similar treatments. A more recent example of this is the sad case of Farrah Fawcett who traveled repeatedly to a German cancer clinic to obtain unconventional treatments not available in the U.S.  Beyond wanting to have the same treatments that famous patients have, we also look to celebrities for hope and inspiration as we fight disease.

More about Dr. Barron Lerner