Medicine + Celebrities + Cash = Disaster

The tragic deaths of Michael Jackson and Anna Nicole Smith have shined a magnifying glass on the doctors who abuse their privilege as healthcare providers. As it should be. Even after I learned what was being stored in Anna Nicole’s minibar or hiding in Michael Jackson’s closet, I felt insulted by these physicians disregard for their profession.

But as I shimmy off my high horse to pick up the phone what do my wandering ears should hear but the voice a frantic agent asking me if I would oblige her famous French designer client by meeting him at his hotel this evening around midnight when he arrives from France. Apparently he is in desperate need of medical attention.

“Sure, why not?” I reply.

In the lobby of a five-star hotel, dressed in my best suit and doctor’s bag full of supplies, I wait until well past midnight. Then I am awakened by a flurry of excitement as this rock star designer enters with entourage in tow – six of them to be exact. The tall Russian looking assistant scans the lobby, notices me and puts his hand out to tell me to stop. I wait another twenty minutes. At which point, a representative from the hotel walks over and tells me they are ready for me in the presidential suite. The urgent emergency I discover is simply a sinus headache. I treat the designer and bid him adieu. The next day I receive a call from the agent. “You’re a rock star,” she tells me.

 

The end result, a limo picks me up later that evening to take me to his latest fashion show. I sit across from Anna Wintour, Charlize Theron and the President of Louis Vuitton. The fabulous Penelope Cruz is to my right. Not wanting to be a total geek, I suppress the urge to lean over and whisper, “You know we have the same birthday.”

It was heaven.

Later I am brought backstage and mingle with the models and celebrties like, Dita Von Teese. Afterward I ride down in the elevator with the adorable and pint size, Kylie Minogue, and as the limo takes me to the after party, I think to myself, “This is the life!”

 

Months later, I receive a call from the rep of a famous super model turned TV star who needs a flu shot, pronto! Since her studio is close to my office, I pack up my doctor’s bag with the appropriate necessities, run home to change into high heel boots and race to her office. There I wait again. This time a mere twenty minutes before a sturdy, assertive, young woman greets me and asks me to sign a confidentiality agreement.

“Sure,” I say.

Then I am led through a labyrinth of hallways until I am finally brought to her inner sanctum office. I wait again. Eventually she comes in, looking even more gorgeous in real life. Her assistant holds out her hand, “Give me your cell phone,” she demands. I comply. Then I prepare for the injection. The super model sits in a chair, which looks like a throne, and says to her assistant, “Leave us. No one can see me get this shot!”

I’ve heard that super stars are often peculiar but this had nothing to do with me and by this time, all I wanted to do was get the F out of there. I administer the shot, apply a cutesy band-aid and pack my bag.

“That was the best shot I have ever received,” she says.

Two months later, they are still arguing over my fee. Hmmm. 

Understand that this multi-millionaire is arguing over a few hundred bucks. And it was a house call!

But wait it gets better. Press agent for a world renowned 70’s rock star is appearing on The View and needs a steroid injection in his vocal cords ASAP. “We’ll pay cash.”

Now, no one loves money more than me, but they were asking me to leave my busy office, travel in the rain up to ABC studios to give a rock star a steroid injection in his vocal cords.

“Are you nuts?” I reply. “Absolutely not. Go find yourself an ENT.”

Later my best friend Eric asks, “How much cash were we talking?”

“That’s not the point,” I answer. But later as I rest in bed, I wonder, “How much would they have paid me?”

The next day, the manager of a known alcoholic musician turned reality show star, calls to ask if I would write him a prescription for a Z-Pack and some Xanax. The catch is that he can’t come in, and I needed to do this over the phone. “We’ll pay,” she says.

We’ll pay apparently have become the magic words some doctors need to hear in order for them to bend the rules and potentially lose their licenses. Now I am no saint. Believe me whenever I have been approached, I do sit there and weigh the options. In my head, I try to convince myself that, “It would only be this one time and who will know?”

Then I remember Michael Jackson and Anna Nicole Smith and think about those doctors who are under investigation and my heart stops.

Get thy behind me celebrities, you will not take away my license no matter how much money you throw at me… But it is tempting.

Halloween

Probably the best holiday ever. Name another day when you can dress up and walk around outside? Here are some of my favorite shots of the night.

 

Lobster Therma-dog

 

Chad my undead boyfriend

The Ho-Bots: Jesse Archer and Bam Bam

Troll Girl and Chad

Count Frankula

 

 

 

Napoleon minus Josephine

It’s no secret that I’m short. I’m 5′7” on a good day. But what you might not know is that being vertically challenged is an obsession of mine. I freely admit that I have a Napoleon Complex. I have all the classic signs: I feel inferior to those who are taller than me and harbor a secret resentment toward them. Plus, I even have a sister named Josephine. At least I admit it. No one would say that I have Napoleon Complex to my face. I’m described as scrappy. Perhaps what I lack in height, I make up in assertiveness. I hate to hear the word, No, and I become even more determined when someone suggests that I can’t do something.

Chad is 5′11”, a perfect height for a man. Fortunately for me, he likes shorter guys. My friend Ron Ferg feels the same way.  “Pocket gays are so cute. They’re compact. What’s not to like?” For some reason being assigned to a ”type”  irritates me more than being short.

I don’t know what it is but I hate being short, and what makes matters worse is that every time I go to a party lately, I feel like everyone around me is so tall. I’m serious. It’s as though every gay guy under thirty has been blessed with height. At the last Out 100 Party, I felt like Lil’ Sprout amongst a forest of Jolly Green Gay Giants.

That night I vowed to never go to another party again unless I grew an inch or devised a way to appear taller. Then a friend suggested I get lifts for my shoes. “You know those pieces you lay in your shoe? You can add like two or three inches to your height.”

“Are you joking?” I asked.

That night I located a distributer of shoe lifts on the Internet. Who knew they were so popular. One particular company in London sold various types of lifts including ones that added six inches to your height. I nearly gasped. However I did not want to be greedy, so I purchased lifts that added a modest four inches. “That would make Chad and I the same height,” I told myself.

Within ten business days my lifts arrived. As I raced up the elevator to my apartment, I opened the box only to become deeply disappointed. These lifts were simply a soft rubber wedge that appeared very narrow particularly for my wide flipper-like feet, and the ridiculous thing was that it is impossible to put your foot inside a shoe that has a four inch lift in it. When Chad returned home that evening he found me on the bedroom floor in a sea of shoes, jamming my expensive English wedges into every pair of shoes I owned. He winced quietly and walked away. Hours later, I emerged from my room exasperated. All my efforts to gain several vital inches had failed. So I decided to accept the loss and throw out those stupid lifts. Marching through the kitchen, I passed Chad paring and apple with a knife. That’s when the light bulb went off. I grabbed the knife from his hand and began sawing my wedges so that instead of four inches they were now fitfully two. It was a stroke of brilliance. My new lifts nestled perfectly into every shoe I owned. All had not been lost. I could live with being 5′9′. Anything is better than 5′7”.

When the invitation to the Advocate Magazine Party arrived, I knew that would be the perfect occasion for me to try out my new and improved wedges. No more staring at slender knee caps in tights pants that cut off at the ankles. Now I could look those tall, young gays in the eye and feel superior to those Pocket Gays who enjoy being dominated by taller men. I felt liberated like Norma Rae. No tall gay man was going to use me as a crutch, resting their arm on my shoulder for support or tussling my hair as if I was a child. I am no tall gay man’s child!

Dressed up in my best suit and new heels,  I entered the party and began working the room. But over the course of the evening my serrated wedges starting digging into the soles of my feet, and with every step I took, my face winced with pain. Even though I tried my best to hide my agony, it was all becoming too difficult to manage. “Are you okay?” asked Chad.

“No,” I barked. “My feet are killing me.”

“Why?”

“I’m wearing those lifts.”

“Oh my God,” he said rolling his eyes in frustration. “Well I seriously suggest you go to the bathroom and discretely remove your pumps because your face has the expression of someone in an advanced stage of constipation.”

“Thank you,” I said sarcastically as I limped away. “I hate tall people.”

All About Web MD

Juan, my assistant, hands me a chart. He’s written, Bobby has an STD. “That’s his third in the past six months,” I said. “Bobby do you solicit men outside the Department of Health?”

“Yeah, I know,” he laughed. “But this guy is different. He thinks he got it from his ex-boyfriend. They just broke up.”

Secretly I thought Bobby should quit while he was ahead and get rid of this guy before he contracts some thing worse than gonorrhea, like leprosy. But I’ve known Bobby for years, and a hot boy with a limited vocabulary is worth more to him than a raging case of genital herpes. “So what’s it this time?” I asked, “discharge, burning upon urination, or gangrene?”

“No, nothing like that. I went to poop and I found worms.”

“What are you, a puppy?”

“Seriously, I looked it up on Web MD.”

Internet sites that allow public access to a cornucopia of symptoms and diagnoses which ultimately point them in the direction of a fatality, has become the bain of my existence. Yet most times patients ignore the obvious, common and less threatening ailments because it’s easier for someone to cling to a dramatic disease then it is for them to even consider that they have something far less threatening.

Why settle on a common cold or indigestion when you can have bone cancer or Tay-Sachs Disease?

“Bobby, listen,” I said. “I don’t know what you saw clinging to your anus but I seriously doubt it was a pin worm.” But I could be wrong. So after a careful and thorough examination, I failed to find any evidence of a pin worm. “Let’s say we do a stool culture and see what grows from that?” I offered. Bobby agreed. Two days later, the stool culture came back completely negative. So I called Bobby with the good news.

“That’s ridiculous,” argued Bobby on the phone. Unbeknownst to me, Bobby consulted with the new illegal alien boyfriend’s doctor who prescribed them both a healthy dose of an antihelmenthinic drug, the likes of which I have never had to prescribe before.  But I guess there are some doctors who prefer if you come in waving a print out diagnosis. It saves them the trouble of having to make one for themself.  But I don’t fly that way, and like Gary Merrill said to Anne Baxter in All About Eve, “I don’t like what I want to come after me. I come after it.” So you see my issue with Web MD has nothing to do with the people behind the website; it’s the patients who want to self diagnose and then have a doctor, in this case played by moi, write them prescriptions. Well that’s not going to happen. It’s the performer that makes the play and not the playwrite.

Two days later Bobby called back. “I finished the medication and there is no evidence of any worms but I read on Web MD that I am suppose to take two more weeks of another medication. My boyfriends doctor won’t prescribe it for me. Will you?”

I gripped the receiver tightly, trying my best not to break it in half. “Bobby I don’t come to your office and dictate how you should work. So I would ask that you respect the years of education and training I have completed and not order me to write prescriptions or treat you based on your limited knowledge, which by the way comes from an internet resource.”

“Maybe I was too harsh,” I said to Chad later that evening.

“No, he should respect you and not tell you what to do,” said Chad. “That is total bullshit.”

The next day I called Bobby who admitted that he was out of line. At this time, he is still free of these mysterious worms even though I suspect he really might have jumped the gun and completely misdiagnosed himself in the first place. He probably wiped his toosh too hard and mistook some toilet paper residue as worms. Whatever. It’s over.

Then this morning another frantic phone call. “Doctor I don’t feel well. I have some cramps.”

“Are you moving your bowels and passing gas?”

“Yes,” he responded. “But I think I need an upper GI series.”

“What?” I shouted. “What makes you think you need that?”

“I read it on Web MD.”

“Juan hand me the axe.”

Ask the Doctor: Support Groups: part I

Please check out the latest installment of Ask the Doctor where I focus on HIV support networks.

My guests include Andreas Hoyos, Associate Director of Mental Health Center Care Wellness and Katie Douglas, Director of Mental Health Callen Lorde Community Health Center.

Click on Advocate.com for a direct link to view the episode.

Rape on Eighth

Today a new patient I’ll call Jim, described an event that occurred Saturday night. He was leaving a bar and headed up Eighth Avenue when a hispanic male strolled up alongside him to strike up a conversation. “He started asking me about drugs and if I wanted any,” said Jim. “I ignored him but he kept following me.” Foolishly, Jim veered off the avenue and down a side street where things took a turn for the worse. “He said he had a gun and pushed it in my side. Then he lured me down a dark stairwell of a brownstone.”

There the man forced Jim into performing oral sex.

Afterward he took Jim’ s wallet and fled on his bicycle.

Jim took the train back home to Long Island. The next day he went to the doctor who diagnosed him with HIV. This diagnosing was completely unrelated to the event from the night before but traumatic nonetheless. Honestly, this has to be, hands down, the worst one two punch in recorded history.

Jim was referred to me by a colleague. In my office, I listened to him as he recounted this story. I was concerned that Jim was still in shock, and I urged him to go to the police but he refused. Then I called a therapist and together we spoke, and Jim agreed to meet with him later this afternoon.

Jim is 37 and very sincere. As he told me this story, I immediately thought that I would have never walked down a dark alley with a strange man at 2am on a Saturday.  But then again, who knows how I might have reacted in that situation.

Unexpected encounters that occur when ones inhibitions are down can result in actions that are atypical  to our normal selves. Often times it is difficult, particularly for gay men to deal with sexual assault. Issues associated with internalized homophobia are exacerbated by aggressive male statements or actions. Some gay men might shy away form joining a conversation that is stimulated by robust talk over a football game to avoid feeling like a sissy. Likewise, a male suffering from internalized homophobia might relinquish control when confronted by a dominant male on a dark street, especially if he had too much to drink earlier.

It is important for us to be aware of these triggers so that we can recognize them when confronted. I hope Jim reports this incident to the police. He has nothing to be ashamed of.

Roman Polanski

Roman Polanski is currently being detained in Switzerland stemming from charges that he had sex with a minor in 1977. After his initial arrest, Polanski fled to France where he has remained in exile to avoid sentencing by California law enforcement.

Over the years there have been many men like Polanski, most notably Woody Allen, who have used their power to influence naive girls into sex by manipulating them. Woody Allen went on to marry his long time partner, Mia Farrow’s adopted daughter, Soon-Yi Previn. Even though Allen was not Soon-Yi’s father, he was her mother’s significant other and likely represented a dominant male figure in her life. So for him to make the transition as Miss Previn’s pseudo-father figure into lover seemed repulsive to me. You don’t help raise a child and then marry her.

With Polanski there is a long history of trauma. A victim of the Holocaust, Polanski fled his native Poland to make films in the United States. And that he did with acclaim, creating iconic films like Repulsion, Rosemarie’s Baby, The Tenant, and Chinatown. He was a well respected director at the time of his arrest and pleaded guilty to having sex with a minor after drugging her with Quaaludes and intoxicating her with champagne at the home of Jack Nicholson. Perhaps her mother was wrong to leave her young daughter alone with a man. My parents left me in the charge of a Scout Master who was also a highly decorated police officer when I was eleven. He molested me for over a year before I finally told my parents.

Mr. Polanski was left a widower from one of the most famous and gruesome cases the world has known. Charles Manson and his followers brutally murdered Polanski’s wife, Sharon Tate, who was pregnant at the time. This left an already traumatized Polanski, bereft and devastated. This was made quite clear in the 2008 documentary, Roman Polanski: Wanted and Desired. I know because I watched it  several times and came away feeling as though the California criminal justice system manipulated the 1977 incident making Polanski into a monster. A small monster who was deeply troubled by his torturous past.

In the documentary, the victim, now an adult pleads to have the incident put behind her. She also settled with Mr. Polanski for an undisclosed amount. Perhaps if my Scout Master paid me off, I might have done the same. I hope she used that money to seek the help of a great therapist. I continue to see a therapist to this day.

My intention is not to provoke a discussion on the merits of Mr. Polanski’s film making. He is a great director. The issue at hand is whether or not you believe that time heals all wounds; and if you do, then Mr. Polanski should be set free. He has led a law-abiding life: got married, had children. He has made a significant contribution to society with award winning films, The Pianist and Rosemary’s Baby.

But allow me to refocus some facts on the life the camera obscurer often imitates. During my book tour last year, I discovered that the man who molested me wrote his own book, The Cop and the Kid, in which he described how he talked a suicidal teenager off a building and then adopted him. Since then my molester has adopted 13 boys in total. He was awarded father of the year. He is now a retired police officer who lives happily knowing that the sins of the past are now behind him. I am unable to press charges due to a statute of limitations even though it is a fact that most victims of child molestation do not come to terms with their abuse until they are adults. 

Portraits of men like Polanski and the one who molested me on camping trips are Polaroid pictures from an event that never fade in the minds of its victims. I ask you to stop focusing on the abuser and redirect your attention on their victims. They are the ones that suffer the most.

As a budding film maker in college, I viewed a special screening of Repulsion, and I remained an admirer of Polanski’s films ever since. My favorite directors of all time are now the ones that are rallying behind him in support. Men like Martin Scorcese, David Lynch and Pedro Almodovar. These men, like Polanski, have created some of the best cinema the world has ever known, often utilizing an eerily similar vein of the malevolent amidst normalcy. I only hope these men stick to what they do best and leave the legal system to do what is right and just.

POZ I AM

The Advocate Party

Last night The Advocate celebrated its October issue by throwing a party at Bogardus Mansion. Cover boy, Andy Cohen was there along with some Real Housewives including, Dina Manzo from New Jersey and my own fav, Bethenny Frankel, escorted by her new beau, Jason Hoppy, who I was surprised to discover is colleague of mine. As they made their way out of the party, I moved toward them like a torpedo, pushing random gays out of my way. “Hi,” I screamed frantically, trying to get their attention. Luckily, Jason stopped and offered an expression of recognition. Thank god since Chad doubted I knew him.

“He probably resembles someone you know,” Chad whispered. Not true.

Without even thinking I hugged Jason even though his hand was outstretched. “You blew me off,” he said. I had. We were to have dinner next week, and I cancelled earlier that day. Had I know he was engaged or soon to be with one of the most famous non-housewives in America, not only would I have swam the Hudson River to attend, I would have done his laundry for a month. Once I was sure that he recognized me, I introduced him to Chad. That’s when I went in for the kill and turned my attention to Bethenny.

“Hi,” I said. “I’m your biggest fan (Pathetic. I know, but that’s what reality celebs want to hear). “My friends and I love you. Why I was just texting my friend Eric that I was at this party and I wrote: Dina from New Jersey is here and so is Andy Cohen. Then when you arrived, I texted: Bethenny just walked in. He wrote back: Now I’m jel.”

“You’re so sweet,” she said as she continued to text using her Blackberry.

In real life she is much prettier and taller than I expected. Dina, too looked very glamorous. After our little encounter with Bethenny and Jason, I turned to Chad with a look to suggest that he never doubt me ever again in the future. Then we left. What more was there for us to do? We met some housewives, said hello to Josh from here TV, and of course Jon Barrett, the Editor in Chief of the Advocate along with my former editorial editor, Matthew Breen, who is really very tall.

Walking home I called Eric to brag. “Can you believe I met Bethenny Frankel?” I asked.

Without missing a beat, Eric sang back, “Don’t be tardy for the party, oh, oh.” Then hung up.

Toxic Sex Toys

 

As far as sex toys go, the vibrator was initially prescribed as a cure for the treatment of hysterical women. Historian Rachel P. Maines wrote in her book, The Technology of Orgasm: “Hysteria,” the Vibrator and Women’s Sexual Satisfaction, that “hysterical” women turned to their doctors for treatment who obliged by performing manual clitoral stimulation. By 1880, Joseph Mortimer Granville’s patented electric vibrator alleviated this tiresome task for physicians. Women were also pleased by his discovery, and by the turn of the century, magazines advertised do it yourself vibrators for home use.

In 1952, the American Psychiatric Association dropped hysteria as a recognized condition. After the sexual revolution, women no longer needed a medical excuse to purchase a sex toy. 

Today vibrators and dildos are advertised in store front windows from Chelsea to the Castro. As manufacturing evolves so does the material in which sex toys are made, and unfortunately, there is no “Consumer Report” on these products. One potentially harmful substance that is incorporated into dildos and vibrators, especially the jelly type, is the same substance used to make PVC flooring. I’m referring to phthalates, a plasticizer, which is easily identified by its smell. Think of a new car or a freshly unwrapped shower curtain. Phthalates emit a gas that escapes from the plastic. Studies on lab mice concluded that large doses caused damage to liver, lungs, kidneys and the testes. A 2006 study performed by the National Toxicology Program concluded that phthalates adversely affected the reproductive organ development in exposed male infants. Most baby toy manufacturers quickly removed them from rattles and pacifiers. Sex toy manufacturers continue to use phthalates because they are inexpensive. Complicating matters further is that phthalate sex toys are porous and do not withstand extreme temperatures. This makes them difficult to sanitize. Manufacturers recommend washing them with mild soapy water. I urge that you avoid these jelly toys and opt for ones made with silicone, hard plastic, glass, or metal. If you insist on using one of these jelly toys then be sure to put a condom over it. (Condoms should be used regardless and be sure to change the condom if you are going to share the toy with your partner.) Since silicone sex toys can withstand extreme heat; throw them in the dish washer for a thorough cleaning.  You can not do this with jelly toys. Avoid oil based lubricants with jelly toys as they can facilitate leaching of phthalates.

 

Members of the Coalition Against Toxic Toys (CATT) informed me that some manufacturers hide behind phrases like “trade secret” and “novelty use only,” in relation to phthalates. This is so they can avoid any liability. Currently the FDA does not regulate sex toys.

A jew for Christmas

Christmas time in New York is magical.

 

Radio City Music Hall

 

 

The streets are buzzing with pushy shoppers and tourists, (easily identifiable by their oversized sweaters adorned with Santa or a Snow Man), colored lights everywhere, and Christmas music playing all day long.

This year it has been unseasonably warm, which makes me sad because I do love a white Christmas. But I feel fortunate, because I don’t have to travel this holiday. My sister Maria, her husband Marc and all the little M’s: Matthew, Michael, Madeline and Mitchell, will be coming up from Alabama to join my sister Josephine, her husband Joe, Mom and Dad and me to celebrate.

What more could I ask for? Perhaps a lunch date with my idol.

Yes, Virginia there is a Santa Claus, and her name is Meredith.

Today I had lunch with the very woman I have idolized for well over 25 years.  Best selling author, celebrity, lecturer, and infamous sex therapist Dr. Ruth Westheimer. And yes, she is everything I expected and more.

Warm, funny, talkative, and short (even shorter than you might think), but with a personality as big as the season itself.  

We ate at Mr. K’s, one of her famous haunts. They even have chop sticks engraved with her name that they keep just for her. Meredith Kadlec, my lesbian Santa from here TV, organized the lunch. Dr. Ruth was so giving. She showered us with gifts including an orchid, key chains and pens. I was beside myself, and imagine my excitement when she agreed to take a picture with me.

 

The book was her idea... I swear

 

After lunch she complained that I didn’t offer her a hug or a kiss when I joined the table, but geez Dr. Ruth, I didn’t want to push the boundaries of our sexual relationship just yet. But in the end I had to oblige. It’s Dr. Ruth for Christmas sake.

 

 

After lunch I floated home on a cloud filled with snow and glitter.  It was the best Christmas gift I could have ever hoped for. I intend on pressing that orchid between the pages of my copy of ‘Twas the Night Before Christmas. That way I will only have to open it to remember my day with Dr. Ruth – my idol, my inspiration and hero.

Bewitched, Battered and Bewildered

As news of Chris Brown and Rihanna’s alleged altercation comes to light, it reminds me of the many gay men and women who suffer from abuse at the hands of their partners.

 

Nearly one out of four gay relationships are abusive and only one-third gets reported. This is due in part to the reluctance of the victims to report the incident to the police in fear of insensitivity.

Violence toward gay men and women need not only be physical but also emotional abuse.

One particular case involved a gay couple who were together for five years. After a heated argument about money, the financially secure one decided that he would no longer allow himself to be the receptive partner during anal sex. This confused his partner who was unable to make the connection between money and sex. In an attempt to compensate, he asked how he should approach becoming a bottom after all these years. To which his angry partner replied, “Practice on this,” and then threw a dildo at him.

Another patient said his boyfriend would make fun of his career in front of friends. He humiliated him for not being able to contribute equally toward the couple’s monthly expenses. For some, abuse can take the form of intimidation or even the threat of violence; other abusive partners find the way to control their victims is by using economic deprivation.

I treated a couple where one refused to give his partner money even though he was out of work. He agreed to pay for meals and fit the bills, but the unemployed partner was not allowed to have any money of his own. This left him feeling kept, like a pet. When they argued about this, his partner simply said, “If you don’t like it, then get out.”

There are a myriad of reasons why people abuse their loved ones: some psychiatrists believe there is a link to having been abused as a child or having been raised in a household where one parent was abused.  Substance abuse, mental illness, stress and even poverty can lead someone to take extreme actions with their partners.

No one deserves abuse. It is important to remember that abuse comes in many different forms and that it is cyclical. Ultimately, it is a form of control, and the victim is rendered alone, isolated and afraid. Know that your actions never warrant someone’s rage, and their violence is not your fault.  If you are being abused, please seek out help through your doctor, your local LGBT center or the GMHC.

From Sweden with love

The aerial view from the plane approaching Arlanda Airport displayed patches of green intermixed with icy waterways indicating the cold, brisk weather that awaiting me in Stockholm.

I am meeting Chad, my partner, who is attending the Annual European Society of Urology. My own interest in urology dates back to my early years as a surgeon when I wanted to perform sex change operations for a living. Interestingly, it was a 1970 movie called, The Christine Jorgensen Story, about an Ex-G.I. from Scandinavian descent who became a female that prompted my fascination.

At the conference it was apparent from the start that we weren’t in American anymore when I saw the huge poster ad for Levitra, displaying a couple in the throws of passion. Erectile dysfunction medications are not FDA approved for recreational use. The symposiums continued this theme by using such words as “hardness” and “duration of action,” all valuable marketing ploys. Then throw in some scantily clad women in bikinis making smoothies and abracadabra; you have a line of doctors wanting to hear all about your drug.

One of the biggest draws at the conference was the European approval of Priligy, a new medication indicated for premature ejaculation, which incidentally is defined as “three thrusts or less.” And I’m not kidding.

Major news here is the debate over using PSA’s to screen for prostate cancer. Two studies were recently published from Europe and America.  Currently, the American Cancer Society recommends screening men over age 50 using the PSA, (a blood test used to measure the level of a protein produced by the prostate gland).

Other interesting abstracts and studies involved penile elongation procedures and surgeries to correct Peyronie’s disease (a progressive disfiguring condition that causes the penis to curve abnormally). It’s my opinion that major advances have not been made.

Other than that what can I say about Sweden: the people are incredibly tall, blonde, and welcoming. They speak English very well; and if it wasn’t so damn cold, I might have enjoyed my stay even more.

The city overall is pristine with waterways intersecting the city at every possible juncture. Apartment houses flank the rivers, painted with the same yellow butter, terracotta orange and pale green colors.

Copper and gold domes glisten when the sun decides to show it’s face, but despite the crisp exterior, the Swedes were warm and hospitable.

I’m mean really how could I dislike the country that brought  me the music of ABBA, those amazing meatballs, and incredibly long words with funny looking symbols over the letters?

Natasha, you will be missed

In 2008 I witnessed Vanessa Redgrave’s performance in The Year of Magical Thinking, the Joan Didion play based on her book of the same name. It is an account of the year following the death of her husband while her daughter struggled with her own health. Ms. Didion’s daughter, Quintana, died after publication of the book but her death was included in the play.  

 ”Life changes fast.  Life changes in the instant.  You sit down to dinner and life as you know it ends.” 

This line, repeated throughout the book like a montra, haunted me.

This past month when Natasha Richardson died, I couldn’t help but associate Vanessa Redgrave’s peformance as a forshadowing of events to come. I had been a fan of Natasha’s for many years beginning with her performance as Mary Shelley in Ken Russell’s Gothic. I followed her career ever since then and even felt an unexplainable comfort like most fans do when their starlets find love and get married. In this case it was to Liam Neeson.  Whenever a newspaper or magazine posted a photo of the happy couple, I read the accompanying article with joy. When she triumphed on the New York stage, I applauded vigorously when she won the Tony Award for Caberet and then earned another nomination for Closer. Her career was destined for the same greatness as her mother’s.

That’s why when she died tragically due to injuries suffered during a skiing lesson, I was shocked and confounded. How did his happen?

My deduction is that she suffered a  subdural bleed. Trauma to the head causes a contra coup injury as the brain hits the opposite side of the skull to where the impact occurs.  This can disrupt the bridging veins, causing a slow progressive bleed. That would explain why Natasha was lucid initially. Then as blood collects in the small confines of the skull, the victim becomes sleepy, complains of headaches,  and finally gets more and more obtunded until eventually they die if untreated. 

 ”Life changes fast.  Life changes in the instant.  You sit down to dinner and life as you know it ends.” 

If only Natasha had been brought to a trauma hospital. She would have recieved a CT Scan of the head. Burr holes would have been drilled into her skull, evacuating the blood and saving her life.  

I worked in a trauma ER for nearly two years. It was a living hell. Some head traumas have distinctive signs to look out for:

- Raccoon Eyes consistent with a periorbital fracture

- Battle Sign consistent with basilar skull fracture

And one that I will never forget because it saved a woman’s life – blood behind the tympanic membrane. 

As a doctor, we try to learn from our mistakes. Hindsite is 20/20. If anything it’s important to remember that Natasha should have been wearing a helmut during her lesson and after the accident, she should have gone directly to the emergency room.

Farewell Natasha. You will be missed.

e-cigarette

 

It’s electric. That’s right. An electric cigarette. Touted as the alternative to smoking tobacco, this battery operated device provides inhaled doses of nicotine delivered by a nicotine solution. In addition to nicotine, the solution is also flavored (cherry, chocolate and mint). Physical sensation is similar to inhaled tobacco smoke.

World renown photographer, Aaron Cobbett sports one of the many ultracool e-cigarettes, stating, “I have fallen in love with these things, and haven’t smoked a cigarette since. Of course Mayor Bloomberg (undoubtedly with big tobacco behind him) is trying to ban these things, but I must tell you they are great. So far I seem to be the only one in NYC with one. Everyone freaks out when they see it. Not only are they legal indoors (for now) but they look super cool.”

The FDA is currently investigating e-cigarettes.

Flying the not so friendly skies

Flying business class is addictive. The first time I was upgraded it felt like I’d won the lottery. The seats are wide and comfortable. My only complaint it that there is too much leg room. I’m on the short side and don’t need all that extra space. In fact, I don’t know what to do with it, but I manage, particularly when all the free alcohol starts flowing. Getting upgraded unfortunately can be very anxiety provoking. So when I had the opportunity to fly business class in order to attend a conference in Mexico City, I jumped.

Fifteen minutes after take off, I sense a commotion going on in coach. My first instinct was to ask the flight attendant to close the curtain that divides first from coach, but he ran by me so quickly, I couldn’t grab him in time. When I look back there is a woman lying down on the floor and others have gathered around her. The woman in the aisle next to me says, “Someone’s having chest pain.”

“How do you know?” I thought. “Do you have a bionic ear or is that headset you’re wearing one of those amplifiers I’ve seen on television?”

 

Of course, I go to the back of the plane and sure enough there are three people huddled around a hispanic woman who is clutching her chest and moaning. A younger hispanic woman, who I assume is her daughter, is shaking the woman’s shoulder, calling out, “Mamita, mamita?”  There is a man reaching over the seat in front holding the semi-conscious woman’s hand. He identifies himself to me a  doctor. The chubby woman standing next to him states she is a nurse, but not just any nurse. She is an ICU nurse. I assume she felt the need to clarify this so no one would ask her to change a bedpan.  Not to be out done, I tell everyone that I am an internist. Then I assume command and demand to know what happened.

“Just after we took off she fell down and clutched her chest,” says the doctor still holding her hand. I’m wondering if he knows some alternative method of dealing with chest pain that involves pressure points in the hand.

Soon a flight attendant brings over a tackle box with tons of goodies inside. I remember ten years ago when I was on a flight from Puerto Rico, a man was having a seizure. When I asked the flight attendant for supplies then, she handed me an oxygen mask. “What am I suppose to do with this?” I said sarcastically. “I need Valium.”

“Sorry,” she replied. “Anything more would be a liability.”

What a difference ten years make. Now they even have a defibrillator on planes and all kinds medical supplies. It’s like a candy store for doctors.

Immediately I grab the stethescope and listen to her chest. The nurse attempts to put in an IV and blows the vein. I look over at her and she is red faced with embarrassment. I don’t berate her although it does cross my mind. Doctor ”Aladdin” is still rubbing the woman’s hand like a lantern, so I reach over from the seat behind him and insert a 20 gauge IV. I let the nurse hang a bag of normal saline. Afterwards she takes the woman’s vitals signs and informs us that the blood pressure is very low. Dr. ”Aladdin” continues to rub her hand while simultaneously petting her forehead. I look over at the nurse who rolls her eyes. 

We administer three rounds of nitroglycerin, glucose, and another bag of normal saline. Finally I remember the defibrillator. So I suggest we put the paddles on her chest in order to get a rhythm. When the flight attendant sees me reaching for the machine, he grabs my arm. ”Please don’t shock her!” he says with eyes so wide you could see the whites above and below his pupil.  I look at his name tag. It says, Jorge.

I say, “Calm down Jorge and go get me some pretzels.”

 

Once we place the paddles on her chest, I see the rhythm is normal, but I’m not risking my license. So I grab the pretzels from Jorge and ask him, “Where are we?”

He says, “Some where near Houston.”

“Well go to the cockpit and tell Captain Stubbing we have to land because Celia Cruz over here needs an ER.”

Within a half an hour we land. Although I knew this was going to screw up my plans, it felt very empowering to have the ability to land a plane. One minute, I’m watching some George Clooney movie in buisness class and the next thing you know, Houston we have a problem.

 

The EMS comes aboard, like they are landing on the moon and carry Mrs.  whatever her name is, off the plane, still clutching her chest. The plane takes off shortly afterwards. Everything is back on track and hopefully the woman was just having some indigestion, the result of a bad peanut.

Jorge comes over to me. I think he’s going to give me some award or citation. Instead he makes me fill out some documents. “Do I get a copy of these?” I ask. He looks as me as though he just smelled an onion. I guess not.

 

We arrive two hours later then we were scheduled. The car waiting for me charges me an additional eighty dollars.

 

Five days later, after the conference is over, I call the airline to inquire about the woman I saved. The customer service representative tells me that she cannot release the woman’s name or the details of what transpired after she was taken to the ER. I try to explain that I signed documents and legally, I was the doctor of record. The representative is not impressed and repeats that their policies prohibit them from identifying passengers.

“Even in this situation? Did I tell you I made them land the plane?”

“Sorry,” she says.

 Then I get angry.

“Well, I bought a full priced business class ticket, to do business that I couldn’t do because some woman in coach had chest pain. Will I be compensated for that?” 

“Sir, it’s not our policy to compensate doctors for helping passengers. It is your PREROGATIVE to do so.” 

“But I contained a situation. I alleviated the fears of the other passengers including her daughter. I even put in an IV and did some other doctorly stuff.” 

“Sir, we do not compensate you for helping. That is your PEROGATIVE.” 

“I’d like to speak to your supervisor please.”

“I am a supervisor.”

“Well good for you. I want to make a complaint because if you do not give me this woman’s name then I cannot follow up and there fore your airline is obstructing the completion of my care.”

 ”Like I said before I can not do that.” 

Then I decide to get crafty with some doctorly made up logic.

“I’m sure this woman was given a copy of the reports. Those reports have my name on them. If she decides to sue me, can I sue you for obstructing my follow up?”

“Please hold.”

I thought so.

Twenty minutes later, she makes me repeat everything and asks me for my number. Then she says, “Do you have another number in case this one is busy/”

“Don’t worry I’ll answer. By the way, can I have your name?”

“It’s Hannah, and we can’t give out our last names. So don’t ask.”

“Okay Hannah, talk to you in a few.”

As I wait by the phone, I think, “Well played. You really showed her whose boss. I bet they offer you platinum for life.”

Seconds turn into minutes which eventually accumulate into an hour, then two. Finally I give up hope that Hannah will call. Eventually, I begin to doubt whether my argument has any merits at all. “You did a good deed,” I tell myself. “Be proud of that. You didn’t do it so that you could get a free ticket?”

That weekend, my friend Sharon, who has an opinion on just about everything disagrees. “No, no no,” she yells one afternoon from the front seat of her car. I just finished telling my story to her and her husband, Justin. My partner Chad was in the back seat staring out the window in a daze, probably hyponotized by hearing this story one too many times. ”No, what that airline is telling you is that it is a de-sentive to help someone. They are sending out a bad message to other health care professionals. What they are saying is, ‘You’re on you’re own people. We just drive the plane. If you want to help that’s your prerogative.’” I like Sharon’s argument and wished I had thought of it when I was speaking to Hannah. “And then she doesn’t even call you back?” Sharon pulls on her hair in a way that reminds me of the comic strip Cathy. “Oh I would have been pissed. Right Justin?” He nodds silently, staring ahead at the road, acting mysteriously like Chad: calm, quiet and suspiciously tolerant.

 

Two days later, I’m sitting in Chad’s aptartment still questioning why Hannah never bothered to call.  So with Sharon’s voice still ringing in my head, I dial the airline’s customer service number.

After navigating through the endless prompts, I reach a human who identifies herself as Kit. I love her because once I finish explaining what happened she says, Honey for what you did, we should have you on the payroll.”

She tries to find Hannah’s complaint but is unable to locate it. “Well, let me tell you what I am going to do for you doctor. Would you mind holding? I promise not to hang up on you. It seems as though someone didn’t do her job.” 

“Of course,” I say. How could I refuse? I mean she did call me doctor and nothing titilates me more than to hear someone call me that outside the context of my office or a hospital. I’ve often thought that Chad should call me doctor in bed but never asked because I was sure he’d have me committed. 

 

“I promise it won’t be more than a few minutes.” I sense that Kit does not like Hannah. I imagine they have a long history of competitiveness between them.

As promised, Kit returns mintues later. “Dr. Spinelli,” her voice, clearly apologetic. ”I’m afraid we are unable to offer you anything other than a letter of thank you. If it’s any compensation, I will make sure your concerns get voiced to the review committee.”

I don’t argue with Kit because I believe she really wanted to do something for me. I feel inclined to ask her if she was remprimanded but then think against it sensing that “they” are listening in on our conversation. Poor Kit. I hope I didn’t get her into too much trouble.

Then she says, ”Doctor, we here at the airline appreciate what you did, and we would like to thank you sincerely.” Suddendly, it felt as though Kit had been replaced by some airline animatronic like the ones in a Disney World ride. In those few minutes when she had me on hold, the airline big wigs must have nabbed the real Kit and replaced her with a robotic Kit, just like in the film, The Stepford Wives.

Once I realize what  happened, I hang up the phone. There was no point in saying thank you or I understand. I was no longer speaking to the real Kit. This robot wouldn’t appreciate my gratitude anway. Clearly she has no feelings. In the end, I write off the entire experience as points toward my sainthood.

Later that evening, I dream that I’m on a flight to Mexico. This time, instead of some hispanic woman having a heart attack, Hannah is lying there on the floor of the plane. Leaning in toward her, I whisper softly in her ear: ”Remember me? I’m that doctor you didn’t call back. I think I’ll take you up on your advice and go back to my seat and have a cocktail, maybe two. I mean it is my prerogative.”

 

 

Sesame Street

“Can you tell me how to get; how to get to Sesame Street?” 

Apparently that means getting on the number 2 train to 174th Street. Yes, that’s right kids. Yours truly was cast as “a doctor” on Sesame Street: Word on the Street. I was hired to help Murray define words while he ran around the Bronx Zoo. Why was there a doctor with a human skeleton walking around the zoo? I didn’t ask. I was just thrilled to be on Sesame Street. 

My words included, HABITAT, HIBERNATION, METAMORPHOSIS and BONE. Correct me if I’m wrong but isn’t Sesame Street for pre-schoolers. These words are hard to define to an adult let alone a child. Anway I managed.

My prop and costar, Skelly

Taking public transportation to the Bronx posed it’s own set of problems because I don’t use mass transit that often and never as far away as the Bronx. When I got off the train on 174th Street, Dr. Frank quickly realized he wasn’t in Chelsea any more.

 

Murray and Dr. Frank

It takes two puppeteers to work Murray. During the breaks and in between shots, the puppet is taken off the actor and quickly slipped into a black cloth bag by a muppet handler. That’s to keep the illusion alive. “No on can see a deflated muppet,” I was told. That would be too frightening for a child to witness. But then how do you explain the actor’s legs sticking out of the bottom of Murray’s body?

Oh well, Sesame Street has its own rules. I suppose they know a thing or two about muppets and kids, since they just celebrated their 40th anniversary and are broadcasted in over 120 countries.

Sesame Street has been on the forefront of children’s programming, taking on current events like 911 and casting children of all races, creeds and even some with disabilities. Sesame Street has never shied away from pushing the envelope and in the South African version, Takalani Sesame show, Kami, is the first HIV positive muppet.

Congratulations to to them for being so open minded. California could learn a lot from them.

Crystal meth and HIV

Shane, an HIV+ patient diagnosed in 2007, began antiretroviral medication a year ago. Within two months he reached goal: HIV viral load was <48 copies per ml, (This is considered undetectable) and his CD4 subset or what is also referred to as T cells, hovered at 450.

Based on this, it was my opinion that this forty five year old male, who was otherwise healthy, would remain stable on his current regimen as long as he was one hundred percent compliant with his meds. That meant taking them as directed daily.

Last month he came in for a routine visit. Blood was drawn and several days later when I received the results, something was seriously wrong. His CD4 dropped to 231 and his viral load rose to 170 copies per ml. Immediately I called him. “Have you been taking your medication faithfully?”

“Yes,” he replied. “Never missed a dose.”

“Have you been feeling ill or has anything changed in the past couple of weeks?”

“Nothing out of the ordinary as I can recall.”

“Have you been using recreational drugs?”

“Why can that have an affect on my T cells and viral load?”

Good question.

“Yes possibly.”

“Last week I did some crystal with my boyfriend, but we stayed at home and didn’t go out. It was only that one time, and that was one week before I had my blood drawn.”

A week ago I attended an HIV speakers training hosted by a pharmaceutical company. One of the lecturers gave a talk on recreational drugs and HIV. The doctor provided no insight as to the affects of crystal methamphetamineon T cell proliferation or viral load. In fact, he didn’t offer any information that I didn’t know already. There is limited data on the affect of recreational drugs on HIV and their affect on antiretroviral medication. Most resources state the well known fact that drugs, particularly crystal meth, is associated with an increase in high risk sexual behavior leading to HIV.

My own clinical experience leads me to believe that crystal meth decreases CD4 cell count, but this information is anecdotal.

Today Shane came in to have his blood drawn. “I haven’t used crystal in two weeks and before then I hadn’t used crystal in 2 years.”

I’m curious to see what his numbers will be?

June 19, 2009

Shane’s T cells rose to 295 and his viral load is undetectable again. Currently, he has not used crystal for one month. 

 

I want your sex

 

Chastity Bono is rumored to have begun the process of gender reassignment.

 

Gender identity refers to a person’s sense of maleness or femaleness. Sexual identity refers to your biological sexual characteristics. This would include your chromosomal make up, external genitalia, internal organs and sexual characteristics.

Men and women who have a persistent discomfort with their assigned sex and wish to get rid of their physical sex characteristics and acquire the sexual characteristics of the opposite sex are referred to as transsexuals. These individuals wish to live as a member of the opposite sex. Transexualism is more common in men (1 in 30,000) than in women (1 in 100,000).

Women who begin the process of gender reassignment may choose to bind their breasts or have a double mastectomy. Some have an elective hysterectomy (remove the uterus), oophorectomy (remove the ovaries) and take testosterone (male sex hormone) to increase muscle mass and deepen their voice.

 

double mastectomy

Female-to-male sexual reassignment surgery has achieved lesser success than male-to-female, due to the difficulty of building a functioning penis from the much smaller clitoral tissue available in the female genitals. Penis construction entails several surgeries during which a tube-shaped structure is constructed by peeling and rolling skin from the abdomen or upper thigh and ultimately attaching it over the clitoris to preserve as much sexual stimulation as possible. This procedure often creates unsatisfactory ability to urinate and, while the penis can be used for intercourse, it is less than perfect.

 

Heidi Krieger was the 1986 European Champion in shotput. In 1997 she underwent  sexual reassignment surgery and changed his name to Andreas Krieger.

 For more post op surgery pictures see: MARCI BOWERS

Medical Rules of Travel

This July Fourth, I visited my sister and her family in Birmingham, Alabama. Chad and I spent the weekend at their house on Smith Lake.

Chad wake boarding

me wake boarding

Traveling to Birmingham can be difficult. Recently, Continental discontinued their non-stop direct from Newark, and Delta rescheduled our flight three times. We almost left for the airport Thursday night, but luckily Chad checked only to find it had been cancelled. It was rescheduled for 6:30 am the next morning.

Fifteen minutes into the flight, the attendant asked if there were any medical personnel on board. Some of you may recall that this has happened to me several times in the past. Needless to say, I now embrace the call to arms and ran up the aisle ready to first do no harm.

Since I was sitting way in the back, I had to make my way up to the front of the plane. There an Asian woman was lying on the floor shaking her entire body.

Rule 1: Patients who have seizures don’t shake their bodies like they’re dancing the Pony.

Another doctor, a pediatrician, followed behind me. We introduced ourselves. Then she took the patient’s blood pressure while I asked how she was feeling. “My mother wouldn’t let me have steak.”

Rule 2: Patients who make off the wall statements usually are trouble.

I ignore this and begin to check her blood sugar. “If you put that needle near me I will kill you,” she said.

Rule 3: Patients who make death threats are not to be trusted.

Then the woman’s mother appeared with several bottles of prescription anti-psychotic medication.

The flight attendant asked to speak with me. “Does this woman need medical help?”

“No she needs to be restrained.”

I go back to my seat. Later, the same Asian woman uses the bathroom. After looking through the galley, she finds paper and begins to make paper airplanes and throws them into the aisle.

After we land, I see her sitting on top of the headrest of her chair. As we pass she makes a motion as though she was knighting us. At the entrance of the plane I notice policemen and EMS workers. Chad and I quickly walk off the plane. Inside the airport we make our way to our connecting flight. Suddenly I hear shouting and then the Asian woman barrels passed us barefoot and running in a serpentine manner.

Rule 4: Patients who can run like they are in the NFL have been chased before.

I looked at Chad who shrugged his shoulders. We made the connecting flight and this time I put on my iPod.

As an update I made this short film for my niece and nephews.

Finding Neverland

Diprivan, an injectable anesthetic, was said to be one of the many pharmaceuticals found by police and EMS workers when they responded to a 911 call from Michael Jackson’s house.

Diprivan Injectable Emulsion is an intravenous sedative-hypnotic agent used in the induction and maintenance of anesthesia or sedation. Intravenous injection of a therapeutic dose of diprivan produces hypnosis rapidly with minimal excitation, usually within 40 seconds from the start of an injection. I know first hand because I was given diprivan when I had a colonoscopy last year. The doctor told me to count to ten and I said, “What?” Then a nurse shook my shoulder and asked if I wanted to use the restroom. “No, I’ll wait until after you’re all done.”  They already were.

I’m assuming who ever gave MJ this diprivan got it from a private source, as I am sure any ethical pharmacist would not dispense an injectable sedative-hypnotic to the King of Pop.

At least I can rest knowing his death was blissful. The rapid onset of hypnosis likely transported this iconic man back to Neverland, not the ranch but to the actual place itself where Peter Pan, no doubt, whisked him out the window and into the starry night above.

My Dad

On July 17, 2009 my father, Angelo Spinelli, passed away from heart failure. Over the past five years his condition deterioated to the point where he was no longer able to drive or walk up a flight of stairs. Complicating matters were diabetes, an enlarged prostate and gout, which eventually led to an infection of his toe. Upon surgery to debride a very painful case of osteomyletitis, my father suffered a second heart attack in thirteen years and a stroke. Eventually, died from complications from all of the above.

An immigrant from Salerno, Italy, my father had very little education. He watched Wheel of Fortune to learn how to spell and often sat fixated in his leather chair whenever a James Cagney or John Wayne movie came on the television. His idol was Carroll O’Connor who portrayed Archie Bunker in All In the Family, a show that portrayed a man much like himself: a hard working laborer who stereotyped other men not simply to exclude or ridicule them but as a crude attempt to to unite these other hard working shlubs who came to this country to ensure a better life for their children but not necessarily for themselves.

It would be a lie for me to tell you that my dad and I were best friends. Even as his only son, we butt heads on many subjects but we did agree on one thing: That life was unfair and the only thing anyone has to do is die and pay taxes. He has now completed both those tasks.

Today Chad and I adopted a rescue dog from Haven Animal Shelter. Named Hoffman Angelo, our eight week old beagle mix now sleeps quietly by our side as I write these thoughts about my father.

As a doctor, I have experienced life and death many times over the years. I feel detached from the dead once life has left their bodies. Perhaps that is why I was able to sit there quietly yesterday watching my father’s body in his casket as my family weeped. His three grandsons and one granddaughter stood at the entrance of the room, too afraid to get a closer glipse of their lifeless Popi. I don’t blame them. Why should they remember him that way.

Like them, I want to recall the sarcastic, overbearing, hard working, insufferable man who devoured every day as if it was his last. Eating foods he shouldn’t, drinking wine he made himself, which tasted like kerosene and smoking, cigarettes, cigars and even a pipe whenever he chose because life to him was to be lived and not feared, that each day could be your last and to surround yourself with others who thought like you.

I will miss him. But at least I have my niece and nephews to remind me of his spirit of adventure and now a new puppy who bears his name like I do, Frank Angelo, somewhere in the middle, yet always close to my heart.

Tales of Hoffman

As you know Chad and I adopted a puppy from a shelter. Having grown up in Arizona, Chad had dogs throughout his life. I did not. Correction, we had dogs but  they would mysteriously disappear in the night as if abducted by an evil dog collector. I recall one particular time when my father brought home a beagle we appropriately named Snoopy. Being a hound, he howled most of that evening. I heard his wining even all the way upstairs in my room, three floors above. The next morning when I woke up, I raced downstairs to see my new pet and low and behold, Snoopy was gone. I was five.

When I was seven a neighbor’s dog had a litter of a mixed breed of puppies. I begged my mother and reluctantly she gave him. My sisters and I picked out the smallest pup and named her Fifi. This time I tried my best to keep Fifi’s wining down to a minimum, but it wasn’t her barking that annoyed my mother. It was something else far worse - incontinence. Fifi couldn’t negotiate the whole wee wee pad thing. She peed on the floor. She peed on the couch and then finally, she did the worst thing of all; she peed on my mother’s wall to wall orange shag rug (It was the 70’s).

The next morning my mother took Fifi to “the vet”. When she returned I asked her how Fifi did. “Very good,” she replied and then she said she left Fifi outside on the front porch. When I went to congratulate her, I was unable to find my dog. Fifi was gone. Devastated, I decided to control my emotions, and so I rallied all the children on my block to help me find Fifi. Hours later, after combing the entire neighborhood, we were unable to locate her. As the sun set, I realized my worst nightmare was becoming a reality and Fifi was not coming back. How could my mother leave such a young puppy alone without being tethered to a lease? For years I harbored deep resentment toward my mother. Many, many years later, when my sisters and I became adults, we recounted these stories of our previous pets to whomever dared to ask, “Did you guys ever have a dog when you were kids?” Then without a second, I would tell my story of woe and how my mother lost my Fifi.

Then one year when I was thirty,  my mother, without any provocation declared that she did not lose Fifi. But in fact it was a calculated plan. She never took her to the vet. In reality she went to a nearby park and tied Fifi to a bench with a sign that said, “Adopt me.” You can imagine how her elegy infuriated me. Even my sisters agreed that my mother’s heart was as black as onyx and as pungent as sulfuric acid. How could anyone steal away her child’s puppy and abandon it, alone in some park, just waiting for it to be abducted by some psychopath?

I never forgave my mother.

Of course we laugh about it now, but whenever we sit around the dining room table, and I tell this story to guests who have not heard it (And I tell this story A LOT!), I look over at my mother. As she laughs with tears running down her eyes, I can’t help but wonder who this woman is that could have done such a thing.

Now don’t get me wrong. I love my mother. And this was not the only pet we had that suffered a mysterious disappearance. My pet rabbit Fluffy was later found skinned in a pot of water in the basement and later served as chicken that evening. My sister’s rooster, George, met with a similar ending (I must say I didn’t really care about his early morning crowing anyway). Needless to say, we never had any other pets, dog, cat or rooster, again.

My mother met Hoffman this weekend. Her voice, like anyone else who meets a cute animal, rose ten octaves as she pet him. But as I sat there quietly watching her, I wasn’t taken in for one second by my sweet old mother who disposed of my Fifi when I was seven. Right then and there I promised Hoffman that he would never stay at grandma’s house unattended as long as I lived and all appointments with vets would be handled exclusively by me.

No chance for e-cigarettes

This week the U.S. Food and Drug Administration announced that laboratory tests on electronic cigarettes found they contain carcinogens and other toxic chemicals dangerous to humans.

Known as “e-cigarettes,” the devices are battery-operated and contain cartridges filled with nicotine and other chemicals, spiced with flavors such as chocolate or bubble gum (because nothing says Marlboro better than a bubble gum flavored cigarette).

Up until now, manufacturers maintained that e-cigarettes were a  ”healthy way” to smoke. The FDA claims the device turns the highly addictive nicotine addictive into a vapor that is inhaled by the user.

“The FDA is concerned about the safety of these products and how they are marketed to the public,” said Dr. Margaret A. Hamburg, commissioner of the FDA.

Samples examined by the FDA found diethylene glycol — a chemical used in antifreeze – in one brand of e-cigarettes. Based on the FDA findings, e-cigarettes will likely be included in the ban on smoking indoors.

July? Ju-lousy

I’m depressed, but only for twenty-four hours. That’s how long I am going to allow myself to wallow in self-pity.

July 2009, hasn’t been a good month. It started off well enough when Chad and I visited my sister and her family in Alabama. But then I went wake boarding and injured my left arm. No big deal. Right? That’s what I thought. Then my Dad went into the hospital for bridgement of a toe infection. Three weeks later he died from complications of congestive heart failure. The funeral was on the exact day I was scheduled to begin filming a movie where I was to play, of all things, an ER doctor.

“Maybe that was cosmic luck,” said my friend Larry Flick. “You might of ended up as Coco at the end of the movie Fame.” He’s referring to scene where she meets a movie producer in his hotel room who eventually persuades her to take off her clothes.

Then my tenant moved out. He said the bank he works for cut his salary by twenty-five percent. I guess I should feel lucky working in medicine which is recession proof. “People still get sick no matter how bad the economy gets,” said my friend Basit, a colleague from residency. At least I have my new puppy, baby Hoffman. He’s so sweet, and he never barks. Good boy. And of course there is always my supportive and ever-loving, non-legal husband, Chad. So what it if it has been raining like every day since the beginning of the summer. If it didn’t rain then we would all be complaining of the drought.

I do try to look on the bright side of life. Yes, I am a fan of Monty Python.

But then Sunday I returned to the gym after an extended hiatus. As I attempted curls with less than twenty pound weights, I noticed something was amiss with my left arm. (The same arm I injured over the Fourth of July weekend.) My bicep was curled up at its insertion near my shoulder. It was balled up and looked like Popeye’s arm. But not in a good way. I knew immediately what that meant- a ruptured biceps’s tendon. Dr.Delaney, my orthopedist confirmed my diagnosis last night. Yes, I have an orthopedist. Once I turned forty and tore my right medial meniscus, I have been in close contact with Dr. Delaney. It’s so nice to get old.

Perhaps now I’ll start taking Chondroitin Sulfate and Glucosamine. Maybe even some fish cartilage. Anything to prevent more tendon or ligamentous tears. I keep thinking of that scene in the movie The Hitcher, (the original from 1986) where Rutger Hauer ties Jennifer Jason Leigh’s arms and legs to the back of two different trucks and then drives away in one of the trucks. I would be ripped apart faster than a bag of potato chips at my friend’s Eric house.

Oh July, the 31st can’t come fast enough for me. Damn it. Is that Hoffman barking?

Lyme Disease or is it?

How do I know it’s summer in New York? Is it the smothering heat that encases me as I walk the streets of Manhattan as though I am wearing my mother’s mink coat?

No.

Maybe it’s the days that seem to linger endlessly almost to the point where the sun sets just before Conan O’Brien’s show begins?

No. Not that either.

I know summer is in full throttle when patient, after patient, after patient comes into my office hyperventilating in fear that they have contracted Lyme Disease.

Transmitted through deer tick, and caused by three species of the spirochete Borrelia burgdorferi sensu lato. B. burgdorferi is the sole cause of the disease in the United States especially in areas where there are deers, like Fire Island. Yes, those mangy deer that inhabit Fire Island bear more than those sweet brown eyes. They are just teaming with ticks, chock full of B. burgdorferi.

The clinical manifestations of Lyme disease can generally be divided into three phases:

• Stage 1: Early localized disease is characterized by the appearance of the characteristic skin lesion, erythema migrans, with its distinctive target lesion, which usually occurs within one month following the tick bite.
• Stage 2: Early disseminated disease is characterized by multiple erythema migrans lesions and/or neurologic and/or cardiac findings (that typically occur weeks to months after infection).
• Stage 3: Late Lyme disease is typically associated with arthritis involving one or a few large joints, especially the knee; and neurologic problems. Late Lyme disease may develop months to a few years after the initial infection. Arthritis may be the presenting manifestation of the disease.

So if you plucked a tick off your body there really is no reason to get tested for Lyme disease because the results will invariably be negative. You should still contact your doctor.

Not to make matters worse, but you know I love to instigate a hypocondriac; here’s another fun fact: Babesiosis is an infectious disease caused by protozoa of the genus Babesia and transmitted through, yes you guessed it, ticks. Symptoms  develop one to six weeks after the tick bite. Patients typically experience gradual onset of fatigue, malaise, and weakness. Fever accompanied by: chills, sweats, headache, body aches, muscle aches and no appetite. Less common symptoms include neck stiffness, sore throat, dry cough, shortness of breath, weight loss, nausea, vomiting, diarrhea, and dark urine.

So go ahead. Enjoy your summer share. Next year get a full share, and while you’r at it go play in traffic or juggle knives. I don’t care. I’ll be sitting here in my nice, air conditioned, deer tick free office… waiting for you.

And if anyone happens to have a spare weekend available on the Island, Chad and I would love to join you. I’ll even make lasagna.

Cutest Puppy Competition

Even Hoffman’s an activist.

Proceeds will go to Amfar, and if the picture doesn’t lure you into voting, might I ask you to note the cast on my arm? Shameless, I know.

The wait is over

After two weeks of living with a cast that ran from my left shoulder to nearly my finger tips, the shackle has been removed; and I am free at last. I met with my orthopedist, Dr. Delaney, and he removed that plaster loaf of bread from my arm and replaced it with a very fashionable metal splint. It has a hinge guard at the elbow so that I can’t extend my arm fully. It looks very cyborg-esque. I’m loving it. But what I love more than anything else is that I am able to type and exam patients with both hands.

It really is true what they say about taking the little things for granted. Who knew I would miss my left arm of all things.

On a completely different note, I am proud to announce that Here Media and HealthyWithHIV.com will announce a new partnership encouraging living healthy with HIV.

“The campaign begins Tuesday, September 15^th, and includes an on-line video series titled “Ask the Doctor,” featuring popular doctor, author and health expert Dr. Frank Spinelli (The Advocate Guide to Gay Men’s Health and Wellness).”

Four segments were filmed earlier this week. My guests included: The Center’s Associate Director of Center CARE Wellness, Andrés Hoyos, and the Director of Mental Health, Katie Douglass from Callen-Lorde Community Health Center’s.

I will be sure to keep you posted on when the videos are available on Advocate.com in September.  In the meantime, check out these community resources:

Center CARE Wellness
Callen-Lorde Community Health Center
Advocate.com Health & Fitness

Male, Female or Intersexed

Caster Semenya has been asked by to undergo a gender test to determine that she is female. This after the eighteen year old South African posted a world leading time of 1 minute, 56.72 seconds in the 800 meters at the African junior championships. Then suspicions raged on after she won the gold medal at the International Association of Athletics Federations World Championships in Berlin on Aug. 19.

In the human, there are normally 46 chromosomes, two sex chromosomes and 22 chromosome pairs for which one copy is inherited from each parent at conception. The sex chromosomes are called the X and the Y chromosome. Everyone needs at least one X chromosome to survive. Females normally have two X chromosomes and males typically have one X and one Y chromosome. In the absence of a Y chromosome, babies will develop as females. When the Y chromosome is present, they will develop as males.

Global athletic committees  stopped testing chromosomes in 1999, citing unreliable results. If Miss Semenya agrees to undergo analysis of her chromosomes, she will retain her title only if she is genetically female. The problem however, is what if she or any athlete is found to be Intersexed.

Intersexed or what was formerly referred to as hermaphroditism, is a term used to describe a variety of conditions in which a person is born with ambiguous reproductive or sexual anatomy that does not fit with the typical definition of female or male.

For example, Androgen Insensitivity Syndrome (AIS) affects sexual development before birth and during puberty. Newborns are genetically male with both XY chromosomes  however as the body develops it is unable to respond to androgens and as a result the individual has mostly female characteristics. Urban legend alleges that the actress Jamie Lee Curtis was born with AIS as well as Kim Novak.

 

AIS on far right

Klinefelter’s Syndrome affects males and involves having three chromosomes (XXY). Born anatomically male, at puberty the body matures with female characteristics due to a release of estrogen. Young males will develop breasts, small testes, long legs and lack facial hair.

Although intersexed newborns occur in 1 in 2,000 live births, it fails to be seen what the ruling would be if any athlete’s chromosomes are found to be intersexed.

Party Hazards

So wasn’t it just a week ago that the Pines in Fire Island hosted its annual Ascension Party?

No, I didn’t go, but apparently everyone else did. I spoke to Josh Rozenzweig from here TV, who said he lasted ten minutes. Something about the heat and how he was spritzing through his T-shirt. You mean you wore a T-shirt Josh?

Like the thousands of other gay men who were dancing topless and sometimes even bottomless out there on the beach with the sun beating down on their over-processed, highlighted hair, the Ascension Party, which incidentally is the evolved incarnation of the Morning Party, raged on. Fiercely, I might add, even when Kelly Rowlands took to the stage to sing.

“Who knew she had a song?” I asked. “I’m still trying to figure our how she got that job hosting, The Fashion Show.”

“What?” said Johnny Lee. “When Love Takes Over, is the song of the summer. It’s this year’s Pine’s Party anthem!”

Well, excuse me Miss Lee.

I guess I’m too old because I don’t get excited by such things anymore. Or perhaps it’s because one week after the Ascension Party the real party takes place in my office as men file into the waiting room in droves complaining of body aches, bruises and sinus infections (God only knows why?), and of course urethral discharge.

One such patient blacked out Saturday night, woke up briefly flat on his back in some bushes, and then blacked out again only to wake up Sunday evening. Over twelve hours later! Not good. And when he did wake up, he had so many bruises and injuries you would have thought he was dragged from behind a truck and hog tied to some tree in the meat wrack. Good Lord. Vodka and Red Bull should not be mixed. Let that be a lesson.

This all reminds me of the one and only time I was the doctor on Fire Island over two years ago. I took charge of my post on the day of the Ascension Party. Within two hours, I was called to a house where a twenty-five year old male was on the ground lifeless while his hysterical friends fluttered about. He had overdosed on GHB while soaking in the hot tub. Then when his friends tried to revive him, they panicked when he became unresponsive. Unfortunately, they delayed calling 911 and someone had the bright idea to insert some Crystal Meth into his anus in an attempt to wake him up from his coma. Meth plus the GHB likely caused his myocardial infarction. I spent that afternoon carrying a dead boy into an ambulance.

Now you understand why I don’t go to the Ascension Party.

 

And just what is it we’re celebrating anyway? Ascencion to this former Catholic commemorates Jesus’ ascencion into heaven. Is that what we’re doing out there? Baking in the sun, instigating God into taking us up to the heavens? Not me. If I’m going to heaven, it will be while I’m eating pizza in bed watching Project Runway with Chad on my left and Hoffman on my lap.

Make it work, Lord.

Pay it forward

Do you remember the movie, Pay It Forward, starring Kevin Spacey, Haley Joel Osment, and Helen Hunt? It’s the story about a young boy, Trevor, who conjures the idea of paying a favor not back, but forward–repaying good deeds with new good deeds done to three new people. Trevor’s efforts to make good on his idea bring a revolution not only in the lives of himself, his mother and his physically and emotionally scarred teacher, but in those of an ever-widening circle of people completely unknown to him.

I hated the movie. It’s sappy and self-indulgent but I love the idea. Perhaps I dislike this movie because I despise Helen Hunt. Don’t ask me why.

Today Chad and I brought Hoffman to the Haven Animal Shelter for his last round of vaccinations. We had lunch at a nearby Mexican restaurant called La Esquina. We ate outside and enjoyed the beautiful weather. A couple seated nearby asked about our dog and we told them about the shelter. They had already been there and were debating whether or not to adopt a pit bull/Shepard mix named King. They were very pleasant and praised our dog’s sweet demeanor, which won them high marks from Chad. Soon after they payed their bill and wished us a good day. Then the waitress came by and said that the couple payed for our meal. Since they were already gone, we couldn’t thank them. We were completely taken aback. Neither of us has ever been treated so kindly by complete strangers. It left us feeling surprised and shocked. We couldn’t believe that two random people could be so generous.

As we walked home, I found myself smiling brightly and even noticed a spring in Chad’s step. This couples’ act to pay it forward reminded us both that people can be genuinely kind, even in New York. So for the rest of the day, I made sure to hold open doors and smiled as strangers pet our dog.

It has been studied that positive acts reduce stress and release endogenous opioids which improve the immune and cardiovascular system. Long term studies show that reducing stress promotes longevity. Similar finding have been found with owning a dog or volunteering at a hospital.

I only hope that I can remind myself of this wonderful August day long after it passes. It was a glimpse into a world where everything could be right and that an act of kindness could influence two strangers in such a positive way. But regardless whether Chad or I can remember this day at least we have Hoffman to help us live longer, healthier lives.

Medicinal Hugs

I have a patient named Cathleen Hoat, a 70 year old woman, who looks exactly like Mrs. Claus minus the red outfit. She has  been coming to me for several years, and by all intent and purposes, she is a good patient. She always keeps her appointments, follows my instructions to the the letter, and greets me with smile each and every time we meet.

I call her my “little ho”. She laughs but I’m sure she has no idea that I am referring to a ghetto whore. Unfortunately, Cathleen hates having her blood drawn. In fact she goes into hysterics every time I tell her I need to draw blood.  Inevitably, after much arguing, she gives in. Lying back on the exam table my assistant Juan has to hold her hand as I stick her gently in the vein. By the way she carries on you would think we were performing surgery on her without anaesthesia.

Before Cathleen leaves, she reviews her “problem list”. Then when she is sure that we have discussed all her issues for the day, she begins her ritual before exiting my office. Digging into her purse she removes a plastic bag filled with Hershey Kisses and presents each one of my staff with a Kiss. (I refuse to eat her chocolate so now she brings me in a small plastic baggie filled with cut carrots). Finally, before Cathleen departs, I must hug her. Yes, I said HUG.

Cathleen is a firm believer in the power of hugs, and she has instructed me on the variety of hugs that exist. The first is when she hugs me and I accept her hug. The second is when I hug her back, and the third is when we hug each other at the same time.

As a doctor, I am adversed to this kind of maudalin behavior. I grew up Italian where we had to kiss and hug every relative when we entered a room. Gay men too, enjoy hugging and kissing when they meet, particularly the Italian ones. I’m not so keen on all this affection especially after I’ve been treating patients with viral and bacterial infections all day however, I do oblige Cathleen.

 

The Official Hugs Book, written by Martha Bolton, states that hugs have a healing affect. Just watch an injured child’s tears dry up in the circle of a mother’s embrace. And watch an old man barely clinging to life suddenly light up with renewed strength and a will to live when his estranged son walks into the room and embraces him.

Apparently my “little ho” knew something I didn’t. Regardless of how I feel about hugging patients, it does feel good when Cathleen puts her chubby arms around me and presses her bussoms against my chest. Maybe she really is Mrs. Claus?

Hold back the reigns

 

Death is something every doctor has to deal with at some point in their career. It’s inevitable. As a intern during my oncology rotation, patients died often, and it was our responsibility to notify their families. I remember one time an old man, Mr. Gambotti, passed away at 1 am from a long fight with metastatic prostate cancer. He had been admitted one week earlier for chemotherapy, but he was so skinny and frail that he could not withstand the grueling treatment. Looking at him reminded me of those pictures of the holocaust, where you could see a person’s entire skeleton beneath their skin. When I got the page from the nurse telling me that he had passed, my resident, a tall red head named Sheila, looked at me and said, “Well do you think you’re up to it?” By that she meant, tell the family.

I was.

Thankfully, she coached me through it. Even though I didn’t know the Gambottis well, I still felt deeply saddened, particularly when his wife’s voice crackled as she sobbed. Her last words before she hung up were, “Thank you.”

The next evening my fellow intern, Jack, a putz from Illinois, received similar news from the same nurse about one of his patients. Sheila eyed him up and down. ”So Jackie poo are you up for it?”

He shook his head aggressively, but I could see it in his eyes that he was only giving in to pressure. In all fairness, she coached him very well, more than she did for me. When he was ready, he picked up the phone and dialed the family’s home. Within seconds, his eyes widened and he began to speak, “Hello, this is Dr. Draper from Cabrini Medical Center. I’m sorry to tell you this but your dad just died. Please call us back if you have any questions. Bye.”

Sheila jumped up from her seat. “You didn’t just leave a message did you?”

“Yes.”

“You don’t leave a message like that! You identify yourself and instruct them to call you back. How would you feel if someone called your mom and said, ‘Uh, your husband bit the bullet and let me know when your able to pick up the body.’ Are you a complete idiot?”

He was. Luckily for all of us, he went into radiology.

I can’t say I haven’t had my own trouble informing a family of the death of their loved one. As a resident in the medical ICU, I oversaw all the patients. Residents refer to the ICU rotation as a “make or break” month. That’s because if you manage getting through it unscathed then you will probably graduate. If you show off your talent for saving lives, then you will be a star and likely be considered for any fellowship. However, if you don’t shine or if several patients die during your reign, then you will be branded a “weak” resident. No one will want to work with you. Your interns will not respect you, and it is quite possible that you might not advance to your final year of residency.

That month I wanted to shine. Two weeks into it, I hit my stride. A surge of confidence came over me. It was going to be smooth sailing from here on out. Then an elderly woman, Mrs. Castanetta, transferred to the ICU from one of the general medical floors. She was the mother of the CEO of the hospital. I was “talked” to by several of the doctors overseeing her care, and I even received a “friendly” call/warning from the medical director himself. Needless to say, my ability to care for this one patient was going to be the barometer for my entire month as the ICU resident. She was my “make or break” patient.

Unfortunately, her condition deteriorated to the point where everyone knew that she was going to die however, no one could say when. One Friday evening, while I was on call, I received a frantic page from my intern informing me that Mrs. Castanetta’s blood pressure was dropping. Racing up to the ICU, I took the stairs two at a time. At her bedside, the intern and respiratory tech were standing vigil. Her blood pressure was 80/60. In an attempt to shine, I  called the family directly.  I wanted to inform them of her impending fate and give them ample time to see their mother before she died. Within a hour the entire Castanetta clan filed into the ICU and with tears in their eyes, they encircled their mother’s bed. I drew the curtains myself to offer them privacy and waited patiently by the nurse’s station. Since she was DNR, there was nothing more we could do for her. I felt good about calling the family, but more importantly, I felt empowered by my decision not to call the ICU fellow or my attending first. I took matters into my own hands. I was acting like a doctor and not just an ICU resident.

Mrs. Castanetta did not pass away that evening. In fact she went on to live two more weeks. By the time, she did pass, I was already onto my next rotation – the ER. I was mortified. Every time I saw the CEO in the halls I diverted my eyes to the floor, embarrassed by the fact that I had alarmed his entire family and made them get out of their beds. No one berated me officially, but I felt the subtle decline in my standing as a resident. My ego had interfered with my ability to act ethically. One afternoon in the cafeteria, my former resident, Sheila, who was now a pulmonary fellow, sat down beside me.

“I guess you heard about Mrs. Castanetta?” I asked.

“You mean how you called that poor family in for last rites, and then she went on to live another few weeks?” she said giggeling into her tuna fish sandwich. “Yeah, I heard. Everyone has.”

“Oh, great,” I mumbled.

“Don’t worry about it Frankie,” she said. “We all can’t be stars like me. Next time you want to act cavalier, remember to calm yourself down and hold back the reigns. Most mistakes get made by jumping the gun. Even the smartest doctors have to remember to think things through before they act. I wouldn’t worry about it too much more. Just think about it this way, you’ll never do it again.”

She was right. I never have. Not that I don’t get alarmed and well, yes, maybe I have told a patient or two that their prognosis was worse than it actually turned out to be. There is nothing wrong with being overly cautious. 

After graduation, I lost touch with Sheila. The last I heard she got married and moved to California. Someone told me she had triplets.  I can just see her walking down the street holding onto three red headed toddlers while talking on her cell phone. ”Yes, I’m sorry to tell you your mom died.” All the while reigning in her three children with the greatest of ease.

Sex and the City

Walking a dog around the block has given me a new perspective on city life. Usually I’m racing to the office, darting to the hospital and then rushing home to nest. Now I circle the block casually, waiting, hoping, praying that Hoffman will sniff something that might trigger a response in his puppy synapses and make him want to go pee pee or poo poo. Yes, I have become one of those wandering minstrels with their dog on a leash circling the city waiting for their pet to evacuate.

To make the best of this time, I have resorted to photography. My friend, Jesse Archer, recommended that I always keep a camera handy. He’s absolutely right. As my BFF, Eric Ostrow, always says, “You never know when God is going to deliver you a present and show you something to brighten up your day.” So here are a few photos I took.

This is a park on 23rd and the West Side Highway where children were frolicking.

Is it me or do these fountains seems especially phallic? I known I have a dirty mind but this park is in Chelsea. Maybe they should change the name to Butt Plugs Park. Children were running in and out of the water, and one particularly excited girl wrapped her arms around one of those fountains and began rubbing it up and down. That’s when I had to leave.

Remember the Olivia Newton John classic, Hopelessly Devoted, from the movie Grease? Well this is what I call Homeless and Hopelessly Devoted.

It looks like some one’s getting to second base. I hope this isn’t a first date.

But life in the city isn’t simply about butt plugs and homeless sex. There’s more…This morning I was emailed by a patient who had gotten herself into a little pickle. The subject was entitled:

Help- please don’t delete

Patient: So sorry to ask you this but don’t know what else to do. I left my 7 day prescription of effexor at some guy’s house last night as I apparently left my whole gym bag. Would you be willing to call in for just a 7 day prescription?  Sorry to bug you and even ask but not sure what to do.

Me: Excuse me Madonna in Justify my Love video………where do I call the prescription?

Patient: You are too funny. I actually called my dad and gave him a totally different scenario (of course) and I think he called it in for me. So embarrassing…but kind of funny. Sad to lose all that stuff though. I had a really good sports bra in that gym bag!

Me: Was the sex that bad that you can’t get the bra back?

Patient: Didn’t take his number – gave him mine…I’m pretty sure he’ll call though. They always do when you leave your wardrobe….

Me: Well he probably thinks you left it there on purpose to ensure a second date.

Patient: I know – that’s the worst part cuz I so don’t want to see him again and now I kind of need to….I want that sports bra.

Me: Oh Carrie Bradshaw, just bite the bullet and when he calls just say, “Thank God, I need that bra. It’s my favorite. Can you be a lamb and leave my bag with your doorman?” That way you won’t have to see him. It will knock his ego down a few pegs but who cares?

Patient: I love you – you are frigging hysterical

FASHION!

Fashion can be hazardous to your health.

SYMPTOMS – Gay male wearing a loose fitted V-neck T-shirt (black, white or bold stripes), with similarly loose fitting sweater jacket, skinny black jeans AND a tote (worn hanging off the shoulder possibly with a scarp knotted to the handle).

DIAGNOSIS - This Hamptons-esque tote with knotted scarf and accompanying outfit are sin que non for a new wave Uber Gay Fashionista Male.

PROGNOSIS – Fatal if not stopped immediately.

What is it about fashion that has some people on the edge of their seat? My mother was a seamstress and designer before becoming a mom. After she had three children, she made all my sister’s clothing. I grew up with fashion, reading Vogue instead of Sports Illustrated, but for many men, fashion is superfluous.

“It’s something to make fun of because people generally don’t understand it,” said Vogue editor, Anna Wintour, in the documentary, September Issue. Interesting, when you think that this silly industry is estimated to be worth 300 billion dollars.

Regardless of your point of view, everyone has an opinion when it comes to fashion. What’s in or out is a matter of personal taste, and everyone loves to share their own insights into what works and what is a fashion faux pas.

I am by no means a fashionista although, I do know what looks good on me. My partner, Chad, is meticulous when it comes to choosing something to put on his back. This is substantiated by the multiple clothing options shrewn all over the bed after he leaves for work. Discarded piles of pants, shirts, belts and shoes that never made it through to the final editing process, lay on the bed like the aftermath of an explosion at the men’s department is Saks. I generally buy clothes that are similar, making choosing options on a daily basis infinitely more simpler.

“You take less fashion risks,” says my fashion forward friend, Scott. I agree, but I have been known to pull an ace out of my sleeve on occasion, opting for color instead of my usual basic black.

But personal choice doesn’t just end with one’s own look. Views on fashion extend to the masses, and I myself, am no angel when it comes to ridiculing other’s people fashion choices. The Hamptons-esque gay male with the tote and scarf is a look that infuriates Chad and myself. Why should it though? Everyone is entitled to their own fashion choices. Not true because gay men and metrosexuals subscribe to the Rules of Fashion. We do. Regardless if you believe it or not.

“You sold yourself the minute you put on that pair of Jimmie Chu shoes,” said the injured Emily to Andie in the Devil Wears Prada. And she was absolutely right. The moment you catch yourself staring a little too long at a fashion spread in GQ or entranced by that Armani billboard on 10th Avenue, realize that you are spellbound and fashion is seeping into your blood.

So the next time you giggle at that young man wearing high water slacks with no socks and shoes like Chad and I did while eating brunch outside on 14th street and 10th Avenue, remind yourself that it’s not him you should be laughing at. You should be laughing at yourself because he chose to take a risk and you didn’t. You can make all the excuses you want or tell yourself that it’s age inappropriate, but the truth is exactly how Miranda Priestly put it: “You think you made a choice that excludes yourself from fashion because you take yourself too seriously.”

Think again.

True Blood Tears

If you only thought vampires cried blood then think again. Calvino Inman, a 15 year-old from Tennessee, two states away from that fictitious town in Louisiana, where the HBO series True Blood exists, cried streams of blood laden tears. Seen and treated in the local ER, Inman was discharged to home without so much as a clue as to why this happened. When the blood tears returned several days later, he returned to the hospital.

Haemolacria or “crying blood”, is common in people who have experienced extreme trauma or a head injury. Not the case with Inman.

Dr. James C. Flemming, an ophthalmologist at the Hamilton Eye Institute, has been reviewing Inman’s medical records for possible treatment.

Flemming says complications to look for include blood clots, a growth or tumor near the eye, or even a simple infection. A research study published in 2004, looked at children with spontaneous episodes of blood tears from February 1992 and January 2003. Only four cases were recorded. It is quite possible that after all the battery of tests have been ordered and reviewed, the cause of Inman’s bleed may still not be found.

For all you True Blood fans, like myself, you might recall when newly made vampire, Jessica, became so upset that tears of blood streamed forth from her eyes. But her case is an unfortunate occupational hazard that comes with being a vampire. If no other cause is found in Inman, may I suggest they check his teeth for fangs.

Rihanna Redux

Poverty + Addiction = Abuse

That’s what Lee, a social worker who specializes in domestic violence, said to me in response to the Chris Brown/ Rihanna story.

“It’s a mockery. I bet she’s not even in therapy and will likely go back to him. I know she was influenced to do the “right” thing.”

And by that he means, keeping her mouth shut and allowing Chris Brown’s reputation and career to recover after his arrest.

I felt my own outrage surge up again after his appearance on Larry King. Seated next to his mother and lawyer wearing a baby blue sweater made me even angrier. Were we suppose to think that Mr. Brown is a “good” boy who loves his mother and wouldn’t hurt a fly? Then when he denied remembering the incident, I nearly combusted from fury.

“That was biggest insult of all,” ranted Lee. “His career will likely flourish. What really angers me is that young women defend him, stating that Rihanna should have kept her mouth shut and likely deserved that beating. I bet they were high. Supposedly, Rihanna got a text from someone who said she got syphilis from Chris and that’s when the shit hit the fan.”

As the rumors swirl, the unfortunate reality is that this was a missed opportunity for the entire country and for Rihanna to learn something. This could have been the example that would have been the benchmark for other abused girls to learn from. We must remember that Rihanna is only 21 years old. Abuse among young women, particularly teenagers, at the hands of their boyfriends is not discussed and underestimated.

“Rihanna will prevail,” added Lee. “Unlike most women I deal with, she has money and shelter. Those are resources most of my clients don’t have, and the biggest reason why they stay with their abusers.”

Pro Bono

Researchers in Sweden provided the most compelling evidence that being gay or straight is a biologically fixed trait. Reviewing brain scans, researchers found that key structures in the brains of gay people resemble those in straight individuals but of the opposite sex.

For the most part, straight men have asymetric brains. The right hemisphere is slightly larger. Gay women were found to also have this asymetry. Meanwhile, gay men had more symetrical brains like those of straight women.

How do there findings relate to the transgender community?

Researchers unfortunately, have yet to extend their research to include transgender individuals.

Experts do agree on two crucial concepts: being transgender is not a choice and biological sex and gender identity are two different things. Labeled a psychiatric illness (“Gender Identity Disorder”) by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), transgender patients are not adequately covered by health insurance, which often denies them hormonal and surgical therapy, claiming they are non-covered cosmetic treatments.

In 2008, the American Medical Association House of Delegates passed a resolution for insurance to cover treatment of gender identity disorder in adolescents and adults. Unfortunately, many transgender patients continue to receive inadequate medical coverage and resort to buying hormones illegally and undergoing surgery in countries outside the United States where it is cheaper.

No one knows how many transgender people exist. Hopefully as more and more come to light, the public and political opinion will change toward them and treat them less like freaks and more like individuals who have grown up feeling isolated, ashamed and bullied.

 

As of recent, the biggest public figure to come out officially as a transitioning F to M is Chaz Bono ( Chastity Bono), daughter of Cher. Chaz’s decision to go public with his private struggle is extremely brave. His publicist said, “It is Chaz’s hope that his choice to transition will open the hearts and minds of the public regarding this issue …”.

Unlike most other transgender individuals, Chaz represents a small minority who has money and family support on his side. I do commend him for his willingness to go public with such a private matter.

Dieting with Meth

When I was much younger, my sister Maria would announce to the family every Sunday night that on Monday she was going to put the die in “Diet”. This declaration was usually made after a weekend long binge, eating cake, cookies, bacon or too much homemade bread.

Growing up my sisters and I struggled with weight, and it wasn’t until I moved out of my parent’s house that I learned to regulate what I put into my mouth. At 5′7” I maxxed out at nearly 200 pounds before I decided to learn the truth behind nutrition and weight loss.

Being gay only makes matters worse. Once I moved to Chelsea, I realized almost immediately that looking a certain way mattered more than what I did for a living. Working out and dieting became a necessity.

As a new gay “adolescent” I stumbled through this world and even meandered into the gay party circuit – a subculture that thrives on dance music, sex and drugs.

Cocaine, ecstasy, ketamine and crystal methamphetamine are the drugs of choice for avid party goers. Ecstasy and GHB are used most often for their euphoric effects while crystal meth is taken to maintain arousal so that party goers can last long hours without sleep. Meth is also the drug of choice for men who surf the internet in search of sex, and it has become synonymous with unprotected sex and HIV.

I have been treating patients for meth addiction my whole career, and just when I thought I had heard every scenario, a new one recently took me by complete surprise.

“I just need to lose ten more pounds before my high school reunion this weekend,” said Tom during a physical exam.

“That’s impossible,” I said. “It’s Tuesday. You can’t lose ten pounds in three days.”

“Wanna bet?” responded Tom striking a pose and placing a very shaky hand on his hip. “It’s easy. I’ve been sorting crystal. How do you think I lost the first ten pounds?”

“Are you insane? How long have you been using crystal?”

“About a month. First, my boyfriend and I did it for fun one weekend, and then I noticed on Monday my clothes fit perfectly. It was fabulous. So I thought if I could lose a few pounds in just a couple of days, imagine what I could lose using crystal for a week. Then the next thing I knew I was using meth for a month and bam! I’m wearing skinny jeans.”

“I don’t know what to say. I think the meth has gone to your brain.”

Truth be told, Tom’s rational is not unique. CBS News ran a story about a group of young girls who took meth in order to lose weight before their prom. This proved disastrous when the girls became addicted.  

Gay men and young girls battle with eating disorders by using crash dieting, starvation and vomiting all to lose weight. In addition to fitting into their clothes, these individuals can expect to lose much more like, enamel from their teeth due to the vomit’s acidic content, hair loss from vitamin deficiency, and a decrease in lean muscle mass secondary to starvation. Adding crystal meth to the mix shifts this crisis into another dimension.

I won’t burden you with the reasons why you shouldn’t use meth as a dieting aid. I don’t believe in diet pills, crash dieting or starvation as productive, healthy ways to shed pounds. I do believe that long term  meth use will cause you to lose something more precious than weight, hair or enamel. Researchers have shown atrophy of the brain secondary to long term meth use. Bet you didn’t count on losing weight there?

So you see, my sister was only being dramatic when she said she was putting the die in “diet”. I guess Tom took a more literal approach.

Ask the Doctor

Beginning September 22nd, I will be hosting,

Advocate.com’s

(click here)

“Ask the Doctor”

Ask the Doctor is a web series dedicated to addressing relevant topics for the modern day gay man. Over the next few months, Advocate.com will air video installments alternating with written editorials on the topic of HIV.

I invite you to watch and please write back with your opinion. (Please be kind). You can email me at

FrankSpinelliMD@aol.com

I love New York

New York is alive with inhabitants that invigorates you as you walk down the streets. Here are a few of the pictures I took this weekend walking Hoffman.

Hoffman and me

Watermelon Pizzazz

White jumpsuit with dog

Bumble bee girl

Bumble bee girl from behind

Red head in white slip dress

Woman with dry cleaning