Way to go Paula

Pour some sugar on me

“Way to go Paula,” is a line from the movie, Officer and a Gentleman. Remember that final scene where Richard Gere picks up Debra Winger and sweeps her off her feet? Her teary-eyed girlfriend, Lynette, shouts out, “Way to go Paula!” as she watches her best friend being carried out of the factory where they work. It’s a bittersweet ending for Lynette seeing her best friend reveling in the happy ending she will likely never experience for herself.

That’s how I felt when I heard Paula Deen was diagnosed with diabetes and is endorsing a new oral medication to treat  her disease. For years, I’ve watched along with the rest of the country as this larger than life Southern woman warmed our hearts and enticed our bellies with recipes that went against everything doctors and nutritionists have been preaching about for years. I remember once watching Paula Deen as she dropped whole sticks of butter into a bowl with the same disregard Joe Pesci’s character in Goodfellas unloaded bullets into mobsters. The cruel twist is that Deen knew she was a diabetic for years and still she relied heavily on fatty foods without once acknowledging her condition was directly related to her obesity and eating habits. This week she admitted to being a diabetic but her announcement came suspiciously once she  signed a lucrative endorsement deal for an oral diabetic medication.

I wonder if Paula Deen and the Food Network will alter her format and use Deen’s diagnosis as a cautionary tale that this can happen to you if you eat like glutton? Improving Deen’s ingredient profile could prove deleterious to the food star who typically doesn’t mince words or cut corners. Her food is rich, high in calories and loaded with fat. I guess you could say she lives life like her hair: big, brassy and dangerous. Will the public watch a streamed down Deen? We shall see.

One out of every 10 American women is living with diabetes, which causes more deaths each year than breast cancer and AIDS combined. Still, most Americans don’t see it as a serious disease, according to a recent survey. Here’s why women should worry…

Are you overweight and hate working out?

Were you diagnosed with gestational diabetes during a past pregnancy?

If you answered yes to either of these questions, you’re at risk for developing diabetes, a chronic, incurable disease that raises the risk of heart disease, kidney failure and more. And women with the disease are also more likely to die younger.

“If you see a 40-year-old woman with chest pain, she’s not likely to have a heart attack,” says Andrew Drexler, M.D., an endocrinologist and director of UCLA’s Gonda Diabetes Center. “But if she’s diabetic, that’s not true.”

The federal government spends billions each year conducting diabetes research, with scientists searching for more efficient ways to manage the disease.
What’s the difference between type 1 and type 2 diabetes?
Type 1 is an autoimmune disease that destroys islet cells [which produce insulin] in the pancreas. Insulin controls [blood sugar levels] in the body.

[With] type 2 diabetes, the insulin is there, but it doesn’t work – not because the insulin isn’t normal but because the body doesn’t respond to it well. The body compensates by producing more insulin.

What causes diabetes?
We really don’t know what causes type 1. There’s no way of avoiding it. There is a genetic component to it, but we don’t fully understand the trigger. That’s why even if we were to catch it early, we couldn’t prevent it.

Type 2 is [largely caused] by eating too much and not being active enough. The data are pretty strong that the problem is the calories – not the type of food.

Which type is more common?
Between 90%-95% of diabetics have type 2.

We’re seeing an increase in both types, but type 2 is being called an epidemic. That appears to be true worldwide. As obesity becomes an epidemic, so does type 2 diabetes. It’s that simple.

Are the symptoms the same for type 1 and 2?
Type 1 develops rather quickly, with dramatic symptoms occurring within a week to a month. Symptoms include frequent urination, weight loss, blurry vision and thirst.

[Symptoms are] the same with type 2, but it develops more slowly.

Can someone be diabetic and not know it?
The feeling used to be that 50% of type 2 cases were undiagnosed. It’s better now, but still grossly undiagnosed. [Being diagnosed with type 2 diabetes] is more likely to happen as you get older.

Actually, something like 25% of people in their 80s have diabetes.

What problems do women have in managing diabetes?
Women are thought to have a harder time with weight than men. Excess weight makes everything worse: It makes it harder for insulin to work. You can’t produce enough insulin for your body’s needs. The more overweight you are, the more you have to produce.

How does pregnancy affect a woman with diabetes?
When a woman’s pregnant, the placenta produces hormones that make women more insulin-resistant. That’s why they develop gestational diabetes and often end up on insulin when pregnant. Nature doesn’t care a lot about you: It cares about you having children. There are a number of hormones made by the placenta – most are designed to be good for the baby and the hell with you.

What role does diet play in preventing or managing diabetes in women?
A restricted diet isn’t the most important part of preventing diabetes; women have to eat the right things. The best diet  includes whole grains, fresh fruits and vegetables, low-fat cheeses and yogurt, and baked or broiled fish and meats.

How does menopause affect diabetes?
Menopause doesn’t have any direct impact on it. But women often find it hard to control their diabetes because menopause is stressful, and with any stress, diabetes is going to get worse. Stress hormones cause a number of actions that can counteract insulin’s effect. For example, stress causes the release of glucose by the liver, which raises blood sugar.

Can you manage diabetes without medication?
Most type 2 patients end up on medication. (The starting medication is metformin.)

Exercise is critical.

Most doctors would say that cardiovascular exercise [is important], but there’s some evidence that increasing muscle [through resistance training] may help as well by increasing the use of glucose. What about insulin?
Patients may want to stay off insulin, but most physicians feel we don’t start insulin soon enough.

At some point, in almost all cases, medications fail, and when they do, the only alternative is insulin.

The goal isn’t staying off insulin; the goal is keeping blood sugars under control.

Death of your therapist

Yesterday I received an angry message left on my voicemail from a patient who was furious that his therapist – someone I recommended – was a no-show at his last appointment. “Some emergency must have come up,” I assured this patient. “There had to be some emergency,” I repeated to myself after I hung up. That’s because it just wasn’t like Bob to miss an appointment, let alone not call to cancel. Then I began receiving other similar irate text messages and emails from other patients all referred to this therapist, who had similar experiences this past week. So I called Bob, but there was no answer. I left a message. Then I decided to check his Facebook page. There I learned the awful truth

Bob had died.

I was shocked.

I met Bob Bergeron nearly ten years ago when I began referring patients to him. He specialized in gay men’s health specifically HIV. I had been sending patients to Bob almost exclusively for a period because we became friends, but more so because patients adored him. It was uncanny how many said the same thing, “I love Bob. He’s so nice. Bob really understands me, and he’s not judgemental.”

Each morning for years, I worked out at David Barton Gym. I often saw Bob there and we chatted, not just about patients, but also about each other. I got to learn more about him, and eventually I began to reveal more about myself to him. He was an amazing listener, something I feel most doctors need to learn how to do.

It was a huge relief and comfort to have Bob in my arsenal of healthcare providers I referred to. He always made himself available to me and fit my patients in even when I’m sure he didn’t have the time. Bob even saw patients on a reduced fee schedule and sometimes even for free. But that was how Bob practiced. He loved taking care of gay men, and he especially loved helping them navigate through their lives when most of them didn’t know which way to turn next.

Last year Bob called to tell me he was working on a book focusing on life after 40. I told him I thought that was a great idea. The proposal was picked up by a publisher, and he’d begun working on it feverishly. Often he called to ask for advise, and I was so excited for him because this book was going to add another dimension to his life both professionally and personally. I only wish he would have seen that dream come to fruition.

If you were a patient of Bob Bergeron please contact Stanley Siegel at 917-991-5077. He is assisting Bob’s patients and can help you deal with the emotional impact of his death. He is also helping Bob’s patients transition their care. I am also available to help assist you. I can be reached at 212-929-2629.

I will always remember Bob as a warm, kind, friendly and compassionate man. My prayers go out to his family.

New Year’s Resolutions

Seriously, who was it that came up with the idea for New Year’s resolutions? I suspect the idea germinated from a marketing meeting after a pitch by some advertising agency as a way to get us to buy stuff we don’t need.  

Generally, the promise to give up smoking and drinking are the most common resolutions followed closely behind are losing weight, becoming more punctual, being honest and more self confident. Surveys suggest the success rate of adherence to resolutions is very low, but for some strange reason each January we make the same commitment year after year.

Who invented New Year’s Resolutions and where did they begin? Well, people have always associated new years with a fresh start. Even in the most ancient traditions, it was a custom to make improvements at such times. During the reign of the Babylonians, people made promises to do better starting March 23, their new year (spring equinox). One common resolution was to give back something one had borrowed in the past year.

InRome, Janus was the god of the New Year. The month of January was named after him. The New Year began on January 1st according to the Julian calendar invented by Caesar in 46 BC. Janus had two faces: one looked back on the past and the other into the future. The Romans worshipped him as a symbol of endings and new beginnings. During the holiday, they would do things that would hopefully kick off their year to a good start. They would make up with people they quarreled with and exchange gifts.

Judaism expects their followers to look back on one’s behavior during the past year. This was supposed to motivate the person to do better the following year.

I gave up on resolutions years ago, but for some reason I can’t help but make myself secret little promises right before the clock strikes twelve. Last year it was read Anna Karenina. P.S. she’s still sitting on my nightstand, but I am on page 325. This year it was exercise more, ban anything Kardashian from my life and learn a foreign language (preferably one the Kardashians’ don’t know). 

I agree with Judaism. We should reflect on the previous twelve months and think how we can improve ourselves in the new year. So if you fall off the resolution bandwagon, don’t be discouraged. Either start over again or wait for 2013.

Cronenberg’s Freudian Slip

For those of you who may not know me, I am a cinemaphile. That means I LOVE movies. Before I went to medical school, I hoped to become a film director. In my twenties, I directed several horror movies I shot on video tape (remember that?). In college I won a Best Actor Award for playing psychotic twin brothers.

I love many genres but psychological thrillers, especially Alfred Hitchcock’s movies, resonate with me on such a deeper level. I still hate all birds because of his film. Whenever I hear the music to Vertigo, I become entranced in a hypnotic state, and I defy you not to straighten out your spine at the slightest hint of a violin screech to the soundtrack of Psycho. It’s impossible. 

Let’s just say if there is a movie about girls in a sanitarium (Girl Interrupted) or crazy girls in a boarding school (Picnic at Hanging Rock, Cracks) then I’m there. 

Yet, only certain directors are able to navigate their way into your subconscious so that when you watch one of their movies you become completely and utterly transfixed, even when you have nothing in common with their characters. 

You can imagine by now how excited I was when David Cronenberg released, A Dangerous Method, a movie that depicts the relationship between the grandfather of modern psychiatry, Sigmund Freud and his contemporary, Carl Jung. The film explores their relationship and its subsequent deterioration as it relates to Jung’s patient, Sabina Spielrein, a hysterical Russian woman, who becomes involved in a sadomasochistic relationship with Jung while under his care. 

It had all the makings of a classic psychological thriller: great director, great cast, great story!

Unfortunately, I found the movie beautifully photographed, very well acted, particularly, Kiera Knightly and Viggo Mortensen, but painfully dull. 

This is Cronenberg  for Freud’s sake! Where were the sadistic director’s touches I grew to love in Dead Ringers with Jeremy Irons, probing female private parts with instruments designed for mutant women? Where were those intricately choreographed sex scenes that aroused me in Crash with Debra Kara Unger and James Spader?

 Has Cronenberg gone soft? 

That night I dreamt I was being attacked by the roots of a tree with veins and tendons branching out from every limb. Just as I was being pulled apart, I awoke and saw Freud himself, sleeping there next to me. He whispered, “Sometimes a tree is just a tree.”

Well, hopefully, next time, Cronenberg will bring his C@CK.

here! TV Debuts Documentary 30 Years From Here

 

 

Documentary special shares real-life accounts of the 30-year war against the AIDS pandemic

 

November 9, 2011 (NEW YORK) – here! TV (www.heretv.com), the world’s leading premium gay television network, proudly presents the original documentary 30 Years From Here, featuring real-life accounts from the decades-long war against AIDS. The special premieres November 25, 2011, exclusively on here! TV and here! Online, here! TV’s premium online subscription video player found at http://premium.heretv.com/. 

 

“When here! TV’s General Manager, Eric Feldman, and I began discussing plans to make a documentary looking back at the last the 30 years of the AIDS pandemic, the most difficult part was deciding on what part of this massive epic to tell. 30 Years From Here is just one story among millions. Focusing primarily on the epidemic and how it unfolded in New York City, we follow a timeline that shows where it began, what has been accomplished, and how we arrived here,” says Josh Rosenzweig, here! TV’s Senior Vice President of Original Programming & Development.

 

30 Years From Here examines the trials and tribulations the AIDS pandemic has created over the past 30 years. The documentary looks at how this nondiscriminatory disease has affected many lives over many years. Hear personal accounts from people who were there in the beginning and have seen both the sorrow over lives lost and the hope generated by advances in medical research. Activists, medical experts, and people who were on the ground describe their stories from the war on AIDS. Interviewees include playwright Terrence McNally; activist and ACT UP found Larry Kramer; Marjorie Hill, CEO of Gay Men’s Health Crisis; physician Frank Spinelli; director and choreographer Jerry Mitchell; and radio talk show host Larry Flick.

 

To obtain a screener of 30 Years From Here, please contact Mark Umbach at mark.umbach@heremedia.com.

 

 

Get exclusive here! TV updates on Facebook at www.Facebook.com/HereTelevision and on Twitter at @heretelevision.

My Halloween Top Ten List

I have to say I love Autumn. I’m not made for summer. In fact, I have the opposite of seasonal affective disorder in which individuals become depressed during the winter when there is a limited amount of sunlight. I, like vampires, feel repelled by the sun. Yeah, okay, so I love the beach, but summer weather is for vacations. Living day to day during those hot summer months in Manhattan, walking to and from work, sweating like a pig is not fun. Keep your hot weather, short pants and long days where the sun sets after 8 pm. Give me cool crisp September mornings, orange and yellow leaves scattered on the ground and bowls full of hot creamy soup. I want to wear hats, scarves, and other clothes that conceal my body. Summer to me is nudity with sunscreen. By August I feel like a walking chicken cutlet.

What I love most about the fall is Halloween. Hands down it is my favorite holiday of the year. I always loved dressing up in costumes as a child. Then as a teenager and young adult I created my own characters and make up effects. At an early age I even learned how to use latex thanks to special effects pioneer Tom Savini. NO, he didn’t tutor me personally, but I watched his documentary repeatedly. In my twenties, I made my own horror movies, casting my friends and creating my own gory special effects. Boy, do I miss slitting Janice Anastasio’s throat against my parent’s oak tree or dismembering Karen Lassen with a garage door. We had so much fun back then.

I still dress up for Halloween. This year I’m going as silver Evil Knievel. Chad is going as the gold version.

But more than anything, I grew up loving and fearing horror movies. And so I have put together a list of my top ten and in no particular order. Let me know if you agree or disagree.

1. The Exorcist – Still to this day this movie is like no other. How they got a young Linda Blair to do those things, I’ll never know.

2.The Birds – Yes, I know you would have said Psycho, but watch it again. Hitchcock didn’t even use music, only the sound of those horrible birds.

3. The Changeling – (with George C. Scott not Angelina Jolie) Never before was a grown man terrorized by a little red ball.

4. The Shinning – Forget Jack Nicholson. It was all about those creepy twin girls.

5. Suspiria – Who could forget the trailer with the girl brushing her hair singing, “Roses are red. Violets are blue…” The first time I sat through it I nearly puked. Dario Argento is a master at creating elaborate death sequences that are gory and at the same time wonderfully artful, almost beautiful.

6. Halloween - The original is a classic. Jamie Lee Curtis screaming up at Tommy’s bedroom window to let her in still makes me writhe in my seat.

7. Texas Chainsaw Massacre -Two words – “meat hook”

8. Jaws – That little boy getting eaten on a raft nearly put me in a coma.

9. Alien – Space never felt so futuristic and frightening. Even at the very end, I swore that cat was not to be trusted.

10. Nosferatu – This classic vampire tale left me haunted. The visuals are stunning. Isabel Adjani walking the beach was like watching a Monet.

Honorable mentions go to ‘Salem’s Lot, The Others, Sixth Sense, Carrie, The Legacy, The Fury, The Omen, Rosemary’s Baby, and The Sentinel.

Bachmann’s Vaccine Debacle

Oh, those crazy politicians. First, they comment on medicine and when confronted about their remarks, they excuse themselves by saying they’re not doctors.

That’s what Michele Bachmann did when she referred to the vaccine to prevent cervical cancer as “dangerous.” I suppose she knows better than the FDA, who approved the vaccine as safe.

Gardasil is a vaccine that protects against the Human Papilloma Virus (HPV), a sexually transmitted infection that can lead to cervical cancer in women and anal cancer in both men and women. Indicated for adolescents and young adults, the vaccine initially had a slow start. Some parents feared the vaccine condoned having sex at an early age. The vaccine is recommended beginning at age 11 or 12. I seriously doubt a child would rationalize that a vaccine was their parents’ way of giving them the greenlight to have intercourse. Besides, 17 seems to be the magic number where most individuals engage in first intercourse. Of course, if you have a mother like the one Sissy Spacek had in Carrie, then I would agree that this vaccine was made by the devil to entice young children into acting on their lustful urges. Then again, if you have a mother like the one played by Piper Laurie or one like Michele Bachmann, who is married to someone who thinks you can cure homosexuality with therapy, then you probably shouldn’t get the vaccine because you’ll spend the rest of your life worrying that you’ll burn in hell for it.

Aside from all the guilt brought on by the religious right, the fact is that the rates of sexually transmitted diseases increase every year. HPV is extremely common with millions of new infections each year. That’s because any kind of intimate contact can transmit the virus. For some, the immune system fights off the infection. Unfortunately, for others, the virus persists and can lead to cancer. Gardasil was initially indicated to prevent cervical cancer, but it has been show that HPV causes cancer of the penis, anus, vagina, and even the throat.

Among gay men with HIV, anal cancer rates have increased. At a recent HIV conference, it was recommended that all HIV positive men undergo annual anal Pap smears followed by high resolution anoscopy for Paps confirming HPV. I routinely recommend Gardasil for my HIV positive male patients even though it is not covered by insurance.

Vaccines have been given a bum rap over the years with unproven ties to autism. Each year vaccine rates decline. The public’s growing concerns with vaccines ignore the statistical proof that they prevents certain diseases and death. It’s interesting to think a patient would refuse a flu vaccine despite the fact that thousands die from the flu each year.

The repercussions of Bachmann’s comment will linger in the minds of skeptical patients and parents when their doctors recommend vaccines for them and their children. It’s unfortunate when someone like Bachmann, who said she wasn’t a doctor, offered her medical opinion on a matter she obvious knows little about. Perhaps she had a mother like Carrie.

Penis ennui

The penis industry is huge, pardon the expression.

When I was a surgical residency doing my urological rotation back in the late 90′s, the clinic was packed with men complaining of erectile dysfunction. This was before Pfizer came out with Viagra. I vividly recall my Attending urging me to invest any money I had in Pfizer stock.

“What extra money?” I replied. “I’m an intern.”

From that day on I realized how big a deal men’s penile function was, and it has become a lucrative market for pharmaceutical companies to tap into. Just think how far we’ve come sinceViagra. Now we have Levitra, Cialis (which lasts 36 hours), and there are even sublingual versions produced by the makers of Levitra so that you don’t have to carry around that annoying little pill.

The surge in the penis market was also evident in men’s quest to enlarge their penis -  a problem pharmaceuticals, surgeons and technology have failed to conquer. There are penis elongation procedures but none are widely recommended and often they are disfiguring.

I can’t help but think back to my youth when I first saw what Barbie’s boyfriend Ken looked like under his pants. My best friend Diane was playing Barbie’s with her younger sister, Karen. Undressing them I found Ken did not have a penis but a lump where his penis ought to be. Recently, it got me thinking: Isn’t the penis a waste? I mean, honestly, what function does it serve?

Yes, the penis is important to excrete urine.

The penis also acts as the vehicle to expel semen with great velocity into the female vagina in order to procreate. But when you set aside the physiological functions, what is the penis other than a sign of male virility?

Imagine if all men were like Ken.

We had a lump that looks like the cup I wore during Little League. Of course it would still have to have an opening so that we could urinate and also propel semen (I suppose the velocity would have to increase). It could still orgasm and stimulate females to orgasm. Think about it: female orgasm is primarily clitoral. Of course, you could argue that nothing is more erotic than a man’s penis, but if we all looked the same then we wouldn’t have to waste so much time worrying about why it doesn’t get hard enough or why isn’t mine as big as Johnnie’s?

I’m not saying this is the answer to all our penile problems, but when you think about it, isn’t the penis really just obnoxious? It’s like six-pack abs. I mean it looks good and all, but really how long can you keep it up?

Forgetful or early Alzheimer’s?

I keep my iPhone plugged in next to my bed. At night while I watch television with my partner, I often write myself notes. Before I go to bed, I email them to myself. Chad is old fashion and prefers paper and pen. In the past I kept lists on random scraps of paper and accumulated them until my briefcase was full of reminders. I stopped using paper because if something came to mind, and I didn’t have anything to write it down on, I’d forget it. Chad sometimes forgets what he was about to write before he even makes it into the other room.

We’re both in our forties. Are we overscheduled, forgetful or experiencing early Alzheimer’s?

Millions of Americans suffer with mild cognitive impairment (MCI), which could manifest as lapses in word-finding or name recall. Other examples include forgetting appointments, losing your train of thought in mid conversation and difficulty paying bills.

Dr. Ronald Petersen, a neurologist with the Mayo Clinic described MCI as an intermediate state between the normal changes that occur with age and the severe deficits associated with dementia. Petersen wrote that MCI occurs in 10 to 20 percent of people older than 65. 

Differentiating MCI from normal aging can be difficult. Problems like depression, medication side effects, Vitamin B12 deficiency and underactive thyroid glands can mimic MCI. Patients with HIV experience an increase in cognitive impairment in the long-term. Antiretrovirals that penetrate the central nervous system are being used as first line treatments to prevent future cognitive impairment.

There are people like my best friend Eric who insists he has early Alzheimer’s disease. Eric complains he loses his keys, misplaces his cell phone and forgets appointments. People with MCI often experience prominent impairment, typically forgetting telephone conversations, recent events and important appointments. Being forgetful or what I refer to as pulling an Eric is often just a normal sign of aging.

So what can you do?

It is important to reduce your cardiovascular risk. Smoking, elevated cholesterol and high blood pressure can impair memory as does certain medications like, Demerol, certain antidepressants, Valium, and Benadryl (Tylenol PM).

So far there is no conclusive evidence that memory games help reduce  impairment. I do recommend them. For example, can you recall what MCI stands for?

The most promising study focused on regular exercise, which reduced amyloid accumulations in the brain. This study performed in Australia had patients walk for 150 minutes a week to improve cognitive function.

So next time you forget your doctor’s appointment, don’t pull an Eric and blame it on early Alzheimer’s. Chances are if you have a career and live in a city, you more than likely suffer from being just too busy.

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

Before and After

I love botched up plastic surgery. The tabloids provide me with endless photographs of these unfortunate celebrities and socialites. You think that if money was no object then why wouldn’t they all look amazing?

Beauty is subjective and certain wealthy people should not be allowed to orchestrate their transformations. Even though all doctors take the Hippocratic Oath, there are some who will do anything for money. Case in point, Michael Jackson.

The aging process is unfair. Women get the short end of the ugly stick when it comes to public opinion. Men age gracefully. There are some men who look better as mature adults. George Clooney, Brad Pitt, Johnny Depp and yes, even Sean Connery and Clint Eastwood, all maintain their sex appeal even a they pass into middle age.

That’s not to say that there aren’t men who have gone the route of cosmetic surgery only to do more harm than good. Take Mickey Rourke or Burt Reynolds for example. Clearly something went wrong. Unfortunately, we don’t hold them to the same standards as we do women. Mickey Rourke almost won an Oscar for playing down on his luck wrestler. He’ll likely have a long career playing villains due to his hideous face.

Women don’t have it that easy. I admit, I watched in horror and amazement as Joan Rivers metamorphosed into the taught, slant-eyed muppet she is today. “Good for her,” my friend Eric says. “If you have the money and you want to change something that bothers you, then you should.”

Hmm.

Perhaps he’s right. Yet when I see, Meg Ryan, Kathy Griffin, Ellen Barkin, and yes, even the late, great Farrah Fawcett, I cringe. Their faces are distracting and in certain lighting you can almost see the sutures pulling at the temples. Dolly Parton was on the Tony Awards last year and I thought she stole Jack Nicholson’s mask from Batman, before going on stage. The corners of her mouth were pulled back so tightly that even in her resting position her face took on the Joker’s sardonic grin.

But when it’s done right, it looks flawless. Check out Courtney Cox, Michele Pfeifer, Madonna and yes, Demi Moore, whose face and body seem to defy the laws of gravity. Either her plastic surgeon is a genius or I need to become a Kabbalist pronto.

Dr. Sam Riszk, a celebrity plastic surgeon, calls it the new face, when asked why these women look better than let’s say, Meg Ryan. His technique involves sculpting the underlying fat and muscle instead of simply pulling the overlying flesh. I think he’s a genius.

There are some women in Hollywood who not only choose to grow old gracefully, they seem to embrace age as it comes. Kathleen Turner, once a sex pot in Body Heat, nearly scared the be-Jesus out of me when I saw her in Marley and Me (but not as scary as the movie itself). A long time fan of Ms. Turner, I followed her career as well as her battle with alcohol dependance and Rheumatoid Arthritis. Unfortunately the booze and steroids transformed her. Others like Vanessa Redgrave, Kathy Bates, Frances McDormand, and Judy Dench have all refrained from surgery, looking wonderful in their skin and appropriate for their age.

I, too worry about age. I’m in my forties now. Okay 42. I broke my nose when I was twelve and never had it repaired. I often wondered if that was a mistake. Now as I mature (a word I despise), I contemplate if I will undergo the knife for a nip or tuck as I approach the big 5-0. Who knows? I already get Botox, but I do maintain my salt and pepper hair. Maybe Eric is right: if it’s your money and it makes you happy, then fuck everyone else.

But, that still doesn’t mean we can’t make fun of you.

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

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.

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.

POZ I AM

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.

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.

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.

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.”

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.”

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

 

 

 

Ask the Doctor: HIV and Aging

 

Please join me for the latest installment of Advocate.com’s

Ask the Doctor

Set in San Francisco where I attended the International Conference on Antimicrobials and Chemotherapeutics

HIV Chat on ADVOCATE.COM

I will be hosting a live chat on Advocate.com sponsored by HealthywithHIV.com

The subject is HIV.

Please feel free to log on and ask questions. I look forward to this interactive experience which ultimately depends on the participation of the viewers.

It begins at 7pm

See you there

Laughter Does the Body Good

The concept that humor or laughter can be therapeutic goes back to ancient times. This belief has had varying degrees of support from the medical community. Current research indicates that humor is well accepted by the public as a coping mechanism.

So then how does humor and laughter influence physical health?  

Laughter is thought to induce physiological changes in the body which can have various beneficial effects on the body – improves respiration, stimulates circulation, releases endorphins and decreases the production of stress related hormones. But whether or not you believe any of this, you can’t deny the affects of a good laugh.

Here’s a little video I made. Enjoy it.

 

World AIDS Day 2009

Each year,  December 1st is the day set aside to remember those we have lost to the pandemic and to think toward the future as we continue to battle this deadly disease.

AIDS has taken the lives of 25 million people and 33 million more are estimated to be living with HIV/AIDS around the world today.

As the rates of infection continue to rise, particularly among younger gay men, the fact remains that AIDS stigma prevents individuals from getting tested.

This morning, I was invited to join Larry Flick on his radio show, Morning Jolt on Sirius Radio. As an HIV provider, I forget that many people would like nothing more than to forget this day or act like it doesn’t exist. Larry Flick is not one of those people. I commend him for dedicating his show today to AIDS awarenss, and I was pleasantly surprised by the support he received from various celebrities. Rosie O’Donnell, Boy George and Wendy Williams were all on hand to lend their thoughts about this disease. I am grateful that they did.

Many people, including Larry Flick find fault with the way the gay community handles their own and HIV. In stealing a line from Larry Kramer, Flick repeated, “We are not a community. We are a population.”

I understand how he feels.

This afternoon I received an email that gave me hope:

As this yearly date comes and goes, my emotions are always very mixed.  However, in counting my blessings, I thank God that I live in a society that affords me the care I need but mostly I thank God to have YOU in my life.  You are not just a great caregiver but a friend.  This day belongs to you and I hope you get the appreciation you deserve.  Thank you!

Ward Rounds

This month I am the ward Attending at St. Vincent’s Hospital. The ward Attending is just like it is on TV. Pick a show: ER, Grey’s Anatomy, or more like Nurse Jackie. I am the doctor in charge, overseeing a resident and two interns. We meet each morning at ten o’clock and round on the patients that were admitted to my service. Usually these are individuals who have no private doctor of their own and so they are admitted to a House Doctor. No, like the TV show, House, but like Hugh Laurie, I portray myself as a curmudgeon, older, wiser doctor who teaches the young, nubile residents while spewing out snide comments because I’ve become bitter over the years thanks to health care and insurance companies. But I digress.

Being the house attending, we round on patients, who need us.

Well it actually boils down to homeless, foreigners, morbidly obese people on disability, crack addicts and alcoholics. Or any permeation including any or all of the above mentioned. So you see it is nothing like television, and now you understand why Nurse Jackie is a junkie herself.

Why just yesterday we were talking to Mrs. Jacobs, a 52-year-old, Christian, African-American, morbidly obese, diabetic woman who is out on disability. She was attending church services, dropped her glove and when she went to pick it up fell flat on her face and was taken to the emergency room. I’m still not sure why she was admitted but we were happy to help. I mean, St. Vincent’s is a Catholic hospital. When I met Mrs. Jacobs she was lying flat on her back, her entire body sprawled out like freshly made flan, her small head nearly enveloped by her chins.

“How are you today Mrs. Jacobs?” I asked.

“What do you  think,” she responded sharply. And for good reason, Mrs. Jacobs has long been suffering with multiple joint pain due to an accident that occurred while at work, she went on to tell me. (I smell a workman’s compensation case). But low and behold, after a Cat Scan of the head and a series of X-rays, there was nothing new that was wrong with Mrs. Jacobs other than her body being three times the size for someone her height. She didn’t like when I told her that. In fact, she said, she was going to call the hospital administrator. But that’s okay. It’s good to vent your frustrations. It’s better than reaching for a jelly doughnut.

The next day when we visited her, she was sitting up in a chair. Or at least I thought it was a chair but realized she was on a portable potty. “Oh excuse me,” I said.

“No don’t go I have to talk to you,” she demanded.

“But your busy,” I said.

“No, I’m done.”

“Thank goodness,” I thought. “Then please don’t get up.”

“I prayed last night and the Lord healed me,” she said smugly.

“That’s great.”

In the end, I told her she would have to go back home today.

“Home!” she cried. “How am I going to get around? Who is going to help me around the house?”

“Gee, I don’t know. Why don’t you ask Jesus?”

But I’m not completely heartless, so I asked the social worker to see if there was anything she could do for Mrs. Jacobs. As the team and I said our goodbyes and walked out of the room to visit, Mr. Bartholomew, an alcoholic, crack addict with blood clots in his legs, I could hear Mrs. Jacobs screaming at me from her room.

“I am going to pray to Jesus,” she shouted. “I’m going to ask him to save you Dr. Spinelli because you need saving.” As I turned to tell her thank you but no thanks. I’m sure the Lord has more important people to save, I see her moving toward me using the portable potty as a walking, pushing it closer to me, the lid open, and dare I say it full of the Holy Spirit of Mrs. Jacobs.

Alexis Ray Joel

Alexa Ray Joel, the daughter of pop star Billy Joel and supermodel Christie Brinkley, was brought to the hospital by emergency services after taking eight pills at her Manhattan apartment.

A friend frantically called 911 from the singer’s Greenwich Village apartment saying Joel, 23, had taken several pills. It wasn’t clear whether she had accidentally overdosed or attempted suicide.

The singer, songwriter and pianist self-released a short album in 2006 and debuted a new song, “Invisible,” this year about a failed relationship with the opening lyrics, “They say it doesn’t matter/This love is in my mind/We never got it right, anyway.”

In her MySpace blog posted this summer, Joel described herself as “forgotten” and said she was finding it hard to meet a nice guy.

“Just Men. UGH!!! MEN!!!!” she wrote in August. “I’m so terrible at dating — I don’t know if I’ll ever get used to it! And I HATE the game-playing! Can’t stand it.”

It is rumored that Miss Joel took an overdose of Traumeel, a homeopathic medication containing 12 botanical substances and 2 mineral substances. It has been sold in the United States since 1986 and in Germany since 1937, and it is available worldwide for use as an anti-inflammatory, analgesic, antiedematous, antiexudative drug.

The indications for its use include temporary relief of symptoms associated with inflammatory, exudative, and degenerative processes due to acute trauma, repetitive or overuse injuries, and minor pain from osteoarthritis, rheumatoid arthritis, gouty arthritis, and ankylosing spondylitis.

If she did take Traumeel in excess along with an opiod or a sedative hypnotic, she would have certainly gone into respiratory distress, coma or worse. 

I wish Alexis a speedy recovery, and please get yourself a therapist. No man is worth ending your life for.

Jersey House

 

Okay, so I watched it.

Don’t act stupid.

 

You know you watched it too. I’m talking about the new reality show on MTV called Jersey Shore, which is about a group of young Italian- American boys and girls from New York and New Jersey,  who spend the entire summer in Seaside Heights, New Jersey at a shore house.

Chad and I watched the two-hour premiere and I have to say, I couldn’t turn away. It had all the trappings of great television: a mixture of handsome and not so handsome boys and girls, who all think they are the hottest things on the planet, stupid as wood, and either in the midst of telling one another off or about to get so drunk that they climb into bed or jacuzzi in this case, in order to hook up, get rejected or both.

In the first episode alone, Sammi, a.k.a. Sweetheart hooks up with Mike only to drop him faster than a hot zeppoli so that she can make the moves on Ronnie.

Pint size Nicole got plastered on her first day, passed out and then considered leaving the house because no one liked her.

“Get away with me with that vomit breath,” said the not so sweet Sammi.

Later Angelina meets a ginormous guy and is baffled when the house mates tell her she hooked up with him. In a panic she called her boyfriend to wash the metaphoric blood of shame off her hands and then threw a fit when her boyfriend isn’t able to speak to her because he’s busy at work. The nerve.

Who needs writers when real life is so much more complex. I don’t know who the brains is behind this show, but this person knows the powder keg potential of putting these particular people together. I felt like I was at my Aunt Mary’s house, watching my cousins Connie, Angela, Sal and Frankie fighting over who gets the eat the end piece off the loaf of Italian bread.

Unfortunately, certain Italian American groups are not seeing the humor. MTV is under fire for allowing these young adults to portray themselves in such an unflattering light. The Italian American Coalition orchestrated an attack on MTV, saying that the director has obviously coaxed these self-absorbed, over tanned, gum chewing juveniles into over exaggerated scenarios by feeding their egos with enough alcohol and sausage and peppers to instigate behavior no self-respecting Italian would ever allow themselves to do on camera.

These groups obviously haven’t seen my cousin Mickey’s wedding video where she came up from the floor at the Chateau Brion as smoke filled the dance floor or better yet, the time my cousin Frankie kicked my Aunt Filomena out of her own brother’s funeral because Frankie and her son Dominick weren’t talking.

No, Italians do not act ridiculous like Marissa Tomei and Joe Pesci in My Cousin Vinnie. We’re not all gangsters like the Gottis. Of course not. We’re also upstanding doctors, plumbers and X-ray technicians.

I agree. These kids were probably coerced into acting more over the top than usual, but I truly believe this is how they would act regardless if the cameras were rolling or not. So let this be a lesson: stereotypes exist because we allow them to. Each of us has to take responsibility for ourselves.

Now if you will excuse me I have to go steal some money from in between my mother’s mattress because I need to buy a new pinkie ring.

I am no man’s Precious

This is a true story.

I went to the grocery store last night to buy food to make dinner. At the check out counter, a young, African-American girl smiles as she processes my groceries and says, “Hi.” So I return the greeting and smile back. Meanwhile an Asian woman begins to place her food down on the conveyor belt and runs off. When she comes back she shouts at the cashier, “This is mine. Don’t mix up food.”

Of course I felt protective of my new friend. I mean it is so rare that a cashier in New York smiles and says, hello, let alone gives you any eye contact at all. So I yell back at the Asian woman. “Don’t worry,” I say. “I don’t want your Sarah Lee cake.” The Asian woman prunes her face and the cashier smiles back at me – a silent but understood thank you.

After she’s done ringing up my food, I proceed to pay, swiping my credit card, but still sneering at the Asian woman. As I wait for the receipt the cashier says, “Okay precious.”

I do a double take and say, “Excuse me?”

She smiles and repeats, “Okay precious.”

I think to myself, is she flirting with me or do I remind her of an ugly, fat black girl?

Then I look over at the Asian woman to see if she heard her correctly, but of course my neurosis has kicked in by now and I think that she is smirking along with the cashier and together they are both laughing at me. So I say, in a very direct way, “What are you saying to me?”

The cashier bugs out her eyes, shifts her head from side to side and says, “OKAY! PRESS YES!”

My bad.

Tree Man

“Doctor can you please help me with a wart?”

How many times have I heard that, I ask myself.

Warts, particularly genital warts, plague certain unlucky individuals. Unlucky I say because transmission is through contact via one of the hundreds of subtypes of the human papilloma virus or HPV that can coalesce on the skin and appear as unsightly clusters. Some strains of HPV even cause cancer. However, I have never seen a case of a viral infestation such as this referred to me by a patient who thought I might be interested.

His name is Dede, an Indonesian fisherman who has a rare genetic defect that enables the human papilloma virus to hijack his immune system. He is also known as Tree Man.

Adam Lambert

Last week a patient came in with complaints of a very itchy rash on his torso and arms. He was alarmed because several of his friends had the same suspicious rash. Interestingly, they were all my patients. The first one came in last Monday. After examining him, I diagnosed him with Scabies.

“What?” he screamed. “How disgusting. How do I get rid of it?”

Scabies is easily treated with topical permethrin cream which is applied from head to toe before bedtime and then washed off in the morning. The problem with Scabies is that it is easily contracted via contact like sleepin in someone’s infested bed, lying on their couch or rolling around with them during sex. After treatment, it is imperative that you wash all contaminated clothes and linens.

After I treated this patient, then all his friends began lining up outside my office in order to rid themselves of these pesky critters.

Now to shift gears. I like Adam Lambert. His new CD is interesting. He has an amazing voice and quite frankly, I feel he should have won American Idol.

Because of his performance on the American Music Awards, it seems you can’t turn on the television, open a magazine or read a blog, without seeing Adam out and about. Last week, he was spotted at several gay hot spots here in New York City. I won’t mention which one, but I did see him in photo where he is surrounded by a gaggle of gay boys, all of whom I treated for Scabies after the photo was taken!

Now I’m not suggesting that Adam gave them Scabies or perhaps they passed the mites onto him.

BUT, if anyone knows Adam Lambert tell him not to ignore any itchy rashes and get treated for Scabies ASAP!

Oh Christmas tree

This week has been insanely busy for me. I don’t know if it’s the holiday rush or every one is loosing their minds.

Today a patient came in and said, “I went to a bdsm party, and now I have diarrhea.”

“Wait,” I interrupted. “What is a bdsm party?”

He smiled, revealing a mouth full of metal, and said, “You know a bondage, discipline and sadomasochism party?”

No, I don’t know.

“Can I ask what goes on at one of those parties or is that too personal?”

“Oh no,” he said. “I get in a harness and then the others take turns using sex toys…”

“Okay, you know what?” I said. “I get the picture.”

Upon examination, I noted piercings in his ears, toe rings, and an array of tattoos all over his body. Now I have my own personal theory on people who get tattoos. They really say a lot about a person, particularly the type, color and location. His were a mixture of fire engine red, sunflower orange and wicked witch green.

Their were flames coming up from his pubic region, lightning bolts adoring his penis and wild ivy growing around his waist which ultimately fed into his anus vase.

Could you just imagine this fifty year old man wearing braces, piercings, and covered in tattoos resting in some harness. He must have looked like a Christmas center piece with his tinsel mouth, colorful ornamentals, lightning bolts and those mistle toes.

But as my Italian mother would say, “To each his own.”

I know this time of year is a festive one and there are parties galore but a bdsm party is one I can’t wrap my head around. I will, however, tell you the tips I shared with my patient:

1. Always use a condom correctly.

2. Always put a condom on sex toys and change them often.

3. Try to shower after sex and never floss or brush your teeth before and right after sex.

4. Likewise don’t share toothbrushes and razors.

5. And when in doubt, stay away from the guy wearing braces and covered in poison ivy.

Tweens and Drugs

Tweens. You gotta love them? Miley Cyrus, Taylor Swift, Taylor Lautner and all their young friends who’ve infiltrated my aging world. They’re all so wholesome and pure. Why the Jonas Brothers don’t even believe in premarital sex.

That’s why it broke my old heart to learn that pot and pills used to treat ADHD have surpassed smoking cigarettes as the most abused substance among teens. A National survey published by the University of Michigan declared cigarette smoking among teens has dropped to its lowest level since 1975. Meanwhile researchers reported a major increase in pot use and pills for ADHD.

Use of pot, prescription painkillers and medication to treat Attention Deficit Disorder like Ritalin, Adderall and even Provigil are said to have replaced smoking cigarettes. Crystal Meth was also high on the list. Even Salvia was included. Salvia is a natural herb from the mint family, is not illegal and is said to induce a brief high after chewing.

Now I’m no prude. I remember when I was in high school. I tried pot, but honestly, it made me very paranoid. To the best of my knowledge alcohol was the most widely abused drug back then. Pot was also very popular among the “cool kids” as well as Qualudes and Mescaline. Remember those?

It bothers me to think that the Taylors might be getting high. Sure I can see Miley getting smashed and having a three-way but not Miss Swift. She’s just a innocent baby.

Oh, you tweens. Don’t rush into my adult world so quickly. It’s not that great, and once you dip your toe in Lindsey Lohan’s toxic aged pool, you might find your flesh has been eaten away and there is only some residual bone and a lot less cartilage left behind.

Sex, drugs and Rock and Roll sound hip and cool, but before you know it, you’ll be thirty and like Tara Reid, on your second round of plastic surgery and air brushing the shit out of your pics in Playboy.

Have a Diet Coke with lemon instead.

Southwest Christmas

Mom and sister, Stacy. Yee Haw.

This was this was the first Christmas I spent without my family. My father died in July. Mom spent the holidays with my sister and her family in Alabama. Josephine, our middle sister, stayed in New York with her husband Joe, and I accompanied Chad to visit his family in Arizona.

I had a Southwest Christmas.

Chad: very 90210

The Shroers make up a total of ten people: Dad, Vern, mom, Roxanne (her license plate proudly states: FoxyRoxy), their eldest son, Jeff is married to Donna. They have three boys: Philip, Kent and Brandon. Stacy, Chad’s younger sister, is married to Lonnie and they also have three boys: Tyler, Shane and Colby. It’s a lot of testosterone if you ask me.

As for myself, coming from a family that is predominantly made up of women (two sisters and a mom), I felt intimidated as we drove through the desert on route to their home in Scottsdale. I was daunted by the idea of being around that many men under one roof. And it’s not just the sports talk or discussions of war, even though Philip, is in the marines and about to be deployed to Afghanistan in February. He’s been to Iraq several times already. Even Lonnie was in Iraq, although he has retired from the military since. The military is a way of life for this family. Why even the younger boys shot their new  bb guns on Christmas Eve, donning fatigues and protective facial gear. Vern even joking said to me one morning that he bet I hadn’t spent a night in a house with so much armed artillery, and he was taking about the real thing, not toy guns.

No, the thought hadn’t even crossed my mind until you said that. Thanks Dad.

Scene from the Schroer's living room

The Shroers are proud Americans, and they should be. Of course I felt anxious, and yet, even though we all slept under one roof out in the desert, a large rock my view from their living room window, reminds me that we are in middle America. The land of the Indians, cowboys, and Republicans but also a place where people say, hello, thank you and how are you?

I always find it interesting to visit with other people’s family, particularly if it is the family of someone you are involved with. Seeing your partner in such a context, answers questions about them that you didn’t even think to ask. How curious was it for me to see Vern cooking breakfast for us, Chad waiting with fork and knife in hand, seated at the island waiting for eggs and cinnamon rolls to be served up. Or noticing how quiet he gets as his older brother tells jokes or ribs his brother-in-law about college football. (I admit I got quiet too). But then to watch him play with his youngest nephew Colby, his blue eyes strikingly similar to Chad’s.

Then again, all the Schroers, even the in-laws, excluding this one, all have light eyes. Big, wonderous blue eyes that rest equidistant from each other on pale, clean skin, and don’t let me forget about the height. All the Schroers are tall, including the in-laws, except for this one. Why Lonnie has to be over 6’4”. Donna is at least 6 foot in flats. Why even her son, Kent, is over 6’2” and has a size 14 shoe. You could say I spent Christmas in Arizona among Vikings and here I was, a gay Danny Devito, standing tippy toe on my hind legs to hug them hello and then three days later to say goodbye.

It was a short visit but a comfy, cozy one. I mean really, how could it not be when Roxy makes you sing, “We wish you a Merry Christmas” before each person opens a gift, one at a time, I might add. Yes, you could say it got tedious but that’s what makes the holidays so memorable.

There is some validity in the expression, we appreciate what we have only when it’s gone. I appreciate the Schroers. They made me feel at home. And regardless of whether or not you agree with someone’s politics; they’re still your mom and dad. And that man who is going to Afghanistan is going there to protect you and me. Even if Chad and I can’t get married, we’re still free people because of men like Philip and Lonnie.

So Merry Christmas Schroers and thank you for making me feel at home.

Double Standards

Happy New Year one and all. I hope this decade is better than the last.

I arrived home from London this past Sunday where I spent New Years with my family. All the details will be recounted in an upcoming blog.

Yesterday, as I snuggled up to my puppy Hoffman, watching television with Chad, I had a WTF moment.

Have you ever had one of those?

Well, it all started when I stupidly relinquished the remote control to Chad and stared, half asleep, as he channel surfed (and badly I might add). You know there is an art to it? Chad’s idea of looking for something to watch consists of him hitting the page down and then reading all the episode summaries instead of hitting your favorite channels first and then going to the movie channels and then… well you get the idea.

CBS advertised an upcoming episode of “Two and Half Men” starring Charlie Sheen. Sheen you may know was arrested on December 25, 2009 for domestic violence, including second-degree assault against his wife, Brooke Mueller, who is mother to their twins. Sheen has a dark history stemming as far back as 1990 when he “accidentally” shot his then girlfriend, Kelly Preston, who left him shortly after and later married John Travolta. On May 20, 1998, Sheen tried injecting cocaine and overdosed. He was hospitalized, but discharged soon afterward. His father, actor Martin Sheen, reported him for violation of parole. A warrant was issued for his arrest, and Charlie was sent to rehab. On June 15, 2002, he married actress, Denise Richards. In March 2005, while still pregnant, Richards filed for divorce, accusing Sheen of abusing drugs and alcohol and threatening Richards with violence. They divorced in November 2006. On May 30, 2008, Sheen married Brooke Mueller, who also has a history of cocaine use and DUI. It remains to be seen if the couple will stay together.

Now call me confused but have you noticed that none of the sponsors have pulled their endorsements from the show, “Two and Half Men”? At least not to my  knowledge or it hasn’t been announced publically.

There are no front page headlines running daily stating the where abouts and who’s abouts of Charlie. If you ask me, Tiger Woods needs to get Mr. Sheen’s PR people. If you follow Sheen’s story, he’s being sublimely perpetrated as a wounded soul who unfortunately falls off the wagon every so often and well, hits his wife or injects some cocaine. I mean, I’m not justifying what Tiger Woods did as being a lesser of two evils, but why are we so consumed with Tiger’s infidelity when he doesn’t have the track record Charlie Sheen has?

I mean WTF?

Then today on CNN.com, it was reported that Charlie Sheen is back to work. He is said to be “the consummate professional and is well liked by the crew”. Well, he would have to be a complete A-hole to give up that gig. Where else would he collect a paycheck and be welcomed back with open arms? I bet Domino’s Pizza hasn’t pulled their commercials from “Two and a Half Men.” Unlike MTV’s hit reality show, Jersey Shore, which seems to have everyone’s panties dripping with tomato sauce. Oh, yeah, I forgot. They showed a man punching a girl, Snookie, in this case. Perhaps if we had seen footage of Sheen hitting his wife or injecting cocaine on YouTube we might have all gotten a little bit more upset. But it was Christmas, and we were in the forgiving mood.

Now I have no quarrel with Mr. Sheen. Obviously, I’ve never met him, Tiger or Snookie. Out of the three, I’d like to have a slice of Domino’s pizza with Snookie. She seems the most authentic.

My hope is that in 2010 we don’t maintain this air of bias toward certain people while forgiving those who are just as guilty. I guess I’m still pissed over the whole Adam Lambert thing.

I suppose if anyone really cared what I thought, they might orchestrate a televised kiss between Tiger Woods and Charlie Sheen, sponsored by… Domino’s, of course.

On New Year’s Day

… I’ll be with you again.

Well, we survived the holidays: Christmas in Arizona with Chad’s family, and New Years in London with la mia famiglia.

Why London you ask?

Short story: my sister’s two eldest boys’ marching band was invited to perform in the New Year’s Day Parade in London. So my sister Josephine, her husband Joe, our mother, my other sister Maria, and her husband, Marc, and their four children along with Chad and myself headed across the pond to Merry ol’ England.

Some highlights and tips:

1. Fly Virgin Atlantic. It’s the best hands down. They known hospitality. The flight attendants are lovely, courteous, and polite. Even in coach, each seat gets their own television with an unbelievable number of movies to watch. We flew in First Class on Continental to Arizona and since they removed their projection system and installed Direct TV, we had no entertainment on either flight because they couldn’t pick up the satellite feed. Horrible. Plus on Virgin you get plenty to eat and a free alcoholic beverage. So screw you, Continental.

2. Let Chad pick your hotel. He is a guru, a human divining rod for locating luxury accommodations in boutique hotels that don’t cost you a month’s salary. We stayed at the Andaz Hotel. I highly recommend it. Remember the exchange rate in London is 1 pound = 1.6 dollars.

3. Be prepared to eat at McDonald’s. Now don’t get on me. I know I preach about nutrition, but if you haven’t eaten British food, then you don’t know what I’m talking about. There’s just so much fish and chips you can ingest. Besides our big night out on New Year’s Eve cost a small fortunate and all we had to choose from was pheasant, venison and squab. After dinner Chad and I went across the street and ate two cheese burgers with fries. Delish.

Josephine and Joe

Madeline and Mitchell

Marc and Maria

4. When in doubt, offer your family member a drink. Yes, it’s true. Family is more fun on alcohol. Even my mom was tolerable after a glass of champagne. My sister, Josephine and her husband were a hoot. She was wearing sequined slacks on New Year’s Eve and posed for the camera like she was on America’s Next Top Model.

Mom's glasses are from the Sophia Loren Collection

5. See the sights. My brother-in-law, Marc, arranged a great tour of London. Don’t miss the view from the Eye and check out Windsor Castle (I didn’t. Josephine, Joe, Chad and I hung out in the lounge at the Mayfair Hotel and had drinks instead), but mom and the kids said it was grand. Skip the boat ride up the Thames. Remember it’s freezing in London this time of year.

6. Go to the theatre. We saw War Horse, a play in which actors work with life-size puppets. Josephine, Joe and mom took in Billy Elliot but got screwed in their seat selections. Note the English don’t use orchestra or mezzanine. They say, stalls (our orchestra) or… well don’t worry about it. Anything but the stalls probably sucks.

And do not take your mom to the Pop Art exhibition at the Tate Modern. Unless you have that kind of relationship with your mother where you enjoying looking at enormous photographs depicting penetration. It was too risqué for me mum.

BDSM again?

I’ve hit the ground running this year. Professionally I predict there will be some exciting changes in the months ahead. As far as patients are concerned, life goes on and so do the stories.

John, a 54-year-old male comes in with complaints of testicular pain. On exam, I notice several small circular lesions surrounding his pubic region. “Is this what you were referring to?” I asked.

“Oh, no,” he said. “Those are burn marks from my master’s cigar.”

“Master?”

“Yes, I’ve finally found the perfect BDSM ( bondage, discipline, sadomasochism) master after searching for years.”

“Well I would imagine it’s not like getting a free toaster oven when you open up a savings account.”

“No, not at all.”

“And the cigar burns… that’s something you enjoy?”

“It’s part of it.”

“May I ask you a few questions? I’m intrigued because you’re not the first patient I’ve had that’s mentioned BDSM.”

“Please, fire away. No pun intended.”

“Are you always in the role of the submissive?”

“It’s not a role. It’s a way of life.”

“I stand corrected,” I said. “But isn’t it exhausting to be submissive all the time? Taking orders? Begging?

“He stays with me three to four days a week,” he said. “So I have some days when I’m alone, but when he’s home with me, I obey him.”

“Like how?”

“Well, I like to talk a lot, and if he’s had enough, he’ll say, ‘Shut up’ or he’ll burn me with a cigar. You know, to get my attention.”

“Sure. I suppose if someone came at me with fire, I’d shut up too.”

BDSM is intriguing to me as are the men, I’ve met, who make up this subculture. It does scare me, but then again, aren’t we all frightened of things we don’t understand?

In the end, my patient had a small hernia. I referred him to a surgeon. “Thanks,” he said as he pulled up his pants.

“Take care of those burns,” I said.

“Don’t worry,” he winked. “You should see the whip marks on my back.”

Single in the City

“Why isn’t I can’t meet a nice guy?” asked Terrance, a HIV positive gay man living in Manhattan. He’s been positive and single for over five years. “It’s not the HIV thing. I meet tons of guys who are cool with it. It’s just I meet such freaks in New York.”

Dating in general is something everyone struggles with. This is proven by the increasing number of people who turn to on-line match makers and dating websites. If I see one more happy couple who found their true love on eHarmony, dancing on the beach or canoodling on some mythical park bench, I’ll slice my gums with a razor blade.

Dating is tough: gay, straight, bi, transgender or BDSM.

Poz dating, in particular, is fraught with its own intricacies. Do you disclose your status on the first date, knowing it could frighten someone off? Or do you wait until you get to know them better before you tell them your status?

Ask this question to any group of gay men, poz or not, and you will get a different answer every time.

That’s because each case is different. Every time someone’s faced with that point in the relationship when they’re supposed to have, “the talk,” you can never be sure how it will go.

My recommendation is you don’t have to disclose your status on the first date. Get to know them, but don’t tell them six months into the relationship. However, I do believe that once you begin having sex, you should disclose your status.

Don’t ask, don’t tell does not apply in this case.

You have an obligation to tell and for those of you who are negative, you have the same obligation to ask your sexual partner their status before you engage in any sexual activity. We are all individually responsible for our own health and that means asking the right questions and always using a condom.

But let’s get back to poor Terrance.

He met someone really special, Dan, he said his name was. They met on Manhunt.net and were primed for their first date.

“Okay,” I said sarcastically. “Just be careful.”

“I know. I know. But he seems really nice and he invited me to his dad’s birthday tonight.”

“It’s a first date AND you’re meeting his family?” I asked in amazement. “I’m sorry. I can’t let you do this. This is a horrible idea. You barely even know this guy and already you’re meeting the parents. This is a disaster waiting to happen. Don’t say I didn’t warn you.”

“Well, it’s too late now,” he said holding up two shopping bags from Balducci’s. “I already bought a fruit tart and some pastries.”

“What if he turns out to be a nut,” I offered. “His family could be a clan of cannibals.”

“That’ll mean more tart for me,” he laughed. “Seriously, I don’t mind. I like to take risks. The only problem is that he’s recently single.”

“NO, no, no,” I said. “This is getting worse by the minute. I won’t let you do this.”

“Too late,” he said whipping out the door. His shopping bags flaying behind him.

Two weeks later.

“How did that date go?” I asked while reviewing his labs.

“It was a disaster,” said Terrance. “The birthday party was fine, but I stupidly decided to introduce him to my parents the following weekend. For some reason, he asked to borrow my dad’s car, and he ended up getting into an accident.”

“What?”

“No wait it gets better,” he said. “We got passed that. If you can believe it? Later that night we’re having sex for the first time, and while we’re doing it, he gets up and says, ’I can’t do this.’ Then he gets dressed and leaves. I hate dating.”

All I could think of was that episode from Sex and the City, when Miranda calls Skipper while he’s having sex with his current girlfriend and then breaks up with her because Miranda wants him back and she says, “You mean you’re breaking up with me while you’re still in me?”

“I’m sorry was there cherry in that tart?”

Anabolics and heart disease

Anabolic steroids cause damage to your heart.

Think about it? If anabolics steriods increase muscle mass than why wouldn’t they also enlarge this vital organ which in and of itself one big muscle.

Damian, a 29-year-old bodyguard at a gay club is an active steroid user. He was recently diagnosed with HIV when he was admitted to the hospital for pneumonia. His labs showed elevated liver enzymes. Also noted were an increase in his heart rate and blood pressure, attributed at first, to the infectious process taking precedence over his body. Later when his fever, cough and shortness of breath resolved with antibiotics, his blood pressure and heart rate remained elevated.

A 2-D Echocardiogram found: severe left ventricular dysfunction with an ejection fraction (EF) of 35% (normal EF is 55 to 75 %), and an enlarged left ventricle with mitral and tricuspic regurgitation.

Anabolics are often used in patients with HIV to sustain or increase muscle mass secondary to wasting. Recreational use of anabolic steroids exposes the body to superphysiological doses, which can have devastating and irreversible effects on the heart, kidney and liver.

Damian has a five-year old son. I asked him to consider how difficult it was going to be to throw a football around with his kid in five years with his current ejection fraction?

Gaines Adams, an All-American defensive end in the NFL with Chicago and Tampa Bay, died  after going into cardiac arrest at Self Regional Hospital. He was 26. Autopsy results are pending. Most cases of sudden cardiac death, in otherwise healthy athletes, is often due to hypertrophic cardiomyopathy. Of course, when any young adult dies toxicology reports are necessary at autopsy.

I’ve seen several cases of hypertrophic cardiomyopathy secondary to anabolic steroids. I’ve actually held one in my hand after the trauma team opened up the chest of an Italian male at St. Joseph’s Hospital in Paterson, New Jersey, (no he wasn’t a cast member of the Jersey Shore), when he fell off his motorcycle and died from trauma to the chest. Unfortunately, anabolics do not enlarge brain mass. Maybe if they did, he would have worn his helmet.

A case of Parkinson’s disease?

Individuals infected with HIV are able to live longer fuller lives thanks to highly active antiretroviral therapy (HAART).

That’s what’s the journals and pharmaceutical studies report. Yet, with lower mortality rates and longer lives, comes the concern that HIV will complicate certain medical conditions, particularly those associated with cardiovascular and neurological systems.

The number one killer, regardless of HIV status, is heart disease, with over 12 million people suffering from coronary artery disease (CAD) in the United States. Over 1 million people die from cardiovascular disease each year, and roughly 25% of these deaths occur suddenly.

With regard to HIV positive individuals, heart disease and neurological issues are accelerated.

Case in point: Jimmie, is a 43 year old HIV positive male, infected 12 years ago through unprotected sex. He has been stable on HAART with a T cell count of 350 and an undetectable HIV viral load. Otherwise, Jimmie is healthy and training for a marathon. One month ago, he noted limited mobility in his left arm. Likewise, his left foot felt numb particularly after running.

On exam he has some loss of sensory perception on his left side with minimal weakness. I referred him to a neurologist who made the presumptive diagnosis of Parkinson’s disease.

Parkinson disease (PD) is a chronic, progressive neurodegenerative disorder characterized by any combination of four cardinal signs: rest tremor, rigidity, bradykinesia, and gait disturbance. An accurate diagnosis of PD rests on the clinician’s ability to recognize its characteristic signs and associated symptoms, especially in the early stages. PD generally affects the elderly not a otherwise healthy 43 year old male.

Before death, approximately 30 percent of all HIV- infected persons will develop an overt dementing illness, evident on bedside neurological examination. This illness has been referred to as AIDS dementia. An additional 30 percent of HIV-infected persons will exhibit significant cognitive abnormalities. On physical examination, these individuals often display abnormalities that are quite reminiscent of Parkinson’s disease. In very rare instances, an older person infected with HIV may be misdiagnosed with Parkinson’s disease until other AIDS-related illnesses become apparent.

HIV infects the brain very early after the initial infection. It can be demonstrated in the brain within two weeks of infection, although it rarely causes clinically apparent disorders at this stage. The virus has a predilection for deep nuclear structures, such as the basal ganglia, including the substantia nigra. This latter region is chiefly affected in Parkinson’s disease.

Papa bears having children

Papa can you hear me?

Scott Moore is due to give birth in February. Moore was born a female and is undergoing gender reassignment surgery to change his sex. Scott Moore is legally a female and yes, he still has a uterus, ovaries, fallopian tubes and a vagina.

You may remember that in 2008, Thomas Beatie gave birth to a girl. He made headlines after he took those nude photos alla Demi Moore and was featured on Oprah. Beatie had his breasts surgically removed and legally changed his gender to male ten years earlier. The law allows women to legally change their gender once they initiate gender reassignment even though, he left his uterus and vagina intact. Despite years of hormone therapy and living outwardly as a man, Beatie claims he retained his female sex organs because he intended to conceive one day.

‘I feel it’s not a male or female desire to have a child. It’s a human need. I’m a person and I have the right to have a biological child,’ he told the Oprah Winfrey Show.

“Good for you,” I say.

Yet is it human right to bear a child if you are capable?

That is truly the question. Then again, are these so-called men really just a bunch of jacked up woman on ‘roids?

Women who undergo gender reassignment often have to make complicated decisions.  Chastity Bono, is undergoing this very process. She will have to decide on a mastectomy, a hysterectomy, hormone replacement and ultimately, the creation of a penis (although all women do not take this final step).

But what about all that testosterone? Does it have any effect on an unsuspecting fetus? Well, of course it does. Testosterone can have a virilizing effect on an unborn child, even if the mother says she’s ceased treatment while pregnant. And by virilization; I mean masculinization. Perhaps that’s why it was so difficult for Beatie to find a doctor to help him conceive his child.

So Beatie and Moore may contend that it is their right to bear a child, but I ask you, what if that child develops birth defects due to hypertestosteronemia? What then?

I guess my concern is that we’ve all witnessed the horror of certain women who have run amuck with their uteruses. Recently Nadya Suleman celebrated her octuplets first birthday. Her doctor is currently being investigated for taking part in their conception.

But don’t get me wrong; I support Roe vs. Wade.  Yet, I can’t help but wonder that if all these women really wanted was to have a child then why didn’t they maintain their privacy? Then again, I’m just a cold, insensitive, childless man who doesn’t have a uterus to stand on. 

As far as the F to M community, I wonder if this new wave of child-bearing among pseudo-men will produce a new subspecies of children. One that is more androgynous, more aggressive, more alla Children of the Damned or dare I say, Spawn of Chucky.

Super Bowl bans Gay commercial

CBS has rejected a commercial from the gay dating website ManCrunch.com. It has been confirmed that CBS will not air the commercial during SuperBowl XLIV on February 7th.

The commercial depicts two men kissing after their hands touch while reaching for a potato chip. “After reviewing the ad — which is entirely commercial in nature — our Standards and Practices department decided not to accept this particular spot,” a network rep said in a statement. “As always, we are open to working with the client on alternative submissions.”

A rep for ManCrunch.com also confirmed the rejection. “We are totally of the opinion the ad was rejected due to the homosexual content,” spokeswoman Elissa Buchter said. She added, “The creative is PG-rated and doesn’t feature any tongue or overt sexuality.”

“CBS officials have approved a script for a Super Bowl spot, starring Tim Tebow and his mother, from Christian group Focus on the Family,” trade publication Media Daily News reports. “It was originally believed by many that the ad would carry a pro-life message, but the non-profit group suggests it will not — at least not an explicit one.”

“It is against CBS’s policy to run advocacy ads, even those with “implicit” endorsements for one side of a public debate,” Media Daily News reports. CBS will review the spot before giving it final approval.

Focus on the Family said only that the ad would carry a “Celebrate Family, Celebrate Life” theme.

If this doesn’t infuriate you then you’re reading the wrong blog. Wake up gay people. I feel it’s time we take a stand. The ManCrunch commercial is not pornographic. I suppose America is okay with effeminate gay men on television so heterosexuals can laugh at us, but God forbid CBS broadcasts two regular, beer drinking men sharing a kiss. That would just  rock the heterosexual community to their core.

I ask you gay Americans, “Boycott CBS, not just on Super Bowl Sunday but for good.” Why support a broadcasting station that promotes a drug addict, wife beating man like Charlie Sheen but shuns a commercial that promotes gay men dating? Why?”

Gilead Investigators’ Meeting

I returned early this morning from San Francisco where I attended the Gilead Science investigators’ meeting for their new QUAD/GS-9350. If you thought the one pill once a day regimen of Atripla, (Sustiva, Viread and Emtriva), was a big deal, then wait for this new QUAD, which is four in one. Made up of, Viread, Emtriva, GS-9350 (cobicistat) and their new intergrase inhibitor, Elvitegravir, the QUAD will also be one complete therapy for the treatment of HIV. A once daily dose with a pill that is even smaller than Atripla.

Hopefully it will have less side effects and better tolerability than Gilead is expecting.

I arrived Friday night, ordered room service and then settled into my heavenly bed at the Westin St. Francis. Such an amazing city. It was a quick trip unfortunately. The meeting was on Saturday and afterward, I hopped on the red-eye and high tailed it back to New York. Chad is in Zürich and so I wanted to get back as soon as possible to see Hoffman. (I know. Can you believe how much this dog has changed my life?) The flight was okay. I’m just not happy with Continental’s new Direct TV. I want movies!

Two hours into the flight, I was dozing off when I heard, “Are there any medical personnel on board?”

Yes, I know. I’m cursed.

Apparently,  a young woman passed out and had some seizure activity. Needless to say, I jumped into action, made a quick assessment and diagnosed the woman with a case of dehydration and a subsequent vasovagal response.

Vasovagal syncope is the most common cause of fainting. It occurs when your body reacts in an exaggerated way, triggered by the sight of blood, extreme emotional distress, or hearing there’s a sex tape involving John Edwards with his pregnant mistress. The trigger results in a sudden drop in your heart rate and blood pressure, which reduces blood flow to your brain and causes you to briefly lose consciousness.

So I spent an hour on the floor next to her husband, offering her water as she reclined on the seat, legs elevated so that the blood could rush back to her brain. This young woman was wearing a mohair sweater dress, tights and a pair of Uggs. It was very warm inside the plane. Ladies, please, I appreciate you dressing up to fly but a thick sweater dress and leggings? We’re not going to Alaska. Dress appropriately. I know layering can pose a hassle going through airport security but temperatures fluctuate inside the cabin. It’s important to stay hydrated and not to over heat during the flight. Otherwise you’ll end up passed out with me standing by your side, holding your legs up in the air with a Continental blanket covering your lady parts. In the end, she was fine and I went back to my seat.

Vasovagal syncope is usually harmless and requires no treatment. But your doctor may recommend tests to rule out more-serious causes of fainting, such as heart disorders.

Bleach Bum

Diarrhea is defined as an increase in the fluidity, frequency or volume of stool output, usually results in increased daily stool weight (>200g/day).

We’ve all experienced the discomfort and unexpectedness of diarrhea, as it comes on quickly, particularly when someone is infected with a virus, bacteria or parasite. And as if things weren’t bad enough, some infections can result in gastroenteritis, which includes nausea, vomiting and diarrhea.  Often patients remark that ”it was coming out of both ends”.

In the community in which I serve, parasitic infections are common, especially Giardia lambia, which I have discussed in the past. Transmitted through fecal/oral contamination, most people acquire gastrointestinal bugs when their infected waiter forgets to wash their hands or in the case in which I am about to describe, a man who enjoys performing oral sex on his partner’s anus.

Tom found himself feeling nauseous with increased gas and then profuse diarrhea. He said he was unable to “hold down” any food and had to run to the toilet every hour or so. He denied fever, nausea or vomiting. Most infectious processes will run their course. It is important to stay hydrated because the body’s natural response is to promote the expulsion of watery feces so that the bug is released. That is why most doctors do not recommend anti-diarrheal products which only act to contain the infective agent.

Frequent bouts of diarrhea can cause irritation and ulceration of the anus from frequent passage of fluid and constant wiping with toilet paper. Tucks Pads Medicated Pads are a great product because they are infused with witch hazel, an astringent, which acts to soothe the tender surface of the anus. Tom keeps a box by the toilet. He used them after each bout of diarrhea but quickly noted that his anus was becoming even more irritated. Over the course of the day, it even felt like his anus was “on fire”. That night when he got home, he had another bout of diarrhea. This time, before he wiped with the Tucks Medicated Pads, he looked at the box, and low and behold, he realized he was wiping with Clorox sanitizing wipes, which are meant for sterilizing surfaces, not your anus.

The lesson learned here is to look before you wipe and leave the anal bleaching to the aesthetic experts.

Gay Gene Debate

A new study found that homosexual men may be predisposed to nurture their nieces and nephews as a way of helping to ensure their own genes get passed down to the next generation.

It has been a great source of debate but scientists agree that homosexuality is in some part hereditary. So than how do these genes get passed on?

Since homosexual men are les likely to reproduce then heterosexual men, why haven’t we become extinct?

“Maybe what’s happening is homosexuals are helping their kin reproduce more by just being altruistic towards kin,” said evolutionary psychologist Paul Vasey of the University of Lethbridge in Canada. “Kin therefore pass on more of the genes which they would share with their homosexual relatives.”

So just by the nature of maintaining close contact with my own niece and nephews, I will inadvertently pass on my altruistic gay genes? Sounds implausible yet Vasey and his student Doug Vander Laan tested this hypothesis among a group of men called fa’afafine on the Pacific island of Samoa.

Fa’afafine are effeminate men who are exclusively attracted to men, and are generally recognized and tolerated as a distinct gender category. The researchers surveyed about 300 fa’afafine, and found that they were significantly more likely to be altruistic toward their nieces and nephews than either single men or women, or mothers or fathers. The scientists call this behavior avuncular, or uncle-like.

The kin selection hypothesis was first proposed in the 1970s, but previous efforts to test it among gay male populations in Western societies found no effect. A study in Chicago and another in England found no difference between gay men and straight people in altruistic behavior toward family members.

One major cultural difference is the individualistic nature of Western society, compared with the Samoan culture. “We think we’re close to our families, but Samoans are really close to their families,” Vasey said. “People are more geographically connected in Samoa.” Additionally, there is less discrimination against fa’afafine, compared with the widespread homophobia that exists in many Western societies. Even if many Western gay men wanted to be doting uncles, their families might not always encourage it.

Vasey said the next step is to test whether this trend exists in other non-Western cultures where homosexual males are accepted as a unique category. Although Vasey’s research is interesting, I still think a more logical answer to support how gay genes are perpetuated in future generations is that it is carried on a recessive chromosome or is sex-linked. That way a straight mother or father could pass the gene onto their offspring.

In a 1995 study, researchers analyzed the genetic makeup of 456 men from 146 families with two or more gay brothers. The genetic scans showed a clustering of the same genetic pattern among the gay men on three chromosomes — chromosomes 7, 8, and 10. These common genetic patterns were shared by 60% of the gay men in the study. This is slightly more than the 50% expected by chance alone.

While religious advocates denounce the idea that homosexuality is genetically linked, the research continues.

Too fat to fly?

A Southwest Airlines flight attendant asked filmmaker Kevin Smith to get off a flight after it was deemed he was a safety risk. Smith left quietly but then took to his twitter page.

“I’m way fat, but I’m not there just yet,” Smith twittered.

Interestingly, Smith said he initially bought two seats for himself on the  Oakland-Burbank flight. When he arrived at the airport he was able to get on an earlier flight, but it was the last seat. Smith  says a flight attendant told him the pilot had determined him a safety risk and asked him to leave— even though he fit in the seat with the armrests down.

Southwest officials apologized to Smith and offered him a $100 voucher. They also used their own blog and Twitter account to defend their “Customer of Size” policy, which requires overweight passengers to buy two seats or risk getting ejected from the plane if the flight crew feels they are too big.

But how fat is too fat to fly?

It is still unclear how much Smith weighs, and he certainly hasn’t offered up this information. Instead he used his blog and website to launch a public war against Southwest, stating that he will never fly them again. Aided by fans, it seems he’s gotten quite a bit of support.

But honestly Kevin, don’t you have enough money to purchase a first class ticket? I hear the seats are very big in first.

Why aren’t there strict criteria outlined for passengers so that we know exactly what constitutes too fat to sit in one seat. If you’ve ever sat in between two people, you know how uncomfortable it is to sit next to someone who clearly needs two seats. What I don’t understand is why we ignore the elephant in the room. I, for one, agree that the ultimate decision needs to be made by the pilot or flight attendants. In this post 911 world, no one should be arguing with them; however, airlines should have weight restriction for individual seats. Theme parks have no problem enforcing their height requirement. Why shouldn’t airlines have weight restrictions? They certainly enforce weight restriction on baggage.

That’s because obesity is ubiquitous in this country. Our super size nation promotes bigger as better. Thank God Michelle Obama has waged her own campaign against childhood obesity.

I commend Southwest. Okay, maybe the problem should have been dealt with when Mr. Smith bought his ticket, but the safety of the other passengers as well as the comfort of the people sitting next to him comes first.

If that sounds rude obese Americans, then buy two seats. We should not have to make concessions for the obese, considering the increased cost of healthcare that gets allocated for these 72 million Americans who are more prone to diabetes, stroke, high cholesterol, hypertension and heart attacks.

No country for old men

“Sit down and don’t rush me,” said Martin as soon as I opened the door. He is a 65 year young man who came in yesterday for his annual physical. Sitting on the exam table with nothing but baggy boxer shorts, he was holding a sheet of notebook paper and peering at me through his bifocals.

“You see this?” he asked waving the paper at me. “I have a lot of things I need to ask you, and I don’t want you rushing me out of here.”

“Alright, alright,” I said taking a seat to listen.

I knew this was going to be good. Martin is a self-diagnosed agoraphobic who only leaves his house once a year to visit me. “I’m all ears.” His annual physical usually runs an hour at the very least.

He began: “I’ve got a lump on my back, there is a mole on my face that bleeds, every joint in my right leg hurts, I can’t gain weight, I have toe nail fungus on both feet, and last week I got semen in my eye and now I see lightening bolts.”

“Is that it?”

“No, I’m just getting warmed up,” he smirked sarcastically. “Take care of those, and then we’ll move on.”

“Semen in the eye?” I laughed. “You’re still having sex at your age?”

“Every day smart ass and sometimes twice.”

“Are you still dating the same person?” I asked knowing very well he is. I love instigating him.

“You mean “muscles”?” he winked. “Yes, but he’s married with five kids. Technically, I’m single and I like it that way.”

“You must be a magic man to keep him coming back for more?”

“He’s twenty years younger than me, and we have sex everyday,” he said flatly. “There is a lot you don’t know about us old folks.”

“A lot I don’t want to know.”

Thinking the elderly engage in sexual activity for most is like asking them to imagine their parents having sex. Yet, the fact remains that most of my elderly patients continue to engage in sexual activity well into their 70′s. Sexual enhancing medications like Viagra, Levitra and Cialis have definitely lent a helping hand in bedroom.

When I first started residency these medications did not exist. I can recall my urology rotation where middle age men were lined up outside the clinic waiting to be seen, all with similar complaints of erectile dysfunction. I learned quickly that there was little we could offer these men other than emotional support for feeling emasculated. Dr. Jorgenssen, the Chief Urologist, ordered a battery of tests and even prescribed an injectable product called Caverject, which helped to engorge the penis but you had to stick a needle in it first. Ouch. The other alternative was Muse, a pellet that had to be pushed inside the urethra. Double ouch. Often the only other viable solution was to surgically implant a prosthetic that either inflated the penis through a pump that was implanted under the skin or surgically insert a silicone rod into the shaft so that it could be manipulated up, for sex or down, for non-sexual activity.

Half way through my rotation, Dr. Jorgenssen came into the clinic and said to me, “Do you have any money?”

“Why?” I asked. Was he going to ask me for a loan?

“Buy stock in Pfizer,” he said mysteriously.

I didn’t. Of course that was the year Pfizer launched Viagra and the rest is history.

The funny thing is that some older gents, like Martin, don’t need anything but a warm body named “muscles” to arouse them. I hate to think what he would be like on Viagra – a shut in with a chronic erection. That would be a recipe for disaster. I can just imagine his frantic 911 call, the EMS busting through his door and finding him  naked with a blue penis and a 40-year-old Italian passed out on the floor.

Now you see why I don’t want to imagine the elderly having sex?

Harvey Milk High School

February 25th I had the pleasure of speaking to the students at the Harvey Milk High School. It was my second time. Two years ago I gave a lecture on child sexual abuse and molestation. This year I spoke to the students about sex education and at the end, we played a round of medical jeopardy. It was so much fun. These students are fortunate to have an environment in which they can learn that promotes individuality and supports their sexual identity. After a while, I stopped wondering who was a boy and who was a girl and just learned to accept the students as young adults. It was complete 180 degree from the high school experience I had back in the 80′s where I attended an all boys private Jesuit brothers high school. Despite the fact that it was a Catholic school, I learned very little about acceptance and kindness. I graduated in three years instead of four. Mainly because I hated high school. I felt completely foreign to the other boys.

After my first lecture at the Harvey Milk High School, I was invited to their prom. Since I hadn’t gone to my own, I graciously accepted. Chad and I went together. We even have one of those cheesy photographs of us sitting on a huge wicker chair in front of a tropical backdrop. We drank virgin cocktails and danced to rap music. When they announced Blessing, a female dressed in a tuxedo, as king of the prom, I knew I had just experienced something I would not soon forget.

I strongly urge everyone to make donations in support of the Hetrick-Martin Institute and the Harvey Milk High School.  LGBTQ youths are three times more likely to drop out of school, two times less likely to go to college, and a majority of them report being verbally harassed at school. For 30 years The Hetrick-Martin Institute, home of the Harvey Milk High School, has been giving these young people an opportunity of a lifetime. Please visit www.hmi.org and make a donation.

Toilet seat cover & rug

 

 

Last night I had dinner with Dr. Larry Higgins. I’ve known him since I was an intern. He is probably one of the funniest people I’ve ever met. Occasionally we meet up and gossip about other doctors, bitch about healthcare and trade patient stories. This is one story he told me last night. Larry has this patient named Juan who has a mother that lives in Puerto Rico. “She loves to decorate her bathroom,” said Juan. ”She even has a crocheted toilet paper cover with a doll stuck in the middle on her toilet bowl tank.” Being the good son that he is, Juan went to 14th street one Saturday afternoon and bought her one of those shag rugs that fits perfectly around the toilet along with the matching shag toilet seat cover. He shipped it to her, and one week later he received a thank you card.

 

It said, “Thank you. I love the shawl but the hat’s too big.”

John Mayer

I’m sort of perplexed by the whole John Mayer thing.

Originally, when I heard him back in 2008 with his single, Daughters, and then I saw him perform it on television, I thought, “Oh this looks like a sweet, clean-cut guy. Not my cup of tea but certainly if you like to hear acoustic music from a singer songwriter with a smokey voice playing a guitar, then he’s your man.”

But then I heard he sold the rights to this song to be used for a Hallmark commercial. Again, not my cup of tea. I think artist who sell their music so early in their career seem like they’re selling out too soon. What’s the hurry John?

Then came the Hollywood lifestyle, dating women like Jessica Simpson, Jennifer Aniston and other model types. Then I saw the tattoos, the pictures of him drunk, and I thought, “Wait, what the hell happened to John Mayer? I thought he was like this Indie/Jazz singer songwriter. Now he’s acting like a 70′s rock star and getting all drunk and nasty with the ladies.”

I started to wonder, “Is this the same guy who wrote these lyrics:

Fathers, be good to your daughters
Daughters will love like you do
Girls become lovers who turn into mothers
So mothers, be good to your daughters too

I mean really John Mayer. Are you telling parents how to raise their daughters? Why? So you can possibly date them, get all sloppy drunk and then break up with them? Then after you’re done, you can dump on them, like you did with Jessica Simpson, referring to your experience with her as sexual napalm.

I’m confused. Why is he popular with the ladies? Is it the bad boy syndrome? Did he strategically re-invent himself in order to separate himself from that good boy image we initially fell in love with? I think so and here’s why: Most people don’t want to listen to a boy singing about how parents should raise their daughters when he doesn’t have any children of his own. John Mayer created this bad boy persona because musically we are drawn to tortured souls. If we wanted to hear uplifted, goody good lyrics, we’d listen to gospel music.

I do not have any daughters of my own, but I did grow up with two older sisters. Throughout the years I watched a parade of boys, some good and some bad, come in and out of their lives. It was difficult to watch them get hurt, but I was much younger than my two sisters, too young I suppose to beat these boys up when they stood up one sister or broke up with another. You would think that after it happened the first time a girl wouldn’t go back to a bad boy again? Yet, there is something inexplicably (dare I say it?) sexy about a bad boy. He’s dangerous, sexual, rebellious and everything our parents warned us about. Hell, I can recall a woman, who at a cocktail party, referred to Scott Peterson as hot. I thought, “Lady! Wasn’t he convicted for murdering his wife?”

Well, John Mayer I probably won’t buy any of your music. Not that you’ll even notice. You’re probably already very rich selling your songs to Hallmark. Now every time I buy a greeting card for one of my sisters I’ll think of you and those lyrics to Daughters and laugh to myself. If there truly is a God, one day John Mayer will have children, hopefully a daughter of his own, and she will likely be drawn to a bad boy like her mother. Perhaps one evening she will be out past her curfew, and John will be waiting nervously in the den wondering if she’s okay.

I don’t know John. Will she?

Breast milk dessert

In August 2007, Chad and I went on a blind date. Together we discovered a new Austrian restaurant on 9th Avenue called Klee. Chef Daniel Angerer and his wife had just opened the restaurant. We had such a great experience that night and have gone back numerous times. We’ve even gotten to know the Chef and his wife, Lori Mason, who recently had a baby.

Today Chef Daniel Angerer told the New York Post that he is giving his patrons a taste of his wife’s breast milk. ”It tastes like cow’s-milk cheese, kind of sweet.” I was completely thrown off by this comment when I read it today. I knew he was an inventive chef. He even beat out Chef Bobby Flay in an Iron Chef competition where the mystery ingredient was beer, but I had no idea how truly resourceful he was. Chef Daniel went on to say, “The phone was ringing off the hook. So I prepared a little canapé of breast-milk cheese with figs and Hungarian pepper.”

Daniel’s main supplier, his wife, is happy to help her husband out. ”I’m not here to walk people through their psychological problems,” she said. “I think a lot of the criticism has to do with the combination of sex and cheese, but the breast is there to make food.”

True, but it is a little disconcerting to consume breast milk. I don’t want to even drink my own mother’s breast milk. Unfortunately, Mason’s assessment is astute. I do mistakenly link breast milk with sex. It’s an Oedipal association.  But Mason is also correct with regard to her response. Breast milk is a nutritious resource. I’m just not sure she should be sharing it with her patrons.

The topic of breast-feeding has always been controversial. Public breast-feeding is often frowned upon in this country, and when should mothers stop breast-feeding? I can recall a particularly gruesome attack on Lindsay Wagner, TV’s Bionic Woman, when she admitted to breast-feeding her children well past two years of age. Her response was that breast milk was far more nutritious and available than providing her children with sweets, carbonated beverages and junk food. “She’s nuts,” said Mrs. Benevento, my mother’s friend. “She’s breast feeding so her tits stay big.” That was one hypothesis. “I don’t breast feed if my child can ask for the bottle themselves,” offered Mrs. Comparo, my mother’s other best friend. “And what about the teeth?”

I’d rather not think about the teeth or the breast milk. Women should breast feed their children as  they see fit. I don’t particularly want to see it happen, but that’s my problem. I can always look away. So congrats to the Angerers on their new addition. I look forward to eating in their restaurant again. I’m not having the canape’. Incidentally, the Department of health has issued a statement, warning Angerer that breast milk cheese is not for public consumption. Just as well.

Too fat for film

Today I was on Morning Jolt with Larry Flick on Sirius Radio. I’m lucky not only because I get to answer questions from his audience, but I get to laugh myself silly with Larry and Keith Price.

As I waited in the holding area before I went on, there was large group of people gathered. Eager women with firm handshakes and notes in their hands. I deduced they were publicists. Whatever it was, there was a lot of commotion going on. When Keith came out to get me, he revealed that Howard Stern had made a comment earlier on his show that the Academy Award nominated actress, Gabourey Sidibe, star of the film, Precious, “Is just another fat, black girl.” I’m paraphrasing.

His comment set off a firestorm of debate from those who mistook his observation as prejudice toward the obese and African American. Later, when I got back to my office and signed onto my computer, Pop Eater prompted me into taking a poll, asking me if I thought Miss Sidibe was too fat for film?

Debating whether or not overweight actresses can maintain a career without succumbing to peer pressure and losing weight, is nothing new. Whoopie Goldberg, an African American Academy Award winning actress has battled her weight for years. She talked about it openly on The View. Even Jennifer Hudson slimmed down after winning her Oscar last year. So have the Academy Award nominated Oprah Winfrey and Queen Latifah. Although these women have maintained that they will never and can never be an unrealistic size 2, the fact remains that all of these women have tried to lose weight. Regardless if it was for their own benefit or an attempt to be more commercial has yet to be proven. Unfortunately, there are so few roles available for African American women and even fewer that require an overweight one.

With so many actors and actresses vying for roles, I predict Miss Sidibe will attempt to lose weight in order to continue working. Movie goers want to see beautiful people up on the screen. Heaven forbid we see a romantic comedy starring a fat girl with a hot guy. I’ll admit Hairspray did just that, but it doesn’t happen often. That’s interesting to me when you consider that we’re often color blind when it comes to casting, particularly on Broadway, but we don’t condone the same equality when it comes to body habitus or beauty. Women get the short end of the stick. Unattractive, overweight women are not treated equally as their male counterparts.

Think about it. If you turn on the television you’re likely to see a sitcom featuring a fairly attractive, slender actress with a robust, which is just a macho euphemism for fat, male lead. I can name several: King of Queens paired my sister’s doppelgänger, Leah Remini, with Kevin James. Poor Courtney Thorne-Smith was married to Jim Belushi in According to Jim. And who could forget the forgettable Still Standing, a show that asked us to believe that Jami Gertz might have actually bedded down with actor Mark Addy and not come away with ruptured pancreas.

But the obesity hypocrisy doesn’t stop there. It extends onto the silver screen. Movies like the disastrous Couples Retreat had not one but three weight discordant couples. Writers Jon Favreau and Vince Vaughn appropriated the above mentioned sitcoms’ recipe and actually believed that we could imagine a world where a beautiful woman like Kristen Davis would marry someone like Favreau. Sure Harvey Weinstein is really married to the stunning, Georgina Chapman, who is co-designer of the house of Marchesa, but their relationship doesn’t resonate with non-celebritites.

Most guys don’t make a gazilion dollars and their wives basically look the girls they dated in high school only older. You’ll not likely find an Angelina Jolie look alike driving an SUV in Jersey City towing three boys whose father is some one who looks like John Goodman.

The real issue here is not Miss Sibidie at all. It’s the fat, out of shape men we allow to brainwash us into thinking that a huge torso is manly and muscular whereas on a female it’s flabby and gelatinous. Maybe Howard Stern was a tad bit snide when he made that comment, but his point is well taken. There will be no High School Musical starring Zac Ephron and Gabourey Sidibe. Neither do I see a future film starring Ms. Sidibe working for an evil boss played by Meryl Streep whose unrelenting demands becomes the impetus for her transformation. In the case of the Devil Wears Prada: frumpy into chic. In Miss Sidibe case: fat into thin.

And why is it the women always have to change and never the men?

Unfortunately, there are so few precious roles to go around.

I don’t have a solution of course, but as Whoopie Goldberg in Ghost put it, “Gaby, you in danger girl.”

Head first

Although it has been proven that music soothes the savage beast, it also helps to alleviate mood in bestial human beings. During these difficult and troubling times, I have never encountered more patients in my career who present with the same common complaints, fatigue and stress.

Fatigue can stem from any number of causes, insomnia, depression and even hypothyroidism. But other than prescribing stimulants and counseling, what can I do other than encourage supportive therapy?

Last week a patient passed out while my assistant took his blood. He turned completely pale, almost blue, broke out into a sweat and then shook uncontrollably. This scary and sometimes common reaction to phlebotomy called a vasovagal response happens every so often. My assistant and I placed him in reverse Trendelenburg to raise his legs above his head so that the blood could rush back to his brain, and soon he was back to his normal self. Jokingly, I asked, “Where did you go?

His response, “I can’t tell you but in time I will.”

The next day, another patient passed out after I told him he needed surgery for a hernia repair. Same thing happened: pale as a ghost, sweat oozing from every pore, and complete loss of consciousness for a several seconds. After he came to, I asked, ”So where did you go?”

He responded, “I feel like everything is turning inside out.”

Two weird responses in two days. I took it as an omen, a sign of the times.

Then today some hope. Obama’s health care bill passed.

In the meantime, if you want to lift your spirits may I suggest you get yourself a copy of Goldfrapp’s new CD, Head First. I’ve been listening to it all weekend and I feel, dare I say it? Happy. My other recommendation is Sade’s new CD, Soldier of Love.

Child at heart

I guess you could call me a forty-two (going on forty-three next month) year old child at heart. I enjoy being silly, especially with my friends Eric and Gary. We cackle like chickens when we’re together. I talk to my dog Hoffman and respond for him in a high-pitched voice so that I can pretend we’re carrying on a conversation. I play tricks on my staff at work. Sometimes I make prank phone calls to the office disguising my voice to sound like I’m from India in order to get Lesley to make an appointment for Basit Vindalo because I have very, very bad diarrhea. Usually she just hangs up because she can hear me laughing in the other room.

Most of all, you could say I’m childish because I still collect toys.

In fact, I keep a secret collection of action figures in my bottom dresser drawer – superheroes, vixens, Purgatoria and even a dead girl. All female. I have a fetish for women in tights. Since I moved in with Chad I threw away (or secretly stashed some under the bed) most of my toys. Some remain as mementos to remind me of those days when I played with my Evel Knievel action figure and Scramble Van or my army of micronot men.

What is it about toys that we adults cling to them? Is it to hold on to some shred of childhood as the aging process accelerates?

In an abstract written in Developmental Psychology, the author Carollee Howes and Phyllis Stewart wrote that toddler-age children’s (11 to 30 months old) play with care-giving adults and with toys. More nurturing and supported families were associated with higher quality child care, whereas more restrictive and stressed families were associated with lower quality child care. More restrictive and stressed families were associated with more changes in child-care arrangements. Greater numbers of child-care changes also were associated with lower levels of competent play with objects and peers.

Another study pointed out that delayed adolescence in men resulted in a predilection to collect toys. Some of these toys were noted to be “adult” variants like cars, guns or even collective objects of art.

But what about adult men like me who still collect children’s toys? Are we still in a delayed adolescence or are we just immature adults who like to take out of chest of toys and play with them on days when we don’t feel good?

toys that guard the computer

I can only vouch for the latter.

Anyway I freely admit I still collect toys which are clearly displayed in my office. The other day, while one patient waited for me to retrieve a prescription pad he took the following picture. The next day he emailed it to me with a note that said, “I hope you don’t mind, but I took this picture in your office the other day.” I didn’t mind at all.

St. Vincent’s Hospital and Medical Center

All good things must come to an end but why?

Last week the Board of Directors at St. Vincent’s Hospital and Medical Center decided that they would close the hospital due to an overwhelming financial debt. I was a surgical intern and resident at St. Vincent’s from 1995-1997. I transferred to Cabrini Medical Center in July of 1997 where I completed my medical residency and became Chief Resident. As an Attending physician, I maintained privileges at both Cabrini and St. Vincent’s. In 2005, I was made Director of Clinical Services of HIV at Cabrini. Two years later, Cabrini closed it’s doors due to financial problems. It was heartbreaking to watch a hospital close, see patients cry and employees lose their jobs. It was hard to say good-bye to my fellow doctors, the employees and patients who had to find alternative hospital.

Both Cabrini and St. Vincent’s are considered Catholic hospitals. Cabrini was run by the Sisters of Charity, which answered to the Pope. St. Vincent’s is part of the Arch Diocese and is also run by the Sisters of Charity.

So why do hospitals close?

St. Vincent’s debt is said to be more than 700 million dollars. I couldn’t speculate how that debt occurred. I imagine that Catholic charity hospitals lose a great deal of money by treating uninsured patients. Most people don’t understand healthcare. The business of healthcare is confusing to me and I’m a doctor. I do know that when St. Vincent’s closes we will be losing a level one trauma center, the only one in lower West Manhattan. The only other one is on the East Side at Beth Israel, which is where I will be admitting patients.

But there is more to it than losing a level one trauma center. St. Vincent’s is a landmark. It was the hospital where survivors from the Titanic were treated. The poet, Edna St. Vincent Malay was named after St. Vincent’s. As an HIV provider, I think of St. Vincent’s as the epicenter of the AIDS epidemic in the 1980′s. It was the go to hospital after the 911 attack. Now it will be just a memory. When I walk through the Village in years to come, I will look at the spot where St. Vincent’s existed and tell my nephews and niece, “See that Wal-Mart or see that high-rise condo? That use to be a hospital where your Uncle Frank did his residency.”

A friend told me that I’m the black widow of hospitals because everyone that I’ve gotten privileges at since graduation has closed. I hope no one tells Beth Israel.

Lazarus from the dead

I’m back.

April 15th I took my re-certification exam for my Internal Medicine boards. To maintain board certification you have to pass the exam after graduating from your residency program and then again every ten years. Since I passed in the year, 200o, I had to re-certify this year.

Initially, when I received my certificate in 2000, I laughed at the expiration date thinking, “2010. That is such a long ways off.” Well it came very quickly. When I celebrated New Years the first thing that came to mind as the we counted down to 2010 was that I had to take that damn exam this year. If I pass, I’ll have to re-certify in 2020. I’ll be in my 50′s! I shudder to repeat myself and think that is a long ways off.

So what does it mean to be certified? It means that the American College of Physicians and Board of Internal Medicine recognizes that you have successfully completed the requirements (according to them) to practice medicine. It doesn’t mean you can’t practice without being Board Certified. There are doctors who practice without certification. In New York you have to be licensed to practice medicine. For me, it’s just nice to say, “I’m a Board Certified physician.”

It makes me feel included.

Studying for the exam was nothing short of being tortured at Abu Ghraib prison by non other than Lynndie England herself. Imagine having to review not only Internal Medicine but also: Cardiology, Pulmonary, Endocrinology, Hematology, Oncology, Nephrology, Neurology, Critical Care, Gastroenterology and Rheumatology?

Yes, I know there are many that would say, “Duh, I want my doctor to know all that shiz, but like most standardized tests, the one given by ABIM doesn’t really test your knowledge but your test taking capability. (You know I’m just preparing you all in case I fail). Taking mock exam questions, I found myself asking, “Is this the answer they’re looking for or is the answer what I would do in real life?” I started overthinking questions and ultimately getting them wrong. It was very discouraging. I became depressed. I stayed in my office after work and studied until bedtime. I rarely saw Chad and Hoffman except for in the mornings before work and then afterwards before bed.

Since I’m not a great test taker I took a course given by the American College of Physicians, and I learned that I was not alone. There were thousands of us nervous doctors, jittery with anxiety, over having to pass this exam to maintain board certification.

I suppose it is good for doctors to have to re-certify, but why not ask us to complete modules every three years instead of one big exam every ten? Since I’ve been studying very hard I feel very smart at this moment. I read through all the medical books that comprise the MKSAP and I completed the course offered by ACP. So if you need to make an appointment with me I suggest you act quickly before all that knowledge I’ve accumulated these past three months evaporates into the recesses of my corpus callosum or is it substantia nigra? See. I’ve forgotten already.

In any case, I’m back.

Earth Day

To commemorate Earth Day, Sun Chips changed its packaging to an environmentally sustainable biodegradable bag. If you see the new commercial Joel McFadden, the hilarious host of Talk Soup, lures you into this ecofriendly world with the idea that with each bag of chips you buy, the packaging with simply degrade into a natural by-product that will get absorbed by the Earth. According to Frito-Lay, the bags are 100% compostable and made with plant-based polylactic acid (PLA), a renewable material that breaks down in approximately 14 weeks when placed in a hot, active compost bin.

Isn’t that nice?

Initially, I was fooled, thinking next time I go to buy chips I’m definitely going to buy Sun Chips.

Why you ask?

Well, not just for the new Ecofriendly packaging, but because Sun Chips are good for you.

Right?

According to the packaging they have:

- less salt

- 18 whole grams of whole grain, which is as much as a slice of wheat bread

- 0 grams of trans-fat

- 0 mg of cholesterol

- 30% less fat that potato chips

With those ingredients, why not just skip your regular meal and have a bag of chips instead?

As far as I’m concerned this is junk food that your body doesn’t need. Of course, if you HAVE to have  chips, by all means, eat one that comes in a biodegradable bag and one that has all of the above nutritional benefits. But don’t fool yourself. Chips are chips. They contain carbohydrates, salt and fat. Dont’ think that by eating a bag of Sun Chips you’re eating something as healthy as an apple or a piece of chicken. In fact apples don’t even come in packaging. The whole thing is biodegradable.

The problem I have with Sun Chips marketing is not its bio degradable bag. It’s that it’s marketing is degrading. It plays on your sympathy for the environment. If Sun Chips really wanted to do something about the environment, they’d stop making Sun Chips.

How about that?

Excuse me while I finish my bag of Doritos. By the way they’re really bad for you and come in a non-biodegradable bag. At least they’re not pretending to be something they’re not. If you all want to help the environment, stop drinking soda and don’t eat junk food.

Nutritious and junk food should never be used in the same sentence. It’s like saying all fat people are big-boned or obesity is associated with thyroid disease. Next time you crave a chip, buy a potato, peel it and fry it in some olive oil. No biodegradable bag necessary.

Marc Berkley

Mark Bekley died of a reported heart attack on Fire Island this past weekend. Former club promoter and co-founder of HX Media, Marc Berkley will be best remembered to me for his work he did for the Saint at Large.

I am shocked by his passing, and my thoughts are with his family.

Less salt = long life

Recently, I sat  through a Nephrology review course. At one point, the professor stopped lecturing and turned to the 1,000 plus audience of medical doctors and said, “If  you want to live longer, limit your intake of salt.”

For years, doctors and nutritionists have warned patients against the evils of a high fat diet. Trans fats have been implicated as the culprit that increases cholesterol leading to atherosclerosis. These fatty deposits in arteries often result in heart attacks and strokes.

It’s easy to pick on fat. High fat food tastes good. They’re addicting and combined with sugar they are a deadly combination, deadlier than Bush and Cheney combined. But salt meanwhile, has been given a free ride. Of course, doctors, particularly cardiologists, have been jumping up and down, arguing that salt, more than fat, is the cause for hypertension, cardiovascular disease and even stomach cancer.

So how much do you have to give up to live a longer, healthier life?

Most adults should maintain salt intake to less than 1,500 milligrams a day. Unfortunately, most food has nearly twice that amount. Just look at the label. Worse is that low-fat foods tend to have more salt to balance the taste. This makes dieting difficult when you’re apt to reach for something that says, “Healthier” or “Good for you.” Honestly, if the only salt you took in was the sprinkle you applied to your meal than things wouldn’t be so bad, but it’s that extra salt in food that does the most damage.

So what should you do?

1. Don’t pick up the salt shaker. In fact, don’t even have one on the dinner table.

2. If food comes in a can you can be sure it has more salt than is necessary.

3. Stay away from processed food ie, hot dogs, bologna, sausage and bacon. (All my favorites)

4. Beware of fat-free food.

Meals that are high in salt cause fluid retention. That could lead to increases in blood pressure. High blood pressure can result in cardiovascular complications, particularly congestive heart failure. High output heart disease may result in a heart attack and heart attacks are the number one killer of American men and women.

Bomb on Broadway: My theater curse continues

So when I say I went to see a bomb on Broadway. I’m not kidding.

As I’ve mentioned in the past, I have been cursed by some unknown gypsy out of Stephen King’s novel, Thinner, because often when I go to the theater, the understudy performs or someone has a heart attack or some other annoying thing happens. Well, tonight beats them all.

Chad bought me tickets to Lend Me a Tenor, starring Tony Shaloub and Anthony LaPaglia at the Music Box Theater. Unfortunately, Chad had to go away on business, so I took my friend Eric instead. That should have been my first clue that something was amiss. Of course Eric was running late, and we couldn’t catch a cab. So we took the train. Inside the train we were detained several minutes, so by the time we reached the streets of Times Square, we were making a mad dash for the theater. In our haste, I noticed that the streets were unusually crowded but being that I don’t get up to Times Square that often, I figured it was a typical night. That was my second mistake. As I pulled Eric into the theater, I noticed a police barricade forming on West 45th Street. So instead of stopping to look  like everyone else, I dove into the theater. At that moment, they shut they doors, and boom! We were locked inside with the theater less than half full. After several minutes, it dawned on me that the show was not about to go on as scheduled.

An announcement was made that the curtain was being held indefinitely. That’s when panic set in as the frantic audience began calling and texting their loved ones to see what was going on. Soon someone discovered that there was a bomb threat on West 45th Street and it wasn’t Denzel Washington in Fences. No, it was a black SUV with Connecticut license plates parked outside, which had been abandoned and was now emitting smoke. The police discovered a suspicious package inside with black powder and a detonating device.

The show did go on twenty minutes passed 8pm. It was awkward to say the least, but the cast was amazing. Jan Maxwell should receive a Tony nomination along with the three male leads, however as I sat there contemplating my demise and feeling my tooth fillings throb, I wondered, “Is this how I am ultimately meant to go – a bomb on Broadway?”

After the show ended, the cast took their bows and the police made their way on stage to announce the latest news about the bomb. They interviewed several members of the audience, and then we were led, single file, outside the back of the stage, down a narrow path to Shubert Alley. With all the old people and Eric staggering about and complaining, I felt like I was with Shelley Winters in the Poseidon Adventure. On the streets, the barricades were now widened by police as masses of stranded people stood waiting because they weren’t able to get to their hotels or parked cars. It was mass hysteria. Eric and I made it home safely.

So now do you believe me?

If anyone knows someone who can remove this hex from me, please let me know as soon as possible. I’m to attend the Lucie Lortel Awards this evening to honor Off-Broadway achievements. Wish me luck.

Times Square bomber

This man owes me a glass of Pinot Grigio

May 4, 2010: police arrested Faisal Shahzad, a Pakistani-American after he was apprehended on a midnight flight to Dubai. According to authorities Shahzad purchased an SUV off of Craig’s List, paying for it with cash. Then he drove it to Times Square Saturday evening, leaving it parked in anticipation that his make shift bomb, reportedly consisting of firecrackers, would detonate gallons of gasoline.

“Based on what we know so far, it is clear that this was a terrorist plot aimed at murdering Americans in one of the busiest places in our country,” said Attorney General Eric Holder.

Others have suggested that this plot was intended for Viacom, which has an office located near West 45th Street.  South Park, which airs on Comedy Central, and is distributed by Viacom, recently ran an episode which depicted the prophet Muhammed. Muslim Extremist have threatened South Park creators. The posting on Revolutionmuslim.com stated: “We have to warn Matt and Trey that what they are doing is stupid and they will probably wind up like Theo Van Gogh for airing this show. This is not a threat, but a warning of the reality of what will likely happen to them.”

If that’s not a threat than I don’t know what one is.

My question is how did this 30-year-old get all this cash? Sure I suppose he wasn’t acting alone and this bomb was funded by Muslim Extremist. And what’s the deal with Dubai? I read that homosexuality is a crime in Dubai. That upsets me because I also heard that  Sex and the City 2 takes place in Dubai? Why would Carrie and the girls want to promote a location that outlaws homosexuality, particularly when gays make up a huge number of their fan base?

Anyway that Pakistani-American owes me a glass of Pinot Grigio. I had to pay ten dollars for a glass of wine at the Music Box Theater while I was detained by police the night of the explosion. You think the Music Box Theater would have given us all a free drink. I mean really. Can you believe they asked me for ten bucks while the threat of a bomb lingered just outside their doors?

All joking aside, what I find most interesting is that New Yorkers live with the threat of terrorism since 911, and we don’t stop for one minute to take it all in. We just go on with our lives. I wonder if that is the healthiest way to react to such threats? Perhaps we should really stop for a minute and think about what all this violence does to us internally.

On a daily basis I take care of men and women who are depressed, more so since 911. New Yorkers want to act tough but sometimes we have aknowledge our frailty.

We’re only human.

Peanut allergy at ten thousand feet

This past Friday Chad and I got on a plane to visit my sister and her family in Alabama. My nephew Michael asked me to be his sponsor for Confirmation. Traveling to Birmingham from New York is often painful because there are few direct flights and the plane is always one of those small jets that has two seats on either side. My sister Josephine calls them “put puts” because you can actually hear the engines put putting as you fly through the air experiencing every bit of turbulence there is to experience. I hate flying as it is. What’s worse, is that I hate to be reminded that I am ten thousand miles above the ground.

Luckily, our flight wasn’t delayed, which it often is, and Chad and I made our way to our seats. We sat second from the last row, near the toilet. So now I had to contend with turbulence outside and malodorous scents coming from inside. Because it is a short flight, less than two and half hours, they never serve food. In fact this flight didn’t serve alcohol, but Chad had the good idea to buy snacks at the gift shop in the airport. He bought a bag of almonds and two peanut butter chocolate protein bars.

Since I hadn’t eaten breakfast because I was too nervous to eat that morning and I was upset because we had to drop Hoffman off at the Puppy Loft to board, I was famished by the time I sat down in my seat. Within seconds of opening my protein bar, the woman behind me leaped over the seat and asked, “Is there peanuts in that bar?”

She had the most hysterical look in her eyes and for a brief second I thought she was going to ask me if she could have a piece. You have to understand this flight to Alabama brings out the worst in people. I looked at her nervously, preparing myself to reject her politely if she indeed asked me to break her off a piece. “Yes,” I replied cautiously. “It’s peanut butter chocolate.”

“You can’t eat that!” she shouted. “My son has a peanut allergy.” That look in her eyes was so scary I thought she was going to lunge forward and grab it out of my hand. “No one on this plane can eat peanuts within three rows of my son,” she then announced to everyone within ear shot. The woman in front of me, who also had a small son, looked back at me from between the seats and cringed. The woman sitting across from Chad, who had two little girls simply hunched her shoulders in despair. But I wasn’t about to give in to this woman. So I said, “Do you think your son is going to have a reaction just from me eating this protein bar?”

“Yes,” she interrupted even before I had a chance to finish me sentence. “Google it. People with peanut allergies can have a severe reaction from the fumes of peanuts. That’s why they don’t serve them on air planes. Look it up.”

“I’m a doctor lady and I’ve never hear that.” (Yes, I played the doctor card but this woman was deranged.)

“You’re a doctor?” she hissed and then laughed mockingly. “What kind of doctor are you? You should know that.” Her head was wedged in between the seats Chad and I were sitting in and that crazy look in her eyes reminded me of Jack Nicholson in The Shinning.

“I’m an internist,” I responded proudly.

“Well Google it,” she added again sounding like Elisabeth Hasselbeck from The View, as though Google is the Holy Bible of medical references. Instead of arguing further, Chad and I placed our protein bars back in their wrappers and reclined in our chairs awaiting take off. But that didn’t stop this peanut nazi. Instead she went on yelling in my ear from behind me. “Peanut allergies are the number one cause of allergic deaths and no one can eat peanuts on a plane. The flight attendant will make an announcement.”

“Who is she talking to?” I asked Chad. He shrugged his shoulders  and opened his magazine. I, of course, was not about to turn a deaf ear to this woman. So I turned around and shouted back, “Listen lady, I put the protein bar away. I did what you asked even though I never heard about aerosolized peanut allergies, but if you are going to harass me for the next two hours then you’re asking for a fight.” I resisted the urge to say, “Look lady the only nut on this plane is the one sitting next to your son.”

“I’m not harassing you,” she argued. “I just want you to know the facts.”

“Thank you for enlightening me.”

The flight attendant never made that announcement and when this woman went to the toilet, Chad turned to her son and said, “Run!” The two mothers sitting near us both confirmed they had never heard about aerosolized peanut allergies and one of them was a doctor. The woman in front of me added that she worked in a psychiatric hospital and suggested that this woman was a psychopath.

After we landed, I was still intrigued, and so I had to investigate whether or not there was some shred of truth in this woman’s statement. The fact is there is a ton of information debating whether or not you can get an allergic response from being around peanuts if you are indeed allergic to peanuts however, I did find an article published in the Journal of Allergy and Immunology which stated, “A variety of flavor and aroma compounds are in foods, including esters, aldehydes, and pyridines (these last are the ones associated with the characteristic peanut odor). None of these flavor compounds, however, are proteins, and proteins are the components of foods that cause allergic reactions. Researchers have isolated the proteins that trigger allergic reactions in those with peanut allergy, and they are entirely distinct from the flavor compounds. So simply smelling peanuts shouldn’t cause a reaction in someone with a peanut allergy. (This has been confirmed experimentally by researchers who exposed peanut allergic subjects with peanut butter and a soy butter placebo for 10 minutes at one-foot range. None of the subjects reacted.) However, a few related phenomena can cause reactions. First, inhalation of peanut dust and small particles of peanuts can cause reactions in those with peanut allergy. So in situations where shelled peanuts can spread dust in the air, that small exposure may be enough to cause a severe reaction. Second, when foods are cooked, they often release oils into the air — oils that can contain allergenic proteins and cause reactions. Finally, trace amounts of peanut products can get onto hands and be ingested by someone with an allergy, causing a reaction.”

So I can understand this woman’s concern. If you have ever witnessed someone experiencing an anaphylactic reaction, you would be a psychopath particularly if it happened to your own child. So I don’t fault this woman however, there were no actual peanuts in our protein bar. So Chad and I secretly ate our protein bars and the bag of almonds despite the peanut nazi sitting behind us. Her son never had a reaction. In fact, he was rather noisy.

Oh and by the way, the pretzels that were served on the plane had a warning on the label that said, “These pretzels were manufactured in a plant that processed peanuts.”

Mannequins, Manorexia and Metrosexuals

As if I didn’t have enough to worry about I recently read something that disturbed me. New York Magazine published some frightening facts about the male body image in their May 10th issue.

Did you know that the British mannequin maker Rootstein debuted their latest male form – the “Homme Nouveau,” feminized and less than beefy with a 35-inch chest and a 27-inch waist?

27-inch waist!

I read this on my way to Alabama where I was later verbally assaulted by my two nephews all weekend. Now well into their teens and taller than their uncle Frank, I was called shorty short and worse. As if I didn’t have enough to contend with, I now had to recon with my expanding waist line, short stature and apparently robust 40-inch chest.

Can anyone say, “Hobbit?” Well, my eldest nephew Matthew can and he did, all weekend. It was enough to send me into the bathroom in tears ready to purge, but wait things are worse than I thought.

Rootstein changed their mannequin design in response to the effect of metrosexuality. This term coined by the British writer Mark Simpson, in 1994 who was referring to a growing trend among heterosexual men who were paying way too much attention to the way they looked, acted and dressed. As a result designers began designing with metrosexuals like David Beckham in mind and alas a new fab was born. Men began picking, preaning and plucking themselves down to the nubbings. This overly conscious attention to our bodies led to an affliction of unrealistic body proportions. The likes of which were only seen among women who have been suffering with poor body image for ages.

Years ago I wrote about manorexia, a growing trend of eating disorders that predominantly only affected women, which were now seeping into the XY chromosome world. Men like Dennis Quaid, an admitted manorexic, admitted to binge eating. Like so many of my own patients, eating disorders are increasing, particularly among gay men.

40% of binge eaters are men.

In 1990, men made up 10% of the population with an eating disorder. Now they make up 25%.

What does this say about our culture? I can’t say for sure. I just hope Chad doesn’t come home one night and find me stretched out on one of those racks from the days of the Inquisition trying to stretch my diminutive frame so that I can get at least one or two inches before my failing body shrinks even further as I age. I mean I could diet more to get down to a 29-inch waist but that’s not likely to happen, not with my eating habits and Italian background. I predict more men will become depressed by these statistics and ask me for diet pills. And oh how I hate that.

So I guess that means more water and Tic Tacs for me and back to wearing lifts in my shoes even though they hurt my feet. James Cameron truly is a visionary. He predicted we will all want to be skinny, tall and blue in the future. Blue! Oh please not that. I can’t worry about my complexion too. I guess I will have to settle on short, stout and olive skinned.

Delta dog

This coming Fourth of July Chad and I are planning to head back down to Alabama to visit my sister and her family at their lake house on Smith Lake. It’s about a two-hour drive from the airport but worth every second. The house is located in an isolated section. Weekend activities include wake boarding, swimming, and barbecuing. I go every year and last year was the first time Chad and I went together. We had such a good time that we promised to make the trip every year. Well, I had my fingers crossed behind my back so it was a soft promise.

This year we were planning on bringing Hoffman. He would love running around unleashed, and it would be the first time he swam in water not from a bath tub. On our last trip to Alabama we flew Delta. So I looked up on-line what the regulations were for flying with a pet. Apparently, Hoffman is too large to ride in the cabin with me because he is nearly 35 pounds and wouldn’t fit in a kennel under the seat in front of me. The rules state that Hoffman would have to be placed in a kennel and then stowed below the cabin with the luggage. Of course I am hesitant. I don’t want to put my baby in a cold, lonely cabin with luggage. I want him next to me with his seat belt fastened over his chest, watching movies and sipping Bloody Marys. Chad and I discussed it and after much debate we thought it would be worth the trouble because Hoffman would have such a great time outdoors with the kids. So we decided we would sedate him for the journey, and of course, me as well. Otherwise Chad would kill me during the flight especially if we got held up on the tarmac.

But then I read the most horrible story. 

 

Josiah Allen says his dog, Paco, didn’t make it home in Seaforth, Canada from Mexico. Paco was transported in a kennel below the cabin in the luggage compartment. Delta Air Lines says the dog escaped from a carrier on the tarmac.

“I am hopeful that Delta will be able … to locate and retrieve Paco and that he can come to my home and be loved and cared for,” Allen said.

A Delta spokeswoman, Susan Elliot, said Paco broke out of a dog carrier at the airport in Mexico City, Mexico, on May 3. “Our staff have conducted exhaustive searches to locate the dog,” she said. Unfortunately, they have still not been able to locate Paco.Delta has offered its “sincere apologies that we have been unable to recover the dog,” Elliot said. “The airline has compensated Paco’s owner and offered to reimburse all expenses associated with the dog.”

Reimburse them? How much money does it take to reimburse the love you have for your dog?

When the plane landed in Detroit, Michigan, Allen said, the dog was gone. Delta contends that they couldn’t recall another instance when a dog got lost while its owners were in transit. “This is extremely rare,” insisted Elliot.

I should hope it is rare. How do you lose a dog? How many dogs were on the plane? What is Paco some kind of doggie Houdini? I’m sorry but something is rotten in Denmark and eventually, I fear, we are going to hear that the remains of a dog were found in someone’s Louie Vitton bag.

My prayers are with Josiah Allen and his dog Paco. May you two be reunited again soon.

Beyond Betrayal

Woody Allen needs to shut up.

While in Cannes the old fart decided to add his two cents to the Roman Polanski controversy. “It’s something that happened many years ago,” Allen said of Polanski’s sex scandal during an interview with French radio station RTL. “He has suffered, he has not been allowed to go to the United States. He was embarrassed by the whole thing.”

Embarrassed!

I’m sorry Woody. I’m really sorry this sexual predator pleaded guilty to having sex with a 13-year old girl in 1977 after admitting to drugging her. Polanski is now fighting extradition from Switzerland to the United States. It must be embarrassing for him not to mention embarrassing to the United States for allowing him to flee. We should all be so upset for Mr. Polanski. I mean he’s paid his dues. Right? Whatever that means. Woody Allen’s two cents are about as worthless as having KKK members suporting Adolph Hitler. Wasn’t Woody Allen the man who seduced his long time partner’s own adopted daughter?

Yes, we should all listen to Mr. Allen because he is a pillar of morality and ethics. Sure he, like Mr. Polanski, have made tremendous works of art, and there lies the conundrum for me. How do I judge the man as a person who has provided me with some of the most influential pieces of film I have ever had the opportunity to see?

The answer is I don’t. I’m not a judge and neither is Mr. Allen. So stick to making films, and I’ll stick to taking care of patients. But as a victim of child molestation I can tell you that time does not heal all wounds. Mr. Polanski’s victim openly states she wishes the whole case be put to rest. She also settled for an undisclosed amount. And for the record, she doesn’t get to make that decision either. The courts do. I wonder if Mr. Allen knew another victim has come forward with allegations that Mr. Polanski allegedly abused British actress, Charlotte Lewis -  “in the worst way possible” when she was cast in one of his movies at 16?

Woody Allen should shut his face. Why don’t you ask Mia Farrow what she thinks of all this? Ask her how she felt when she found erotic photos of her adopted daughter Soon Yi-Previn taken by you, the upstanding film director who apparently feels that justice is served by spending time in exile in Paris making films and should be absolved when the abuser is sufficiently embarrassed.

Art Therapy

 Artist, Mark Ryden “Incarnation”

The Chelsea district of Manhattan has become the leading center for galleries, hosting openings on Thursday evenings. The Spring is a wonderful time to gallery hop, and I feel fortunate to live here.  My favorite artist whose work has been described as low brow surrealism is Mark Ryden. His works often includes young girls with enormous eyes. His latest collection entitled, The Gay 90′s, was recently featured at the Paul Kasmin Gallery. I had the pleasure of meeting the artist at the opening.

This past Thursday Chad and I visited several galleries.

 Artist, Sophie Jodoin “Indelible Memories”

Chad in a Chelsea Gallery hall

  Artist, Mark Ryden “Josephine”

Art has always played an important part of my life. In my 20′s, I even entered into art therapy as a way to deal with depression. I don’t paint very much anymore, but I do sketch constantly.

Excision of Squamous Cell Cancer of the chest

Recently I’ve begun to photograph patients (with their permission of course). Looking over some of the photos I’ve taken as well as some of the photos I took visiting galleries, you can definitely see where my eye wanders. I believe in the therapeutic power of art, whether it is painting, photography or even attending theater. It provokes thought and hopefully inspires you.

So treat yourself to the theater or visit a gallery.

Over 40 and pregnant

I’m concerned by a growing trend among female celebrities who are having children well into their 40′s. I think they’re sending a message of false hope to young women that having children later in life is as easy as Linsey Lohan avoiding prison.

Television lawyer, Nancy Grace, actresses Geena Davis and Holly Hunter all had twins at 47 years old. Al Pacino fathered twins with actress Beverly D’Angelo when she was 49, and most recently, John Travolta and his wife, Kelly Preston, age 47, are about to welcome a new edition to their family.

The birth rate for women age 40-44 increased 4 percent from 2007 to 2008, according to the Centers for Disease Control and Prevention. Contrast that to the birth rate for women below age 40, which went down as much as 3 percent from 2007 to 2008.

The March of Dimes and the American College of Obstetrics and Gynecologists published the following statistics:

Higher risk of miscarriage

At age 20: 1 in 10 women
At age 35: 1 in 5 women
At age 40: 1 in 3 women
At age 45: 1 in 2 women

Higher risk of any chromosomal disorder

At age 20: 1 in 526 births
At age 30: 1 in 385 births
At age 40: 1 in 66 births
At age 45: 1 in 21 births

Higher risk of Down syndrome

At age 25: 1 in 1,250 births
At age 30: 1 in 1,000 births
At age 35: 1 in 400 births
At age 40: 1 in 100 births
At age 45: 1 in 30 births
At age 49: 1 in 10 births

At birth a woman is born with all her eggs. As a woman ages, so do her eggs. It is a commonly held belief that for a woman to conceive naturally after age 45 is next to impossible. So then how did these women do it? The answer is simple: in vitro fertilization (IVF).

IVF involves combining eggs and sperm outside the body in a laboratory. Once an embryo or embryos form, they are then placed in the uterus. IVF is a complex and expensive procedure; only about 5% of couples with infertility seek it out. However, since its introduction in the U.S. in 1981, IVF and other similar techniques have resulted in more than 200,000 babies.

The clue that most celebrities in the forties are conceiving with IVF is that they are having multiple births, in most of these cases, twins. The chance of any of these women giving birth at their age without in vitro is unlikely. Yet, many of them do not disclose how they conceived.

Why?

I don’t know and there lies the problem.

IVF is not without consequence. It’s expensive. Sometimes it can take multiple attempts before a viable fetus comes to term, and these women have to endure hormone therapy which can affect mood and personality. But more importantly, IVF is really available only to those who can afford it.

The beauty that is motherhood

Also there is the risk of multiple viable embryos. The most famous cases: Kate Gosselin and Nadya Suleman. Many couples have some of the embryos terminated in order to avoid multiple live births.

A vision in stretch marks

Recently, Sarah Jessica Parker had a surrogate carry her twins. I am going to go out on a limb but my Spidey senses tell me that she probably didn’t use her own eggs. Sure it’s possible that she had viable eggs. They would have had to been harvested and then fertilized in vitro with her husband’s sperm. Then implanted into the surrogate. I suspect that the likely scenario is that she purchased healthy eggs and then had them fertilized by Matthew Broderick’s sperm before implantation into the surrogate. It is also possible that Ms. Parker had her eggs harvested years ago with the foresight that she might want to use them later. Many couples harvest eggs, have them fertilized and then frozen for future use. I read that Celine Dion’s husband Rene had his sperm banked prior to radiation therapy so that they could attempt to have a child in the future.

My sister had all four of her children starting in her late 30′s. She had them all naturally and without in vitro. Thankfully, they are all healthy. She told me the benefit of having children later in life is that she was able to become established in her career. Also she felt that she and her husband were more financially secure when they were about to start a family.

I think having children at any age is courageous but the media and doctors need to be very clear that in vitro, harvesting eggs and surrogacy are all very expensive options that are not covered by insurance in most states. Hell, surrogacy is not even legal in every state. Yet, once a woman has delivered multiple births, the care for these babies is covered by insurances and most times, the babies are born prematurely. Do you know what kind of cost those kids incur before they are ready to leave a hospital? Let’s just say they could pay for college with that money.

BTW I don’t have any children and if I was going to, I’d adopt like Sandra Bullock but without Jesse James as the father.

Hoffman’s Birthday

Hoffman turned one on May 25th. Incidentally, my sister Maria shares the same birthday.

Clay Aiken

I suppose you could say I am a bit of a celebrity stalker.

A year ago I was getting out of cab on Fifth Avenue and as I was paying the driver, I heard the distinct sound of one of our greatest living actresses. When I turned around, I saw Meryl Streep walking by with with her daughter. Immediately, I threw some cash at the driver and followed Ms. Streep. She was on the phone talking. Her daughter was busy texting someone and no one else seemed to notice that the woman who won an Academy Award for Sophie’s Choice was in our midst. It was mind-blowing. Immediately, I took out my cell phone and pretended to talk into it so that I could continue following her but not look like I was following her. Then I had the brilliant idea to take her picture with my phone. So I deftly activated the camera and began blindly snapping photos of Ms. Streep. Horrible. I know. When all three of us arrived at Fourteenth Street, it dawned on me that I had turned into something of freak, following this poor woman and snapping unauthorized photos. So I put my phone in my back pocket and walked away. Later, I realized I’m no Annie Leibovitz because all the photos were of the sidewalk.

That December, my sister and her family visited from Alabama. As a Christmas gift, I took them to see Spamalot on Broadway after I heard they were big fans of the film, Monty Python and the Holy Grail. A friend offered us house seats with the added bonus of taking my family backstage. Clay Aiken, the runner-up to American Idol was starring in the Spamalot at the time. He had just come out as gay and so my lunatic brain had the crazy idea to wrap my book, Advocate Guide to Gay Men’s Health and Wellness and if I was lucky enough to run into Clay, that I would offer it to him as a gift.

The show was spectacular. The kids and my sister and brother-in-law loved it and directly after the curtain went down, we were escorted backstage for a guided tour. The kids were in awe, seeing the inner workings of a stage show. Just as we were about to exit, I heard screams coming from the stage door, and lo and behold, there he was – Clay Aiken. I gasped but immediately went into action. I walked casually up to Clay and in a calm voice said, “Mr. Aiken, I think you’re great. Merry Christmas.” With that I handed him my gift wrapped book. He accepted and thanked me.

Cut to yesterday, when my good friend Larry Flick, host of the Sirius radio show, Morning Jolt, emailed me early in the morning to brag that he was going to interview Clay Aiken. Larry knows I am a stalker, so I told him my Clay Aiken story. Of course, he had a good laugh on my behalf and so I hung on him.

That afternoon, Larry paid me a visit in my office. He told me all about his interview with Clay Aiken and what a delight he was. Then he told me that he had a surprise for me. “Close your eyes,” he said. I did; and when I opened them, this is what I saw:

It's signed to Dr. Frank

Larry said he asked Clay if he remembered receiving a book from a crazy doctor. Clay did not recall being assaulted by me back stage but he did say that he saves every gift he receives, and that he would check when he got home.

Imagine that?

In any case now Clay and I have exchanged autographs copies of our work.

Alert the geek squad. I need counseling.

Oil Spill

 

I follow the daily updates of the oil spill going on in the Gulf of Mexico much like when I was eight years old, and I watched the Wizard of Oz from from behind my father’s chair. Every so often he’d say, “Okay you can come out now the witch is gone.” Then I’d peak my head around and see if he was telling the truth. When the coast was clear, I’d sit by his side, terrified, waiting for that evil witch to rear her ugly green face again. BP has now replaced Margaret Hamilton in my nightmares; except now black sludge has replaced green grease paint and poppy fields are floating discs of oil.

BP CEO Tony Hayward

BP won’t say how much oil is in the reservoir below the failed well, saying it is too early in the exploration process to make such estimates. The president of American Association of Petroleum Geologist estimates that it is at least tens of millions of barrels. If the well was left unchecked, it would flow for years, he said. Deep sea offshore wells generally produce oil for 5 to 20 years. Ultimately, the reservoir would stop flowing not when it ran out of oil, but when the pressure above it (from 18,000 feet of water and drilling fluids) was greater than the pressure in the reservoir itself.

As the oil continues to leak, the danger is it will soil more sensitive Gulf marshes, he said. Worse, it could head to the Florida Keys, ruining the most pristine coral reefs in the United States — a prime breeding ground for hundreds if not thousands of species.

Beyond the Gulf, there is a danger the oil could get caught up in the Gulf Stream, which would send it up the eastern seaboard and ultimately end up as far north as Maine.

All of this would impact local economies and wildlife.

I pray every night for a miracle, hoping that some wizard will come up with a solution that will end this disaster as BP’s flying monkeys swirl around the well aimlessly trying to get it from flowing oil. Right now best estimates say the oil will flow well past August.

Father’s Day

On this Father’s Day I’d like to take a moment to remember my dad, Angelo, who passed away last August. I hate to admit it, but over the past several months, there were times when I forgot he isn’t around anymore. One day I was watching television, and I saw commercials urging me to buy that special gift for my dad and suddenly I was reminded that he is no longer alive. My best friend Eric lost his dad 22 years ago. He died suddenly from an aortic aneurysm. On the anniversary of his death, Eric called me. He told me I was now a member of a special club: men without fathers. We both laughed nervously but the truth was that we now shared something else in common.

I urged my mom to come into the city today. I didn’t want to go to my house and see the chair where my father sat or see his jacket hanging in the closet in the foyer. My mother didn’t want to come into the city. She said she would feel out of place. Fortunately, she thought twice and finally agreed. I don’t know what it must feel like to be single again after 50 years. My father needed her so much and now she had no one to dote on.

So to everyone out there who still has a father, make sure you call him or even send him a card.

Chad and I recently went to see the John Wesley exhibit in Chelsea. He is classified as a Pop artist, a label that sat uncomfortably. “But I accepted it because it got me into a lot of shows,” said Mr. Wesley. He has also been called an insurgent Minimalist. Here are some photos I took of his work.

Child Sexual Abuse

I’ve avoided speaking publically about child sexual abuse, but now I think it’s time.

In 1978 I was molested by my Scoutmaster for nearly two years. I was molested along with many other boys. When I told my parents, my Scoutmaster stepped down. No charges were brought against him. Because he was also a highly decorated police officer, I think my parents feared him.

Thirty years later, I discovered he wrote a memoir recounting the events that led him to adopt a suicidal teenage boy in 1982. I was on a book tour promoting my own book, Advocate Guide to Gay Men’s Health and Wellness in 2008, when I discovered it on-line. I was able to track down his sister through his book. She put me in contact with my former Scoutmaster. At that time, I did not confront him about the molestation, but what he told me was so shocking that I felt my whole world was crumbling around me. Since 1982 my former Scoutmaster adopted a total of 15 boys. He still has three in his care today.

I then contacted the police. We wired tapped two conversations with my Scoutmaster and presented the case to the District Attorney’s office where he now resides, but they have not been able to charge him because they said that there have been no complaints made against him by a minor.

Due to the current Statute of Limitations, they can not arrest my former Scoutmaster based on my claim alone.

I’m concerned because he still has three children in his care, and I have reason to believe that they may be mentally handicapped.

I feel helpless. I live day to day thinking that this man still has children in his care. I think about all the boys he’s molested throughout the years. I’ve met with several who are now adults.

Something happens to a child when an adult betrays their trust and exploits them for their own personal gratification. The ramifications of child sexual abuse live on throughout adulthood.

It is known that 90% of child molesters are someone the family or the child knows. I urge parents to be careful not only of strangers but to anyone who pays particularly close attention to your child. Look for signs. Once my Scoutmaster molested me, I started to wet the bed. I was eleven. This should have been a red flag.

Please don’t avoid the signs and listen to your children.

I’ve written a memoir about what happened to me in 1978 and the events that have transpired since 2008. It is currently being considered for publication. I hope my book will help others.

Surrogacy or prostitution

I’ve had many employees over my ten-year career. Most, if not all of them, were women. I usually hire women because the majority of the applicants are female. In the past, I’ve worked with two gay men, but they left me after several months for greener pastures. I suppose you could say I’m difficult to work for, although I try to elevate the mood with humor. But a doctor’s office is not always a fun place. It’s stressful and people are usually here because they’re sick.

I believe my receptionists do an amazing job, and the front desk staff has to put up with a lot.

One thing I have learned over the years is that many of the women who’ve worked for me have babies with men they are not married to. The baby daddy phenomena is something that eludes me. It’s like baseball or football. I kind of understand what’s going on, but I don’t follow it. 

I was  fortunate enough to be raised by two parents. Now before any of you think I am passing judgment, hold your comments until the end. I’m intrigued by the baby daddy phenomena because having a baby outside of marriage is something my parents would have murdered my sisters for. We grew up in a staunch, Italian Catholic family. If a girl got pregnant before she was married, she was a whore. My mother used to threaten my sisters by saying she would lock them up in a convent if she thought they were having sex. Of course, that didn’t apply to boys. My mother quietly warned me not to get a girl pregnant. (Of course, she didn’t have to worry about that).  

I think women are amazing. They can have children, and I believe there are women who can raise a child on her own. She doesn’t necessarily need a man. What confuses me are these men who have babies with multiple women. One of my receptionists told me her baby daddy had two other baby mammas. How many babies does one man need with different women? Is it ego that drives him? Does he need to procreate with multiple women to show his virility? None of these women get support from him. So what kind of father does that make him? Now I’m sure there are baby daddies out there that support their kids. It’s just that I’ve worked with several women, and they all complained about their baby daddies.  

I suppose you could say that I’m intrigued by people who want to have children at all. I never did. My sister Josephine doesn’t have children, but our eldest sister Maria has four. I love her kids. I guess in another time and place Chad and I might have adopted a child, but we’re so busy, and I just don’t see it in the cards for us. Plus we’re in our forties. I don’t want to be a 6o year old with a teenager. But that’s my crazy opinion.   Incidentally, my Maria won’t attend the wedding of a friend’s child because the bride happens to be pregnant (yet barely, if even, showing) because it might send the wrong message of condoning the act of sex out of wedlock to their children.

For the past several years I have been filling out medical clearance forms for gay men who are attempting to have children through surrogacy. This process involves sperm donation by one partner, buying an egg from a donor and then creating a baby through in vitro fertilization AND then implanting that egg into a surrogate who agrees to carry and deliver a child to you for a fee.   It’s amazing the lengths people will go to in order to have a child.

My friend calls them GAYBIES.  

What I find interesting is that there are women who agree to carry a fetus to term for a price. I suppose you could say she is doing something wonderful for a loving couple. Surrogacy is not legal in every state, and it’s expensive.  

My sister Josephine has a progressive kidney disease. I may need to donate a kidney to her. I won’t charge her for that kidney. Of course that is illegal.  

So my question is, why can a woman sell her uterus for money, yet when a woman tries to sell her vagina it’s called prostitution? Prostitution should then be legal in states where surrogacy is legal. In both these instances women are renting out a compartment of their body for a predefined time and purpose for a predefined price.

Vacation

I  returned yesterday from a long weekend in Playa del Carmen, which is 55 minutes from Cancun. This morning as I dressed, I had to unpack my toiletries and found sand amongst my toothbrush and razor. Then I remembered lying on the beach. The sun was so hot, I felt paralyzed by the intensity of its rays even though I was under an umbrella. The taste of salt from the Margarita I had been sipping parched my lips and the sound of the waves soothed me back to a place I had forgotten about. That strange sense of relaxation is something I have consciously avoided. Why?

I don’t know.

The project manager at Here Media is from Australia. She told me that in Australia everyone gets four weeks vacation every year. I barely take a week off once a year. And even when I take five whole days, I’m in a state of panic before I depart as questions cloud my mind: What do we do with Hoffman? What if something bad happens to one of my patients? Who will check the office and make sure it doesn’t explode while I’m away?

I envy those who make it a habit to make time for themselves. Not taking routine vacations does your body and mind a disservice. I suppose I’m like a lot of people who feel they need to be available twenty-four/seven. What is it about us that makes us feel compelled to be available? I think it’s pathological. This want to be needed. My friend Scott told me that when his partner Eric gets up to go to the bathroom in the middle of the night he checks his Blackberry. We both laughed at him but later as I walked home, I realized that I checked my own iPhone several times before I returned to my apartment.

We’re all guilty of it.

Chad didn’t bring his computer to Mexico and neither did I. He didn’t have cell phone service either, and after a brief panic, he felt an unusual sense of relief. I, of course, called AT&T and made sure I had service in Mexico before I left. So I was able to call the Puppy Loft where we boarded Hoffman and checked my emails daily. Okay, twice daily.

But then something miraculous happened after the first or second day. I found myself lying on a beach, slightly intoxicated by the sun, the waves, the tequila or maybe it was the music of the Cranberry’s song, Linger playing softly through the speakers at the bar that made me forget about everything I clung to so passionately as though my entire life depended upon it, and for five days I forgot about those things that seemed so important to me in my real life. To use a word my cousin Paul taught me, I felt transported. I was neither Dr. Frank nor son of Michelina Spinelli. I wasn’t the person who had to write a prescription for some poor soul in P Town who forgot his Valtrex and needed it ASAP because he had a date that night. No. I was none of those people. I was some anonymous male braising in the sun (under an umbrella of course) like a teenager at camp relaxing on the dock with my foot in the water and not a care in the world.

Then as the trip drew to an end, Chad and I were seated at some restaurant in the airport, sipping out last Margarita and eating our last tortilla chip before getting on the plane that was going to take us back to our “normal” lives. I turned on my phone to call Eric to make sure he picked up Hoffman from the Puppy Loft so that he would be waiting for us when we arrived. Suddenly, a text came through:

“My darling doctor. I’m at the Cape and of course in the midst of having a great time with some hot boy, the condom broke. This happened after he ejaculated. That’s when he told me he’s positive. What should I do? I have no luck with men.”

“What is it?” asked Chad.

I crinkled my toes and felt the annoying grit of sand in my sneakers. I closed my eyes and for a moment, I could still hear the Cranberry’s song drifting overhead like a scarf caught in the wind and as it drifted away across the sea, so did my memory of that life I had for five days.

“Just a minute,” I said to Chad as I typed a response to that desperate text. “I have to answer this.”

Gay Pride/Fourth of July

You think after ten years I would know better. Yet for some reason I forget every year. For all you non-gays, Gay Pride New York is celebrated the weekend before the Fourth of July. This translates into one very powerful one-two punch if you know anything about gay men and how they love to party. Unfortunately, I seem to forget this or go into some altered state of denial because if I was a good gay doctor, then I would stock up on intramuscular penicillin and ceftriaxone.

Why you ask?

On July 6th, my day consisted of a seemingly never-ending parade of penises and tushies. All day long, I performed genital and rectal exams on gay men who came in complaining of discharge or bleeding, pain or ulcerations, and my favorite, lost items of little known significance. By lunch time, I was so not hungry, I had to take the dog for a walk around the block in 100 plus degree weather just to shake the visuals out of my head.

Someone should really talk to the government about changing Gay Pride New York to another weekend or at least spacing those two holidays far enough apart to give those poor party hardy gay boys time to rest in between holidays. Seriously. I’m speaking not only as a concerned doctor but also as  earnest gay man myself. It’s too much to ask gay men to show some restraint. They obviously can’t help themselves. So instead of writing and preaching how we, as gay men, should abstain from all the sex, drugs and debauchery, I am going to propose the opposite. No, I’m not going to condone this Party On Garth lifestyle, even though I attended my own fair share of Pride events, but I do want you to take a moment to think.

So next year while your dancing under the hot sun remember these tips:

1. Drink plenty of fluids (And that doesn’t include GHB).

2. Eat something in between events (Yes, the shredded look of dehydration highlights your abs but passing out at parties is so not pretty).

3. Never share water bottles, lip balm or inhalation devices.

4. Carry a condom at all times.

5. And consult your doctor for the first signs of discharge, bleeding or diarrhea.

Thank God there are no other holidays this month.

Glenn Scarpelli

Growing up on Staten Island I loved to watch sitcoms. Long before the first reality show ever aired, shows like Alice, Good Times, The Jeffersons, All in the Family and my favorite, One Day at a Time, starring Bonnie Franklin, Valerie Bertinelli and Mackenzie Phillips, ruled the major networks. These thirty minute shows were like comedy nuggets filled with social commentary and coated in high jinks and sexual innuendo.

Of course I only cared about how Florence talked back to Mr. Jefferson or how Archie stood shocked when Sammy Davis Junior planted a kiss on his cheek.

All sitcoms subscribed to the same basic formula: conflict arising from a misunderstanding, which ultimately gets resolved in the end. Invariably, there was always a moment toward the end of each episode when the lead gave a monologue about how times were tough but as long as family and friends stuck together than anything was possible. Trite as that may seem now, I would give anything to watch an episode of Maude over Two and a Half Men any day.

I was in grammar school in the 80′s and attended St. Sylvester’s Elementary School for eight years. One day, Doreen Cirillo came in and bragged to everyone that her “good friend” Glenn Scarpelli had just been cast in One Day at a Time. Playing Alex Handris, he joined the cast in 1980 and immediately became Schneider’s little side kick and the thorn in Ann Romano’s side. Back then, as child actors grew out of their cuteness or left the show due to drug addiction, writers often added a young whippersnapper to cast in order to mix things up a bit. Sometimes it didn’t work out so well. Case in point, Oliver on the Brady Bunch, but Glenn was different. Right from the start he was animated, quick talking and funny. Eventually, he became a heart-throb, and I think he even graced the cover of Tiger Beat.

I immediately hated him. Why wasn’t it me who was chosen to be on my favorite show? Glenn and I are both Italians from Staten Island. So what he could sing, act and dance. Minor details. Of course, I had to concede defeat and watched the show anyway.

By some cosmic coincidence, thirty years later, I received a friend request on Facebook by none other than… yes, you guessed it: Glenn Scarpelli. It was surreal, like the time I met Mario Cantone on the street. I immediately accepted his invitation and included a little note. I wrote, “We’re both from Staten Island, and I went to school with Doreen Cirillo.”

Glenn wrote back and informed me that his partner and he started a line of lube called Green Love and Bite Me. Crazy huh? Imagine what Bonnie Franklin would say.

For more information go to GreenLoveLube.com.

I invited Glenn to be a guest on Out Q’s Morning Jolt with Larry Flick next time he’s in New York. He agreed. Two weeks later I received a package from the West Coast with several bottles of Glenn Scarpelli’s love elixir. Along with the package was a note. I held it in my hand,thinking back to the days when I watched sitcoms and bit my nails in jealousy over Glenn Scarpelli and now here I was, friends with him on Facebook and a box of his lube in my hands.

Notes from the front line 1

Patient X – I’m so pissed. I came home after the gay pride parade and my boyfriend, who was MIA for two days, was passed out in my bed, cracked out from a two day bender on crystal meth. When I woke him up he said he was out partying for two days at some orgy. I’m a good Catholic boy Dr. Spinelli. I can’t put up with this. I don’t want him near me. So I want you to check me for STD’s because today, when I woke up,  I felt some tingling down there.

Doctor S – Wait a minute. How long was he sober before this?

X – I don’t know. He lives in DC, but I had a feeling this was coming?

S – Why don’t you talk to him. You had your own crystal meth problem. Right?

X -But I’m sober ten years. I can’t be around this stuff.

S – But didn’t I just treat you for gonorrhea last month?

X – Yes.

S – So what’s all this I’m a good Catholic boy talk.

X – I’m not a pig like him. I have sex with guys but one at a time.

______________________________

Phone rings at noon on Sunday

Doctor S – Hello service

Service  - Can I connect you to this call?

S - This has to be good.

Service – The doctor is on the line. Go ahead.

Patient R – Hi doctor sorry to bother you but my stupid ass partner went out last night at some gay pride event at Roseland. He got home sometime this morning, slept a few hours and decided to head to the gym for a quick work out before the pier dance. I told him working out today is not going to make any difference but he didn’t listen. Well the stupid ass dropped a 45 pound weight on his foot. It’s all bloody now and he’s in pain.

S  - Well you’re going to have to take him to the ER.

R – Why?

S – Because it’s probably broken.

R – Oh (mumbles to himself, cups the phone and talks to his partner but I can still hear him) Doctor S says it might be broken and you should go to the ER…….No, you can’t go to the pier dance…..No, you get a cab and go to the ER yourself. My Gay Pride is not going to be ruined by your stupidity. I’m going to the pier dance. No, this is not like the time you went with me to my mother’s house.

I hang up.

____________________________________________

Hair loss

In the August 2010 issue of Men’s Health there is an article entitled, Can I make my Rogaine Work better? The writer references a Korean study that showed “spiking” Rogaine with Retin-A, the topical cream FDA approved to alleviate fine lines and wrinkles,  made the hair potion 25 % more effective. The article went on to suggest that pharmacies would compound custom the make mixture with the caveat that it would not help you grow hair but keep the hair you have. In order to grow hair, you need finasteride, which is the active ingredient in Propecia, the only FDA drug approved for hair growth.

The article states that in order to save money, ask your doctor for Proscar, which has 5 milligrams of finasteride versus Propecia’s 1 milligram. The FDA only recommends 1 milligram for the treatment of hair loss. Men’s Health writer advices readers to quarter the pill with a pill cutter taking one-fourth a day. Incidentally that would still amount to more than the FDA’s recommendation. The data showes that 3.8% of men taking finasteride 1mg experienced some form of sexual dysfunction verses 2.1% in men treated with a placebo. The five-year side effects profile includes: decreased libido (0.3%), erectile dysfunction (0.3%), and decreased volume of ejaculate (0.0%).

Proscar is FDA approved for the treatment of enlarged prostates or what is referred to as benign prostatic hyperplasia (BPH).

Patients often ask me to write them prescriptions for Proscar so that their insurance will cover the cost instead of paying for Propecia out-of-pocket, which is the case, since most insurances don’t cover medications indicated for hair loss since it is considered cosmetic.

My concern is that in writing a prescription for Proscar labels the patient as someone with BPH. This is difficult to explain to pharmacies and insurance companies particularly when prescribed for someone younger than forty years of age. I recall one instance in which a patient was prescribed Proscar by his physician for hair loss but when he applied for life insurance the interpretation was made that he had BPH and thus a pre-existing medical condition.

Hair loss for men is a very sensitive subject. It is as important as erectile dysfunction but splitting ends by utilizing generic brands like Proscar, so you can save money, may cost you more in the end.

Notes from the front line 2

July 12th 8pm. Phone rings. It’s the service.

Doctor S – Hello service.

Service – Doctor we have a Mr. L on the line. Can I patch him through? He says it’s an emergency.

S – Of course.

Service – The doctor’s on the line.

L – Hello, I waiting for the doctor.

S – Yes, this is the doctor.

L- Hello, who are you? I’m waiting to speak to the doctor. It’s an emergency.

S – L, it’s me, Dr. S. What’s the problem? Is everything okay?

L – Oh, Dr. S? Is that you? How did they do that?

S – The service connected you. What’s seems to be the problem?

L – Oh, doctor S. It’s you. That’s so wierd. Well, I have this problem you see. I’m having a problem with my erections. It seems I can’t maintain them. I have an appointment to see you on Wednesday, but I thought I should call you.

S – It’s 8:00 at night. There’s really not much I can do for you at the moment. Did you tell the service this was an emergency?

L – Yes, I wanted to be sure I talked to you before I saw you on Wednesday. That way you would be prepared.

S – I appreciate that. Thank you. Why don’t we just discuss this on Wednesday then?

L – Okay doctor. Thank you for speaking to me.

S – Is there anything else?

L – No that’s it. Thanks. See you Wednesday.

hang up.

_________________________________

Medical Assistant, Juan, hands Doctor S a new patient chart. Dr. S walks into the room and finds new patient SJ.

Doctor S – Good afternoon.

SJ – Hello.

S – After I ask you a few questions, I’m going to need you to take off your clothes, except for your underwear and put on this gown.

SJ – Oh, no. I aint’ had my hair done, my nails done, or my toe nails done.

S – Well, this is an initial consultation. What did you expect?

SJ – I don’t need a consultation. I just need my prescriptions refilled.

S – Well, that’s not how it works. First, I take a history, and then I perform a full physical exam.

SJ – Then why do you need me to take off my clothes?

S – You have to undress so that I can examine you.

SJ – I don’t need you to perform a physical. I just need my prescriptions. So get out your pad and scribble down these names I wrote here on this piece of paper.

S – Mrs. J I understand but that’s just not how it works. So if you want your prescriptions, you’re going to have to answer some questions, and then you’re going to have to allow me to examine you.

SJ gets up, grabs her purse and storms out. As she leaves, I hear her mumble: They charge you 20$ copay and then ask you to undress. These doctors should pay me if they want to see me nekked.

Mosque of the Red Death

If you’d have told me a month ago that I would agree with former Alaskan Governor Sarah Palin, I might have bet you a million dollars that you were dead wrong. Thank God no one did because earlier this month, Sarah Palin posted a comment on twitter with regard to a mosque planned near Ground Zero. “Peaceful New Yorkers, pls refute the Ground Zero mosque plan if you believe catastrophic pain caused @ Twin Towers site is too raw, too real.”

I can understand why she would be opposed to the mosque. Like most people who lived through the experience, particularly those traumatized by this tragedy – firefighters, police officers, survivors and those who lost family and friends - might not approve either. Initially, when I heard of the plans, I was outraged. Build a mosque near Ground Zero? We can’t let them get away with this. And by they, I meant Islamic radicals. During a local news report about the proposed mosque, a project referred to as Park51, an Islamic woman shouted at opposers during a town hall meeting, saying that Ground Zero is now sacred ground. 

It isn’t sacred, I thought. It’s desecrated.

Upon further investigation, I learned that at the center of this controversy is a plan to build a 13-story project a few blocks away from Ground Zero that will house a mosque, a gym and a community center for several groups, including the American Society for Muslim Advancement and the Cordoba Initiative, which promotes cross-cultural understanding between Islam and the West. Daisy Kahn, a spokeswoman for the group said, “We agree with Ms. Palin that it is time to heal from the wounds of the tragic events of 9/11. We peace- loving Muslims have a responsibility to lead the effort of rebuilding Lower Manhattan. We envision a community center for multi-faith collaboration that is focused on promoting integration, tolerance of difference and community cohesion.”

Mayor Bloomberg weighed in on the controversy saying, “Government should never — never — be in the business of telling people how they should pray, or where they can pray. We want to make sure that everybody from around the world feels comfortable coming here, living here and praying the way they want to pray.”

As a gay man, I often confront intolerance especially when it comes from religious organizations who tell me how I should live. I suppose I should practice tolerance more often when it concerns non-gay issues. I’m still not totally convinced they should erect a mosque near Ground Zero, but at least now I know I don’t agree with Sarah Palin.

Notes from the front line 3

Jim – Doc, I just want to lose this (grabs a fold of fat around his belly).

Dr. S – You need to diet.

J – Diet! I’m 5’9” and 160 pounds. How much weight do you want me to lose?

S – You don’t need to lose weight. You need to watch what you eat. Too lose that, you need to cut out carbs.

J – I cut carbs.

S – Yeah, you cut carbs with a knife and then stick them in your mouth.

J – I want steroids.

S – Absolutely not.

J – Come on doc. I’m single and 50 years old. I need to get in shape in order to stay in the running with all these young guys.

S – You’re single because you want to be.

J – No. Seriously. I want to be in a relationship, but all the guys I meet don’t want to be in a relationship.

S – That’s because you’re meeting guys on-line. Right?

J – Yes, but I’ve met some great guys on-line.

S – You mean you’ve had great sex with guys you’ve met on-line.

J – I’m dating a guy now I met on-line.

S – Let me ask you a question? Are you one of those guys who has to have sex first before you date them, like taking them out on a test drive.

J – Yeah, what’s wrong with that? The guy I’m dating now is nice. The sex is okay, but I have fun with him. The only problem is that he’s in recovery for alcohol and crystal. And to top that, he’s gluten-free. I’m like man, you gotta give me a break. At least let me have one.

Anabolic steroid abuse

Steven denies using steroids but comes in complaining of decreased sex drive and an inability to maintain erections. His testosterone level is 98. Normal for a healthy 40-year-old male should be between 400- 500.

Using a trick I learned from Oprah, I lean in; and while maintaining direct eye contact I ask, “Are you sure you haven’t used any anabolic steroids?”

Steven stares back at me nervously and offers a weak smile. “Well, I did do a short cycle of Winstrol two months ago, but Winstrol isn’t a steroid.”

“Oh really? What is it then?”

“It cuts you up and makes you lean. I wanted to look good for the summer.”

Muscular Dysmorphia or Reverse Anorexia Nervosa is a particular psyche issue that predisposes some men into chronic androgen abuse and addiction. These men perceive themselves as small even when they’re muscular and hold unrealistic goals about size and strength. After a cycle of steroids, these men go into androgen withdrawal. This period can last months to years, with accompanying depression, emotional lability and loss of libido.

Chronic androgen use may ultimately lead to permanent suppression of normal testicular testosterone production.

Women of Rock

What was it Sandra Bernhard said in her one woman show?

“Gimme a good ole big tittie woman of Rock n Roll.”

I couldn’t agree more.

Growing up I listened to Bat Benatar, Joan Jett and of course, Heart. These women are Rock n Roll icons, and like Sandra Bernard continued, “They lived it. They snorted it. They fucked it.”

This past weekend I revisited my youth by watching the Runaways, the movie based on the band of the same name, starring Dakota Fanning and Kirsten Stewart. This all-girl band was the first of its kind. Unfortunately, the lead singer Cherie Curry dropped out, but Joan Jett went on as a solo artist with her band the Black Hearts. The Runaways, directed by Floria Sigismondi, the Canadian artist/director who is known for her work with Marilyn Mason, did a great job capturing the innocence of the 70′s.

Storm Large with her band

Saturday night, Chad and I went to Joe’s Pub to listen to Storm Large. (Yes, that’s her real name). A stunning woman who looks like Lindsay Lohan but sings like Alice Ripley on crack. Standing nearly six feet tall, she is an  amazon woman of Rock n Roll who more people should know about. For over ninety minutes she took us on a musical journey of her “fucked up” life (a word she uses and sings about often). Storm will take you by storm, and she is not for the squeamish, singing about sex, drugs and fisting. I kid you not. So listen up all you Pink and Lady Ga Ga fans: you want to hear an amazing voice; step into Storm’s world. Rock n Roll saved her life, she told the audience, from heroin and abusive men with cocks like pepper mills.

Then she went into an amazing cover of Bat Benatar’s, Heartbreaker, followed by a twisted Alice Cooper rendition of Olivia Newton-John’s,  Hopelessly Devoted to You. She ended her set with her own hysterical song, My Vagina is 8 Miles Wide. “A place”, she sang, “where you can run and hide. It’s Vi-gantic!”

I hope she returns from her trip abroad and settles somewhere in New York. Off-Broadway is my prediction.

And finally Chad and I will end our musical journey of the woman of rock by taking in Ann and Nancy Wilson from Heart, at the Hammerstein Ballroom on Tuesday. I can’t wait.

Q Talk

I will be a guest on Q Talk, Saturday, August 21st, 2010 at 9:45pm at The Metropolitan Room in New York City (34 W 22nd Street between 5th and 6th) with Scott Ryan, Billboard Recording Artist, Jason Antone, and Dr. Frank Spinelli.

“Forget “The View.” Qtalk, often described as “the Gay View” is much more fun, sassy and over-the-top. At the same time, Qtalk deals with very real issues, but manages to be entertaining and engaging.

Qtalk’s live talk/variety show format is led by four hosts, theater veterans Joseph John, Frantz Hall, Stacey Todd Holt, and Angie McKnight. The hosts tackle current events, fitness and lifestyle, punctuated by guest performances from Broadway, Cabaret, and the Pop world.

During the show, the hosts invite the audience to ask questions or offer their opinions on specific topics on the table, often leading to some lively discussions and perhaps opening some minds.”

Accidents will happen

Chad traveled to Chicago to attend a meeting. It’s all he thought about for the past few weeks. I heard him get up at 6 am today and I think I said, “Safe travels.” I can’t remember. It was early and I was still snuggling my comforter in some hazy state of REM sleep. The rest of my day went on as usual: opened the office, saw patients, fed the dog, drank coffee and then saw more patients. At one point I heard Lesley, my assistant, say, “It’s Friday night,” as though she was banging her weekend warrior gong. At that moment I thought to myself, “Yeah, it is Friday.”

So I called my BFF Eric.

“Hey Eric you wanna hang?”

“Sure,” he said. “Come on over Mickey. We’re gonna have a party.”

So I closed up shop, leashed up the dog and strutted down Eighth Avenue wearing my beige suede shoes, one foot in front of the other, until I got to Eric’s door. I rang the buzzer, rode the elevator up and there we were: two middle-aged men ready for big night on the town or in this case, ordering take out and watching a movie. His partner was in Long Island visiting his parents. So we felt like two single girls. At one point Eric said to me, “I need to get a copy of Gotham magazine. I jumped right up and said, “Let’s do this.”

We took to the streets walking up Seventh Avenue and low and behold, Mr. Hoffman decides to take a pee. So I stopped, and then I heard a screech. When I turn around I realized Eric had been hit by an SUV. Time slowed down. Eric got up. I latched the dog leash to a nearby post. I quickly assessed Eric. He’s was in shock, but I didn’t find any overt injuries. Within seconds a fire truck, ambulance and a police car arrived. Various strange people were talking to us. I found myself slipping into the shadows like a ghost. I told myself, “Let the EMS and the police do their job.” The driver, by the way, was wearing an eye patch. Eric refused to go to the ER. So we went home. In his apartment, I iced his back, medicated him with a Vicodin and examined him again. No bruising, no palpable deformity. “Okay,” I told myself. “Your best friend is alive.”

“Safe travels,” I reminded myself thinking of Chad.

Later the pain became too intense for Eric so we headed to Beth Israel’s ER. There he was examined, X-rayed, and assessed for internal damage. Luckily, everything was negative. I called Chad. He made it to Chicago safely. He was nervous about his presentation. So I told him he’ll be great and that I loved him.

At home, I couldn’t fall asleep. I wondered about life. Had I not stopped so that Hoffman could pee, would I have been struck or worse, what if Hoffman got hit by a car? Life is so fleeting. It can end in an instant. I took a sleeping pill and tried to watch an old Katherine Hepburn movie.

Suddenly it was 2:30 and the phone ran. Is Chad okay? No, it had to be Eric.

Service: Doctor this is an intern at NYU. I want to inform you that your patient RB passed away this evening.

(RB had been my patient for many years. I took care of him and his partner.)

Doctor S – Where is his partner?

Service – I’ll connect you.

Doctor S – Ronald is that you?

Ronald – Frank he’s gone. He was having a bad week. I went to get the nebulizer ready, and when I returned to the bedroom, he was gone.

Safe travels, I reminded myself.

I almost lost my best friend tonight. I did lose one of the sweetest patients I have ever known and I can’t make sense of any of it.

Dr. Frank’s 5 Health and Wellness Tips

1. Get a complete physical exam, especially if you are over 40 years old.

2. At that exam have your healthcare provider check: Cholesterol, blood pressure, height & weight, urinalysis; and if you are sexually active without a monogamous partner, ask for STD screening to include HIV, gonorrhea, Chlamydia, and syphilis.

3. Exercise at least 4 hours a week with weights and aerobic exercises

4. Know your family history, particularly as it pertains to genetic diseases and premature history of coronary heart disease, colon cancer, prostate cancer and breast cancer.

5. Know that the two most important modifiable risk factors for heart disease, stoke and cancer are smoking cessation and weight modification.

German pop star convicted

German pop star, Nadja Benaissa, was found guilty on Thursday of causing grievous bodily harm to a man who contracted HIV after having unprotected sex with her. In addition to a two-year suspended sentence, Ms. Benaissa was ordered to perform 300 hours of community service. Benaissa had faced up to 10 years behind bars.

The 28-year-old singer admitted that she concealed her HIV status from two other sexual partners. Several German magazines called the trial a “witch hunt” and thus disguising the fundamental issue that these men should have taken responsibility and used condoms.

In her testimony, Ms. Benaissa addressed this issue, “I also thought that my respective partners also bore some of the responsibility to talk about and contribute to preventing infection by using condoms. In this respect, I neglected my own responsibility. Today I have to admit that this was a big mistake on my part.”

Chad and I were drinking coffee this morning as he read the updates from a news website. Professionally, I am often asked when is it the right time to tell someone you’re HIV positive? My answer is, before you have sex with them.

Do I believe that everyone should protect themselves? Absolutely, and as Ms. Benaissa said in court, “My respective partners also bore some of the responsibility to talk about preventing infection by using condoms.” However, the issue of disclosure is often lost in between these two ethical beliefs. My concern is that Ms. Benaissa knowingly engaged in unprotected sexual intercourse with more than one man without warning them that she had an incurable disease. She lives in a country where that is illegal. So in this case, non-disclosure is a crime. More importantly than the community service, I would suggest she undergo psychological counseling. There seems to be a particularly sadist quality to her actions. Think about it. She engaged in unprotected sex knowing she was infected.

Chad said, “But what about the guys? They should have asked her. They didn’t want to use a condom. They are just as responsible.”

I do agree with Chad wholeheartedly. Both sides of this argument are valid, but often what happens is that we get lost in the argument and forget about the person. Ms. Benaissa’s actions strike me as though she was acting out of cruelty or depression.

Should everyone ask each person if they are HIV positive before they engage in sexual intercourse?

YES!

Is it wrong to withhold your HIV positive status when your partner doesn’t suggest using a condom?

I think so.

Chad asked, “So if you go to a bath house and forfeit using a condom, is it the same thing?”

I don’t think so.

When someone goes to a bath house, I doubt they’re thinking, “Oh this place is probably clean and disease free.”

It’s a fact that HIV transmission is increased among men who have sex with men that frequent bath houses. Plus the majority of the sex is anonymous. Ms. Benaissa knew her sexual partners. When I saw her picture on the news, I felt a surge of sympathy for her. She looked like a sweet woman, but one who needs some psychological help, not community service.

Online doctor rating

The Internet has revolutionized the way we gather information. It’s fast, easy but is it always correct? We’ve all heard that information published on Wikipedia can be questionable with regard to its accuracy. Yet, there are scientific publications that reference Wikipedia. So the question becomes which websites do you trust?

If you Google someone, you may find links to resources such as newspaper articles or even police arrest reports. In the wrong hands the Internet can provide clues for any unsuspecting Nancy Drew out there that is looking to create a dossier on whomever they hold a grudge against.

For instance, if you Google your doctor before you make an appointment, you may be directed to one of many online rating sites. Some physicians, as mentioned in a recent article published by the American College of Physicians Internist, are suing these online sites, stating that these websites allow consumers to rate doctors online, giving them free rein to anonymously post potentially heinous comments that can have detrimental consequences for a physician’s reputation. What’s stopping a disgruntled patient from taking out their frustration online, particularly when they can maintain their anonymity? Most reviews are from satisfied patients. Yet, one bad review can drop your rating from 5 stars to 3. As one recent patient said to me after I asked her how she found me, “I looked you up online. You had some good reviews and one bad review, but I figured that was just some angry patient.” Luckily this woman was not persuaded by my one bad review. So this begs the question, how important are online reviews?

Studies show that consumers use online ratings to support their choices whether they are choosing a doctor or buying a blouse. Chad relies on reviews in selecting hotels and picking restaurants. Recent research looked at 33 rating sites and found that while the use is limited, 88% of posted reviews were positive. The authors noted that with regard to doctors, most complaints were about waiting times and courteousness of office staff.

The American Medical Association (AMA), which has criticized rating sites, contends that “the anonymity detracts from the integrity of the reviews while privacy laws prevent physicians from addressing patients’ concerns.” The AMA stated that, “there is no guarantee that the opinions about a physician even come from that physician’s patient. Anonymous opinions can from anyone.” Dr. Tara Lagu suggested that some reviews appeared to be written by the physicians themselves.

So after my patient told me that I had this “one” bad review, I went online to read it. Chad warned me against it stating that I would obsess over this bad review regardless if there were ten reviews that praised me as a doctor. Of course, he was right, but I couldn’t resist.  I, like many of my colleagues, try to improve the quality of our patient care. If this reviewer had something constructive to say, then I wanted to know what it was.

In his review, he claimed that I never looked him in the eye and that my staff was impolite. He said he was dissapointed in his care. Although he never gave his name, he did provide one detail that I remembered clearly. He said that he heard me speak at a World AIDS Day event. He introduced himself afterward and asked if I would be his doctor.  After one visit followed by three “no shows” I told the patient to find another doctor. I guess he did, but not before he wrote his online review.

Evan Falchuk of Best Doctors, runs a service that helps people find the right doctor. He said, “There will always be people out there who don’t like you or the interaction they had with you. But if they feel like they connected with you in some way, they won’t go and say bad things behind your back. The thing patients want most is trust and knowing that they are the most important person in the doctor-patient relationship.”

I couldn’t agree more.

Weight Loss

Larry Flick

My dear friend and patient, Larry Flick, the host of Sirius Radio’s, Morning Jolt partnered with me five weeks ago to improve his overall health. Larry has what I call the trifecta of serious medical conditions: uncontrolled diabetes, uncontrolled high blood pressure, and high cholesterol. After his full physical six weeks ago, I told Larry that within five years he was going to either have a stroke, a heart attack or both. At six feet tall and 328 pounds, Larry was on the verge of death. After a lengthy conversation, which included talk about gastric bypass and the lap band procedure, Larry decided to meet with me once a week for weigh ins and blood work in conjunction with dieting and exercise.

Five weeks later, he has dropped 17 pounds. I have reduced his long acting insulin requirements, and he no longer needs medication to control his cholesterol.

I have been on air with him every two weeks to report updates on his medical condition. Today I was especially proud to present him with a membership to New York Sports Club, donated by Lisa Hufcut and Christopher Coronato. “This clearly is in line with our mission,” said NYSC general manager Coronato, “Improving Lives Through Exercise!”

The only two modifiable risk factors that every individual has the power to control in order to reduce their risk for stroke and heart attacks is weight loss and smoking cessation. I am so proud of my friend Larry.

Breakfast Burrito

Ingredients

2 egg whites, with a dash of yolk for color, but be conscious of your own cholesterol value. My total cholesterol is 170.

2 strips turkey bacon, low-fat but has high sodium so be conscious if you are hypertensive or have high blood pressure.

1 slice of Veggie Slices, a soy based food that is good for melting. My pick is Cheddar flavor with jalapeno. Each slice is individually wrapped and has NO cholesterol or lactose.

1 low carb-low fat wrap

Directions

Frying pan on the stove to heat it up on medium to low heat. Spray the pan with low fat cooking spray. Lay the bacon on the pan and cook until golden brown. Remove bacon. I clean my pan. Sometimes, if I’m lazy and I’m in a hurry, I scramble the eggs directly in the pan. Chad would kill me because the grease tends to turn eggs a brownish color. I don’t mind but he does. After you cook your eggs, remove them and lay the wrap in the pan. In the center of the wrap, place your scrambled, cooked eggs in the center along a line and place your crispy bacon on top. You can either tear up your Veggie Slices, like I do, or simply place the slice on top and then fold the edges of the wrap on to themselves. Press down firmly so that the slice melts and adheres to your eggs and bacon. Remove from pan and eat. I swear, it’s easy and delicious. So delicious that I ate it before I got to take a picture of it. I love dry, crunchy food, but Chad is more the moist and juicy. So I add a dollop of salsa to his plate so he can dip his burrito into the salsa in between bites.

About 300 calories

Health Trust

“You are invited October 1, 2010 from 11:45 a.m. – 1:00 p.m. to join me at the Valley Medical Center in San Jose, CA for an important discussion on gay men’s health–what health professionals need to know. The event will be held in the Sobrato Cancer Center Conference Room on the ground floor of the Valley Specialty Center building at Santa Clara Valley Medical Center . Lunch will be provided.

If you are interested in attending, please send an e-mail to connieg@healthtrust.org with a subject line reading ”Spinelli Discussion Forum“.”

Gay Teens and Suicide

When I was a boy living in Staten Island I was terrorized from grades 6th though 8th by a boy named Sal. He hated me. At the time I didn’t know, why but in retrospect it’s clear that Sal hated me because I was gay. He made my life hell and picked on me incessantly. In the school yard I would peak at him through the corners of my eyes and find him glaring at me. He would tease me, call me names and push me around with his two other mean friends.

As a gay doctor, I lecture to students at the Harvey Milk School in Manhattan, and I speak openly about being bullied as a boy. LGBT teens are more likely  to suffer from depression compared to heterosexual teens. Suicide is the leading cause of death among LGBT teens. They have higher rates of drug abuse, and as a result of their depression often engage in unsafe sex.

This week it was published that 1 in 5 gay men have HIV. The fastest rising group is among gay men ages 13- 24 years old.

Today I was deeply saddened by the story of Tyler Clementi, who took his life after a cruel webcam stunt in which his fellow students filmed him kissing and making out with another boy. After the video was streamed, Clementi changed his Facebook status to, “jumping off the gw bridge sorry.”

What was he so sorry about? What had he done wrong? Nothing.

I leave for San Jose today where I am to speak at a symposium on Gay Men’s Health. Part of my lecture is focused on LGBT teens. Bullying is very powerful, and it can affect young adults to take extreme measures. If you are a teen and feel depressed or suicidal, contact the Trevor Project hotline.

The Trevor Project hotline: 866-4-U-TREVOR (866-488-7386)

For colored girls. I mean gay men

I was on the phone last night with my friend, Basit, a rheumatologist at NYU. We were bitching about life and how healthcare sucks. He said something like, “Girl, if it don’t get better, I’m gonna cut a bitch.”

We laughed as we always do when either of us goes into that character. You know the person you become when you talk like a black woman from the ghetto? Well, if you don’t know what I’m talking about then you’re probably not a gay man. I do it all the time, and then I realized how frequently gay men channel their inner sister. My gay cousin, Paul, will invariably spout out two or three lines from the Color Purple during any random conversation in the exact tone and delivery as Ms. Whoopi Goldberg herself. In fact, he has perfected his Miss Celie by watching the damn movie hundreds of times. I can recall one particular Sunday at brunch when I asked him why he was so late and he responded, “I may be black, I may be ugly, but dammit I’m here!”

I will go on record to say that if you ask any gay man to name their top five movies, one would include, The Color Purple. In fact, I suspect that if you asked any gay man to name their top five movies, one would include any movie starring Whoopi Goldberg. Mine would either be Girl Interrupted or Ghost. Think about it. How many times have you said, ”Molly, you in danger girl.”

“Ghurl”, is often how my producer at here! TV reacts right before he is about to tell me some deep and low down dirty secret, accentuating the pronunciation of the letter, R, as though he was expelling his last breath. “Ghurrrrrl, wait to you hear what happened to her.” And if I react with disbelief, I will inordinately hear him say, ”Child! you better front.” I have no idea what that means, and I doubt he does either.

Last night while I was watching The Real Housewives of Atlanta,  I saw the trailer for the new Tyler Perry movie, For Colored Girls. The movie is based on the 1975 play, For Colored Girls Who Have Considered Suicide When the Rainbow Is Enuf  by Ntozake Shange.  The 1977 Broadway production was nominated for a Tony Award for best play.  As I watched the trailer, starring Janet Jackson and of course, Whoopi Goldberg, I thought, the theater in Chelsea is going to be packed with gay men just like it was when we went to see the movie Precious.

What is it about gay men and African American women? Why do we identify with them?

Maybe it’s the oppression and isolation both groups endure? Better yet, is it the passion that black women express in films and on tv that makes gay men want to embody them in order to overcome any obstacle that stands in our way? In the late 70′s and all thoughout the 80′s, I can recall sitcoms with iconic characters like Florida from Good Times, Florence from The Jefferson and who could forget, Nell Carter in Gimme a Break? I have channeled each of these women throughout my life, and yet, I grew up in a white, Italian, Catholic neighborhood in Staten Island, a far cry from the projects or any black ghetto. I think there was one black girl in my class throughout grammar school, and I certainly would have never had the nerve to go up to her and say, ”Give me five,” in fear of being accused of racism.

Interestingly, all of the gay men in my life, have little or no real attachment to any African American woman other than the desire to be like them, particularly in times of great hardship or when it’s comically appropriate. Perhaps that’s why we’ll line up to see movies like The Color Purple, Waiting to Exhale or For Colored Girls.

So next time you’re standing with a group of gay men, count how many times you hear the word, ghurl, tossed around.

Ghurl, you’ll be surprised.

Movember

                A gentleman is, after all, still a man no matter how gentle he is.

“The Mo, slang for moustache, and November come together each year for Movember.  The Movember challenge is to grow a mustache starting November 1st after a clean shave for the entire month to raise awareness and money for cancers that affect men.”

 
The idea for Movember began in 2003 over a few beers in Melbourne, Australia.  In 2004 the campaign evolved and focused on raising awareness  for the number one cancer affecting men – prostate cancer. 

The prostate is the male reproductive gland located below the bladder and in front of the urethra. As men age, the rate of prostate cancer increases, especially if there is a strong family history. African Americans have higher rates than the general population. Prostate cancer screening begins at age 50 with a digital rectal exam and a blood test to measure the prostate specific antigen or PSA. Symptoms of prostate cancer usually affect urination.
 
In 2009, global participation of Mo Bros and Mo Sistas climbed to 255,755, with over one million donors raising $42 Million US equivalent dollars for Movember’s global beneficiary partners.  

So tickle someone’s fanny… I mean fancy and grow yourself a mo for Movember. For more information go to www.movember.com.

  

 

 

 

Daphne or Dorothy

For Halloween my ten-year old nephew, Mitchell, went as Dorothy from the Wizard of Oz. During an iChat with the entire Kundler family present, my sister explained how they borrowed the costume from a neighbor and made pig tails using his own hair. His two older brother rolled their eyes as my sister went on to say that it was either Dorothy or a Cheerleader, but in the end Mitchell chose Dorothy . When I asked the two older boys what their reaction was to their little brother’s decision, they declined to answer, stating only that he received an appropriate beating when he returned home that evening. They were only kidding, but it was apparent that they did not support their little brother decision to dress up in a costume that is intended for girls.

The youngest of four children, Mitchell is quite special. He loves to play football, does well at school and given the chance, he loves to play the clown in most circumstances. At ten years old, weighing 75 pounds, he stands approximately 4 foot 5 inches tall with big, wonderous, green eyes and extra long eyelashes, the kind that Chad desperately tries to grow using Latisse.

Two years ago, that same sister, a former teacher, confided in me that she and her husband thought Mitchell might be gay. I immediately said it was too early to tell. Psychiatrists have stated that gender identity is solidified only after puberty. If a child identifies with the opposite sex, it doesn’t necessarily mean they’re gay. Since Mitchell is pre-pubescent it is still too early for any of us to  know, especially him. Even her husband, a psychiatrist himself, agreed that it was too soon to make the call, but in light of this latest Halloween selection, I’m beginning to think my sister may be correct in her assumption. Of course they’re is the blaring red light going off in my head that Mitchell chose to be Dorothy, a character with strong ties to the gay community, played by Judy Garland, the number one gay icon of all time.

“Dorothy! You can’t get any gayer than that,” said my best friend Eric.

The very next day, a photograph of a five-year old boy dressed up as Daphne from Scooby-Doo surfaced on the Internet. The picture has gone viral with the tag line, My Son is Gay or He’s Not. His mother posted the photo of her son on her blog in response to the negative reaction he experienced at school from the other mothers. The story was picked up by CNN who interviewed the mother. The CNN reporter asked her why she posted the picture. She said her decision was to show support for her son. CNN psychologist, Jeff Gardere said, “It’s the worst nightmare” of both heterosexual and gay couples “to have to fathom that their child might be gay.”

What bothers me most about the mistreatment of this story is how often little scientific information is provided. Instead homosexuality is once again regarded as a choice. This boy chose to dress up as Daphne. His mother allowed him to. Whether or not he is gay isn’t the issue. He’s only five years old. The real dilemma is that the other mother’s were visibly upset by his mother’s decision to allow him to dress up as a female cartoon character. Unfortunately, CNN failed to present any scientific data: that the youngest boy born after several male births is likely to be gay, that a child born in a family where a gay relative exists has a higher likelihood of being, that boys who like to dress up as girls tend to grow up to be gay as opposed to “Tom boyish” girls who don’t necessarily become lesbians.

Again I’m reminded of Ron Howard’s upcoming movie The Dilemma, in which Vince Vaughn reacts to an absurd situation by exclaiming, “That is so gay.”

I support a child’s freedom to express themselves as whomever they wish to be, whether it is Daphne or Dorothy. I am ashamed that this is not handled more maturely by news makers who refuse to acknowledge that this innate behavior may be sign that they are gay but their expression should be respected regardless if they want to dress up as Daphne, Dorothy or Wolverine. But I’m not stupid. I know if you put a man in a wig and a dress it will get laughs. And if you see the picture of the boy dressed up as Daphne or my nephew dressed up as Dorothy, you will laugh out loud. What I don’t understand is why we can’t analyze these stories maturely with the same journalistic integrity that is reserved for any other developmental observation. We have to stop treating homosexuality as if it was a disability. If anything, history has shown us that gay men and women often exceed, if given the chance, in almost every field they choose. I find the mistreatment of this story is once again steeped in humor and the psychologist’s comments as cautionary. Wouldn’t it have been more informative for Gardere to have said, “Although it is too early to drawn any definitive conclusions about this boy’s sexuality, it is clear that this child identifies with Daphne for some unknown reason and his mother should be commended for supporting his growth, development and imagination.

Gay health is still ignored in medical schools and is only taught in relation to HIV, and for the most part, Americans still consider homosexuality a choice.

I applaud both mothers for supporting their child with love and respect. I hope more will do the same in the future. And if either of these boys grows up to be gay, I’m certain they will be very well-adjusted, considering the support they’ve already received by both their mothers.

Margaret Choke

Friday night Chad and I went to see Margaret Cho at the Beacon Theater in Manhattan. For those of you who have never been to the Beacon, it is an amazing theater with its beautiful ornate neo-Grecian interior. Featured is a thirty-foot-tall Greek goddesses flanking the proscenium arch of its stage. There are other exquisite details throughout the theater including gilded plaster moldings, brass staircase railings and a mural aligning the corridors. However it’s never a good thing when the theater upstages the talent. Unfortunately, that was the case on Friday night when Margaret Cho took stage.

Dressed in a striped green mini-dress, she looked like she was going the mall except for her fierce purple platform shoes. Immediately she updated the audience about being voted off Dancing with the Stars, (a show I hardly watch), but after a while, I felt this sudden sense of deja vu. Most of her material hasn’t changed much since the last time I saw her. There was the reference to her cancelled television show, American Girl, which invariably leads into another story about how she was told she was ugly as a child and how she has learned that beauty comes form within. Thankfully her mother makes an appearance but this time Ms. Cho took it one step further pairing her up with her opening act, John Roberts, in a skit that fell flat where Ms. Cho’s mother does a variation of Bronx Talk with Mr. Roberts playing a Linda Richmond type character. Both appeared uncomfortable because the skit went nowhere. But then the single Ms. Cho (I thought she said she got married last year) went into a lengthy conversation about poop, calling herself Lady Ca Ca (I mean that’s the kind of comedy my little nephew could come up with) and how she likes anal sex over vaginal intercourse. She even referred herself as bisexual with tendencies toward the transgender. I didn’t mind her semi-new material, but I felt like I was watching a dress rehearsal or worse, I thought I was in a small P-Town theater listening to her as she worked on new material. Things only went down hill as the music cues got screwed up and then finally later, Ms. Cho forgot the words to her own encore and she had to stop and look up the lyrics in her book.

I’m all for supporting the arts, particularly those artists who support gay rights. But Margaret, what happened?  Your shows always have me rolling in the aisles. Instead this time I was watching my clock waiting for your show to end. I understand you were on Dancing with the Stars, and maybe you didn’t have time to prepare but then don’t charge me for 75 dollars for  ticket I should have been given for free just so that you can work on your new material. I definitely don’t want to hear how you like anal sex and or take a dump that looks Indonesia. You said it yourself, “You turned forty.” Well then that explains it. You’re going through a mid-life crisis. Maybe that’s why you wrote a song about Head Lice and sang it like Natalie Merchant from Ten Thousand Maniacs. Listen to this doctor and take a break from performing until you come up with some new material. And don’t have a baby just so you can talk more about poopy diapers.

Poor Margaret, I love you but this performance, not so much.

Short sighted

It is a widely held belief that Napoleon Bonaparte was a man of short stature however, there is good reason to believe that this was a myth. The French inch is longer than the British inch. Napoleon was said to be 5 foot 2 inches tall; but if his height was converted into British inches, then he would be 5 foot 7 inches tall, which was the average height for a Frenchman of his time. If this was absolutely true then would it be safe to assume that Napoleon was not as short as he was shown in propagandist depictions sanctioned by his rivals, which was a common tactic of its time to accentuate the slightest flaw in any opponents character.

Unfortunately, the French offered little help, often depicting Napoleon standing alongside his much taller Imperial Guards who had a height requirement, giving the impression that he was much shorter. Napoleon was also given the name Le Petite Caporal, by his countrymen. Intended as a term of endearment  but when translated means, the little corporal. This  further perpetuates the idea that Napoleon was short. But more importantly, and even more important than the rumors that his wife Josephine was asked not to wear high heel shoes in his presence because she stood at 5 foot 4 inches tall, were the constant barrage of negative rumors and depictions by his enemies who insisted on undermining his authority and power by portraying him as diminutive in propaganda as a way to usurp his power.

The fact of the matter is that in 1802 Napoleon’s doctor Corvisart documented that Napoleon was 5 foot 2 inches tall. If he used the French inch than we know that Napoleon was in fact much taller, but this same doctor went on to state that Napoleon was of short stature. At his death in 1821, Napoleon living in exile on the rocky island of St. Helena, was autopsied by Francesco Antommarchi, a Frenchman, who listed Napoleon’s height once again at 5 foot 2 inches tall. Yet, the autopsy was signed off by the British doctors further lending doubt to whether or not Napoleon was indeed taller than listed at his death.

Much of what is remembered of Napoleon’s reign is mirrored in the confusion over his height. He is often considered a mass of contradictions. His legacy however, is often overshadowed by his rumored short stature and is thought to be the basis for the psychological condition, the inferiority complex, described by Alfred Adler in his book, Study of Organ Inferiority and Its Physical Compensation in 1907.

Adler wrote, “To be a human being means to feel oneself inferior. The child comes into the as a helpless creature surrounded by powerful adults. A child motivated by his feelings of inferiority to strive for greater things. When he has reached one level of development, he begins to feel inferior once more and the striving for something better begins again which is the great driving force of mankind.”

Adler himself was no stranger to feelings of inferiority. As the second child of seven children born into a Hungarian Jewish family, he developed rickets, a disease cause by a deficiency of vitamin D which leads to low calcium, poor calcification and bony deformities. Taken from the old English word for “twist,” Rickets was extremely common. Children were often left with a disfiguring bowing of the legs and knocked knees. Adler was unable to walk until he was four years old, and he almost died of pneumonia when he was five. These two life altering afflictions spurred his passion for greater things and that is why he decided to become a doctor.

Part of Adler’s later work involving the inferiority complex, branched into the Napoleonic Complex, which dealt with feelings of inadequacy that stem from one’s own insecurities over their height.

Throughout history, short men and women have made great contributions. Yet often these contributions are seen as overcompensation for their inferior height.

So what is it about being short that often leads those who are below the normal standard of height to feel inadequate?

Currently, the average height for a male over 20 years of age in the U.S. is 5 foot 9 inches tall, a substantial difference when you consider Napoleon’s height. The question remains, do taller people exceed more than shorter people? Do they excel is sports, get more promotions at work and find themselves more attractive to the object of their sexual desire? I say yes.

Last night I attended the Lincoln Center production of a Free Man of Color, the new play by John Guare features a stellar cast including Jeffrey Wright, Mos Def and Veanne Cox ( who happens to play three characters including an elderly man). One of the other central characters was none other than Napoleon himself. Of course, Mr. Guare played on this widely held belief that Napoleon was short and therefore compensated for what he lacked in height by attempting to overthrow Europe, the United States and even Russian. His failure of course, led to his exile.

The study of height or auxology has been used to measure the health of individuals as indicators of health problems, monitor growth trends, and track deviations and genetic expectations.  Right now there are pharmaceutical companies proposing the use of growth hormone to improve height expectations in children who are born to short parents. This is the next wave in creating a super race that is taller, stronger and faster. The movie Avatar was not so ahead of its time when you think about it. Although I have mixed feelings about giving growth hormone to children, it’s better than the alternative, the painful and grotesque tibial elongation procedures. And yes, I thought about it myself.

As I sat there last night watching the performance and laughing along with everyone else at the Napoleonic jokes, I thought to myself, what will the future hold when average height climbs to new heights? How will this affect how we live? We’ll need bigger cars, roomier air planes and bigger seats in the theater so that all you tall people won’t knock your knees into the back of my seat during a play starring a short, French Emperor. It’s proven you shrink as you get older. Perhaps by then I won’t be able to attend the theater unless, of course, I’m sitting on someone’s lap.

GLAAD Auction

Tonight Chad and I attended the GLAAD Auction hosted by Bravo TV realty star, Jill Zarin. Chad and I bought VIP tickdets but quickly realized that meant hanging out with the herd. By the time we got there, one hour into the party, there were no mixers left, and no food. Okay, well it’s for a good cause anyway. The art was an interesting mix of photography, paintings, and other medium. My favorite was a two headed skeleton done with coffee on paper.

I got to meet the artist and honoree, David LaChapelle, and writer and reality star, Josh Kilmer Purcell. All the New York Housewives were on hand, including Romano and Kelly Bensimone. As well as Sheree from the Atlanta Housewives. We didn’t bid on anything. Although Dr. Alan Fard picked up a wonderful photograph of Madonna by David LaChapelle. At one point Jesse Archer walked by with three drinks in her hand. “How did you get those?” I asked. He flashed me his braclet and smiled, “Gold, darling.” Damn it. I hate this heirarchy. All I wanted was a drink and maybe a crab cake. The evening was fine. We left and I stopped off at the grocery store and made dinner when we got home. It’s all good GLAAD.

LaChapelle muse, Amanda Lapore, was looking mighty fine.

The Divine Sister

Last night I took Chad to see the Divine Sister as part of his weekend long birthday festivities. Inspired by some of the more memorable movies about nuns, this latest Charles Busch comedy is hysterical. The play takes place in Pittsburgh during 60′s, which is crucial because that’s when nuns wore those amazing and iconic black uniforms.

• White Coif: This is the garment’s headpiece and includes the white cotton cap secured by a bandeau and a white wimple.

• Black Veil: This element is worn pinned over the coif head coverings and could be worn down to cover the face or up to expose it.

• Holy Habit: This is the central piece of the garment, also commonly referred to as a tunic.

I attended St Sylvester’s grammar school for eight years from grades one through eighth. Before that I attended St. Clare’s kindergarten. I went to an all boy’s Jesuit High School and then St. John’s University. My entire school career has been spent in one form of Catholic institution or another but it was grammar school that left its greatest impact on my memory.

During those eight years I was taught by many nuns, none as clever as Charles Busch’s mother superior but as crazy as Julie Halston’s character. My principal was Sister Catherine who weighed over 300 pounds. She was a strict nun who didn’t think twice about beating us into submission. I feared her and trembled whenever she came near me, scared to death that she was going to hurt me. I wasn’t a bad student, but I did get in trouble for talking too much. Once Sister Catherine saw me whispering to my best friend, Michael. She came behind me and smacked me upside the head.

“Mr. Spinelli,” she screamed. “Why are you such a chatterbox?”

When I finally graduated, I rejoiced in knowing I was never going to see her again. Many years later, when I was a medical school student, I did a surgical rotation at Staten Island Hospital. It was my job to do preop assessments on all the patients that were scheduled for surgery that day. One morning I received my list and the second name was none other than Sister Catherine Anderson, my former principal and tormentor. My neck immediately became drenched with sweat. My heart palpitated in holy memory of her shouting. I was paralyzed with fear. How could I go into her room and perform a preop examination?

“Get a grip,” I told myself. “You’re a doctor. Act like one.”

As I slowly walked in silent procession toward her room, I prayed that she would not remember me. When I opened the door, she was sitting up with the starched white linen folded neatly under her ample arms. Still quiet obese, she was older with grey hair and layers of folded wrinkled skin under her chin. When I noticed that she was scheduled for a right lower extremity amputation, I was overcome with pity. Having been an uncontrolled diabetic for years, Sister Catherine was succumbing to poor circulation. The robust lioness that roared down the halls of St. Sylvester’s was now a dying breed, the last bastion of my Catholic youth. Upset with myself for having such unholy thoughts, I decided to introduce myself. I gently leaned in toward her plump face and whispered, “You probably don’t remember me, but I was a student at St. Sylvester’s.”

She turned her head around slowly eyed me up and down. She said, “What’s your name?”

“Frank Spinelli” I said.

She rolled her eyes and her nose flared as though she was absorbing my scent. Then she growled, “Mr. Chatterbox, I remember you. You couldn’t keep your mouth shut no matter where I put you.”

I stood there with my mouth gaping open. Scared that she was going to leap out of her bed and maul me, I put my clip board under my arm and backed away from her. As I walked away in shock, I looked back and thought, “Good luck standing on that one leg sister.”

She died later that same year.

I’ll never forget Sister Catherine and all the nuns who taught me at St. Sylvester’s School. Those women dedicated their lives in holy servitude to Jesus Christ, God and the Catholic church. They will remain as mysterious to me as their black habits.

My World AIDS Day Story

Patient calls me Monday morning:

Max: Doctor I need to see you. It’s urgent. I had unprotected sex with someone yesterday morning.

Doctor S: Come in right now.

Max arrives several hours later. He is anxious, tearful and short of breath.

Doctor S: Come inside. 

He sits down on the exam table. I wait for him to begin.

Max: I had sex yesterday morning with someone I know. I got drunk and slept over his house. The next day we fooled around and had unprotected sex.  He ejaculated inside me. I’m freaking out.

Doctor S: This happened yesterday morning, less than 36 hours ago?

Max: Yes.

Doctor S: Did you ask him if he is HIV positive?

Max: He swore that he is negative. I asked him if he would get tested today, but I haven’t heard back from him. I’m really nervous. You see, I have a boyfriend.

Doctor S: Did you have sex with your boyfriend after this happened?

Max: No! But he’s going to break up with me after I tell him, and I have to tell him.

I discuss beginning Max on HIV Post-Exposure Prophylaxis (PEP) in the hopes that after taking anti-retroviral medication for 28 days, he will not contract HIV if he was exposed. During his visit he receives a call from the guy he had sex with. He tells Max that he was diagnosed with HIV today. Max hangs up and begins to cry.

Max: This is terrible. He was just diagnosed with HIV. He must have a high viral load, right?

Doctor S: If he was just diagnosed then he probably does have a high viral load. How high? I can’t be sure. The most important thing right now is that you begin PEP immediately.

Max leaves and calls me later.

Max: I took the pills. My boyfriend is visiting his parents. I’ll talk to him later this week. Would it be good for us to know what my friend’s viral load is? I could ask him to forward you the results.

Doctor S: That’s a good idea.

Later that week I receive a call from a colleague who happens to take care of Max’s friend.

Doctor D: Hi, my patient asked me to call you because he is ashamed.

Doctor S: Thank you for calling me. I want to know if you have his viral load yet?

Doctor D: He is undetectable.

Doctor S: He’s undetectable and newly diagnosed?

Doctor D: Let me explain. He’s not newly diagnosed. He’s been HIV positive for 5 years. After he had sex with Max, he was too ashamed to tell him that he’s been HIV positive. That’s why he asked me to call you. The good news is that his viral load is undetectable. I know Max is going to be upset with him for lying.

Doctor S: I don’t know what to say. Thank you for calling.

When I tell Max the truth he doesn’t speak. Finally he says, “I guess all I can do now is wait?”

Today is World AIDS Day. There are over 1.1 million Americans living with HIV today. 1 in 5 do not even know they have it. The fastest rising group of individuals contracting HIV are African American youths, and by 2015 more than 50% of HIV infected gay men will be over the age of 50.

HIV Pre-Exposure Prophylaxis

I was interviewed by ABC News about HIV pre-exposure prophylaxis (PrEP).

“The study they were referring to was performed in 2,499 gay men or transgender women who have sex with men. The group of study participants who took preventative antiretroviral drugs every day for an average of 1.2years had a 44% reduced rate of HIV infections compared to the group taking placebo. The ability of the drugs to protect from HIV infection was dependent on treatment compliance: those who reported taking the pills about 50% of the time had about a 50% reduction in risk of HIV infection. Those who reported taking the medication about 90% of the time had a reduction in risk of infection of almost 73%. Some side effects were observed in the group taking the medication, but were mostly limited to nausea and some weight loss. Interestingly, risky sexual behavior was reduced in the participants of the study, possibly due to the provided risk-reduction counseling and condoms”.

With regard to the PrEP Study the greatest impact would be seen among high risk groups like sex workers or MSM who have multiple sexual partners. Of course that would mean convincing this population to take medication daily to avoid contracting HIV as well as promoting condom use. Another group that might benefit are serodiscordant couples or those in which one member is HIV and the HIV positive individual does not wish to transmit the virus to his partner. 

In theory PrEP is a great preventative strategy and I’m sure many will confuse the issue and think that just because they’re on meds that it will prevent them from contracting HIV, then they could forfeit using condoms. But looking at two PEP studies done in Brazil showed that PEP did not result in increased frequency of unprotected sex as a result of the availability of PEP. Based on these studies and the new study on PrEP, I do not think that offering PrEP will increase unprotected sexual encounters.  

On a global scale, PrEP is far more important, particularly since statistics show the number of HIV cases in Africa are climbing. Currently it is estimated that 6 million people are living with HIV in Africa.  

Since the latest vaccine studies have been halted. The best method to contain HIV is prevention. Both PEP and PrEP need to be discussed in more detail in mainstream media. Most people living in the US don’t even know about PEP or PrEP, let alone those living in Sub Saharan Africa. It’s time we stop thinking about the negative repercussions that could come out of a prevention strategy and celebrate this break through. PEP and PrEP have both been shown to reduce transmission of HIV. Isn’t that enough to warrant its use?

The Man who Defeated HIV?

In November 2008 doctors in Berlin reported a case that sent shock waves throughout the HIV community. Doctors of the Berlin Charité had managed to eradicate HIV in one of their patients. This patient, referred to as, “The Berlin patient” caused a worldwide stir and remained anoymous until now.

Timothy Ray Brown is a 44 year old man who was diagnosed as HIV positive in 1995. Subsequently, in the summer of 2006 he developed leukemia. Doctors in Berlin treated him with stem cell therapy, locating a donor who had an HIV-resistant immune system.

The result, Brown was cured of his leukemia and HIV.

Timothy’s case is an isolated incident which has not been duplicated. However, it does open the door to the possibility of gene therapy.

Caulk Criminal

My phlebotomist, Sheniqua, routinely asks me to inject Sculptra, a haluronic acid filler used to increase volume in the faces of men and women who have lipoatrophy secondary to HIV, into her butt so she can have the booty she’s always dreamed of. I roll my eyes every time she says this because on one hand, I know she’s half-joking but on the other hand because I think it’s a ridiculous request. Unfortunately, I have heard stranger requests from some patients and friends. I respond to them in a similar manner: roll eyes, purse lips and then the obligatory, “Why?”

So you think I wouldn’t bat an eye when I read an article about one New Jersey woman, plus-sized model Anivia Cruz-Dalworth, who was arrested for injecting several women in their buttocks using bathroom caulk.

Ms. Cruz-Dalworth is not a doctor nor is she licensed to perform cosmetic procedures, which she did in her own bathroom. This begs the question, how desperate are some people to undergo cosmetic procedures at a discount rate that they could be enticed to check in to Ms. Cruz-Dalworth’s bathroom for some booty injections using a thick, white substance she called, “hydro-gel?”

According to court documents, Anivia Cruz-Dilworth  told the women that she was a trained professional and that she would inject them with a substance the 28-year-old called “hydro-gel,” which is supposed to enhance the buttock. Instead, the New Brunswick resident injected her clients with a silicone sealant, the very same material used to caulk bathtubs. The injection sites were also sealed with Krazy Glue.

Now before you head over to your local hardware store you might want to know what happened to these people after they were injected with silicone. The human body rejects foreign substances like plastic or caulk. Most of the women Ms. Cruz-Dilworth injected developed skin necrosis and were forced to have surgery to remove the caulk and the damaged surrounding tissue in order to prevent gangrene. Incidentally, Ms. Cruz-Dalworth was charging her clients $1,000 for the procedure, a discount if you consider what a plastic surgeon charges to inject FDA approved fillers. Unfortunately, caulk does not dissolve over time, and these poor women ultimately lost a substantial amount of those booties they were so desperate to enhance.

Now I don’t know about you, but my bathroom isn’t large enough that I could fit a table. I can’t help but imagine that Ms. Cruz-Dilworth performed this procedure with these women bent over her bathroom sink. And then to top it off, she only charged them a $1,000 bucks. How neighborly of her.

Dalworth has been charged with three counts of practicing medicine without a license.  As for the women who had their butts caulked: all are expected to make a full recovery. Only their egos remain damaged permanently.

Stealth

“I went down some dark roads after my ex broke up with me,” said Joel. “He was the love of my life. After he left, I felt worthless. I kept thinking, ‘Now I have to start dating again? Who’s going to want to date me? I’m forty, I’m HIV positive and I’ve just been dumped.’”

Soon after his break up, Joel, a 43-year-old menswear designer, found himself on Internet sex sites. He quickly met up with several men who encouraged him to bareback and use crystal. “That drug became part of my diet. I got down to 180 pounds.” At 6’2”, Joel weighed the same as when he was a junior in high school. “I started seeing this guy who was totally hot but he fucked with my head. He even whored me out to his friends. I felt like I was part of this club. These guys would just show up at my house. Then they started to invite new guys. We’d take turns gang banging them as though it was an initiation rite of passage. It was hot at first, but then I realized what was really going on.”

After talking with one of the new guys, Joel discovered that his new buddies were lying about their status on-line in order to lure HIV negative men into their group. They used crystal to persuade them to engage in unsafe sex. When Joel confronted his new fuck buddy, he was berated harshly. “He flipped out on me,” said Joel, “He said, ’Grow up. You knew exactly what we’re doing.’”

Joel told me that this underground group of men designate themselves as Stealth.

“I contracted so many STD’s during that period. It was embarrassing. That drug is poison and some of these guys have been using for years. Their brains are fried. Thank God I finally got my act together. I’ve been going to Crystal Meth Anonymous (CMA) and Alcoholics Anonymous (AA). And just to tell you how pervasive this Stealth group is; I brought it up at a meeting and more than half the group had either heard about Stealth or was a member at one time.”

To out or not to out

During in an interview promoting his new movie, Casino Jack, Kevin Spacey evaded questions about his sexuality until the reported finally asked him why he was living a lie. Spacey responded: I don’t live a lie. You have to understand that people who choose not to discuss their personal lives are not living a lie. That is a presumption that people jump to.” He went on to say, “Look, at the end of the day, people have to respect people’s differences. I am different than some people would like me to be. I just don’t buy into that the personal can be political. I just think that’s horse shit. No one’s personal life is in the public interest. It’s gossip, bottom line. End of story.”

Since his break out role in The Usual Suspects, Spacey went on to win two Academy Awards. I always assumed he was gay because I saw him on Fire Island once, and yes, I know that doesn’t mean anything. Even among my gay friends it was always rumored that Spacey was closeted. Of course, I assumed he did not want to discuss his sexual orientation in fear that he would be type cast as gay.

Last week Carrie Fisher responded to a question about John Travolta stating, “Wow! I mean, my feeling about John has always been that we know and we don’t care. Look, I’m sorry that he’s uncomfortable with it, and that’s all I can say. It only draws more attention to it when you make that kind of legal fuss. Just leave it be.”

It seems like more and more, reporters have been pushing celebrities to fess up about their sexuality. Rumors have swirled around certain celebrities like John Travolta, Tom Cruise and Kevin Spacey for years.

These recent events remind me of the late 1980’s when Sirius Radio host Michelangelo Signorile was co-founding editor of OutWeek. He began writing about the media’s double standard in reporting on homosexual and heterosexual public figures, and how he believed it made gays invisible during the AIDS crisis. Signorile outed producer David Geffen and other performers, such as the comedian Andrew Dice Clay, and gossip columnist Liz Smith.

You would think that someone’s sexual preference would be considered off limits. Yet, having lived through the AIDS epidemic I understand the importance of Act Up and OutWeek. Since the 80’s the gay movement has made tremendous strides. More than ever, we have left our mark on television, movies and even in politics. Yet, we still don’t have the right to marry and we’re still not allowed to serve our country openly. The AIDS crisis is now considered past its peak and HIV is more of chronic disease. Recently, the gay community has been plagued by a recent string of gay teen suicides. Promoting a healthier attitude toward gay men and women is more necessary now then ever before. Campaigns like, It Get’s Better, are trying to instill hope in our gay youth. Perhaps that is what has sparked this new interest in asking “closeted” men and women if they are gay?

The best example I can think of is Anderson Cooper. I see him at David Barton Gym in Chelsea. I know people who know him personally. They say he’s gay and even has a boyfriend. He quite possibly lives as an out man but has not indicated so publicly. If he is gay, does he have an obligation to come out? No, of course not. Just because he’s in the public eye doesn’t make it his responsibility to become a gay role model. Like Kevin Spacey said, “No one’s public life is in the public’s interest. It’s gossip.” And yet I can’t help but wonder what if Anderson Cooper came out? He could be quite possibly be the most influential gay male public figure our community has.  

Lesbians on the other hand have shown less fear in coming out. In fact lesbians make up some of the most influential women in the public arena: Rachel Maddow covers the news and current events. Ellen DeGeneres is a brilliant talk show host and comedian, and Suzie Orman is considered a great financial advisor. Unfortunately, gay men do not influence Americans as much outside the realm of fashion, television and theater.

I agree with Bravo TV executive Andy Cohen, who in an interview with Joy Behar said, “It is not cool that Carrie Fisher outed John Travolta.” It’s not anyone’s responsibility to out another individual. Coming out is a very personal issue and making the decision to do so should not be influenced by the media.

I say we celebrate those individuals who live as out men and women and leave the ones who don’t to wrestle with their decision.

German doctors declare “cure” in HIV patient

When this case was first reported in 2008, several patients asked me if these German doctors were on the brink of a cure. Now that the full journal article has been published, stating that a German medical team is claiming that a stem cell transplant has cured a man of HIV, the media has picked up on this story. Unfortunately, most HIV experts agree that the method in which these German doctors cured one man of HIV is not practical for widespread use because it depends on harvesting donor stem cells that have a mutation which eliminates the CCR5 receptor, that is one of the two receptors used by HIV to enter the human cell. These donor cells are rare. About 1 in 100 people in Central Europe have this mutation.

 

Of course we would all like to believe that a cure for HIV is possible, particularly since the vaccine trials have been disappointing.

 

I think beyond the scope of presenting this one isolated cure, doctors and the media have a responsibility to present the facts and not promote unrealistic expectations. We need to be sensitive to those living with HIV. Besides, stem cell transplant is not without its own problems. The mortality rate is approximately 30% when it is used in cancer patients.

 

But I am very excited by this case. Having treated HIV for over ten years, part of the difficulty lies in the virus’ ability to remain dormant in reservoirs. After the stem cell transplant was performed in this patient, I fully expected the virus would reactivate in these reservoirs. That has not happened. As for the future, although this is one isolated case, it has ignited interest in stem cell research to find a cure for HIV. In July, researchers led by John Rossi, PhD, of City of Hope Medical Center in Duarte, Calif., showed they could modify stem cells to resist the virus.

 

I believe this case has shown us that this elusive virus can be cured. Just not right now.

Christmas blizzard in New York

Scenes from one of the largest blizzards in New York history which began on December 26th. Unfortunately, Chad and I were supposed to leave for Paris that same day. Our flight was cancelled but only after we waited on line for nearly 5 hours. Today we are going to try it again. Wish us luck.

 

9th Avenue and 23rd Street. Cold, lonely and desolate.

A phone booth on 9th Avenue. The same one Open Skies Airlines refuses to answer.

An abandoned car after an explosion on 10th Avenue.

(or a foreshadowing of things to come)

On route to Newark Airport

(as visions of sugar plumbs danced in our heads)

And I in my kerchief and Chad in his cape, settled down in a line for a long winter’s wait.

In flight spectacle

While sightseeing over New Years in Paris it became obvious that I need to wear my reading glasses. Trying to navigate through the city, riding the subways, I discovered that my eyes could not focus on the small print of the subway map, especially in the dim light of the train stations. Holding the map up to my face, I was reminded of my Dad trying to read the paper in the den. All I needed was for my mother to cry out, “Angelo, open a light and put on your glasses. You’re going to go blind.”

At 43 years old, I’m starting to lose my vision.

So why don’t I wear my reading glasses? I own a pair. In fact it took forever to find the perfect ones, something different, yet classic. Something that says, here is a smart, sexy guy. I searched for months to find a pair of unique and special frames and not those stupid nerdy glasses Demi Moore and Ashton Kutcher wear. No, my glasses were cool in their own way. But like many things I desperately need and spend way too much money on, I grew tired of my glasses. It didn’t take long. I don’t think I’ve owned them for a year, but wearing them always seemed like such a pain in the ass. They have to be kept in their case otherwise they’ll get destroyed. Then I had to keep them in my bag or murse, which meant that I had to carry my murse every where I went. Not that I don’t already.

At the end of my vacation, I found my glasses along with the two books I brought and never opened, sitting at the bottom of my carry on. So that it wasn’t a complete waste of time and energy to carry those books and glasses all the way to Europe, I decided that I would read for an hour on the plane while wearing my glasses. Within 30 minutes I grew tired and so I placed my glasses in my front shirt pocket and took a nap. After I awoke, I got up to use the toilet. Still groggy from my nap and several cocktails, I used the restroom and just as I leaned forward to flush the toilet, I felt something slip out of my front pocket. Before I had a chance to realize what it was, I saw my nearly new pair of way too cool reading glasses fall into the toilet and through the circular metal flap into the abyss of the airplane septic tank.

What took seconds felt like hours as the realization of what just happened sank into my consciousness. This horrifying event sobered me up pretty quickly and many things began to race in my mind. For one, how was I going to explain this to Chad? Second, how deep is an airplane septic tank anyway? And finally, who would know if I slipped my hand in there to see just how deep an airplane septic tank is?

I suppose you could say I was crazed or drunk for thinking in such a way, but you have to understand that it was the principle of the matter. All I could think about was what Chad said to me once the 4G iPhone came out and I had just fallen down and accidentally smashed my 3G iPhone. “Oh, I suppose you accidentally dropped your iPhone so that you could buy the new 4G one?”

“No,” I said. “That was the furthest thing from my mind.”

But was it? Had I just lost my pair of reading glasses because I subconsciously wanted a new pair? During our stay in Paris, I noticed how the Parisians wear the most unusual and artsy frames. Every time we went shopping I took notice of the different types of frames and even tried on several pairs. Had I just lost my old glasses so that I had an excuse to buy a new pair? Maybe. But at that very moment all I could think about was Chad. I couldn’t go back to my seat and tell him what had just happened. I knew he would roll his eyes and say something condescending like, “Yeah, right,” or “Sure, what ever you say.”

So I quickly scanned the small confines of the restroom until my eyes landed on something that made my decision very easy: a vomit bag.

You know I’ve always been intrigued by vomit bags and never had the opportunity to use one. Suddenly here was a golden opportunity. All I had to do was slip the bag over my hand and use it like a paper bag puppet to search for my glasses in that sea of poop and piss. It seemed like a stroke of genius. Now I know what your thinking, what if my hand got caught in that small circular drain? How was I going to explain this to the flight attendants. What if I couldn’t get my hand out and I had to remain in the restroom with my hand stuck in the toilet until the end of the flight at which point they would have to get an engineer or mechanic to set me free. I would certainly be detained for questioning or psychiatric evaluation, but before I had the chance to talk myself out of it, there was my hand sheathed in waxy paper digging through the muck to locate my glasses. Now you’re thinking, what if I had found those glasses? Would I have simply rinsed them off and placed them back on my face so that I could finish reading my book? Again, I hadn’t thought that far ahead. All I was thinking at that moment was that I had invested way too much money and time to find those glasses, and I was not about to lose them to some stupid, foreign toilet because of my own stupidity. Yet, after several seconds it was clear that an airplane septic tank is much larger and deeper than I had imagined. As I withdrew my hand and threw the vomit bag into the trash receptacle, I thought, you’ve really gone too far this time Frank, but at least I had a reason to go shopping for a new pair of glasses.

Domesticated bliss

A recent issue of Emerging Infectious Diseases, warns that sleeping and cuddling with your pets could put you at risk for catching some bugs.

Chad and I have a ritual. Every night we watch television in bed. After we turn out the lights, I can hear the tippy tap of Hoffman’s feet on the hard wood floor as he makes his nightly journey into our dark and quiet bedroom. Then he leaps onto our bed, nestles in between us, and faces the door so that he can stand guard as he falls asleep. Every morning, he wakes us up to hugs and kisses as he shimmies his way up to our faces and rolls onto his back so that we can rub his tummy. It’s very cute and yes, even I would vomit if I heard this story from someone else, but he’s our dog and essentially our baby.

This report warns that “pets can bring a wide range of zoonotic pathogens into our environment.”  Zoonotic pathogens are infectious agents that can be transmitted between animal and humans. “The probability of getting sick from sharing your bed with your pet is extremely rare,” said lead author, Bruno Chomel, a professor of zoonosis at University of California Davis. But he warned that children and people who have compromised immune system should be aware of the risks. Chomel and co-author Ben Sun looked through published literature about cases in which people’s illnesses correlated with sleeping, kissing or being licked by pets.

So now what am I suppose to do? Am I expected to simply throw my dog out of the bed without any explanation? Won’t Hoffman see this as rejection and then fall into a deep depression? Worse still, not having Hoffman in bed will likely throw me into despair.

Some of  examples included in the article were:

– A man had a dog sleep under the covers with him.  The dog licked his hip replacement wound and the owner got meningitis.

– A 9-year-old boy slept in bed with a flea-infested cat and got the bubonic plague in 1974 in New Mexico.

– A newborn was sickened with meningitis.  The pet cat had stolen the baby’s pacifier and had been toying with it.

– A 44-year-old woman developed meningitis and admitted that she was “regularly kissing the dog’s face and feeding it by transferring food mouth to mouth.”

In a survey from the American Kennel Club, 21 percent of dog owners said they regularly slept with their dogs. Chomel said he’s not trying to overstate the risks. “It’s a matter of common sense,” he said.  “I never said, ‘Don’t have the pet in the bedroom.’ I’m saying, if you put the pet on the bed or in the bed, there are consequences.”

Well Mr. Chomel perhaps it would be wiser not to be so cautionary and better to offer solutions for pet owners who want to sleep with their pets. For instance domesticated animals, particularly those who live in a city as opposed to a suburb, spend very little time outside compared to wild animals or those who live on farms or homes with lots of acreage. He said that cats and dogs catch fleas that owners don’t always catch. He goes on to say that “If you have a pet that’s well taken care of and sees a vet on regular basis, is properly dewormed, properly vaccinated and well-taken care of, that lowers the risk quite a lot.”

Most pet owners take very good care of their pets, and if you don’t care for your pet by seeing a vet regularly to have it dewormed and vaccinated, then you shouldn’t be allowed to own a pet. Who is this man speaking to? I mean what kind of person sleeps with their dog after they’ve had a hip replacement? Was he sleeping in the nude? It’s one thing to cuddle with your pet who sleeps on the covers. It’s another to invite your pet to sleep with you underneath them. Crossing this line could be confused as a form of bestiality.

So take precautions like washing your hands especially before meals. Bath your pet routinely. Wipe their paws and nose with a clean, moist towel if they’ve been to a dog park, sniffed a fellow furry friend’s butt, or if the weather is particularly nasty out. It’s common sense. There are dangers with sleeping and living with humans, no offense Chad. Heck, I bet we as individuals are more of a threat to ourselves than our mates or pets. More people slip in the shower then contract meningitis by kissing their furry little baby. I mean dog. And I would go on to bet further that some humans have dirtier mouths than my dog. Ever been to a cocktail party in Chelsea? Sometimes I feel like bathing in bleach or at least wiping my lips with Purell before, during and after.

“Pets have a therapeutic effect on humans. Some research suggests children who grow up with pets can build more robust immune systems.  Being around animals, petting and touching them increases levels of oxytocin – a  feel-good hormone.  It can lower stress-causing hormone like cortisol,” said one opponent of the article.

Plus it is a known fact that people who live with pets live longer lives.

So don’t worry Hoffman. Your not going anywhere.

Retrovirus vs. the Oscars

If there is one thing you probably don’t know about me it’s that I love award season, particularly The Academy Awards. Every since I was a child growing up in Hollywood Staten Island, I’ve been obsessed with the Oscars. I even have my own acceptance speech prepared. I’ve rehearsed it numerous times over the years while staring at myself in the bathroom mirror. The scope of my obsession knows no boundaries. I’ve read many books about the Academy Awards, memorized trivia such as, which two actress tied for Best Actress?

Answer: Katherine Hepburn and Barbra Streisand

I know who’s won the most Oscars, which star has been nominated the most times and which unsuspecting actor was interrupted as he presented an award by a nude man racing across the stage.

Every year I host my own Oscar party. It is an event that is more important to me than my own birthday. Because in many ways it is a celebration of my life or rather the life I should have had. I intended to go to film school but instead chose pre-med.

This week the Oscar nominations came out. I was thrilled to see Annette Bening was nominated again. She deservs to win Best Actress for The Kids Are Alright. I’m sorry Natalie Portman fans. Natalie was amazing in the Black Swan, but most of her dancing was digitally enhanced. Her face was superimposed onto another dancer. She wasn’t even there! But I digress. Annette has lost three times and twice to Hilary Swank. It’s Annette’s year!

As fate may have it, I have been selected to attend the 18th Conference on Retroviruses and Opportunistic Infections (CROI). CROI is a scientifically focused meeting of the world’s leading researchers working to understand, prevent, and treat HIV/AIDS and its complications. The goal of CROI is to provide a forum for translating laboratory and clinical research into progress against the AIDS epidemic. Over 4,000 leading researchers and clinicians from around the world will convene in Boston, Massachusetts from February 27 through March 2, 2011.

So you see for the first time in many, many years I will not be able to enjoy the Oscars live because it coincides with the Opening Plenaries, which begins promptly at 5pm and not from the Kodak Auditorium. Instead I will be listening to Bryan Cullen from Duke University and Anthony Harries from the International Union against Tuberculosis and Lung Disease in France at the illustrious Hynes Convention Center located at 900 Boylston Street Boston, MA.

This year there will be no Red Carpet Show for me. I’ll be in my hotel room preparing to brave the harsh elements to congratulate CROI award and scholarship recipients. And after the real Oscar show ends and all the stars gather over to the Vanity Fair Party, I’ll enjoy a cheap glass of Chardonnay at the Welcome Reception.

Unfortunately, there will be no Oscar party at Chad and Frank’s this year. I apologize. You’re on your own.

Perhaps I can catch a glimpse of Annette accepting her Oscar while I order my second Chardonnay at the hotel bar. Do you think they’ll be watching the Oscar telecast at the bar in the Copley Westin?

Man claims Glaxo drug made him ‘gay sex addict’

A 51 year old French father of two is taking GlaxoSmithKline to court. He is alleging the British company’s drug, Requip, which is indicated to treat Parkinson’s disease turned him into a gay sex and gambling addict.

His lawyer states that his patient’s behavior changed radically after he began taking the medication. Didier Jambart, a married heterosexual man claims he attempted suicide three times, became addicted to Internet gambling and lost his family’s entire life savings. Interestingly, Mr. Jambart has also become a compulsive gay sex addict and began exposing himself on the Internet and cross-dressing.

A sexual encounter led to rape, said his lawyers.

In 2005, he stopped taking Requip and his behavior dramatically reverted back to his normal heterosexual, non gambling self. Unfortunately, he had already been demoted and was suffering psychological trauma as a result of the rape. Mr. Jambart is seeking 450,000 euros ($610,000) in damages from Glaxo. He accuses the drug company of selling a “defective” drug, and has cited his neurologist for having failed to properly inform him about the drug’s side effects.

Incidentally, I checked the package insert for Requip and no where does it mention sudden loss of heterosexual tendencies or an inexplicable desire to gamble while wearing a ball gown. That drug by the way is called, vodka.

Glaxo said it did not wish to comment on the case.

Back up

This weekend was not a pleasant one for me. Not only did it start out wet and gloomy but it seemed to go down hill after I received a text from Chad asking if his friend, Stephen, could stay the night. “Just one night,” he wrote. “He has an early morning flight on Saturday.”

Last time his best friend Stephen showed up on our door, he stayed for several days drinking, smoking and arguing with me about why he hates lesbians. When I defended them he nearly threw me out of my own house.

Stephen is loud and tells long-winded stories about the good old times he shared with Chad in Arizona, Portland or Uganda. Apparently, Stephen and Chad have lived all over the world or maybe Stephen just likes to elaborate and when I say elaborate I mean, stretch the truth.

But Stephen only stayed one night. He did leave promptly the next day, back to Siberia from whence he came I suppose. I like him better now then I did the first time I met him. Maybe it was me, but the first time I met Stephen I was in the throes of cramming for my Internal Medicine Recertification Exam. Just like his last visit, he drank, smoked and argued with me about lesbians, but on his way out of the apartment early Saturday morning he said, “I leave here today with a better appreciation of lesbians thanks to you and your lesbian haircut.”

But my weekend didn’t end on that high note. In fact it plummeted further into the abyss of tragedy because I had a 10 o’clock appointment at the Apple Store, no excuse me, the Genius Bar. My Mac Book Pro was not working properly. You don’t realize how much you use your computer until it stops working. So I packed up my poor little lap top and made my way into the rain heading south toward 14th Street in the Meatpacking District.

The Apple Store is pretty cool if you haven’t been to one: white walls, spiral glass staircase, and smiley happy Apple workers, eager to check you in or ask you if you need help. They all look the same: nerdy yet cool, disheveled and wearing glasses. I was broughy to the Genius Bar where Chris ran a diagnostic on my Mac. “Looks like everything checks out,” he smiled. “We’ll need to take it in. Come back in 30 minutes.”

“Sure,” I said.

Chad and I went to French coffee shop and ate bland, organic food on organic bread. We sipped coffee from cups without handles as I listened to other people’s conversations. “…I took German while I attended a music conservatory… Are the fruit fresh? …Oh God, when will this snow clear up its ruining my entire winter wardrobe.”

After thirty minutes of eaves dropping I returned to the third floor of the Apple Store. For some reason I thought the girl who checked me in would remember my name. When she didn’t I felt as though her original genuineness was nothing more than an act. That left me feeling suspicious of her. Then she asked me to step aside while she took care of other people. I wanted to shout out to them: “Don’t bother giving your name. She won’t remember it.”

After Chris finished up with his current customer, he waved me over. I said, “Hi, Chris.” In my mind I was thinking, “See I rememeber names.” He was not impressed and immediately said, ”We’ll need to change the hard drive. Luckily, you have the extended warranty. Did you back up your computer?”

“No,” I said.

Then I thought, Of course not. Does anyone really back up their computer? I mean, how do you back up your computer? I know you’re supposed to. I mean, Christ, they did a whole episode about it on Sex and the City, the one where Carrie loses all her stuff because she didn’t back up her computer. You think I would have learned from her mistake. I guess I’m just lazy.

Chris smiled because I’m pretty sure he knew the answer to his question even before he asked me. “No worries,” he said. Easy for him to say. Then he showed me various portable back up devices (just one more thing I can’t afford right now) and quickly went  through the process of how to back up my computer. I nodded even though it sounded like he was speaking Cantonese. I thought for sure Chad would know how to back up a computer. I’m positive Chad performs this vital  function routinely. Then I got slightly unnerved and wondered why Chad hadn’t urged me to back up my computer all along, knowing very well  I don’t.

Anyway, I bought a mid priced back up thingy and went home to do what I should have been doing the past several years – backing up my computer. To make a long story short, it wasn’t easy. You see my hard drive was dying. She couldn’t let me back her up because with each attempt, she was drawing on her last breath. After several hours I gave up. Resigned to the fact that I was going to lose all my most important files, photos and music, I quietly closed my laptop and though I was closing her casket.

The next day I went back to the Genius Bar at 9:45 am and for the next four hours, I sat there as Josh, Drew and Davi did there best to back up my computer files to my newly purchased, mid-priced back up device. Each time one explained the issue with the other, I could see them exchange glances that said, “No, he never backs up his computer. He’s one of those. You know, one of those people who thinks their hip enough to own a Mac but doesn’t really want to invest the time or energy to learn how to use one or get the most out of it. Then when something goes wrong, those people, people like him (and then he subtly nods in my direction)shows up here at the Genius Bar expecting us to just fix it, like where Wizards or Magicians.” I hang my head in shame, just hoping they can fix my Mac. I silently pray to Steve Jobs. I said, “I’ve learned my lesson. I promise to back up my computer. I’m even going to use the Time Machine, even though I thought that it was a just a game. I’ll even learn how to speak the lingo so that I don’t say stupid things like, ‘I got it to come up on my computer’ instead of download, or better yet, I’ll learn the meaning of acronyms like RAM or GB. I’ll even find out what kind of operating system my lap top uses. I’ll do all these things Dear God or Steve Jobs as long as you save my poor Mac Book Pro. Don’t take it out on her. It’s my fault. I’m a bad parent.

They took my lap top in and told me they would keep her for 3-5 business days. I felt like the Apple School had called social services and I was having my child taken away from me. I’m childless now. I hope they give me back my little girl. So learn a lesson from me and back up your computer.

Thallium poisoning

Thallium, for him.

A New Jersey woman is being held on murder charges in the death of her husband. Tianle Li, a 40-year-old chemist who worked for the pharmaceutical company, Bristol Myers Squibb, allegedly used Thallium to poison her husband, Xiaove Wang. The couple were in the midst of a nasty divorce.  

Investigators said Li gave her husband the highly toxic chemical in December and early January. Believing he was sick with the flu, Wang left home and checked himself into a hospital. Less than two weeks later, he died.

Li’s bail is set at more than $4 million.

Thallium was discovered by Sir William Crookes, an English chemist, in 1861. Crooks had obtained the sludge left over from the production of sulfuric acid. After removing all of the selenium from the sludge, he inspected it with a device known as a spectroscope to look for signs of tellurium. Instead he observed a bright green line that no one had ever seen before. Today Thallium is used in conjunction with cardiac stress tests.

But more importantly, I want to know how Li thought she was going to get away with this. First, the couple is involved in a nasty divorce and both members are living in the house. If you’ve seen the movie, The War of the Roses, you know that when the husband and the wife both want the house, it’s vital that they remain in the house. However, two incompatible people residing under one roof can lead to some fierce fighting. If Li was poisoning her husband, why did she let him go to the hospital? You know they’re going to run tests? I’m no CSI fan but hello, Li, what were you thinking? If you’re going to poison your spouse, you have to be clever. Li is a chemist. Once they found traces of thallium in  her husband’s blood it would be easy to trace it back to her.

My favorite case of marital discord that led to partner poisoning was the true story of a Texan plastic surgeon, Dr. John Hill. In the 1981 made for TV movie, Murder in Texas, John Hill, played by Sam Elliott, came from a middle class family. In the late 50s, he attended medical school in Houston and met, Joan Robinson, played by the amazing, Farrah Fawcett, a beautiful blond equestrian in her mid 20s.

John and Joan married, had 1 child, and all appeared well for 10 years. After developing a lucrative plastic surgery practice, Dr. Hill became entangled with a divorcee named, Ann Kurth, played by Katherine Ross, the real life wife of Sam Elliott (Now if you’re thinking I know too much television trivia; you’re absolutely right).

In March of 1969, the otherwise healthy and athletic Joan Hill became deathly ill. Now listen up Li, according to some accounts Dr. Hill basically ignored his wife’s failing health until it was too late to save her. Now widowed, John married his mistress. Meanwhile, John’s father-in-law, Ash Robinson, played by Andy Griffith, was convinced his son-in-law was responsible for his daughter’s death and made it his full-time job to prove John’s guilt.

Now for the interesting part, early toxicology reports from Joan’s autopsy pointed to toxic shock syndrome as the cause of death. In the made for TV movie, John is shown feeding his wife French pastries laced with cultures grown from her own fecal material. Flawless when you think about it. John poisoned his wife using her own excrement. He fed her eclairs stuffed with cream mixed with cultures grown from her feces. Now if that is not the best, most resourceful way to use your medical education to murder your partner than I don’t know what is. I certainly know you don’t bring home Thallium from work and poison your husband. Thallium is traceable Li; feces, not so much.

My 2011 Oscar picks

I love the Oscars. Even though I won’t be able to watch the broadcast live this year, I thought I’d give you my picks for who will win and who should win. This year the most controversial category is Best Supporting Actress. It seemed like it was Melissa Leo’s year. After winning both the SAG and the Golden Globe, it appeared that Leo was destined for the award season trifecta by picking up her first Oscar. Unfortunately, the Supporting Actress category has often been the one where Academy voters think outside the box. Mira Sorvino seemed to have come from nowhere when she beat out Kate Winslet or how about Anna Paquin who had to be escorted by her mom because she was still a “wee little baby”. Remember 1992 when Marissa Tomei surprised everyone including Judy Davis and Vanessa Redgrave, or 1996 when Juliette Binoche walked right past Lauren Bacall?

Surprises are what the Oscars are all about, catching those stars at their most vulnerable, and then throwing them a curve ball as they sit trapped in their seats as the whole world witnesses their humiliation. And don’t act like you don’t hope for that moment when the shoe in’s name isn’t called, and they practically leap up out of their seat before they realize they’ve lost. I know that’s how I felt when Marcia Gay Harden beat out the favorite, Kate Hudson. Kate sat there with a frozen expression on her face. She couldn’t do what I did at home: scream at the TV, throw cushions from the sofa and storm off into the kitchen for a bag of chips.

The Oscars is really a lesson in sadomasochistic restraint. Stars have to laugh at the unfunny jokes, make sure they don’t pick their noses and clap when their name isn’t called so that they’re perceived as a good sport. The Oscar broadcast isn’t for them; it’s for us, the viewer. I suspect that most stars would rather have the award delivered to their homes then to have to undergo the challenge of the Red Carpet. In those hours during the broadcast, stars are tortured for our viewing pleasure. That’s not to say that winning doesn’t change their lives, but let’s face it, they’re already a member of a very fortunate few.

These past few years, Academy voters have been conservative, but it’s not a show until someone goes home crying. Sorry Eddie Murphy. Here are my picks:

Best Picture

Should win – King’s Speech.

Will win – King’s Speech.

Best Actor

Should win – Colin Firth

Will win – Colin Firth

Best Actress

Should win – Annette Bening

Will win – Natalie (I didn’t really dance) Portman

Best Supporting Actor

Should win – Christian Bale

Will win – Christian Bale

Best Supporting Actress

Should win – Melissa Leo

Will win – Hailee Steinfeld.

Sex on the “high” seas

Drinking, drugs and unsafe sex: The risk-taking behavior of the gay party male.

Imagine for a moment that you’re a doctor- a gay doctor with a practice that predominantly treats gay men. Now, guess how many text and phone calls you might receive during any given weekend involving questions that have to do with recreational drugs, penile discharge or the risk of contracting HIV from unprotected sexual encounters? Now, take that number and multiply it by ten if that weekend should occur around Gay Pride, Folsom, Gay Disney or any one of the Atlantis Cruises. Welcome to my world…

At this point, you might be thinking, what did you expect when you decided to treat gay men?  I guess I knew what I was subscribing to.  The life of a gay party boy is not foreign to me. I’ve been to Folsom, Gay Disney and several Atlantis Cruises. But even I struggle to understand the brain of a gay man, especially of those who make the regular 3am Sunday morning calls to me seeking advice, reassurance or quick pharmaceutical relief. Over the years I have monitored and treated gay men with curiosity. I’ve concluded that some of the most telling insights into the gay mind come from watching my own seemingly heterosexual nephews. At fifteen and sixteen years old, they don’t always listen to their parents, they’re eager to push the limits set by their teachers, and when confronted about their risk taking behavior, they invariably roll their eyes to show their disinterest in having a rational conversation. That’s because teenagers, like gay men, are a conundrum, baffling scientists and doctors for centuries.

I’m not alone. My colleagues in Manhattan and in Los Angeles give similar reports about their patients. We scratch our heads and wonder why the rates for syphilis are at an all time high among men who have sex with men. And with all the media attention paid to HIV prevention and risk modification, the majority of new HIV cases in the United States are among gay men. As doctors, we do our best. I counsel my patients accordingly about drugs and sexually transmitted diseases, including HIV. Although I feel confident in my abilities, I still picture my nephews’ eyes rolling into the back of their heads when I try to instill some sense of caution in my patients before a circuit event. I don’t judge, or at least that is what I tell myself. But I suppose I do. I stopped going out years ago when it became a never ending merry go round of witnessing overdoses and retreating STDs. I tell myself I’m getting older. When I was younger, I didn’t listen either, but the age of the modern day party boy is well beyond the age of when any of us should be referring to each other as “boy.” I’ve read that the average age of an Atlantis Cruise ship passenger is 41.

The trouble with gay men is that, like teenagers, they fall prey to the rush of hormones that drive the reward-system network. Essentially, this is the spot in the brain that reacts to desire or a bump of crystal. The body responds to this reward-system network by releasing the neurotransmitters dopamine and norepinephrine. Cocaine raises dopamine levels 400 percent higher than normal. In comparison, methamphetamine triggers a 1,500 percent increase in dopamine. Although dopamine affects many parts of the brain and body, the effect is most important on two brain sites: the nucleus accumbens, and the ventral tegmentum. These two brain sites are connected by a bundle of cells called the mesolimbic pathway, or the brain-reward center. This is the area of the brain that is most powerfully associated with pleasure and addiction. Stimulating this pathway makes a person want to repeat this behavior in order to feel the reward it brings. Unfortunately, that reward is never truly like the first time – no matter how much sex you have or how many bumps you take.

Of course the obvious culprit is that we are fueled by our desires, whether these are sexual or drug-fueled escapes, especially when these desires have been liberated after years of confusion and confinement. Who wouldn’t want to go on a sex, drug and alcohol binge while drifting through the Caribbean on a gay cruise where there are no judgmental eyes watching your every move?

On February 6th, the Royal Caribbean ship “Allure of the Seas” set sail from Port Everglades, Florida. Billed as the largest gay cruise ever, Atlantis hosted more than 5,400 passengers. “Where does it go?” I asked one patient as he reviewed a list of prescriptions he would need for his upcoming trip: Cialis, Xanax and Ambien.

“Who cares,” he said. “I’m never getting off the boat.” Several days later the text messages started to arrive, “This trip is a disaster. Guys are overdosing left and right. The authorities bordered the ship and arrested a drug dealer. They have dogs and they’re making surprise room searches.”

Agents who searched the suspect’s cabin reported finding more than 140 ecstasy pills, nearly three grams of methamphetamine, a small quantity of ketamine and about $51,000 in cash. While waiting for the suspect in his cabin, two more passengers stopped by seeking drugs, according to agents.

When I read the article online and spoke to passengers upon their return, I felt angry. In a time when gay men and women want to be taken seriously so that we can serve openly in the military and have the legal right to marry, isn’t counter productive to read about the drug busts and overdoses on a floating circuit party? Or maybe we just want it all – the rights we deserve and the option to choose which, if any, fit into our particular circumstances and plans.

The normal reward-system in the brain serves a vital evolutionary purpose. As this center matures it helps us deal with the terrifying realities that face us in the modern world. This world also includes access to illegal drugs and risky sex. If these signals continue to trigger the reward-system, they may lead to anxiety, depression and addiction. On the other hand, the cognitive control network is the part of the brain that acts like our moral conscience. In teenagers, the reward-system network matures rapidly due to the rush of hormones. These hormones do not speed up the cognitive control network. In fact, cognitive control matures slowly. So then why doesn’t an adult gay man have the cognitive control to chaperone their risk taking behavior? One explanation is that most gay men do not feel the same pressures of responsibility as most heterosexual men. Gay men who enjoy circuit events are more likely to be single. If they are in a relationship, the couple often negotiates rules that include three-ways or sexual encounters outside their relationship. More often these men do not have children. This freedom supports explorative behavior to indulge in sex and drugs. For most teenagers, gaining control of the reward-system center comes with maturity, especially as their cognitive center develops. Unfortunately for some gay men, the strong impulses of the reward-system center often outweigh the associated risks that face the average party-going male.

If 5,400 people, mostly gay men, go on an Atlantis Cruise, what percentage will succumb to the impulses of the reward-system by using recreational drugs, drinking alcohol and engaging in unsafe sex? Now take that number and multiply it by ten.  Despite the arrest, Atlantis announced that it will repeat the trip in 2012. I hope it’s over a weekend when I’m not on call.

Cancer from oral sex

In the US, oral cancer due to HPV infection is now more common than developing oral cancer from tobacco. Scientists at Ohio State University say there is strong evidence linking oral sex to cancer, and have urged more study of how human papillomaviruses may be to blame for a rise in oral cancer among white men.

In the United States, oral cancer due to HPV infection is now more common than oral cancer from tobacco use, which remains the leading cause of such cancers in the rest of the world. Although the lifetime risk of developing oral cancer is 1.41%, odds are that 1 in 71 people will develop oral cancer in their lifetime. The single greatest factor that is increasing this number is contracting HPV from oral sex. This fifteen year study concluded that when the number of partners increases, the risk increases. Previous studies suggested that people who perform oral sex on six or more partners over their lifetime face an eight-fold higher risk of acquiring HPV-related head or neck cancer than those with fewer than six partners.

There are as many as 150 different types of HPV, and about 40 of those can be sexually transmitted, according to the National Cancer Institute. Some may cause genital warts, while other high-risk variants can cause oral, anal, vaginal and penile cancers. Genital warts are quite common and easily treated with cryotherapy that ablate warts by either using electrodessication or freezing them with liquid nitrogen.

According to the CDC, half of all sexually active Americans will get HPV at some point in their lives. Two vaccines, Gardasil and Cervarix, were approved by the US Food and Drug Administration in 2006 for HPV types that cause cervical cancer and genital warts.

A study published earlier this month in the New England Journal of Medicine found that the HPV vaccine could prevent 90 per cent of genital warts in men, and the vaccine has also been approved against anal cancer in men and women.

Doctors are still undecided about recommending the vaccine to the general population because research has not shown effectiveness beyond 5-8 years. If the vaccine does not last for a minimum of 15 years then it will only postpone cancer not prevent it.

CROI 2011

I recently returned from the 18th Conference on Retroviruses and Opportunistic Infections or what is more commonly referred to as CROI. Considered by most HIV clinicians to be the most important HIV meeting of its kind, CROI gathers physicians, scientists and healthcare providers from around the world.

One of the most interesting symposiums addressed the growing number of cases of anal cancer. Over 5,000 cases of anal cancer are diagnosed annually. A little more than half are among women. Anal cancer develops from the human papilloma virus (HPV), the same organism implicated in cervical cancer. HPV is transmitted via contact through receptive intercourse, which begs the question: If more than half the cases of anal cancer are among women, then how much anal sex do women engage in?

Very little has been reported about anal cancer rates. Part of the issue is the stigma attached to this sex act. Farrah Fawcett supposedly died from complications related to anal cancer. Upon her death I read many articles that said she died from colon cancer.

Further analysis of the date showed that HIV positive men who have sex with men (MSM) had high-grade anal lesions 2- 3 times more than HIV negative MSM’s. High grade lesions can go onto become cancerous.

Gardasil is an FDA approved vaccine used for the prevention of HPV serotypes 6, 11, 16 and 18. The latter two are potentially cancerous. Initially approved only for women, the indication now includes men. Unfortunately, Gardasil is not always covered by insurance. Given in 3 separate injections over 6 months, Gardasil can cost over $300 for the entire series.

It’s important to discuss your sexual practices with your doctor. The consensus at CROI is that Gardasil should be offered to all women and MSM’s, especially those with a history of HPV.

Sleep

Check out the first of two webisodes on sleep featured on Advocate.com’s Ask the Doctor.

I was pretty excited about this two part series because I got to work with a green screen. Although you’re never really sure what it’s going to look like until it’s done, I think they did a good job in the end. My producer, Josh Rosenzweig, and the editor, Athena, came up with the concept. Let me know what you think.

Gay Cure App

I kind of love my iPhone. It looks cool, the camera takes great pictures and there are all these apps you can buy that do really cool things. One of my favorite apps is the Hipstamatic camera. It allows you to take photos with different grainy qualities and interesting color shades. My favorite game is Hanged, which is hang man but with a dreary cartoon love affair. I’m not a big app buyer, but I do browse the App Store when I’m bored.

 

So you can imagine my shock when I read about an app that encourages, “”the freedom to grow into heterosexuality” for those who are gay or transgender. Apple has come under fire for approving the app called, Exodus International, which is the name of the organization which describes itself as “the world’s largest ministry to individuals and families impacted by homosexuality. With over 35 years of ministry experience, Exodus is committed to encouraging, educating and equipping the Body of Christ to address the issue of homosexuality with grace and truth.”

 

I keep forgetting the body I inhabit was loaned to me by Jesus. Luckily, Exodus International has a cure to keep me from burning in hell in the form of an app I can buy with my iPhone. Now that’s technology. But it’s more than that, contends social activist group Change.org, which along with Truth Wins Out, which “fights anti-gay religious extremism,” is behind a petition drive against what is being dubbed the “gay cure” app.

 

“Exodus’ message is hateful and bigoted,” says Change.org. “They claim to offer ‘freedom from homosexuality through the power of Jesus Christ’ and use scare tactics, misinformation, stereotypes and distortions of LGBT life to recruit clients. They endorse the use of so-called ‘reparative therapy’ to ‘change’ the sexual orientation of their clients, despite the fact that this form of ‘therapy’ has been rejected by every major professional medical organization including the American Psychological Association, the American Medical Association, and the American Counseling Association. But reparative therapy isn’t just bad medicine — it’s also very damaging to the self-esteem and mental health of its victims.”

 

On Exodus International’s website, the organization says it “upholds heterosexuality as God’s creative intent for humanity, and subsequently views homosexual expression as outside of God’s will.” Exodus cites homosexual tendencies as one condition that “beset fallen humanity.”

 

And here I am thinking the fall of humanity lies in the hands of religious extremists who blow themselves up in the name of their god. I guess it’s how you look at it?

 

When my father died, the priest residing over his funeral mass told my mother that even though my dad went to church every day, he still wasn’t in heaven yet. He instructed us to pray for my father every day in order to secure his place with God. Apparently getting into heaven is harder than getting a reservation at Minetta Tavern or Waverly Inn. Or was the priest merely preying on our grief as a way to secure our asses into church every Sunday?

 

Humanity is falling all around us like rotten apps from Apple’s tree.

 

While no one can change what Exodus International believes, we can force Apple to pull this app from its store. Please visit Change.org and sign the petition.

 

Staten Island doctor helps cops

BY MICHAEL PRESTON

DAILY NEWS WRITER

Saturday, March 26th 2011, 4:00 AM

M. Roberts for News

Staten Island District Attorney Daniel Donovan praised Frank Spinelli for his role.

A Staten Island doctor played an instrumental role in busting a former hero NYPD cop accused of molesting three boys, law enforcement officials said Friday.

Frank Spinelli, 43, alerted Staten Island police about William Fox, 65, in 2008 after reading the retired officer’s memoir and recognizing him as the man who molested him as a boy.

The tipoff eventually led to the ex-cop’s arrest in Pennsylvania on Monday.

Staten Island District Attorney Daniel Donovan praised the physician for his role.

“I am grateful to Mr. Spinelli for coming forward, because if he hadn’t, that arrest likely would have never happened,” he said.

Spinelli told authorities Fox molested him when he was a Boy Scout in the late 1970s.

“It was sociopathic to advertise his sickness in a book,” Spinelli told the Daily News.

He worked with authorities by making taped phone calls to the retired officer.

While the recordings didn’t lead to an arrest, the NYPD contacted law enforcement in Pennsylvania, where Fox was living. A probe led to arrests on more current charges.

Spinelli said he wasn’t seeking any credit by getting involved.

“I couldn’t believe that what was happening was still happening 30 years later,” he said.

Fox gained national attention in 1981 for talking down a 17- year-old runaway threatening to jump out of a Bowery building. He later adopted the teen, Michael Buchanan, and penned “The Cop and the Kid.”

Read more: http://www.nydailynews.com/news/ny_crime/2011/03/26/2011-03-26_si_doc_helped_nab_exofficer_in_molest.html#ixzz1HjwhlA4O

Frank Spinelli: Assisting Arrest

Posted on Advocate.com March 29, 2011

By Julie Bolcer

Frank Spinelli at 11

When startling news unfolded last week that William Fox, a decorated former New York City police officer, had been arrested in connection with the sexual abuse of three teenage boys under his care in Pennsylvania, Frank Spinelli felt mixed emotions. The doctor had assisted authorities in the investigation sparked by his own childhood abuse, which he says occurred at Fox’s hands, but more boys had been hurt in the intervening years.

“Right now I feel a little regret that it had to go on so long and that children had to suffer after me when it could have stopped,” said the Manhattan internist for HIV-positive and gay men, who then reverted to the clinical terminology of his practice. “This is a sickness. We need to get help for him and protect children and he needs to be stopped from doing this further.”

In an interview, Spinelli, 43, said that between 1978 and 1980, Fox molested him and other boys repeatedly by taking advantage of his role as a Boy Scout troop leader on Staten Island. He reported the abuse to his parents, who tried to take action, but little came of their complaints in the community of Italian and Irish immigrants where life revolved around the Catholic Church.

“He was the scoutmaster,” said Spinelli. “He was in charge. He asked me about masturbation and pubic hair and ‘fucking’ when I was 11 and he gave me a ride to camp. He led me to believe this was a right of passage for all boys.”

Spinelli, an Advocate health contributor, then put the experience out of mind until 2008, when a book tour and conversations with old friends aroused his curiosity. He found newspaper accounts of the police officer’s accomplishments in talking a suicidal teenage boy down from a ledge and later adopt him, a story Fox retold in the book The Cop and The Kid.The officer was named a National Father of the Year in 1982 for his efforts.

Sickened, Spinelli called Fox, by then retired and living in Pennsylvania, and heard that he had adopted 15 boys, some with disabilities, in New York, Florida, and Pennsylvania over the past 30 years. Spinelli said he learned that the abuse continued and that Fox remained at least tangentially involved with the Boy Scouts.

“I was shocked that what had happened to me is still happening today,” said Spinelli. “I thought, This man in one book has rewritten his history. I cannot let him do this. It will rewrite what he did to me and I know what he did to other boys.”

Spinelli contacted the New York City police and a two-year investigation ensued with the Pennsylvania state police department, which had already received complaints about Fox and decided to reopen the case based on the new information. The details included two phone conversations that Spinelli agreed to wiretap.

For the rest of the article go to:

http://advocate.com/News/Daily_News/2011/03/29/Gay_Doctor_Puts_Child_Molester_Behind_Bars/

NY 1 Interview

Click below to watch the video

 

NY 1 Interviewed aired last night.

 

Thank you to Mara Montalbano for allowing me to tell my story last night on NY1. Currently, my former molester is currently in jail. A hearing is set for early April. I will keep you posted on any further developments.

William Fox preliminary hearing

MANSFIELD – William P. Fox Sr., 65, of 39 Liberty Lane, Liberty, charged with several counts of rape, corruption of minors, involuntary deviate sexual intercourse and sexual assault, will face those charges before District Judge James Carlson April 6.

State police charged Fox following a two-year investigation into the alleged sexual assaults against three minor males at Fox’s residence between February 1996 and February 2009, which was heard by the 30th statewide investigative grand jury.

According to documents filed at Carlson’s office, Fox sexually assaulted the juvenile males repeatedly during the 10 years in question.

According to documents, Fox’s original preliminary hearing was set for today. He remains in the Tioga County Prison in lieu of $100,000 bail.

© Copyright 2011 Williamsport Sun-Gazette. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

April

The month of April is very significant to me.

On a personal note, my birthday is on April 28th. Although I don’t really care to celebrate the day, I do recognize the significance it holds in that it brings me one year closer to the end of my life. At this point in time I cherish the years I have left to live because of the man I love and the many things I have yet to accomplish.

The Center for Disease Control recognizes April as Sexually Transmitted Disease Awareness Month. I encourage everyone to discuss sexual health with their healthcare provider to ensure the safety of you and your partners. It is imperative that if you are not in a monogamous relationship (and maybe even if you are); you should get checked at least annually for HIV, syphilis, gonorrhea and Chlamydia. Women should get annual Pap smear and men who have sex with men should get annual anal Pap smear.

At this point in my career I diagnose at least one person a week with HIV and many more with other STD’s. Please practice safe sex and use condoms correctly.

April is also the National Sexual Assault Awareness Month. Sexual violence, including child sexual abuse, crosses all ages, genders, races, ethnicities, and economic backgrounds. According to research published in the journal Violence and Victims in 2007, in the United States, an estimated 2.7 million women and 978,000 men are victims of sexual violence each year. In recognition of the widespread prevalence of sexual assault in this country, the National Sexual Violence Resource Center has designated the month of April as National Sexual Assault Awareness month.

Although the amount of sexual violence is alarming, there is hope for survivors. As Esther Deblinger, PhD, co-director of the CARES Institute, an expert in the field of child sexual abuse, and an NCTSN member, says, “There is increasing evidence that, with support from a caring adult and high-quality treatment, many children and parents effectively recover and may feel stronger and closer as a family in the aftermath of a traumatic experience.”

The NCTSN is proud to observe National Sexual Assault Awareness Month, and offers the resources to help educate parents, professionals, policy makers, and communities about the profound impact that sexual violence has on men, women, and children.

If you or someone you know is being abused sexually or was sexually abused as a child, please notify the authorities and get help. 

It is not your fault.

William Fox Timeline

1978: William Fox is alleged to have sexually abused Frank Spinelli, an 11-year-old boy Boy Scout at the time.

1981: Fox, then a 36-year-old New York Police Department officer, convinces Michael Buchanan, a 17-year-old boy, not to jump from a Manhattan building. He then becomes the boy’s legal guardian.

1982: Fox co-authors a book called “The Cop and the Kid” about the Buchanan experience.

1990: Fox moves to Palm Bay. He has four adopted boys living with him, according to a neighbor.

Mid-1990s: Fox leaves Florida to go live in Pennsylvania.

2008: Three decades after the alleged abuse, Spinelli talks to NYPD, leading to an investigation by Pennsylvania State Police.

March 21, 2011: Fox is arrested in Liberty, Pa., and charged with sex crimes against his adopted children. Bail is set at $100,000.

April 25, 2011: Fox is arraigned and enters a plea of not guilty. His request to have his bail lowered is denied by the judge.

Cell Phones, Brain Tumors and mothers

My iPhone makes my ear burn whenever I speak on it for more than ten minutes. The reality is that I’m not a phone person. Of course, I use my cell phone with the same obsessive compulsive behavior I reserve for checking my Facebook messages, but the truth is that I really don’t like to talk on my phone for more than ten minutes at a time. Unless of course I’m on the phone with my mother, and in that case, my ear is probably burning because she’s been yelling in it for over a half an hour. I basically use my iPhone for texting and Internet access.

In a recent article in the New York Times, Siddhartha Mukherjee, an assistant professor of medicine in the division of medical oncology at Columbia University, gave a timeline of certain carcinogens and their relationship with certain cancers. For example, smoking and lung cancer. Researchers identified smoking as a cause of cancer through careful clinical studies in the 1950s and 1960s.

“To ask whether cellphones increase the risk of brain cancer, then, we might begin by turning to this question: Has the age-adjusted incidence of brain cancer increased in the recent past?

The answer is no. Brain cancer is rare: only about 7 cases are diagnosed per 100,000 men and women in America per year, and a striking increase, following the introduction of a potent carcinogen, should be evident. From 1990 to 2002 — the 12-year period during which cellphone users grew to 135 million from 4 million — the age-adjusted incidence rate for overall brain cancer remained nearly flat. If anything, it decreased slightly, from 7 cases for every 100,000 persons to 6.5 cases (the reasons for the decrease are unknown).

In 2010, a larger study updated these results, examining trends between 1992 and 2006. Once again, there was no increase in overall incidence in brain cancer. But if you subdivided the population into groups, an unusual pattern emerged: in females ages 20 to 29 (but not in males) the age-adjusted risk of cancer in the front of the brain grew slightly, from 2.5 cases per 100,000 to 2.6. These cancers appear in the frontal lobe — a knuckle-shaped area immediately behind the forehead and the eye. It is difficult to imagine that cellphones caused these frontal-lobe tumors: how, or why, would a phone’s toxicity have skipped over the area nearest to it and caused a tumor in a distant site?”

Most epidemiologists and biologists agree that tissue-skipping is not plausible, and most do not believe that frontal lobe tumors are the result of cellular phones.

Like most people, I often worry that I have a brain tumor especially since my maternal grandmother died of a brain tumor in the 1960′s. Of course she did not own a cell phone. Every common symptom that could be attributable to stress like, headaches, fatigue, blurry vision or even indigestion, leads me to a definitive diagnosis of brain tumor but only in myself. Of course when any patient comes into my office, I reassure vehemently that the likelihood of having a brain tumor is very low. So why can’t I talk myself out of it? I suppose I’m like everyone else. We assume the worst and expect the inevitable.

This mother’s day my sister and I are taking my mother out to dinner. No cell phones allowed. Researchers say that the lag time for the development of brain tumors from cell phones is estimated to take between 50 and 70 years. I should only hope I have my mother around for that much time.

Talkin’ bout a revolution

When I hear revolution I’m reminded of songs from the Beatles or Tracy Chapman. I think of going against the establishment. There have been great revolutions in this country: the women’s movement, the civil right’s movement and even the Stonewall revolution, which marks the gay movement for equality.

That’s why it’s hard for me to digest the five-year study commissioned by the nation’s Roman Catholic bishops, which concluded that the church’s sexual abuse crisis had nothing to do with either the all-male celibate priesthood or homosexuality.

Oh no, the reason why there was a surge in the number of sexual abuse cases by priests against minors was because “priests were poorly prepared and monitored amid the social and sexual turmoil of the 1960s and ’70s.”

The “blame Woodstock” explanation has been floated by bishops since the church was engulfed by scandal in the United States in 2002 and by Pope Benedict XVI after it erupted in Europe in 2010. But this study, which to me is as ridiculous and carries as much wieght as South Park’s hysterical, Blame Canada Theory, is likely to be regarded as the most authoritative analysis of the scandal in the Catholic Church in America. The study, initiated in 2006, was conducted by a team of researchers at the John Jay College of Criminal Justice in New York City at a cost of $1.8 million. About half was provided by the bishops, with additional money contributed by Catholic organizations and foundations. The National Institute of Justice, the research agency of the United States Department of Justice, supplied about $280,000.

The researchers concluded that it was not possible for the church to identify abusive priests in advance. Priests who abused minors have no particular “psychological characteristics,” “developmental histories” or mood disorders that distinguished them from priests who had not abused, found researchers.

“Since the scandal broke, conservatives in the church have blamed gay priests for perpetrating the abuse, while liberals have argued that the all-male, celibate culture of the priesthood was the cause.” The report notes that homosexual men began entering the seminaries “in noticeable numbers” from the late 1970s through the 1980s. By the time this cohort entered the priesthood, in the mid-1980s, the reports of sexual abuse of minors by priests began to drop and then to level off. If anything, the report says, “the abuse decreased as more gay priests began serving the church. One of the more outrageous findings report that fewer than 5 percent of the abusive priests exhibited behavior consistent with pedophilia, which it defines as a “psychiatric disorder that is characterized by recurrent fantasies, urges and behaviors about prepubescent children.”

“Thus, it is inaccurate to refer to abusers as ‘pedophile priests,’ ” the report says.

That finding is likely to prove controversial because the report uses a definition of “prepubescent” children as those under the age of 10. Using this cutoff, the report found that only 22 percent of the priests’ victims were prepubescent. The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders classifies a prepubescent child as generally age 13 or younger. If the John Jay researchers had used that cutoff, the majority of the abusers’ victims would have been considered prepubescent. It angers me to think that the distinction between pre and post-pubescent is used to discount those victims who were still very much minors. So a 13-year-old is up for the taking. Another reason why this distinction is ridiculous is because children in Catholic school enter at about age 5 or 6 and graduate at age 13 before they enter high school Priests would have access to these children for many years. The process of grooming in order to develop trust could occur from age 11 until graduation. Excluding these children is yet another way of protecting the perpetrators.

The report, “The Causes and Context of Sexual Abuse of Minors by Catholic Priests in the United States, 1950-2002,” is the second produced by researchers at John Jay College. The first, on the “nature and scope” of the problem, was released in 2004.

New HIV cases on the rise

Since January 1, 2011, I have diagnosed one new HV patient a week. They have all been men under 40, and more than half had no health insurance. What makes this most worrisome was that many were in the twenties.

 

In the current issue of the Journal, Levy et al. describes some of the issues associated with the emerging and evolving HIV epidemic in Israel. They not only documented that the absolute number of HIV infections has been increasing over the past decade, despite wide access to HAART, but that the preponderant number of those recently infected and newly diagnosed were MSM. Particularly concerning was the finding that 29% of the men were infected with HIV that was resistant to at least 1 of the antiretroviral classes, and coinfection with syphilis was common.

 

In my practice nearly half of the men diagnosed with HIV had a concomitant syphilis infection. Several contracted a strain of HIV with one or more major mutations. “These findings call to question some of the recent optimism about “treatment as prevention”, which presumed that if expanded efforts at increasing HIV testing and linkage to care could be undertaken, and individuals could be promptly treated, that the AIDS epidemic could be brought to a halt.”

 

That doesn’t seem to be true. The data suggests that a subset of these infected men may be engaging in unsafe sex. 

 

Why?

 

The current school of thought states there is a low risk for transmitting HIV to HIV negative partners if the patient is on medication which effectively suppresses the virus. One explanation for the increase in transmission is that a subset of HIV positive men are not compliant with their medications due to depression, drugs or forgetfulness. Also co-infection with a sexually transmitted disease can possess sufficient concentrations of resistant HIV in the genital tract secretions to transmit to uninfected sexual partners. “This study is not the first to document that some individuals are newly infected with resistant virus [27] and that syphilis is increasingly common in HIV-infected MSM [28, 29], but the combination of these factors and their association with an expansion of a national HIV epidemic heightens the acuity of the concern that a new generation of MSM could face an AIDS epidemic with constrained therapeutic choices.”

Why is this happening? 

 

Therapeutic optimism is only part of the explanation. Since the earliest days of the epidemic, affective disorders, like depression, as well as substance use, have been associated with unprotected sex and multiple partners [30, 31]. For some, early life experiences, ranging from sexual abuse to homophobic violence, may result in decreased self-efficacy and lowered self-esteem [32]. The use of disinhibiting drugs and unprotected sex may serve a depressed MSM as ways to “self-medicate” in an adverse environment [33, 34]. These conditions not only tend to co-occur, they synergistically interact to enhance the risk of engaging in unprotected sex and becoming HIV-infected [35]. Thus, attenuating the spread of HIV among MSM requires the scaling up of evidence-based programs that not only encourage HIV testing, linkage to care, and treatment, but also engage providers in the provision of culturally competent care to sexual and gender minority patients [36]. For example, drug treatment programs that are tailored to substance-using MSM have been shown to be more effective than those that do not acknowledge the participants’ sexuality [37]. Unfortunately, many MSM who engage in practices that put them at risk for HIV and other sexually transmitted infections (STIs) report that they are not always comfortable disclosing their behaviors to their medical providers [38, 39], creating multiple missed opportunities for slowing the epidemic every day around the world.

 

The last patient I diagnosed with HIV had been my patient for over five years. He was very distraught to learn he was HIV positive, and so I encouraged him to see a therapist. When the therapist called to confer with me, he asked if I knew the patient had a crystal meth addiction. I did not. Even after five years of treating this man, he denied ever using drugs whenever I asked.

“The Israeli study holds a mirror to the future of the epidemic in this population, suggesting that MSM should not assume that their partner is HIV-uninfected, and if he is infected, it is unwise to assume that his medication will make him noninfectious.

Gay Marriage

My cousin Sal recently married his longtime girlfriend Lauren. It was the first time in my adult life I had been invited to an event where the host knew I would be accompanied by my male partner. It was a big deal for me being a first generation Italian American. Although I come from a loving family it is implied that what goes on behind closed doors, remain behind closed doors and not in plane sight. Most times I felt my own close family preferred I remained closeted for the sake of maintaining peace. Ruffling feathers and creating drama is something any Italian knows very well. As a people, we rarely shy away from confrontation and in fact we invite it, thriving on its energy as a source of inspiration to propel us through our otherwise mundane lives.

Arriving at the Venentian in Garfield, New Jersey just before 7:00 p.m last Friday night, the Spinelllis arrived in two cars. I drove my mother’s cream Jaguar accompanied by Chad and my sister, Maria, who flew up just for the wedding from Alabama with her 13 year old daughter Madeline. This weekend excerusion was a surprise gift to her granted by her father who gave her permission to attend the wedding because she was the flower girl to the groom’s sister nearly eight years ago. In the other car, jettisoning perillously like a slalom skier through the careening traffic was my brother-in-law, Joe driving my other’s sister, Josephine’s blue BMW325 with my overly sequined mother in the back seat. They were not without their own backstory. Josephine was once married to a man related to the groom and his entire extended family would be present.

It was a big night for all of us. Themes of betrayal, homosexuality, fury and alliances rang out long after the church bells. Ultimately, little happened. There was no table flipping, no glasses of wine thrown into faces or worse, actual pushing and shoving. The wedding was simply just that, a union of one young man to a beautiful young lady. Of course we had our own internal dialogue. I’m sure one of my disapproving cousins had something to say about Chad’s presence as likely my sister’s ex had something to say about my  her current husband. I know we had lots to say about his wife. The only spillage was when I knocked over a glass of wine at the table and the server had to set a new place setting next to Chad after removing the chards of glass. I suppose you could say that the body count was kept to a minimum as Italian weddings go.

It took decades for me to be invited to a wedding with a male partner. At the same time it made me consider when I might marry myself. As another Italian, Governor Cuomo is pushing through legislation to allow gay marriage, it made me proud to be part of a culture that was so passionate about issues whether they be pro or against it. If this should happen then maybe this time next year, cars will be jettisoning over bridges and tunnels from Queens, Staten Island and Brooklyn… and even Alabama to attend the union of this doctor to his own primary care physician.

Time will tell.

Comedy or just plan hate?

30 Rock star Tracy Morgan found himself in the center of a heated debate after he went on an anti-gay rant during a show in Tennessee earlier this month. Reportedly, Morgan said he’d stab his son if he were gay. Homosexuality, he went on, was a choice because “God don’t make no mistakes.” Eye witnesses said his jokes were met by cheers from the audience.

Many comics rely on cruelty. Joan Rivers has made a career at poking fun at celebrities. She tormented Elizabeth Taylor for years, insulting her weight. During an interview, she was asked if there were any topics that were off limits. She replied no, but then added that when Elizabeth Taylor was admitted to the hospital, she stopped making jokes about her until she was better. Her rule was that she didn’t kick people when they’re down.

Recently Chelsea Handler went on a tirade about Angelina Jolie, calling her a “cunt.” When asked by Joy Behar if she thought she had gone too far, Handler responded that she was not going to apologize because then she would have to apologize to everyone she’d ever made fun of.

Tracy Morgan spent much of last week on the remorse circuit after his anti-gay rant. He was sorry, he told anyone who’d listen. He meant no harm. Later that week, Morgan met with New York youths who have been shunned by their families because of their sexuality. Joan Rivers  later commented that Morgan should not have apologized.

In light of the recent number of LGBTQ suicides, is it the right time for any comedian to jokingly say they would stab their child if they were gay? Tracy Morgan should have apologized. Why doesn’t Joan Rivers own rule of thumb apply in this instance as well. As far as I’m concerned comedians can provoke, insult and joke about each other all they want, but from some accounts it seemed Morgan’s rant went too far. It touched a nerve among anti-gay supporters who probably feel that gay marriage should never be allowed or that homosexuality is a choice. When Morgan offered his violent solution to dealing with one of his own children if they said they were gay, he was inciting hate and perpetuating violence among the LGBTQ community. Imagine the outrage if Jeff Foxworthy said at his next Redneck Roundup that if his daughter brought home a black man he’d shoot her in the head?

I will say that Morgan was smart to apologize immediately however, Tina Fey’s response that he is not a hateful person and is much too sleepy, is a lame excuse for his behavior. What really bothers me is Joan Rivers, who after watching her documentary clearly feels that no topic is sacred, but that is not true. Good comics provoke thought and make us laugh at ourselves, and yes, mean comedy can be funny when it’s pointed at ridiculous social norms or holds a mirror up to the way we live.

In late 2010, Tracy Morgan underwent a kidney transplant for chronic renal failure secondary to diabetes. You’d think he’d have a new outlook on life now that he’s been given a second chance. So stop the hate Tracy, it’s bad for your health, and you’re already working on borrowed time. Pay more attention to your sugar and less about your child’s sexuality.

Rehab

I remember the year Amy Winehouse’s CD, Back to Black came out: I was given the CD by a patient who said you must listen to this. I did and was pleasantly struck by the innovative way Mark Ronson fused that early Motown sound with contemporary beats under scoring Winehouse’s smoky voice. And those lyrics with nods to pop culture!

Anybody that can weave a James Bond reference in with Stella and fries had me at hello.

I recall singing, Rehab in my office after all the patients had gone. My then receptionist and I would sing along to the CD, dancing and creating our own choreography, waving our index finger at each other as we sang, “No, no, no!” That receptionist incidentally ended up in rehab.

As life often imitates art it was clear that Winehouse wasn’t just singing about her refusal to attend rehab. She wasn’t going. “No, no, no.”

I suppose if you believe in freedom and civil liberties then you have to agree that a person has the right to live as they see fit. Even if it isn’t how you would.

What bothers me most about Amy Winehouse’s death is that we won’t have any more music from her. “No, no, no.” And that unfortunately is the biggest tragedy.

But if you ever knew anyone who was addicted to drugs or alcohol it would be easy for you to understand that you CAN”T make someone go to rehab. They have to decide for themselves. The awful truth is that if you are dependant on either drugs or alcohol or both, your view on life is skewed. Your vision of how life really is can be described as myopic. I’ve been around many people in my career who were either addicted or used drugs recreationally. Most of the time they thought they were in complete control.

My worst memory is when I visited a friend in the hospital after she overdosed. I offered to go to her house to fetch some of her personal belongings. She pleasantly refused. Later she confessed that she didn’t want me to find her stash of drugs fearing I would dispose of them. Thankfully, she did go to rehab and has been sober for two years.

Yet, rehab is not for everyone. That much I know is true. Your choice of rehabilitation is a decision you should make with professionals like a therapist, doctor or a drug counselor.

Today I was watching television while listening to Amy Winehouse’s Love is a Losing Game. The announcer stated that Winehouse’s death at age 27 added her to an infamous group of artists who all died at 27 years old. This list includes Kurt Cobain, Jimmie Hendrix and Janis Joplin. I don’t know if that is an honor or a curse.

I suppose if you believe in immortality then it was for the best that Amy Winehouse check out now. I don’t agree. The tragedy is that she was an artist who let her own personal demons get in the way of living her life. It takes a strong person to admit they have a problem. It takes an even stronger person to get help and stick with it. The fact is that most people who enter rehab fall off the wagon. That still doesn’t mean you shouldn’t get right back up and try it again.

There is no glory in being included in a group of artists that died tragically at age 27. Instead we should celebrate the ones that choose to live. I hate when the media glamorizes this live hard, die young mentality.

When Alexander McQueen died tragically, I spoke with a friend who knew him. He told me that McQueen’s death wasn’t a tragedy. Tragedy would imply that we should be sad. McQueen’s death left him angry. When I attended the Metropolitan Museum’s exhibit, Savage Beauty, which showcased McQueen’s work, I understood why he was so angry. We’d lost a great art.

For me it all goes back to the root of the problem, which is we don’t see addiction as a disease. We see it as a choice, and that’s why many people who are dependant on drugs and alcohol don’t want to go to rehab. It reminds me of the Nancy Reagan years. Her solution to the problem was simply to say, “No, no, no.” Not much has changed.

Gay Men and Prostate Cancer

Gay men have a tougher time dealing with the aftermath of prostatectomy than heterosexual men do, says researchers at the American Urological Association. The physical as well as psychosocial quality of life of a gay man appears to suffer more from the side effects of the cancer treatment compared with the situation for straight men, said David Latini, PhD, Assistant Professor of Urology at Baylor College. “We find that men in our sample are significantly different in almost every domain of quality of life, and these differences are large enough to not just be statistically significant but are also clinically relevant,” Dr. Latini said at a news briefing.

Dr. Latini also noted that many gay men, especially the insertive partner, had severe sexual “quality-of-life disturbances,” mainly erectile dysfunction, because the aftermath of prostatectomy was not helped as much by phosphodiesterase-5 inhibitor medication that allows men with erectile dysfunction to function sexually.

“For gay men this is a particularly difficult area,” he explained. “The phosphodiesterase-5 inhibitors were created with an endpoint in the trials of vaginal penetration. We know that an erection has to be firmer to penetrate someone anally. So for sexual intercourse between two males, these medications are usually not sufficient.” I don’t agree but in my experience I know that men who undergo radical prostatectomy, the majority do not respond to phosphodiesterase-5-inhibitor unlike men who opt for radiation therapy. “Many of the guys in our sample are struggling with that, and are forced, if they want to remain the insertive partner to go to other more invasive treatments.”

The moderator of the news conference, Tomas Griebling, MD, MPH, Professor of Urology at the University of Kansas Medical Center, said, “From my perspective, one of the biggest things we learned from these results is that gay men and straight men experience prostate cancer and the effects of prostate cancer in different ways. For gay men the negative impact on their overall health-related quality of life is more severe. It’s more profound.”

Dr. Latini said that since gay men constitute about 3% to 5% of the total male population of the United States, that also means that about 3% to 5% of the 200,000 men diagnosed with prostate cancer are gay and that 3% to 5% of the men living with prostate cancer are gay men.

More data needs to be collected looking at gay men with prostate cancer and the aftermath of their treatment.

Advocate report: William Fox

Plea Deal for N.Y. Cop Accused of Abusing Young Boys

 

By Julie Bolcer

Frank Spinelli

 

William Fox, a retired New York City police officer accused of sexually molesting three young boys, could spend the rest of his life in jail following a plea deal that resulted from an investigation launched with the help of Frank Spinelli, a gay Manhattan doctor.

The Staten Island Advance reports on the plea from Fox, a former Staten Island resident now living in Pennsylvania, where his trial began this week on sex charges involving the three youths from 1996 to 2009. The boys, now grown men, are among at least 10 children that Fox adopted in New York, Pennsylvania and Florida over the past few decades.

The Advocate reports that on Tuesday, the second day of his trial in Tioga County Court, “Fox, 66, pleaded ‘no contest’ to nine charges, including incest, corruption of minors, involuntary deviate sexual intercourse and indecent assault relating to three victims who lived with him, according to the Pennsylvania attorney general’s office.”

Fox could receive up to 69 years in prison and a fine as high as $125,000 when he is sentenced in the fall. Authorities will first evaluate him to assess whether he is a sexually violent predator.

Identified in police records as William Patrick Fox Sr., the retired NYPD officer won acclaim in 1981 for talking a teenager out of committing suicide and later becoming the legal guardian of the young man. He was named a National Father of the Year in 1982 and wrote a book about the experience.

Police arrested Fox at his home in Liberty, Pa. this past March after a two-year investigation launched at the urging of Frank Spinelli, a Manhattan internist with a practice focused on HIV-positive and gay men. Fox sexually abused him between 1978 and 1980 while leading a Boy Scout troop on Staten Island. Spinelli, an Advocate health contributor, tipped authorities about Fox two years ago and made wiretapped calls leading to his arrest.

Pharmacy phacts

The other day my receptionist left me a message. I was from a pharmacist who was having trouble reading my handwriting. I attended eight years of Catholic grammar school. My principal was a three hundred pound woman named Sister Catherine. I have impeccable penmanship.

I called the pharmacist who explained she was unable to read the name of the drug. I asked, “Who is the patient?”

“John B.,” she said, “The directions on the script read, 6mg SQ QD.”

I know John B. is HIV positive. “Is it for Serostim (a brand of growth hormone prescribed for HIV associated wasting)?”

“Uh, that could be it.”

“Where are you located?” I asked.

“Chelsea.”

Chelsea happens to be one of the neighborhoods in Manhattan with the largest population of gay men. It was unfathomable that this pharmacist hadn’t filled a prescription for Serostim.

“How long have you been working there?”

“One month.”

“A whole month and not one script for Serostim?” I said. Then I asked, “Which pharmacy do you work for?”

She mentioned one of the large chain drug stores. Enough said.

More and more insurance plans are dictating where patients can fill their prescriptions. This is alarming to me when you consider that these same insurance companies are allowing doctors fewer choices of prescription drugs. For instance, I wrote a patient for Micardis, an antihypertensive medication. His pharmacist informed him that his insurance company wouldn’t cover the cost. His insurance carrier then faxed me a list of meds they would cover.

It’s frightening to think an insurance company, not a healthcare provider, is choosing which medications their patients should take.

This year, more insurance companies are requiring patients to use mail order pharmacies. The rue is that it will be cheaper for the patient. This is true. Mail order pharmacies may be cost-effective. My patient, Billy J. gets his HIV meds via mail order. They send him a 3 month supply. The upside is that he only pays one copay. The down side is that his meds often arrive late. This is alarming for someone with a chronic disease like HIV, when missing a dose can have unwanted consequences like, resistance. I suggested he use a local privately owned pharmacy like, New London.

He said, “My insurance company won’t allow it.”

But this problem goes even further. Insurance carriers should not tell doctors which drugs to prescribe nor should they influence where patients get their prescriptions meds filled.

Case in point: Charlie M. travels around the world for work. He has HIV, Hep C and high blood pressure. His is on a laundry list of meds.

His father had a heart attack one Friday night. Charlie called and asked if I could get him an early refill on his meds because he left them in a hotel in Brazil.

I asked, “Which pharmacy do you use?” I’ll simply say it was a pharmacy attached to a popular drug store chain.

I called them. The pharmacist, of course, did not work there normally. Like most chains, pharmacist fill in and rotate routinely so that they are unfamiliar with their clients. I explained the situation. The pharmacist informed me that he was not authorized to over ride a premature request for medications as expensive as HIV meds. Frustrated, I hung up and called my patient.

“What do I do?” he asked.

“Pay for your medication yourself,” I suggested.

Incidentally, if Charlie was diabetic the pharmacist would not refuse him insulin.

Later that same day I went to New London to fill a prescription for my partner, Chad. I asked the owner if she was aware of this trend to use mail order and large chain pharmacies. She explained they were driving small pharmacies out of business.

It’s sad when you think about it. The glory days of visiting a local pharmacist who knew your name and probably your prescription medications by heart is a thing of the past, like visiting Sam the butcher for you meat or Gepetto, the cobbler for your shoes. Perhaps I’m most bothered by this growing trend because I see it shifting toward doctors. Oh wait, that’s already happening. Insurance carriers prefer you see in-network doctors particularly if you have an HMO.

Be smart, if you have to use mail order, stay on top of your deliveries, and complain to your insurance company if they’re late. If you can’t use a privately owned pharmacy then make sure you learn the name of one of the regular pharmacists and the name of the person you paid at the cash register.

Seriously, who …

Seriously, who was it that came up with the idea for New Year’s resolutions? I suspect the idea germinated from a marketing meeting after a pitch by some advertising agency as a way to get us to buy stuff we don’t need.  

Generally, the promise to give up smoking and drinking are the most common resolutions followed closely behind are losing weight, becoming more punctual, being honest and more self confident. Surveys suggest the success rate of adherence to resolutions is very low, but for some strange reason each January we make the same commitment year after year.

Who invented New Year’s Resolutions and where did they begin? Well, people have always associated new years with a fresh start. Even in the most ancient traditions, it was a custom to make improvements at such times. During the reign of the Babylonians, people made promises to do better starting March 23, their new year (spring equinox). One common resolution was to give back something one had borrowed in the past year.

InRome, Janus was the god of the New Year. The month of January was named after him. The New Year began on January 1st according to the Julian calendar invented by Caesar in 46 BC. Janus had two faces: one looked back on the past and the other into the future. The Romans worshipped him as a symbol of endings and new beginnings. During the holiday, they would do things that would hopefully kick off their year to a good start. They would make up with people they quarreled with and exchange gifts.

Judaism expects their followers to look back on one’s behavior during the past year. This was supposed to motivate the person to do better the following year.

I gave up on resolutions years ago, but for some reason I can’t help but make myself secret little promises right before the clock strikes twelve. Last year it was read Anna Karenina. P.S. she’s still sitting on my nightstand, but I am on page 325. This year it was exercise more, ban anything Kardashian from my life and learn a foreign language (preferably one the Kardashians’ don’t know). 

I agree with Judaism. We should reflect on the previous twelve months and think how we can improve ourselves in the new year. So if you fall off the resolution bandwagon, don’t be discouraged. Either start over again or wait for 2013.