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.

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.

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.

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.

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.

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.

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.

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?

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.