E BAD, D GOOD

Many of us doctors have spent years hoping that vitamin E turned out to have some health benefits. Why? I'm not really sure. Maybe because it's cheap, it's an "antioxidant," and it comes in those cool-looking little gel-filled capsules that are easy to swallow. What is amazing is that despite the fact that vitamin E is not profitable for any drug company, more research money has been poured into vitamin E studies than into studies of many of our most widely prescribed drugs and nutritional supplements. In total, there are in excess of 100 high-quality research trials involving vitamin E, many of them using thousands of patients taking vitamin E for years.
The results? Vitamin E has been found to help with NOT ONE GOD DAMNED THING. Given the fact that it is an antioxidant, it was thought that sooner or later, it would turn out to reduce the incidence of heart attacks, or at least a cancer or two. No such luck. In massive studies, vitamin E not only did not prevent heart attacks, but it (very slightly) increased the risk of stroke. Men taking vitamin E for years did not get any less prostate cancer or lung cancer- in fact, the vitamin E takers seemed to get more cancers, though the effects were small. The vitamin has also been shown to do nothing substantial to extend lifespan, reduce the effects of Alzheimer's disease, or improve vision. As my favorite source The UC Berkeley Wellness Letter
states in regard to vitamin E, "when hundreds of studies fail to find a benefit, and so many contradictions emerge, you have to be skeptical." Furthermore, vitamin E deficiency is so rare as to be almost unheard of, even in poor countries where malnutrition is a serious problem.
The bottom line: please don't waste your money taking vitamin E supplements.

WHAT ABOUT VITAMIN D?
You may have heard that you can get vitamin D from milk and other dairy products, and that your skin also makes this vitamin when you spend time in the sun. This is true. Even soy milk and many brands of orange juice are now fortified with vitamin D. So what? Well, it turns out the vitamin D DOES prevent diseases, notably osteoporosis. It also strengthens bones even if you aren't so unlucky as to have osteoporosis. In studies of frail seniors, vitamin D has been found to reduce the risk of falls- we don't know how this works, but the vitamin may have a role in balance and stability. As for osteoporosis, it's generally thought of as a disease that old women get; in fact, bone loss can begin at any age, especially if you are not getting enough vitamin D. Unlike vitamin E deficiency, vitamin D deficiency is rampant. In my clinic, over 30% of patients tested for vitamin D levels have turned out to be deficient in this vitamin, and I'm testing people of all ages.

DO I NEED TO TAKE VITAMIN D?
If dairy products are a major food source in your diet, and if you spend on average 10 minutes or more per day out in the sun (even WITH sunscreen), you probably get enough vitamin D. It rarely hurts to supplement with this vitamin, however; the exception is people who get frequent kidney stones, who should speak to their doctor before taking vitamin D. If you don't eat dairy products, it's a very good idea to take vitamin D. The recommended amount will likely go up as more research is done- for now, most doctors say to take 800-1200 IU (international units) per day. It's also worth asking your doctor to test your vitamin D level if you rarely go out in the sun, rarely eat dairy, or have family members with osteoporosis. It's a relatively inexpensive and easy test which just requires a small blood sample. An easy way to make sure you're getting enough vitamin D and calcium, which also helps bone strength, is to take one of the many combined "calcium + D" supplements that contain both these nutrients.

Finally: watch the media in regard to vitamin D. A lot of exciting research is going on with this vitamin; perhaps because we're done wasting money on vitamin E research...

BACK TO BLOGGING/HAPPY NEW YEAR

I have a calendar that has a page making fun of blogs. It says, "Blogging: Never before have so many people with so little to say said so much to so few." It's pretty funny, and sadly true.
There have never been a ton of readers of this blog, but I'm sure there were more (i.e. 2 or 3) back when I was updating the blog daily. That became a drag, and as a result the blog suffered.
So for 2009, I'm going to get Dr. Tofuhead going again, and set some reasonable goals. If the blog completely sucks please let me know, and I'll revamp the whole thing or shut it down.

NEW FEATURES FOR 2009:
1. The blog will be updated once a week.
2. As usual, there will be a new topic and also reader questions will be addressed as they come in. 3. If I'm lucky, my brother Randy will put up some photos.
4. There will be more of a focus on preventive health, i.e. keeping yourself healthy...and happy. I'm going to be combing the Mental Health literature for useful new tidbits.

TODAY'S TOPIC: USEFUL RESOURCES FOR YOU!
I get a lot of useful health information from sources that are not written for doctors; they are written for "lay people" like YOU. There really are some exceptional sources of health information out there, mixed in with a whole lot of crap. The Internet in particular has a wealth of useless and erroneous health information, and I am dismayed every time I do a general search about a disease using Google. So here are a few sources that are in print, that are readily accessible, and that are LOADED with useful health topics:
1. Harvard Health Letter: this is a monthly newsletter that is relatively inexpensive and loaded with good information from the folks at Harvard Medical School. It covers everything from exercise and nutrition to detailed reviews of new tests doctors use. For example, a recent issue covered cholesterol blood tests, how much sleep you need, what kinds of fish to eat, a review of topical pain creams, cardiac stress tests, and everything you need to know about ear wax. It's available online as well, though you need a subscription to access the current month, which I highly recommend. Check it out at: http://www.health.harvard.edu/.
2. The University of California, Berkeley Wellness Letter: similar to the Harvard Health Letter, this was the health newsletter that started health newsletters. I can't overemphasize how awesome this newsletter is. I can't think of a single health or nutrition-related topic they haven't covered in depth over the last 3 years. The issue on my desk covers generic vs. name-brand drugs, berries, motorcycle riding, organic vs. commercial produce, preventing and treating mosquito bites, exercise, and all the skin cancers you need to know about, plus more. If you have to spend a bit of money on just one source of health information, this is the one I recommend. Check it out at: http://www.wellnessletter.com/. Better yet, try it for a year- it's only 20 bucks.
3. Live Longer, Live Healthier, free online book: the website associated with this newly-published health book sucks. But check it out: the authors, 2 highly respected academic professors in Internal Medicine, want you to have their book, FREE. They are not publishing it for sale; rather, they put the entire book online and they invite you to download the whole thing, with no strings attached. That's a lot of paper, but the book is just over 200 pages and has gotten great reviews from some very tough reviewers, notably the editors of the New England Journal of Medicine.
The web site is new and I suspect you'll be able to search for individual topics at some point. For now, you can open the book in Adobe Acrobat and print just what you want, or you can print the whole thing. Check it out at: www.healthierlongerlife.org.

EAT LESS, DRINK LESS, EXERCISE MORE, LOSE WEIGHT

I didn't come up with this topic idea. The "Leather District Gourmet," who has a blog much better than mine, came up with it. But I like it. I actually think the topic could fill an entire book with hundreds of pages of useful information. So why don't I write that book? Because, in short, nobody would buy it. In America, lots of people need to lose weight, but naturally they don't want to do it the "old fashioned" way. Who likes to be told that they need to eat less, drink less, and exercise more? Answer: nobody. At least not in America. Americans want instant results, without having to do much work. Here are some examples of some potential weight-loss books that would sell like hotcakes:
1. Eat More, Drink More, Do Nothing, and Lose Weight
2. Binge Your Way to a Smaller Waistline
3. Why You Don't Need to Exercise to Lose Weight
4. The High-Fat, Low Activity Lifestyle to Lose Weight
5. Losing Weight by Watching TV
6. How to Take off the Pounds in Less than 2 Minutes a Day
7. How to Change Your Waist Size Without Changing Your Diet
Unfortunately, I'm not going to write these books; I'm going to tell you the harsh truth about weight gain and weight loss.

THE HARSH TRUTH ABOUT WEIGHT
We all know Einstein's wonderful equation, whether or not we understand it: E=mc(squared).
The equation for body weight, in my opinion, is just as sublime:
Calories consumed - Calories burned = Calories converted to body fat.
It's that simple. In other words, if you consume more calories than you burn off, those extra calories will be stored, usually as fat, and that fat will increase your body weight. Fortunately, your body already burns 1500-2500 calories just to keep you breathing and thinking, depending on your age, size, and daily activities. So you ARE allowed to eat SOME calories!

WHAT ABOUT MY METABOLISM?
Nearly every day, at least one patient comes in with a similar story: "I'm not eating all that much, and I exercise, and I keep gaining weight. So I know it's not my calories, I must have a thyroid/adrenal/glandular/diabetic/metabolic problem." And while it is true that some metabolic or hormone-related problems can cause weight gain, it's hard to emphasize how rare that circumstance is. In nearly 10 years of medical practice I have seen exactly 3 patients who had abnormal weight gain for hormonal reasons- all 3 had critically underactive thyroid glands. Most people who think they are gaining weight for hormonal reasons are still consuming more calories than they burn off. Once I have proven this to patients when their lab tests come back normal, I typically ask them to start keeping a "food and exercise diary," so that we can take an honest look at how much they are eating, and how often they exercise. The result is predictable: I never see those patients again. Because the truth hurts.
As for metabolism, there is no question that it slows as we get older. At age 25, for example, you can probably consume 2500 calories per day, or more, without gaining weight. At age 50, that exact same number of calories might add a pound per week to your body weight. I do not dispute that. But this slowing of the metabolism is not pathological, and there is no scientific medical treatment for it. Treating your slowing metabolism as you age is a matter of paying attention to it and respecting metabolic change. Unfortunately, that means eating less, drinking less, and exercising more! You'll find plenty of quacks willing to sell you expensive hormone products to "speed up your metabolism," and prove me wrong. But hormones are powerful substances- I don't recommend messing with them unless you absolutely have to.

CAN MEDICATIONS CAUSE WEIGHT GAIN?
Many patients blame their excess weight gain on medications they take, some of them rightly so. Unfortunately, they tend to blame weight gain on a whole host of medications which usually do NOT cause weight gain. Let me simplify the issue by giving you a list of medications which clearly DO cause weight gain, because it's a short list:
1. Steroids, such as prednisone.
2. Anti-seizure medications, especially Depakote (also used for bipolar depression).
3. Insulin.
4. Some of the oral diabetes medications, such as sulfonylureas and "TZDs" such as Actos.
5. The anti-depressant Remeron, which is used primarily in the elderly.
6. Topamax, a medication used for migraine headaches and seizures.
That's about it. I'm sure I'll anger many people by saying this, but guess what: oral antidepressant medications, anti-anxiety medications, and birth control pills do NOT cause significant weight gain. I know you gained 20 pounds when you started Prozac. But that's because you started eating more. Sorry.

I WANT TO LOSE WEIGHT: WHAT CAN I DO?
The bottom line: you need to burn more calories than you eat and drink. It's that simple. When you start looking at the different calorie types, it does get more complicated, as not all calories are the same. Dr. Atkins, Barry Sears, and their followers are probably onto something when they target simple carbohydrate calories as the most "fat promoting." But recent studies suggest that the extra fat-promoting qualities of carbohydrates are probably a bit overstated. That's because you can still put on plenty of pounds if you're on a carb-free diet and you eat more calories than you burn off.
Here are my basic tips:
1. Cut back on alcohol. Most alcoholic drinks have hundreds of calories, with very little nutritional value. As far as your body is concerned, a margarita is as good a source of excess body fat as a Big Mac. Like beer? Try to find one with less than 100 calories per bottle. They are out there.
2. Eat at least 3 meals a day. Studies have shown that people who skip breakfast, like me, more than make up for it with increased calorie consumption with their subsequent meals.
3. Avoid eating late at night. Your fat cells love a nice dose of calories at bedtime, when they know you won't have a chance to burn those calories off. That means: more fat for your body!
4. Join a gym. Better yet, buy a very nice treadmill or exercise bike for your home, so there will be no excuses. You'll be surprised how many calories you can burn while watching an episode of "Iron Chef" (if you're on a treadmill, that is).
5. Try a diet. Studies have shown relatively equal, if modest, weight loss in patients pursuing the Atkins Diet, the Ornish Diet, Weight Watchers, and the South Beach Diet. Personally, I think the Atkins diet yields the best short-term results, and the South Beach Diet or Weight Watchers are easier to stick with for the long term. These diets work- it's the dieters who fail because too often they "fall off the wagon." I'm not saying it's easy.
6. Get a good scale. You might "feel fat" one day when it turns out that you lost 3 pounds the previous week! Give yourself a chance to feel good about the numbers, and to catch yourself when things are going in the wrong direction.
7. Make slow and steady process and realistic goals. Many people say, "I need to lose 100 pounds," when they should be saying "I need to lose 3 pounds a month regularly." Doesn't the latter goal sound more realistic?
QUESTIONS? Post a comment!

WANT A RECESSION-PROOF JOB?

Hello, dear readers, if any of you are left. I don't like long absences, but sometimes I have no choice. Sometimes, there is just no time for me to blog. Why? Because I've been busy as a beaver at work, every day. When the economy goes down, it seems, my work hours go up. That's because I have the modern-day equivalent of a "goose that lays golden eggs." That's right- I have a RECESSION-PROOF JOB!

There has been a lot of press about the so-called RECESSION-PROOF JOBS these days. The truth is that there is probably only one job that is entirely "recession-proof," and that's the job that Barack Obama just got. But still, there are jobs that are more recession-proof than others. Based on my experience, I think that many of those jobs are in HEALTH CARE. Let's examine some of those jobs, or professions, and examine why I think they are recession-proof.

1. DOCTORS: why on Earth would a high-paid person like a doctor have a job that could be considered recession-proof? Easy. Because the job of a doctor is to heal the sick and to keep the healthy, well...healthy. That job seems to get busier when there is a recession. I'm not entirely sure why; but I can speculate that more people are stressed out, working more hours, and abusing themselves more with their favorite "self-medications:" tobacco, alcohol, and recreational drugs. I certainly see more depression, alcoholism, insomnia, lung disease, and related illnesses during recession. My colleagues in surgery, pediatrics, and even dermatology have the same experience. It's only human; when we are worried about our finances and our job security, we tend to put our health on hold. And that's why society needs doctors even more during a recession.

2. NURSES: Any doctor in his right mind will tell you that a doctor without a nurse is like a pilot without an airplane, or something like that. I'm all but worthless without my nurses. Who do you think starts the I.V.s, schedules the appointments, gives the immunizations, refills the meds, takes out the stitches, and bandages all the wounds in a busy clinic or hospital? That's right, it's the nurses. We doctors have to do a lot of heavy-duty "thinking," "diagnosing," and sometimes "operating," but to be honest the nurses do most of the hands-on work with patients. And as the shortage of doctors grows, nurses are increasingly doing more of the work that doctors used to do. Some of the nurses at my clinic, for example, have their own entire practices full of patients they treat themselves. And the best part is that some of them make as much money as the doctors do. And what about this "doctor shortage?" Well, it's bad. But it's a minor problem compared to the shortage of nurses. If every person in the state of Kansas instantly became a nurse, we'd still need about 20,000 more of them. Imagine how many awesome, unfilled jobs in nursing there must be!

3. PHYSICIANS ASSISTANTS: Despite the misleading name, "P.A.s" do much more than assist doctors. Most of them evaluate and treat at least some patients themselves. They do assist in the operating room, but these days most of them can do some operations and medical procedures themselves. Like nurse practitioners, they may even have their own independent medical practices. They are in high demand, and they get paid well.

4. PHARMACISTS: When the economy is bad, people get sick more often, and abuse themselves more- so guess what? That means they take more drugs! And I'm not just talking about illegal drugs. Every year there are more people on more medications, and new medications coming onto the market constantly. Thus, the demand for pharmacists is tremendous. These are not just the people who count pills; increasingly, they do research, monitor patients on dangerous drugs, evaluate drugs for interactions and side effects, and counsel patients in numerous ways about the risks and benefits of medications. They also counsel doctors. They know more about medications than we do, and doctors beg them for guidance on a daily basis.

5. NURSE ASSISTANTS AND NUSE'S AIDES: The variety of degrees and jobs in nursing has gotten so complex that honestly I can't even give you an accurate list of all the various job titles. Suffice it to say that you can get a nursing or nurse assistant degree in 1, 2, 3, or 4 years, depending on how far you want to go. Bottom line: you can be trained to do a high-demand, kick-ass job in a short amount of time, and you'll have job offers coming at you faster than you can handle. Many of these jobs are at the lower levels, where there is minimal schooling involved. And even the lowest-level nurse's aide can get more training, and work up the nursing hierarchy. There is no limit to where nursing (or nurse assisting) can take you!

6. NUTRITIONISTS AND DIETITIANS: You might think a dietitian is someone who sits down with you and tells you to eat healthy foods. But that's only a small part of what these people do. Many serious health conditions require extremely complex nutritional planning and execution, and nutritionists and dietitians are relied on heavily, in all hospitals and in most clinics. Some people can't eat at all, and are fed for years through tubes and I.V. lines. Who makes sure those folks are getting enough of the hundreds of nutrients we need to survive? Who has the skill to design diets to protect your liver, your bones, your blood vessels, your brain, your newly transplanted organ, or your failing kidney? You guessed it: a dietitian. Or a nutritionist. It's as challenging and rewarding a job as any in health care.

IN SUMMARY:

If you are interested in health, worried about your current job, looking for your career path in life, or just need a midlife change of occupation, consider looking into heath care. Most people make the erroneous assumption that you need a ton of schooling, perfect grades, and an early start to get a good-paying job in this field. But that's no longer true. Even high-ranking medical schools that train tomorrow's heart surgeons are seeing a surge in older applicants and applicants who have worked in other careers for years, or even decades. Believe it or not, they LIKE those applicants. Real-world experience makes better health care workers, even if the experience is not health-related. And if you're in school or just starting school, so much the better. The world of health care is your oyster. And take it from me, a lowly primary care doctor: helping people to heal and stay healthy is a uniquely wonderful experience. My colleagues in nursing, pharmacy, nutrition, and related fields will tell you the same thing.

WHAT CAN YOU LEARN FROM FOOTBALL?

Today's blog was originally going to wrap up the seafood topic; but I'm at my in-laws' house and I don't have my notes, so we're going to take off on a tangent. After all, it's Sunday, and that means it's a day full of wonderful NFL games.

Before you immediately bail on this blog, let me just say:

1. You don't have to be a football fan to learn something useful today.

2. I really like watching football, and basketball for that matter, but I'm by no means a fanatic fan and I'm not going to bore you with a long tribute to sports.

3. Even if you hate NFL football, you can learn something relevant to your health by watching a football game. Or at least by reading today's blog.

FOOTBALL INJURIES: A WONDER OF NATURE

If you watch a football game, it's obvious that people get hurt quite a bit. But given the size of the players, the speed at which they travel, and the body-to-body impact that occurs, it's not how often players DO get injured that's surprising. I think, and my practice partners agree, that what's surprising is how often players DO NOT get injured in these high-impact, intense games. Let's look into 3 types of injuries that don't occur as often as they should, and why.

HEAD INJURIES

Actually, head injuries occur constantly in football. You hear about them sometimes, but the true number of head injuries is hard to estimate, because players are sent back into the game even with relatively major concussions. That's part of football. I'm not even sure a concussion is considered an injury in football. In any case, why aren't there more serious head injuries?

Answer: HELMETS. Helmet technology has improved drastically over the years, and will continue to do so. Any doctor who treats athletes will see people who have sustained severe concussions, even with helmets on. But the feared head injuries (skull fractures, intracranial bleeds, ruptured blood vessels in the brain) are much more common in athletes that are not wearing helmets. Most of you probably don't play full-contact football. But if you bike, ski, snowboard, skateboard, or rollerblade, please do yourself a favor: Wear a helmet. It's the easiest way to avoid the most dreaded type of sports-related injury.

BY THE WAY, THANK YOU: To motorcycle riders who don't wear helmets. They are are largest contributor of brain-dead bodies (namely, themselves); and brain-dead bodies are our largest source of organs for transplant. I fully support motorcycle riders not wearing helmets, as long as their organ-donation cards are filled out.

KNEE INJURIES

The serious knee injuries that are common in football are also common in recreational weekend sports that we all do from time to time. This injuries include tears of the ACL or PCL ligaments, meniscal tears, fractures, and tears of the ligaments on the sides of the knees, known as the collateral ligaments. When I watch NFL football, I'm amazed that ligament and meniscus tears don't occur in huge numbers. How is it that a lineman can dive helmet-first into your favorite quarterback's knee, and not cause a tear?

Answer: KNEE STABILITY. You can stabilize your knee with a brace (especially the expensive, hinged kind), your you can build your knee stability internally. Knee stability is largely a function of the pure strength of the muscles around the knee, especially the muscles of the thigh. Keeping your quadriceps and hamstring muscles strong means that the ligaments and cartilage in the knee joint have extra support, and can take more abuse. Want some specific exercises? Try the following next time you're at a gym:

1. Quad extensions (on a weight machine)

2. Hamstring curls (on the machine where you lie on your stomach and pull your feet up toward your butt)

3. Seated leg presses

4. Standing hamstring curls (on the cable machine)

If you need more exercises or info on how to build strong thighs, ask one of those incredibly fit, handsome trainers most gyms have walking around these days.

BACK INJURIES

Surprisingly, football players get back injuries less commonly than the average Joe who shovels snow, lifts boxes, helps a friend move, or does any of the other activities of life that stress the low back. If you've ever had a "slipped disk" or "low back strain," you know it can be fairly disabling, and you also know that it may come back to visit- frequently. Some studies suggest that back pain absorbs more time and money than any other condition in the American health care system. With all the impact to the spine, pile-ups, hyperextensions, falls, and collisions, why don't football players constantly injure their backs?

Answer: CORE STRENGTH.

You've probably heard about building or strengthening your "core" these days, even if you don't do Pilates, yoga, martial arts, or boxing. Strengthening your "core" simply means keeping your abdominal and low-back muscles strong. The reason to do this is essentially the same reason you want to stabilize your knees: your core muscles add layers of stability and strength to your otherwise vulnerable spine, spinal nerves, disks, and other ligaments in the back. It's never too late to build up core strength. In fact, it's the foundation of treating back pain and even the most severe back injuries. Core strength also protects the spine from injuries, by supporting the vulnerable structures and absorbing forces on the spine.

Football players spend a ton of time working on their abdominal and low-back muscles- a fact that is evident if you've ever seen a picture of a running back with his shirt off. Even those 350-pound offensive lineman have a dense wall of abdominal musculature underneath all that spare tire. That's a big part of why the backs of football players can take a ton of abuse without causing disabling pain.

So how do you strengthen your core? Most gyms have machines to help you do this, and the exercises in Pilates, yoga, and martial arts also have numerous moves designed to keep the core strong. Crunches and sit-ups are the most well-known abdominal exercises, and these work great. I recommend also doing low-back exercises, such as forward bends and back extensions (you need a piece of equipment called a "Roman chair" to do these right, but most gyms have these).

Obviously there are far more parts of the body to injure, and many more techniques to avoid injury, than we've covered here. But this is enough to help you get started, and maybe enough to help you appreciate the resilience of NFL players.

RESPONSIBLE SEAFOOD PART 2

ANNOUNCEMENT: I never quite knew where to put my responses to reader comments, my updates on past topics, and my corrections and explanations to various items I'd neglected, so time and again I've been in the habit of doing a whole blog entry to attend to those matters. From now on, to keep new topics coming, I'm creating a section at the end of the blog called "LEFTOVERS," where I'll address those items, unless a topic is large enough that I can do a substantial blog entry devoted to it.

Hopefully by now some of my readers are eating more seafood, and perhaps finding the sustainably caught or farmed finfish in stores near them. I know it's not always easy. I thought it would be easier to find responsible shellfish, until I read about them and checked out my local supermarket. It was "slim pickins," but then again I was at a major chain grocery store.

As with the other fish, you can get more information about good seafood choices on the web site www.seafoodwatch.org, from which I boosted most of the below information.

RESPONSIBLE SHELLFISH TO EAT:

1. CLAMS, farmed (apparently farmed anywhere is OK according to seafoodwatch.org)

2. CRAB, stone and Dungeness crabs (this seems too good to be true, as local Bay Area sources tell me that Dungeness crab is fast becoming overfished on the West Coast- hopefully seafoodwatch will have an update on this at some point)

3. LOBSTER, U.S. Spiny lobster(wild)

4. MUSSELS, farmed

5. OYSTERS, farmed

6. SCALLOPS, farmed (Bay scallops only)

7. OYSTERS, wild (unfortunately, there is a "mercury warning" on this one)

8. SHRIMP, U.S. ONLY (farmed or wild, but these are considered OK choices, not "Best Choices"). Alas, it seems that no shrimp are great choices.

YOU'RE MOST LIKELY to find U.S. shrimp, or farmed Bay scallops, at a typical grocery store. Fortunately, these are healthy food choices and at least the farmed Bay scallops are considered a "Best Choice" by seafoodwatch.org. If you're lucky enough to live near the coast, you may commonly find such delicacies as Spiny lobster, wild oysters, and stone crabs. In fact, stone crabs are easy to catch yourself if you live near a pier. And they are simply delicious!

NEXT BLOG: we're going to get more into some more exotic fish, mollusks such as squid, and more about fish you can catch yourself.

LEFTOVERS

1. Tilapia: apparently not all farmed U.S. Tilapia are without problems- check the reader comments on my last seafood blog, a reader has a great link to a site that "fleshes out" the facts about Tilapia.

2. Drug questions? Some of my own patients have brought up some amazing questions about pharmaceuticals lately; questions that have sent me off to hit the textbooks and to hit up my pharmacists for more info. If you're on any drugs, prescribed or otherwise, feel free to ask any questions here.

3. Finally, my favorite: What ILLNESS does Kenley from the show "Project Runway" have?

I spent all day thinking about this one. But I need to restrain myself, because of the following disclaimer, which you must read before reading any further:

-I don't know Kenley at all and have never met her.

-I'm not a psychiatrist.

-She may be acting. After all, she should have been fired at least 3 episodes ago. Why do they keep her on? Because a "crazy person" stirring up drama makes a show more exciting. She may be getting paid under the table to act nuts.

-If she does have a mental illness that she's struggling with, it would be harsh to rip on her about it. Unlike her, I'm actually nice to most people and feel guilty making fun of them, unless they are myself.

SO, I'm simply going to list the diagnoses that I've been WONDERING about, when I see her behavior on television. You'll have to find out more about them on your own.

1. (Most likely, in my limited opinion): Narcisisstic personality disorder, quite possibly with antisocial features.

2. Borderline personality disorder with psychotic features.

3. Bipolar depression (currently in bipolar mania part of the cycle).

How she behaves in future episodes may help narrow down this entirely speculative list.

THANKS, PROPS, AND ADMISSIONS BY DR. TOFUHEAD

Short but sweet: that will be today's blog. As Thanksgiving approaches, I'm reminded how much I have to be thankful for.

THANKS:

1. V., for pointing out that Adeline penguins get pink eye. The question of why disparate species can get the same diseases is complicated, and, I believe, has critical clues as to the nature of disease and immunity. Why, for example, do humans, monkeys, birds, mice, and lizards get malaria, while many other species don't? Why do penguins get pink eye, when other mammals closer to humans don't? These issues continue to perplex and amaze me.

2. Mrs. Church for kind comments about my seafood blog. Her blog, The Leather District Gourmet, is amazing, and several quantum leaps in quality above this one. Check it out.

3. Anonymous, for the comments about bird flu. He or she points out that bird flu can be cured by early administration of a medication called osteltamivir (Tamiflu) in specialized hospital. I do agree that early hospitalization of patients with bird flu, who need intensive supportive care, can save lives. But unfortunately there is no scientific evidence that osteltamevir, steroids, or any of the other medications impact the clinical course of this disease. I stand my my assertion that prevention and avoidance are the best approach to bird flu. But I welcome, thank, and listen to people who disagree with me because that's how I learn new things.

PROPS:

To my brother who puts all the images in this blog and helps me learn how to blog in general. I'm not good with most things technological and computer-related, and I could never have gotten this blog off the ground without him.

ADMISSIONS:

1. It's becoming more clear by the day that I'm pretty much the only person I know who thinks camo clothing is fashionable. I stand by that assertion, much like some folks stand by the assertion that the Earth is still flat.

2. I love Crocs and think they look great. But you should know that most people disagree. You should also know that the history and management of that company is so thoroughly dysfunctional that the story of Crocs reads like a bad soap opera. The Crocs company got greedy, and too big for their britches, and as a result there are literally millions of pairs of Crocs in warehouses across the globe gathering dust. That's a lot of plastic, and a lot of waste, and a lot of investors in Crocs lost their shirts. So a message to the Crocs company: GET YOUR SHIT TOGETHER. I won't support your company much longer.

3. Want some good clogs? Skip Crocs for now, and invest in some Danskos. I think they look great, for whatever that's worth.

4. I'm addicted to the show "Project Runway."

5. Despite my encyclopedic knowledge of food, nutrition, and health, I have calculated that I am approximately 23 pounds overweight and have started a new diet. I'll let you know how it works. When I tell you that you should eat something, you should probably eat less of that thing than I would in one sitting.

XXXOOO

Dr. Tofuhead