Category: health care

University of Iowa Psychiatrists Publish Huntington Disease Study Results

I ran across a fascinating story about a study on Huntington’s disease published by members of the University of Iowa Health Care. The study examined how the Huntington’s disease gene might enhance brain development and function early in life prior to the onset of the devastating disease. It was published in The Annals of Neurology:

I also found an abstract for a paper about Woody Guthrie, a famous American musician and activist who was very creative in his early life, but sadly succumbed to the ravages of Huntington’s disease when he was 55 years old. I couldn’t access the full article without paying for it but the abstract was intriguing because I wondered whether the author suspected something similar to the premise of the study:

Ringman JM. The Huntington disease of woody guthrie: another man done gone. Cogn Behav Neurol. 2007 Dec;20(4):238-43. doi: 10.1097/WNN.0b013e31815cfee4. PMID: 18091075. Abstract: Woody Guthrie was an American songwriter, musician, writer, and political activist who died with Huntington disease (HD) in 1967 at age 55. His relatively brief creative life was incredibly productive with countless songs and a tremendous volume of letters to his name. His personal life was similarly driven with Woody having had 3 wives and at least 9 children and an insatiable appetite for traveling the United States. In this essay, I explore Guthrie’s art in relation to the development of the overt behavioral changes and chorea that characterized his illness. Woody’s most productive time artistically was in the 5 years immediately preceding the onset of overt symptoms of HD. I hypothesize that subclinical HD may have been an important driving force behind Woody Guthrie’s creativity.

If anybody knows, please comment.

Woody Guthrie was certainly an important figure in the American history of activism as well as music.

Usually, I would share the music of some of the artists I mention on this blog. On the other hand, one of the co-authors of the University of Iowa paper mentioned above is Doug Langbehn, my former colleague, who’s an accomplished musician and statistician. So instead, I thought I’d share the talent of Doug and his band.

Reading My Old Book in a New Light

Sena bought me a wonderful new lamp to read by and it improves on the ceiling fan light I wrote about the other day (And Then a Light Bulb Went Off).”

The new lamp even has a nifty remote control with which you can choose the ambient feel. There are several selections, one of which is called “breastfeed mode,” a new one on me. There’s a light for that?

The lamp arrived at about the same time I got a notice from my publisher for my one and only book, “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry,” that people are still buying—after 14 years! My co-editor was my former psychiatry department chair, Dr. Robert G. Robinson. As far as I know, Bob has dropped off the face of the earth. I hope he’s well.

Consultation-Liaison Psychiatry is probably about the same as I left it when I retired 4 years ago. I walked all over the hospital trying to help my colleagues in medicine provide the best possible care for their patients. I put in several miles and stair steps a day. I saw myself as a fireman of sorts, putting out fires all over the hospital. I got a gift of a toy fire engine from a psychiatrist blogger in New York a long time ago.

Now I walk several miles on the Clear Creek Trail, like I did yesterday and the day before that. I have shin splints today, which tells me something—probably overdid it.

So, I’m taking a break from walking and reading an old book in a new light.

Pooboo: Our New Exercise Bike

We just got our new Pooboo exercise bike, model D518M. I don’t know why it’s called “Pooboo.” It replaces our old exercise bike, which I’ve called the Anti-Peloton in a previous post.

The Pooboo came in a big box, and it’s worthwhile to figure out how to turn it upside down. That way you can easily slip the box up and away from the bike.

The owner’s manual starts with a scary diagram of the parts, which made me think it would be difficult to assemble. Although there are only 5 pages for assembly, it took me 3 hours to put it together. But that’s just me.

The bike got mostly positive reviews, although there were a fair number of questions about why the seat has a hole in it. Although it’s a fair question, all I can tell you is that none of my important anatomy got stuck.

We could have done without the fancy harnesses on the pedals, but they’re easy to adjust to get them out of the way.

And the pulse monitor (called the “electronic watch”) works fine. There’s also a water bottle (called a “kettle holder” in the manual), but I couldn’t find the screws to install it—nor could I find a good reason to install it because I think it’s good exercise to take the stairs and get a bottle of water from the fridge.

We’re going to give the Pooboo a good workout to decide whether the purchase was a Booboo. And if you find out why it’s named Pooboo, let me hear from you.

U.S. News & World Report Ranks Iowa City Hospital in 9 Specialties

The University of Iowa Stead Family Childrens Hospital in Iowa City has ranked in 9 pediatric specialties, including pediatric behavioral health by U.S. News & World Report!

Progress on the Single Leg Sit to Stand Exercise

Well, it has been since late July since I first tried the single leg sit to stand exercise. Recall the videos of that effort? I couldn’t really do much except collapse in the chair.

I’m doing better lately but it’s hard to figure why. I haven’t really been practicing that much. You’ll notice that I’m using a throw to give myself a little extra height to make it less arduous.

FDA Approves Antipsychotic with New Mechanism of Action for Treatment of Schizophrenia

I just noticed the FDA announcment of the approval of an antipsychotic with a new mechanism of action for the treatment of schizophrenia.

The drug is Cobenfy and it interacts with cholinergic rather than dopaminergic receptors. It has a number of side effects which are anticholinergic. This could lead to psychotic symptoms that consultation-liaison psychiatrists might get called to evaluate due to the anticholinergic delirium that could occur, which can mimic psychosis.

It’s easy to get alarmed about the Cobenfy side effects. I just remember all of the side effects of the one antipsychotic that has sometimes been the only effective treatment for patients with treatment resistant schizophrenia-clozapine.

Clozapine has been associated with agranulocytosis, seizures, bowel obstruction, prolonged cardiac conduction time leading to arrhythmias, liver toxicity and more. In fact, clinicians are required to enroll in a Risk Evaluation and Mitigation Strategy (REMS) program to prescribe it.

Patients who have schizophrenia and take clozapine are often admitted to general hospitals for treatment of medical problems which may or may not be directly related to clozapine itself. This requires close collaboration of internists and surgeons with consultation-liaison psychiatrists.

What do you do for patients who don’t respond to clozapine but are willing to take oral medication? There are augmenting strategies, some of which can be helpful although they could add to the side effect burden.

What do you do for a patient with treatment-resistant schizophrenia who refuses to take oral psychotropic medication? In some cases, it may be necessary to use injections of medications which also can have uncomfortable and even potentially life-threatening side effects. This difficult situation is complicated further by the lack of insight some patients have about their illness and the need for court orders to administer antipsychotics against their wishes.

I hope Cobenfy is a step forward for patients and their families.

Notes on the Blues and Rivers of Whiskey

I listened to the Big Mo Blues Show last night on KCCK radio (88.3 on your dial) as I usually do on Friday nights. It runs from 6:00 pm to 9:00 pm and you can learn a lot from Big Mo (aka John Heim) about the blues.

He also has a podcast called the Big Mo Pod Show, which is based on his blues show. He gets quizzed about some of the songs he played on Friday night by Producer Noah (as Big Mo calls him). Last night he was on target for all 5 of the songs he played and why he played them.

One of the songs I’ve never heard before but it was done by Taj Mahal and Keb Mo, artists I’m familiar with just from listening to Big Mo’s show. The title was “Diving Duck Blues. The chorus goes “If the river was whiskey and I was a diving duck, I’d dive to the bottom and I’d never come up.”

That led to a discussion of how alcoholism was sometimes (maybe more than sometimes) a part of the life of blues musicians. In fact, the lead off song last night was “Big Road Blues,” sung by Tommy Johnson. His last name just happens to be the same as Robert Johnson who made the song “Crossroads” famous because he claimed he sold his soul to the devil in order to become a great blues musician. Several blues artists made the claim, which Big Mo debunked as a ruse to get fans to pay more money to hear them perform.

But Tommy Johnson struggled with alcoholism and, according to Big Mo, was driven to the point of drinking Sterno, which was poisonous because it contained methyl alcohol.

This can lead you to think that maybe all blues music is gritty, played by alcoholics, and even depressing as declared by the lead character, Navin Johnson, played by Steve Martin in the movie “The Jerk” (a white guy raised by a black family).

Incidentally, this reminds me that a recent study showing that digital cognitive behavioral therapy is effective for those suffering from alcohol use disorder.

Anyway, blues musicians don’t always play sad, gritty music and die from drinking Sterno. One that is actually funny is “You Left the Water Running” by Otis Redding. You can look up the lyrics or listen to anyone who covers the song and it would be difficult not to laugh out loud.

And speaking of covering a song, Bill Withers originally wrote and sang “Lean on Me” back in 1972 which Keb Mo covered recently. I think it’s one of those uplifting examples of blues music which won’t send you diving to the bottom of any whiskey rivers.

Can Artificial Intelligence Learn from My Book?

Recently the publisher of a book co-edited by me and my former psychiatry chair Dr. Robert G. Robinson asked me to sign off on a proposal to involve Artificial Intelligence (AI) in using the work.

The book, “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry,” is 14 years old now, but is still a practical tool for learners, at least in my opinion.

Interestingly, it looks like the publisher is also trying to contact Dr. Robinson about the proposal through me. I wonder if that means they’re having as much trouble finding him as I have.

I’ve made it clear that I have misgivings about AI, as I’ve indicated in at least one blog post about Google’s AI, which used to be called, Bard which I think has been renamed Gemini. I think AI is prone to spreading misinformation, which has been called “hallucinations” by some writers.

The publisher makes it clear that this proposal regarding AI involvement in our book is an “opt in” choice. I gather that means if I don’t opt in, they’ll continue to bug me about it until I do.

That’s unlikely to happen.