health care – Page 9 – Go Retire Psychiatrist

Members of the Human Club

I just read Dr. Moffic’s column, “Join This Club for Mental Health” in which he described the Clubhouse movement which got started in the 1940s to help those with mental health challenges to cope with their illness and, more importantly, to recover, grow, and achieve success in life.

It made wonder if there are any chapters of the Clubhouse model in Iowa. It turns out there is and it’s Carol House in Davenport, Iowa. It’s connected with the Vera French Mental Health Center. Its namesake is Carol Lujack, who was a member when the center was called “The Frontier Community Outreach Program” in the 1980s in downtown Davenport.

I was looking at the Carol Center website where you can find many interesting features of the people and activities that go on there. The April newsletter is fascinating and funny. You can find out in the April Newsletter about a few of the current members, April holidays (there’s a slew of them), and famous quotes. One of the quotes is familiar and it’s by F. Scott Fitzgerald,

“Vitality shows not only in the ability to persist, but in the ability to start over,” The quote is worded in various ways, but I remember it because I used it as an inspirational quote when The University of Iowa honored me and several of my colleagues with a Feather in Your Cap award back in 2011.

This was shortly after I returned to Iowa after an unsuccessful stab at trying private practice psychiatry in Wisconsin. And it was the second time I did that—the first time was in Illinois.

Did you know that April is National Humor Month? And have you heard the joke “What kind of candy is never on time?” Choco-Late.

One April holiday is not mentioned and that’s Arbor Day, which varies according to what part of the world you’re in as planting times differ. Sena planted a couple of new trees in the back yard.

Starting new chapters of Clubhouse is a little like planting new trees. They need watering.

SAINT Therapy for Treatment Resistant Depression at The University of Iowa

First of all, if you looked up Saint therapy for depression, you might have accidentally found information on Saint Dymphna, the Catholic patron saint of those living with mental illness.

Actually, SAINT stands for Stanford accelerated intelligent neuromodulation therapy. It’s a personalized protocol for using transcranial magnetic stimulation (TMS) to treat severe depression. The University of Iowa is the first academic center to offer it in the Midwest.

This is a big step forward from the days many years ago when we were starting use right unilateral electrode placement for applying electroconvulsive therapy (ECT) to treat depression because it was thought to lead to fewer cognitive problems post-treatment.

SAINT is a game changer according to Dr. Nicholas Trapp, MD, assistant professor of psychiatry, who describes it as a method to pinpoint the best location in each patient’s brain to target with TMS to treat major depressive disorder. The procedure is quick and recovery from depression can be sustained for months.

Kudos to The University of Iowa. And maybe thanks to Saint Dymphna.

But Will Black Garlic Ward Off Vampires?

Sena got some black garlic, which many people are enthusiastic about and call a superfood. There is a very long Wikipedia article with over 180 references about its beneficial health effects. The authors are very enthusiastic about it. Like many superfoods, it has a lot of support from many people.

There’s a slew of claims about what black garlic can do for you, from supporting immunity to preventing cancers and dementia.

There are some caveats. It can thin your blood, so those already taking anticoagulants should use caution about eating a lot of it.

Ahmed T, Wang CK. Black Garlic and Its Bioactive Compounds on Human Health Diseases: A Review. Molecules. 2021 Aug 19;26(16):5028. doi: 10.3390/molecules26165028. PMID: 34443625; PMCID: PMC8401630.

It’s been used for hundreds of years in Asia although it sounds like a brand-new food. It’s fermented over several weeks, which gives it the dark color.

It’s black and the taste is on the sweet side. If you just found it on the sidewalk, you’d step around it because it looks like animal poop. It has a gummy bear texture.

I didn’t see any testimonials mentioning how black garlic does in preventing vampire attacks.

It’s good in chili.

How to Support University of Iowa with the One Day for Iowa Fund Drive Today!

Okay, so here’s my pitch on how potential donors can support programs at The University of Iowa. Today the One Day for Iowa fund drive kicks off, and it ends at 11:59 PM today on March 26, 2025.

I got a soft spot in my heart for The University of Iowa College of Medicine and University of Iowa Health Care (UIHC), even though my undergraduate Bachelor’s degree was from Iowa State University.

You can find in the UIHC Medical Museum a description of the historical development of the medical school. Following the Flexner Report in 1909 which found fault with all U.S. medical schools including Iowa’s, there was a drive to avoid “inbreeding,” meaning hiring of one’s own graduates. Nowadays, there are legislative efforts to keep as many as we can of Iowa’s best and brightest.

Go Hawkeyes!

Attack of the Toothworms

I had my regular visit to the dentist at The University of Iowa Health Care (UIHC) today, and it was a good thing I did. For the past couple of weeks or so I’ve had cold and hot sensitivity in a couple of teeth. No surprise, the dentist found 3 teeth that needed a little work.

The dental hygienist also suggested I try using a tongue cleaner and gave me a free one. I’d never heard of a tongue cleaner before. The package advertisement (in English, French, and Spanish) says it’s for combatting bad breath, although the dental hygienist assured me in 6 different languages that she didn’t detect that problem in me.

I was there for my annual teeth cleaning but now I had 3 teeth needing work. Luckily, the dentist had an appointment in the early afternoon. It was a 3 hour wait, but I thought it was better to get it done sooner rather than later. Anticipating a visit with a dentist is sometimes almost as bad as getting in the chair and exercising my ability to refrain from flinching as the high-speed instruments whine in my ear while the dentist and the assistant do their level best to see that I gag several times in at least 9 different languages, including Klingon.

It’s hard to explain why I was having tooth sensitivity because, according to the dentist, the damage was not that severe. It wasn’t until I wandered around the hospital while waiting for the 2^nd appointment that I realized I had never visited the Medical Museum on the 8^th floor. And that’s where I found a possible explanation that made more sense than the modern one. It’s probably toothworms.

No kidding, back in the 18^th century, a lot of people thought worms caused tooth decay by eating them from the inside out. There was also a College of Dentistry display in the Medical Museum featuring a typical dentist chair and samples of rusty tools, which made wonder if I should put off the filling work until, say, after my next ten reincarnations.

There’s a human skeleton in the museum which is affectionately called Gertie. The historical note on Gertie is very interesting in that it was thought to be a male when Ottumwa Regional Health Center donated it to UIHC in 2013. It turns out he is actually a she and the “…two symmetrical holes in the upper jaw are the result of large dental abscesses.” Just what I wanted to learn on a day when I’m anticipating dental work.

Anyway, my teeth got repaired. I would say that the UIHC dental clinic has come a long way from 1904. You don’t turn and spit in a bowl anymore. They just siphon the toothworms out with a suction wand nowadays.

What is Foreign Language Syndrome?

I found a very interesting news outlet report about a condition called Foreign Language Syndrome (FLS) which you have to distinguish from Foreign Accent Syndrome (FAS). I wrote a post about that a few years ago. The latter is common by comparison with FLS. FAS is a tendency to speak with a foreign inflection, not speak or be unable to speak a different language, which is what FLS would be.

There are a handful of cases, all within the last 20 years, most of them associated with receiving anesthetic agents prior to surgeries. All could speak more than one language; in other words, they didn’t wake up from anesthesia with the ability to speak another language they never learned before.

I could find only one web link to a case report (see below) about FLS, published about 3 years ago, which is what the news story was about. In fact, the authors of this report describe the case of a 17-year-old male who suffered FLS (forgot his native Dutch language, but who also spoke English) after knee surgery, noting that the other known cases were subjects of news stories.

Humbaba qabDaj luchenmoH Humanpu”e’ ‘ej ghaytan tera’ tach ‘elpu’ jupwI’ ‘e’ vIHon. chaq wa’ Qib rurbogh taS QIpmey, Huj jaghmey luchoHlu’ta’ ‘ach, qaStaHvIS mInDu’ vISuq.

Oops, sorry, accidentally started babbling in Klingon. I meant to say:

Based on the case report, FLS might be an emergence delirium, caused by the choice of a particular anesthetic agent. Emergence delirium is delirium caused by waking up from anesthesia after surgery, which I’ve experienced a couple of times, although I have difficulty remembering the episodes.

Kiu(j) ne eksklud alia kaŭz por FLS, kvankam verŝajne, plimulto retrov plimalpli tute post du tagojn antaŭ la operacio.

Rats, happened again, with Esperanto. What I meant:

That doesn’t rule out other causes for FLS, although it looks like most people recover more or less completely after a couple of days out from the surgeries.

More studies are needed.

Reference: Salamah, H.K.Z., Mortier, E., Wassenberg, R. et al. Lost in another language: a case report. J Med Case Reports 16, 25 (2022). https://doi.org/10.1186/s13256-021-03236-z

Stead Family Children’s Hospital NICU Gets a Wave from the AAP with New Designation

The University of Iowa Stead Family Children’s Hospital Neonatal Intensive Care Unit was recently recognized by the American Academy of Pediatrics (AAP) as one of only two such units in the U.S. having the highest levels of neonatal care.

It reminds me of the Iowa Hawkeye football games where, at the end of the first quarter, all the players and football fans wave from the field to the pediatric patients and their families watching the game from UI Stead Family Children’s Hospital. It’s called the Wave, one of the best traditions in college sports.

Well, the AAP waves to Stead Family Children’s Hospital NICU.

The 2024 Distinguished Education Lecture by Russell Ledet, MD, PhD

Last year, I wanted to present this Distinguished Education Lecture by Dr. Russell Ledet, MD, PhD, given during Martin Luther King Jr. Celebration of Human Rights week. It took a while for my message to the University of Iowa to get through channels, but I want to thank Audra M. King, the Administrative Services Coordinator for the Office of Student Affairs and Curriculum in the University of Iowa Carver College of Medicine for her help in getting it into a YouTube format that allows the general public to see and hear Dr. Ledet’s presentation.

I wrote a post in February last year about how impressed I am with Dr. Ledet as a leader. Now you can hear him tell his own inspirational story.

The Not So Skinny on Exercise Associated Muscle Cramps

I’m just about fully recovered by a sudden case of shin splints and calf cramps in both legs this past Monday. I did no running, just walked for a little over 4 miles between our house and the shopping mall.

I thought I was doing pretty well until I got about a half mile from home. I had to cross a relatively busy street that doesn’t have a traffic light control, just a sign that suggests drivers slow down and stop for pedestrians in the crosswalk. Many drivers breeze through at around 30 mph and so I generally wait until there’s no traffic or when cars slow down enough that I can’t see the driver’s maniacal grin.

As a few cars waited, I began to cross the street and about halfway over, I started to trot and immediately both my calves cramped up. It was painful and I just managed to limp over to the sidewalk. As I leaned over and tried to ease the cramps by grabbing my toes and bending them toward my shins, I wondered why that happened.

Part of the reason was this was the first long walk of the spring after a winter of being relatively sedentary, other than some routine exercises including stationary bicycle, step box, and stretching routines.

I’m used to shin splints, which I noticed before the leg cramps. But I’ve never had both calves cramp like that. I’d gotten enough fluids, I wasn’t dehydrated, and I wasn’t low on electrolytes. Then, I got curious about the interplay of all those and found out there’s a fair amount of controversy about the causes of what I found out was called exercise-associated muscle cramps (EAMC)

Shin splints are a minor annoyance and could be due to me just being an old guy overdoing it and wearing not the greatest shoes on a concrete trail. Resting a while is the main way to get past it. But because of the double whammy of bilateral shin splints and calf cramps, I hunted on the internet for studies of the causes of EAMC, specifically calf cramps.

I’m sure most readers are familiar with web resources like the Cleveland clinic, which provide general guidance. They usually recommend avoiding dehydration and staying up to speed on electrolytes. Rest is the main suggestion. Meditating over an oleomargarine figurine of Elvis Presley is not recommended but has not been sufficiently studied.

Anyway, I found an interesting web site which challenges the usual guidance about the causes of EAMC. One of the authors of an article (“What Are the True Causes of Cramps While Running?” by Phattarapon Atimetin, MD; published May 15, 2019 on the website samitivejhospitals.com website) disputing the cause of EAMC being dehydration or mineral deficits pointed out that these are less likely than something called “altered neuromuscular control,” which appears to be advanced by a scientist named M.P. Schwellnus. However, the author didn’t cite any references, so I had to hunt them down. I think I found the right articles.

I found one the author didn’t mention, which was a comprehensive review (note the publication date, a few months after Dr. Atimen’s article):

Maughan RJ, Shirreffs SM. Muscle Cramping During Exercise: Causes, Solutions, and Questions Remaining. Sports Med. 2019 Dec;49(Suppl 2):115-124. doi: 10.1007/s40279-019-01162-1. PMID: 31696455; PMCID: PMC6901412.

The authors’ bottom line is:

Exercise-associated muscle cramp is a relatively common occurrence in a range of sport and exercise activities. Onset is generally unpredictable, and the intensity and duration of muscle spasms are highly variable. Spontaneous muscle cramping in occupational settings involving hard physical effort suggests that high ambient temperature and large sweat losses accompanied by the ingestion of large volumes of plain water may be risk factors, and there is some evidence that the risk is reduced by the addition of salt to ingested fluids. Laboratory models of cramp involve either voluntary or electrically-evoked activation of muscle held in a shortened position. These studies have produced mixed results regarding the effects of disturbances of water and salt balance on the risk of cramping; however, they do suggest that, at least in this model, sensory organs in the muscle invoke abnormal reflex activity that results in sustained motor drive to the afflicted muscles. There may be different mechanisms at work in different situations, and there is no conclusive support for any of the proposed mechanisms. Preventive and treatment strategies are not uniformly effective.

They mention M.P. Schewllnus, but they don’t endorse the altered neuromuscular control theory or any other as being explanatory in every case of EAMC. The review was supported by the Gatorade Sports Science Institute (GSSI), which makes me wonder about it a little.

I’m not certain but I think the references for the studies Dr. Atimen mentioned are below:

Schwellnus MP. Cause of exercise associated muscle cramps (EAMC)–altered neuromuscular control, dehydration or electrolyte depletion? Br J Sports Med. 2009 Jun;43(6):401-8. doi: 10.1136/bjsm.2008.050401. Epub 2008 Nov 3. PMID: 18981039.

Braulick, K. W., Miller, K. C., Albrecht, J. M., Tucker, J. M., & Deal, J. E. (2013). Significant and serious dehydration does not affect skeletal muscle cramp threshold frequency. British Journal of Sports Medicine, 47(11), 710-714.

Hoffman MD, Stuempfle KJ. Muscle Cramping During a 161-km Ultramarathon: Comparison of Characteristics of Those With and Without Cramping. Sports Med Open. 2015;1(1):24. doi: 10.1186/s40798-015-0019-7. Epub 2015 May 21. PMID: 26284165; PMCID: PMC4532703.

The reference below is more recent and the authors’ bottom line is below:

Kevin C. Miller, Brendon P. McDermott, Susan W. Yeargin, Aidan Fiol, Martin P. Schwellnus; An Evidence-Based Review of the Pathophysiology, Treatment, and Prevention of Exercise-Associated Muscle Cramps. J Athl Train 1 January 2022; 57 (1): 5–15. doi: https://doi.org/10.4085/1062-6050-0696.20

Advances in our understanding of EAMC pathogenesis have emerged in the last 100 years and suggested that alterations in neuromuscular excitability and, to a much lesser extent, dehydration and electrolyte losses are the predominant factors in their pathogenesis. Strong evidence supports EAMC treatments that include exercise cessation (rest) and gentle stretching until abatement, followed by techniques to address the underlying precipitating factors. However, little patient-oriented evidence exists regarding the best methods for EAMC prevention. Therefore, rather than providing generalized advice, we recommend clinicians take a multifaceted and targeted approach that incorporates an individual’s unique EAMC risk factors when trying to prevent EAMCs.

The review was not supported by Gatorade. It turns out the best management is rest and gentle stretching. If that doesn’t work, the advice is to seek advanced medical care. There is no evidence that meditating over an oleomargarine figurine of Elvis Presley is effective in any way—although, again, it has not been studied that I know of.

Rounding@Iowa Podcast: “Advances in the Treatment of Pancreatic Cancer”

This episode of Rounding@Iowa is about important medical advances in the treatment of pancreatic cancer. As you listen to Dr. Clancy interview Dr. Joseph Cullen about what’s new, you’ll hear a lot about high-dose intravenous Vitamin C. This can enhance treatment and improve response to chemotherapy and radiation therapy. Dr. Cullen’s most recent study about this technique showed the overall survival of patients with late-stage pancreatic cancer increased from 8 months to 16 months.

88: Modifiable Risk Factors for Breast Cancer – Rounding@IOWA

In this episode of Rounding@IOWA, Dr. Gerry Clancy sits down with breast cancer experts Dr. Katherine Huber‑Keener and Dr. Nicole Fleege for a discussion of modifiable and non‑modifiable risk factors, modern screening tools, and practical strategies clinicians can use to guide prevention and early detection. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=82146 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Nicole Fleege, MD Clinical Assistant Professor of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation University of Iowa Carver College of Medicine Kathryn Huber-Keener, MD PhD Clinical Associate Professor of Obstetrics and Gynecology – General Obstetrics and Gynecology University of Iowa Carver College of Medicine Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 0.75 ANCC contact hour. Pharmacist and Pharmacy Tech: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this knowledge-based activity for a maximum of 0.75 ACPE contact hours. Credit will be uploaded to the NABP CPE Monitor within 60 days after the activity completion. Pharmacists must provide their NABP ID and DOB (MMDD) to receive credit. JA0000310-0000-26-035-H99 Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.)

Reference:

Kellie L. Bodeker, Brian J. Smith, Daniel J. Berg, Chandrikha Chandrasekharan, Saima Sharif, Naomi Fei, Sandy Vollstedt, Heather Brown, Meghan Chandler, Amanda Lorack, Stacy McMichael, Jared Wulfekuhle, Brett A. Wagner, Garry R. Buettner, Bryan G. Allen, Joseph M. Caster, Barbara Dion, Mandana Kamgar, John M. Buatti, Joseph J. Cullen,

A randomized trial of pharmacological ascorbate, gemcitabine, and nab-paclitaxel for metastatic pancreatic cancer,

Redox Biology,

Volume 77,

2024,

103375,

ISSN 2213-2317,

(https://www.sciencedirect.com/science/article/pii/S2213231724003537)

Abstract: Background

Patients with metastatic pancreatic ductal adenocarcinoma (PDAC) have poor 5-year survival. Pharmacological ascorbate (P-AscH-, high dose, intravenous, vitamin C) has shown promise as an adjunct to chemotherapy. We hypothesized adding P-AscH- to gemcitabine and nab-paclitaxel would increase survival in patients with metastatic PDAC.

Methods

Patients diagnosed with stage IV pancreatic cancer randomized 1:1 to gemcitabine and nab-paclitaxel only (SOC, control) or to SOC with concomitant P-AscH−, 75 g three times weekly (ASC, investigational). The primary outcome was overall survival with secondary objectives of determining progression-free survival and adverse event incidence. Quality of life and patient reported outcomes for common oncologic symptoms were captured as an exploratory objective. Thirty-six participants were randomized; of this 34 received their assigned study treatment. All analyses were based on data frozen on December 11, 2023.

Results

Intravenous P-AscH- increased serum ascorbate levels from micromolar to millimolar levels. P-AscH- added to the gemcitabine + nab-paclitaxel (ASC) increased overall survival to 16 months compared to 8.3 months with gemcitabine + nab-paclitaxel (SOC) (HR = 0.46; 90 % CI 0.23, 0.92; p = 0.030). Median progression free survival was 6.2 (ASC) vs. 3.9 months (SOC) (HR = 0.43; 90 % CI 0.20, 0.92; p = 0.029). Adding P-AscH- did not negatively impact quality of life or increase the frequency or severity of adverse events.

Conclusions

P-AscH− infusions of 75 g three times weekly in patients with metastatic pancreatic cancer prolongs overall and progression free survival without detriment to quality of life or added toxicity (ClinicalTrials.gov number NCT02905578).

Keywords: Pancreatic neoplasms; Ascorbic acid; Controlled clinical trial; Gemcitabine; Nab-paclitaxel

Dr. Cullen mentions that patients contact him not infrequently to ask if taking high-dose oral Vitamin C will help them achieve similar results. Unfortunately, it will not. Giving it intravenously facilitates giving much higher doses. The study had a relatively small number of participants, which limited ascertainment of quality of life.

On the psychological side, there are ways to bolster the mental health challenges of those with pancreatic cancer, which typically has a grim outcome in terms of survival:

Spiegel D. Mind matters in cancer survival. Psychooncology. 2012 Jun;21(6):588-93. doi: 10.1002/pon.3067. Epub 2012 Mar 21. PMID: 22438289; PMCID: PMC3370072.

Further, Dr. William Breitbart, MD, Chair of the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center was interviewed in 2021 and emphasized the need for bolstering mental health for those diagnosed with pancreatic cancer. According to Breitbart, “Pancreatic cancer triggers an inflammatory response in the body, which can lead to mood disorders,” Breitbart explains. Psychiatrists can prescribe certain antidepressant medications that directly target that inflammatory response.”