Holidays and Holy Days; My Christmas Book

This is a book of columns about Christmas and Easter that I put together with the SC Baptist Courier two years ago.  It’s still available and I think you would enjoy it!


Watch for signs of depression in your teen.

This is my latest column in the SC Baptist Courier.  Teens are wonderful!  But that transition from childhood to adulthood can be so hard on them.  Please remember that they can be afflicted by depression, and watch yours carefully. And their friends!  Text follows link.


Wholly Healthy: Watch for signs of depression in your teen

It’s August, and that means that school is starting. Middle school and high school, in particular, are times of significant emotional challenges. Not only are students adapting to physical changes and emotional growth and maturity, the fact is that depression is a big problem for young people. In 2012, according to government statistics, 11% of kids between ages of 12 and 17 had at least one major depressive episode. These episodes increase their risk of suicide and drug abuse.
All parents know that raising adolescents is a challenge. The complexities of adolescent culture are compounded by their even more complex brain chemistry. In the end it can be very difficult to sort through which behavioral changes are normal and which are pathologic and dangerous.
Because of this, it’s very important to educate yourself, and talk to your kids. And talk. And talk. If you think you’re being intrusive or invasive, that’s not necessarily bad. (In general, they want your attention more than they admit.) Young people will frequently say ‘everything is fine,’ when everything is far from fine and they are feeling sadness and despair.
It’s important to spend a lot of time with the kids. And while you do, to watch for signs of depression, like withdrawal from friends and family, loss of enjoyment of normal activities, expressions of guilt or worthlessness and increasing emotional outbursts. Be attentive to increased physical complaints such as fatigue and loss of appetite. This list just scratches the surface, so I’ve attached a link with more details.
Furthermore, as you talk to your kids, don’t be afraid (or ashamed) to snoop. Know what they’re doing, where they are going and who their friends are. Ask who they are texting, what they’re reading, and what they’re thinking about. And don’t accept ‘oh, nothing’ as an answer. They are always thinking about something.
And since most of them seem permanently attached to a telephone, snoop there as well. There are ways to track their phones and to follow the websites they visit and the texts they send and receive. And you can simply tell them that you want access to their passwords. Odds are you’re paying for the thing anyway. This isn’t to be mean, but to be diligent. The texts and searches on their phones can be clues to their emotional struggles and also to dangers or cries for help.
Remember that even kids with loving, attentive families can spiral into dangerous depression. Don’t forget that Christians have brains and depression is a real disease of the brain, not a moral or spiritual failure. So never be afraid to discuss it with the kids, admit that it’s real and seek counseling and medication as indicated.
Your efforts might just be life-saving.

The Wonders of Over the Counter Drugs!

Here is my column in the February SC Baptist Courier.  Not everything requires a prescription, you know!

I recently had an enormous kidney stone. Well OK, it seemed enormous to me. But in terms of kidney stones, it was reasonably large; 9mm in fact. Large enough that I had to have lithotripsy (the use of sound waves to break up the stone) performed by my friend and most excellent urologist, Dr. Robert McAlpine in Seneca, SC.

As uncomfortable as the whole experience was (and it wasn’t my first rodeo either), I was reminded of something very important, which is that prescription drugs aren’t all they’re cracked up to be. In fact, the best pain relief I had from my kidney stone involved the little blue wonder-pill (for which I would have given a lot of money, let me say), the humble, the magnificent Naproxen, aka Aleve). The reason for this is that the class of drugs to which Aleve belongs (nonsteroidal antiinflammatory agents or NSAIDs) acts to relax the spasms of the ureter, which is the tube from kidney to bladder where the demonic stone takes up residence and tortures its victims. When the spasm relaxes, the pain improves.

This is relevant for many conditions and situations, from kidney stones to cough, because the things found in the average pharmacy or grocery store are magnificent medical manna from heaven. Actually, I remember one of my medical school instructors at WVU, Dr. DiBartolomeo, encouraging us to wander the aisles of the local pharmacy and be awed by the variety of useful things on the shelves.

In an age when tremendous numbers of people take too many prescriptions; in an age when vast numbers are addicted to narcotic pain killers, it’s good for us to remember that there are simpler ways to manage our acute illnesses and simpler tools to employ in the task.

I’m sure I have previously subjected the reader to my rants on treating fever, but in a nutshell, ‘fever is natural, usually good and can be treated with ibuprofen and/or acetaminophen…over the counter.’

Bitten by an insect and itching? Inexpensive antihistamines abound in the local pharmacy, which is a true cornucopia of possible allergy therapies. Sore muscles? Twisted ankle? NSAID’s like Aleve or Advil are sitting in their bottles, bursting with willingness to treat the pain of injury…or kidney stone as related above. Mild poison ivy dermatitis? Calamine lotion and antihistamines are a nice, soothing option for treatment. Ingrown toenail? There are antibiotic ointments, salt-soaks and other wonders. Dirty wound? Pour some peroxide in it and watch the chemical go to work! (Kids love it and it doesn’t hurt.) Head cold driving you crazy? Antibiotics won’t help, but some pseudoephedrine, or saline nasal spray might get you through.

If you take medications or have medical problems already, check with your pharmacist about side effects and interactions. But just remember that there are lots of nice ways to treat your common medical problems that don’t require a doctor visit or an expensive prescription.

Human Trafficking; Closer Than You Think

This is my column in this month’s SC Baptist Courier.  If you have a subscription, here’s the link.

One of the wonderful things about medicine is the insight it gives us into humanity on a daily basis. After sufficient time, a physician learns to see, simply in passing, signs of illness or injury in other people. Problems past or present jump out to our eyes. And in fact, as Christians we should develop similar skills out of love. Given that the church is called to be salt and light to the world, it makes sense for us to also serve as scouts, as ‘life-guards.’ As such, we should be constantly on the lookout for the oppressed, the suffering, those subject to cruelty and tyranny, violence and harm.

Unfortunately, in modern times one of the things we should be watching for is evidence of human trafficking. Tragically, all around the world human beings are bought and sold in enormous numbers as victims of such horrors. They are sold as sex slaves (forced into prostitution or other forms of sexual exploitation), as wage slaves (never making enough money to deliver themselves from unfair labor practices and contracts) and into frank slavery in everything from farms and factories to restaurants.

While victims of trafficking may not attend a worship service, there are other places where Christians interact with the public and where we might be able to identify, and report, those in distress. For instance, they might come to our food-banks or other church-related services like children’s festivals or community-wide parties. We might see them putting children onto a VBS bus, or simply observe them in the secular businesses where we work each week.

We can help identify these persons, and alert authorities, by knowing warning signs of human trafficking. The FBI offers a number of identifying characteristics (see also the link below): those who are victims may have no ID or money or documents. We may observe that they are closely watched and are highly controlled by others. It may be evident that they live in terrible living conditions and have poor clothing and nutrition. Furthermore, those who are victims of trafficking may report that they move frequently; or more likely be very evasive about any interaction. We should also be attentive to places where humans are behind locks and fences, or where persons have very long work hours and very little income. These same individuals may suffer wounds from abuse, work related injuries, or other illnesses for which they are not allowed to seek adequate care.

In fact, human trafficking is a problem of exploding proportions, and a business that is worth an estimated $150 billion per year worldwide which currently enslaves some 20 million humans of all ages. While in America, it typically involves foreign citizens trafficked into the US, the fact remains that about 33% of victims are US citizens. The great tragedy of human trafficking is that it preys almost exclusively on the most vulnerable of all citizens: the poor, the alien, the uneducated or undereducated, the weak, the young, substance abusers and those with mental illness. As Christians, this aspect should be particularly galling to us all.

And it should prompt us to learn how to diagnose this disease of humanity so that it can be identified, dealt with and ended.–en/index.htm

Pass The Salt Please! (My latest in the Baptist Courier.)

Here is my latest column in the Baptist Courier.

One of my favorite physician sayings is ‘don’t just do something, stand there!’ Which means that it’s better to do nothing than to do something that doesn’t help. As I move through my career, I find myself agreeing. I am endlessly amazed at the number of things we do for no good reason, and that patients come to expect, also for no good reason. For instance, we believe that every earache and sore throat needs an antibiotic, when it’s clearly not the case. We always give antibiotics for seven to ten days, but without knowing why we picked those durations (other than the fact that they were easy to remember).

We seem to be very gullible when it comes to over the counter cold and cough drugs, even though there’s truly limited evidence that they work. And when the drug companies throw Tamiflu around, we embrace the marketing with joy; despite the fact that it’s a thing of pretty limited benefit (a topic I have covered previously). This isn’t the fault of any one person or group. We want to believe the advice we receive from medical researchers! And as practitioners, we want to have confidence in the things we use to treat the sick and injured.

One of the truly orthodox dogmas of medicine is the low salt diet. If you ask anyone in medicine or nutrition whether to limit salt intake, the answer is a slam-dunk. ‘Of course low salt diets are good for you! Salt is bad!’ For decades we have been taught, and we have preached, the evils of salt. So much so that I remember once when my wife was very ill, and wanted some regular soup (with salt) I was having a terrible time finding anything that wasn’t ‘low sodium.’ However, it appears that like the low fat diet, and the high carbohydrate diet, the low sodium creed may be fading away. (Hopefully the salt-free crackers stocked in hospitals will also be a thing of the past. A Saltine, by definition, should be, you know, salty!)

It turns out that recent reviews of the data on low salt diets suggest that the average American diet just might be well within safe parameters, and that low salt diets only cause small changes in blood pressure (probably only in a subset of patients with high blood pressure). In fact, there is some evidence that diets with normal salt intake may be associated with lower risk of cardiovascular events and death than low salt diets! Who saw that coming?

If you want to read a nice summary of how we developed our ideas on salt, and about the current debate, this is a nice article in the Washington Post.

And for those wanting to delve into the numbers in a large recent study on the topic, here is a link to the PURE study (referenced by the Washington Post), published in the New England Journal of Medicine.

I’m not saying you should start dumping huge amounts of salt on your food. But it may be reasonable to worry a good bit less about salting your food, or finding low-sodium items at the store.

On the other hand, it’s OK for us to keep being the Salt of the Earth. Spiritually the world needs all the salt it can get.


Who do we trust for medical advice?

My February column in the SC Baptist Courier.  Who do we trust, and who should we distrust, when we look for medical advice?

How do we know what to believe about anything? In times past we read books, we took classes, we spoke to experts. These days? These days we do the same, but we also search the Internet. And we seem to do it with special fervor when it comes to questions about our health.

I can’t throw any stones here. Even a physician has knowledge that is limited to his or her specialty, or personal experience. (And even if I had kept all of my textbooks, they would be woefully out of date by now.) So, from time to time, I’ve searched the Internet for answers to questions. Not only for myself and my family, but sometimes even when working. It’s not unusual for a patient to tell me about their chronic condition, only for me to discover that I have no idea what the syndrome actually is. Some of these diseases require specialized care and leave me scratching my head, so it’s off to the World Wide Web I go. Then, once I know enough not to sound entirely ignorant, I try to call their doctor to ask what to do next. Furthermore, new drugs and devices are constantly hitting the market, and I am not ashamed to say that I have to look many of them up! Emergency medicine physicians like myself are generalists, and we know when to cry ‘uncle.’

There are, for physicians, specialized smart-phone applications or Web-based services. And for patients, there are plenty of Websites available. Sadly, not all of them are very good. And not infrequently, the advice and direction given causes more anxiety then relief. I’ve noticed, even on physician websites, that there is a strong, and often inappropriate, tendency to ‘assume the worst.’

Therefore, patients who want to search for medical information should look for well-developed sites which are closely monitored by professionals, and which rely on scientific evidence. The popular site WebMD comes to mind. Likewise, some universities, or medical centers like Mayo Clinic, have extensive data-bases online that can be reliable and useful places to answer common medical questions. Finally, there are many new tele-medicine services, which (for a fee) connect patients to real-time doctors who can answer questions and even diagnose or treat common illnesses.

However, some sources of information are less than stellar. Recently, physicians with the British Medical Journal assessed the therapies recommended on the Dr. Oz show and the popular series, The Doctors ( The results were not encouraging for those who look to those programs for guidance. According to the research, only about 1/3 to ½ of the recommendations made were based on good science. I don’t believe that the hosts intentionally deceive; but when shows depend on advertising dollars, truth can sometimes be obscured for purposes of money or ratings.

Quite understandably, we all want answers; particularly when we’re worried. But in an age of exploding access to information, it’s wise to remember that not all that passes for medical advice is actually true and safe. And that in the end, for any serious concerns, it’s probably best to go to an expert and actually ask your doctor.


The Question of Marijuana…a Christian perspective

This is my column in this month’s SC Baptist Courier.  What should we think about marijuana and legalization, from a Christian perspective?

There’s a lot of media coverage of marijuana these days.  Across the land, marijuana laws are being revisited and its use is being steadily decriminalized.  In many places medical use is allowed, while in Colorado recreational use is legal.  So how should Christians deal with this issue?

First, with knowledge.  Researchers have found that humans have a system of ‘endocannabinoids,’ chemicals like those in marijuana, made in our bodies, and with appropriate receptors.  These chemicals are involved in many things: immunity, craving, bone growth, anxiety, metabolism, pain and pleasure.  Using the drug marijuana seems to mimic some of that activity; though to what extent, and for better or worse, we just don’t know for certain.

Particularly because it is considered natural, marijuana is touted by many as a drug that’s just ‘no big deal.’  After all, users are usually (thought not always) calm and relaxed.  I admit, in my 20 years as an emergency physician, I’ve had to wrestle a lot of drunks, but almost never have I had to fight or restrain someone using marijuana alone.  However, it isn’t that simple.  For example, marijuana may play a role in ‘un-masking’ underlying psychotic disorders in people who have the tendency. That is, if your family has a history of schizophrenia, marijuana might allow you to manifest that mental illness.  And there are other concerns with marijuana use.

Some evidence suggests that marijuana can lower IQ in developing teenage brains, and can have negative effects on memory and decision making.  Is marijuana a ‘gate-way’ drug?  That is, does use its use lead people to other, more dangerous drugs? The research isn’t conclusive.  Some studies say yes, while advocates for marijuana (of course) say no.  However, it’s dangerous enough on its own, as fatal car crashes involving marijuana have trippled in the last decade and the combination of alcohol and marijuana is even perilous.

There are other concerns.  The concentration of active chemical in marijuana is believed to be increasing.  So we may be entering new, uncharted territory in terms of physical and emotional effects.  Marijuana is believed to reduce fertility whether used by men or women.  And while the cancer link has been weak, it isn’t zero; more research will be necessary in that area as well.

I understand the arguments; that criminalization of marijuana is expensive, and that its use is often victimless.  And to the extent that minorities suffer inordinately from the laws, it’s certainly unfair. But for now, it remains illegal at the federal level. And medically, to this physician, the risks are either too great or too uncertain for anyone to simply say that it’s ‘no big deal.’

But an important question remains regarding marijuana.  What need is the drug filling for users?  What pain is it easing, physical, psychological or spiritual?  What trouble is it soothing?  If we answer those questions, then maybe we can reduce its use.  Not only by understanding the physiology of the natural chemicals in our bodies, but by helping users to fill their personal voids, to ease their own pain, with Christ, not chemicals.

It’s all too easy to condemn.  But we’re called to compassion.  And nowhere is it more necessary than in dealing with, and loving, those who use illicit drugs.

Stroke treatment; my December Wholly Healthy column.

Brain Attack!

Brain Attack!

Here’s my column in stroke for the Baptist Courier.


Among the many things that we all fear, stroke has to be one of the worst. Stroke, or cerebrovascular accident (CVA), is one of those medical events that can fundamentally change the way we live. It can affect our speech, our ability to use our hands or to walk, our vision or balance, our comprehension — or any other function that our brains provide. Around the country we now see myriad billboards and television commercials about stroke. The message seems to be that if you have a stroke and you get to the hospital in time, there is a magic drug that will invariably fix the problem. So I want to briefly explain the ups and downs of that drug. The drug most often used is called TPA (for tissue plasminogen activator), and the class of drugs to which it belongs is called “thrombolytics.” The idea is that if you have a stroke that appears to come from a clot in a blood vessel in your brain, the drug will dissolve that clot and lead to resolution of your symptoms. We have done this for years in heart attacks, and it works well. It’s medicine mixed with plumbing. Drano for the heart. Or in this case, “Drano for the Braino.” In theory, it makes so much sense that it’s difficult to see the downside. Have a “brain attack”? Go to your nearest hospital and have the pipes cleaned out! (Mind you, it has to be given in three to four-and-a-half hours, depending on the protocol of the hospital where you are treated.) Nevertheless, for several years this has been a source of great controversy in medicine. A lot of ink has been spilled in the debate, and a lot of research and analysis of the research has taken place. And the answer is that, just like so many questions in theology, it varies with who you read and what you want to believe. The bottom line is this: Some people in the studies completely recovered from their stroke symptoms. I’ve seen it happen, and it’s grand! However, the research also shows that 1) not everyone recovers from their stroke, 2) some people have dangerous bleeding due to the side effects of the drug, and 3) some people die from the bleeding caused by the drug. Remember, the drug dissolves clots everywhere, not just at the stroke. You can imagine that you might have a leaking blood vessel in your brain, or might already have an ulcer or mild nosebleed. In those instances, serious bleeding can occur with thrombolytics. However, for many patients, the risk is worth the chance to recover their normal lives or to keep from being bedridden or otherwise disabled. I hope that you, dear reader, never face a stroke. You can reduce your risk by eating a healthy diet, exercising and controlling your cholesterol, triglycerides, blood pressure and blood sugar. But if you do have symptoms, don’t wait around at home. Go to the hospital. Once there, you may well be offered thrombolytic drugs. Talk to the doctor and assess the benefits and the risks of the drug. But go into it knowing that no drug is a magic drug, and that every drug therapy, however wonderful and promising, has inherent risks. And it’s nowhere more true than in the treatment of stroke.