Killer trees

I am poised behind the gurney. My goal? To jab the Mr. Skosana with (hopefully) a whopping dose of tranquilizer.  Not for the first time I long for one of those dart guns which lucky game rangers use to fell angry rhinos. There are a few obvious drawbacks. Firstly, psychotic patients tend to be smaller and more nimble than galloping rhinos. Secondly, my coordination skills leave much to be desired.

A few minutes later and Mr. Skosana is sedated and doing his best impression to look harmless,  contentedly nibbling at his restraints. His main problem, it would seem, is a scourge of stalking trees. I nod seriously. I think back to that excellent chapter on managing tree paranoia we did in medicine. Not. Time to improvise.

The agreement strategy: Reality doesn’t seem to be an option (and is anyway highly overrated in most cases). Google ‘management of killer trees’. Bingo!  Avoidance. Not too many trees loitering about at Bara so he’s probably safe for now. Best to be rid of indoor plants (probable co-conspirators). I recommend a few sacrificial offerings of fertilizer.

The rational approach: I rapidly run out of killer tree strategies. A chainsaw? I indulge in a little fantasy of Mr. Skosana sprawled under a hefty oak.  A brief stroll down the lane of logic leads to the only plausible explanation: Mr Skosana exists in a hateful herbaceous parallel universe. I try half heartedly to talk him over into my one but we've got killer people over here. Think he's better off with the trees.

Drugs FFS: Prescribe. Prescribe. Prescribe. Ah. The joy of antipsychotics. The screaming seems to have dimmed. Maybe trees just don’t like all the shouting? I’m in full agreement. At least I have the comforting delusion of treating him. 

If the voices talk to you, should you talk back?

If someone really is hearing voices (called auditory hallucinations, not your mother-in-law) there’s a whole scientific community debating how best to handle it. My brother is a ventriloquist so obviously I can see how talking back could lead to a career.

If you’ve ever been around someone with mental illness, a head injury or dementia you’ll know just how awkward the whole thing is. Should you tell granny that Uncle Bob is actually dead? For me it depends how many times I have to tell them.

For those living with schizophrenia or a large bump to the head, they may well know that the ‘voice’ or ‘person’ isn’t real. But its still chatting away to them. Previously we told patients to ignore the voices – play scrabble, watch TV, read a book.

I delighted to hear (no, just read actually) that this is all changing. Patients are encouraged to challenge the personalities (usually depressing, self-destructive rather nasty creatures) rather than ignoring them. Specialists are worried it may give the voices more power – make them more ‘real’. But I guess that’s easy if you’re not the one with the psycho living in your head!

A fascinating account from a guy with paranoid schizophrenia explains how the negative voices have become less frequent since he started addressing them. http://www.guardian.co.uk/lifeandstyle/2009/apr/04/mental-health-health-and-wellbeing  I know Martha Beck advocates giving them names (she calls her negative alter-ego ‘Fang’ and anything coming from ‘Fang’ is not to be believed).

More problematic –the guy now has a new young, friendly voice which also chats to him. He’s a teenager who is ‘mischievous and funny’. Technically this is not a good sign – he’s hearing voices. But if you’re going to hear them, might as well get them to make you laugh. I wonder if he’s considered getting a puppet?

Lizard pill anyone?

The headlines this week are doctors muttering about the FDA’s decision to approved a new antiobesity drug called “Qnexa.” Qnexa is a combination of an already existing weight loss drug - phentermine and topiramate, an antiseizure agent – which is fondly knick-named ‘the stupid pill’ for some if its special side effects – forgetfulness, clumsiness and reduced overall braininess.

This has been followed up with a recent chemical breakthrough. A drug made from the saliva of the Gila monster lizard is the new treatment for chocolate cravings (no, we can’t imagine how they discovered this). Maybe if you take Qnexa you’ll be silly enough start swallowing lizard venom?

Go getters are just after their next 'fix'

Slacker or go-getter? Apparently it’s all about how much you’re willing to do for dopamine. A study published in the Journal of Neuroscience used a brain mapping technique compare slackers vs go-getters

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It seems that some of us are hardwired to release rewarding amounts of dopamine while others are not.  Dopamine is the reward neurotransmitter essential for survival. It wires us to do things like eat, drink and propagate the species.  It’s also the neurotransmitter associated with addiction (we’ll do anything to get a ‘fix’ of dopamine).

Using a brain mapping technique called positron emission tomography (PETscan), the researchers found that "go-getters" release higher amounts dopamine in areas of the brain known to play an important role in reward and motivation. Slackers don’t.  Go getters will therefore continue to work hard so that we can get their next dopamine dose.

The bottom line is you should be demanding some neurochemicals to go with that pay rise.

The myth of multitasking

In a world of multimedia overload, maybe you’ve found yourself, reading a magazine, watching TV and scrolling through smses. We’re all guilty of it - media multitasking. But apparently we’re not very good at it.

In a recent study a group of researchers cornered some college students over a month, monitoring their media use. The findings showed that multitasking often gave the students an emotional boost, even when it hurt their cognitive functions, such as studying.

The study coordinator concluded that while we may believe multitasking makes us more productive, we’re all swallowing one big lie. What multitasking does do is boost our mood. Apparently the satisfaction of multiple jobs done is better than a job well done.  Multimedia keeps us happy and that’s why we keep doing it.

Does my chin look big in this?

And the fastest growing plastic surgery trend is…. Chin tucks! That’s right. We longer care what happens from the neck down, it’s all about how you’re going to look in that all important head shot. These are the stats released on 16 April 2012 by the American Society of Plastic Surgeons (ASPS).

Those ageing baby boomers true to form will let nothing – not even a double chin – get between them and their dream of a corner office. Apparently double chins are off-putting (or perhaps distracting) when your mug shows up on Skype for all the world to see.

The bad news is your chin and jawline are the first to head south when gravity calls. Step aside facelifts – it’s all in a decent chin! Apparently being forced to face a live video chat with our own faces in full view leaves much to be desired. I blame the angle of the camera. Then again if you lift your head nose hairs are more likely to make their unfortunate appearance. Start saving people – if you want that promotion that turkey neck has got to go!

Jilted fruit flies turn to alcohol

My favourite study of the week. A highly educated group of genius scientists are now monitoring the love life of fruit flies. Apparently our DNA doesn’t lie – we’re closer to a small irritating fly than you might think.

Scientists at UCLA have discovered that when male fruit flies are rejected by females (presumably they counted the number of ‘brush off’ lines from snarky female flies), male fruit flies are driven to excessive alcohol consumption.

To be honest the research raises more questions than answers:

1. a)   Can real scientific research be performed in a bar?
2. b)   Exactly how much alcohol is ‘excessive’ for a fruit fly? Were they flying drunk?
3. c)   The underlying mechanism is apparently a bout of depression from rejection. We have  depressed fruit flies? Does this mean we should stop swatting them?

Another giant leap in scientific discovery!

The whole truth? Are you sure?

A recent law passed in Arizona allows doctors to withhold critical information during antenatal consultations regarding congenital abnormalities diagnosed during pregnancy (so that the parent will not be enticed to abort their three-headed offspring). There is something fundamentally disturbing about this type of lying. But then, where does one draw the line at lying to patients? If I haven't lied, I certainly haven't always told the whole truth.

I’ve personally never been great with handing out earth-shatteringly bad news and recall once telling a patient in their HIV post-test counselling that, “Yes, you have HIV, but please don’t look so anxious. There are some really great drugs around and by taking them we can make HIV into a chronic disease. So really thing are going to be great!” Admittedly a tad upbeat - really a bit like telling someone they have cancer, " But it's no biggie!"


A recent study published in Health Affairs, shed light on the fact that I'm not alone. The truth (as best we know it) in medicine can be a very unpleasant thing. Apparently one-fifth of my colleagues feel that the whole, unadulterated truth can sometimes cause more harm than good. Maybe we’re all just whoosies. But then don't we all need a smidgeon of hope along with the rest of our prescription?

It's a miracle you're still alive!

Life sucked! If you were born anywhere prior to the 90s then it's a miracle you're still alive. Your baby seat (if you were lucky enough to have one) faced the wrong way, nobody made you buckle up on the back seat, they used adult 'death-trap' safety belts on the front seat, nobody thought there was anything wrong with additives.  Not only did they let you play with mercury thermometers, but they even stuck some in your mouth for good measure. Your immunization sheet consists of about 3 vaccines (that's all they had), you were liberally smothered in talc powder (now considered lethal inhalations), you were probably dosed with whiskey as teething gel and sucked on a dummy coated in lead.  There was nothing subliminal about ads for smoking, alcohol and violence and you were a nicotine addict before the age of 3. Well done for making it!

No can't come to work... the traffic is just too dangerous

Just when you thought work stress was going to to be the end of you, think again: it's the drive to work which is going to do you in. Nevermind the taxis and tolls - taking deep calming breaths of Johannesburg air exposes you to  fine particulate matter levels of around 53 μg/m3 – more than twice World Health Organization's recommended 'safe' levels. A study published last week in the Journal of the American Medical Association which reviewed 34 studies agreed that the verdict is clear - stop inhaling those traffic fumes or you will be increasing your risk of a heart attack and/or stroke. Just another reason to work from home - and slightly more tactful than telling your boss how you really feel.

World of Warcraft boosts brain power...

When Geeks and Nerds join forces, they can conquer the world... or at least they could if they weren't so busy trying to slay imaginary dragons. 


No, instead they round up a group of unsuspecting senior citizens in Carolina, log them on to WoW (World of Warcraft) for two weeks and then monitor their behaviour. Their findings? WoW  boosts brain power in the elderly - so sayeth the study they went on to publish in the journal Computers in Human Behavior this week. 


According to Andrea Kuszewski who writes for Scientific America, this may actually make sense. The key factors in holding onto your marbles includes a willingness to: engage in novel experiences, network with others, take on challenges and do things the 'hard way'. Contrary to popular belief she believes the only thing Sudoku improves is your ability to play Sudoku. Constant fresh challenges are the way to wire your brain for optimal outcomes.


What the study doesn't mention is that WoW has also been found in other literature to be addictive and hazardous to marriages. So you will be extremely clever and  proficient at bludgeoning trolls - but quite possibly alone.

Sorry God....

Dear God,


Funny story. I think I may have figured out where Jesus has got to. I don't know when you last saw him, but I think I accidentally admitted him to the loony bin last week. Looking back on it there were perhaps a few signs - the hemp sack cloth outfit (very circa BC) and a walking stick (presumably a make-shift shepherd staff).  Anyway, he did introduce himself as Jesus, but I was extremely busy mopping up blood, harassing small children etc (quite frankly I think he could have chipped in a bit more in the 'saving lives' front - we're very short staffed). He was after all the third Jesus of the week (do you send them in batches?). 


Unfortunately 'normal' is all a numbers game nowadays. If it's just the one guy telling us he's Jesus, we have to inject him with antipsychotics. If there are a few in agreement,  we would classify it as a 'cult'. If you get a whole bunch of people, it's a religion.


If he was the real Jesus I am terribly sorry and hope I haven't doomed us all. If he wasn't, apologies for using up your valuable time.


Kind regards,


Dr KK

'Yes I killed her. But I was asleep at the time.'

Here's an alibi you may not have considered - sleepmurdering. It's not foolproof, but for 40-year old Brian Thomas, it was enough to convince the judge. Brian awoke one morning to find that he had accidentally throttled his wife to death, believing her to be in intruder.

Sleepwalking is one of those bizarre human behaviours we don’t fully understand. Humans have been sleepwalking for as long as we have been sleeping. Since we spend about one third of our lives sleeping it’s not surprising that a whole range of conditions can occur while in this state.

Most sleepwalking consists of just that.  Walking. The person won’t remember anything, but will usually walk a short distance, occasionally ramble nonsensical muttering and then return to sleep. About 15 percent of all children sleepwalk and most will stop by their early teens. 

But did you know that people 'sleep drive', 'sleep walk the dog' and 'sleep email'? 

Sleep-murdering isn't a definite 'get out of jail free card'. Here's the line up:

• 1997: Scott Falater, a devout Mormon, stabbed his wife 44 times with a hunting knife. He then dragged her into a backyard pool and held her head under water. Falater tried to conceal evidence in his car. Found guilty of first degree murder.
• 2001: Stephen Reitz killed his married lover, Eva Weinfurtner during a romantic Catalina Island getaway. He smashed her head with a flowerpot, dislocated her arm, stabbed her with a plastic fork and fractured her wrist, ribs, jaw, facial bones, and skull, allegedly fighting off a would-be intruder. Found guilty of first-degree murder.
• 2003: Jules Lowe, 32 punched and kicked his aged father, Edward Lowe, 82, over ninety times until he died. He had a strong history of sleepwalking. He was acquitted

The moral of the story? Think of a better alibi!

Bariatric surgery may shed kilos, but it doesn't cure addiction

Bariatric surgery is currently touted as the ‘only known cure for diabetes’. The physical facts are simple. Bariatric surgery limits the quantity of food the person can eat and the results speak for themselves – the kilograms normally melt off, but the real underlying problem may not have been addressed.

The biological need to eat is right up there with sleeping, drinking fluid and mating. We need to do these things to survive and the brain has developed complex neurochemical ‘rewards’ programmes to compel us to eat.

It doesn’t take much to push them into the realm of addiction. And unlike other addictions, you can’t simply refuse to eat food – so the treatment is different. Many obese individuals suffer from a food addiction. The addiction is normally triggered by underlying psychological problems. If these are not dealt with and the person undergoes bariatric surgery, they become at very high risk for other forms of addiction as an outlet or expression for these needs. This is known as ‘addiction transfer’ and is commonly seen in other areas of substance abuse. Addiction transfer occurs in around 1-in-5 people who undergo bariatric surgery.

Fundamentally this outlines that excessive eating is a complex behaviour involving elements of socialisation, habits, psychological make-up and often food addiction. Simply wiring up someone’s jaw, sending them to a fat camp or cutting off half their stomach may change their weight, but not the addiction.

Childhood obesity or childhood abuse?

This week an Ohio mom had her 7-year old 200 pound (90kg) child taken into foster care when she failed to help him meet health-related weight loss targets. Maybe it is extreme, but with childhood obesity having tripled over the last two decades, the health risks for our future generations are serious. Fundamentally we’re looking at the first generation in the last 100 years who has a lower life expectance than their previous generation.

South Africa obviously has far more serious issues like sexual abuse, malnutrition and childhood HIV to cope with and yet, third world countries also predicted as those which will be hardest hit by the rise in metabolic syndrome. Countries like Australia are discussing the responsibility of doctors to report childhood obesity to Child Protection Services.

Anybody who’s watched an episode of “Too fat for 15” will see that the issue of obesity is more systemic than simply the child. The parents are almost never pictures of perfect health themselves. Children in their earliest development phases have no real sense of ‘good’ from ‘bad’ food. Yes, some children are born with a preference for sweet foods, but really they have no judgement where food is concerned.

What makes it worse is that the ‘abusers’ are my own generation of peers. We were brought up on the ‘eat everything until your plate is empty’ policy. This, in addition to the guilt of the starving children in Ethiopia seems to have backfired in a way that makes us punish the next generation.

The issue really is that bad eating habits start incredibly early in life. These habits get harder to change with time. By the age of 7 or 8, a parent still has some control of their child’s eating, but certainly not as much as at earlier ages. Moreover, the parents may also need foster care – they’re probably not feeding themselves correctly either.