Monday, 31 October 2016

Alternatives

For the 2 or 3 of you who noticed the "Idiot" story I mistakenly posted when it was approximately 15.327% (approximately) completed, this is not that story.  For the rest of you, this is still not that story.  Unfortunately the "Save" button is right next to the "Publish" button, and Mrs. Bastard was pressuring me to hurry up so we could leave, so . . . yeah, I guess I'm blaming Mrs. Bastard for that.  It seemed to make more sense in my head than on the screen.  Hmm.

Anyway, this is still not that story.  In case the first few paragraphs piqued your interest, I'm sorry but you'll just have to wait.  After we returned home (from whatever uninteresting thing we had attended . . . possibly shoe shopping), I finished the Idiot story and was all ready for some final editing (BigBrotherBastard always seems to find a typo no matter how careful I am), but before I had the chance I saw a real, actual patient in my office who prompted me to write this.

I know I know, anecdotes are worthless because anyone can make up anything.  But that's all this blog is - anecdotes.  None of you has any idea if any of these stories are real or fabricated (except you, Mrs. Bastard).  Perhaps I'm just a 26-year-old guy sitting at his computer typing fiction. 

But no, I assure you they're all true.  Well, all except one.  Regardless, this really did happen:

Trudy (not her real name™) mentioned Dr. Mercola.  And Dr. Oz.  IN MY OFFICE.  TO MY FACE.

I almost passed out from the rage, and when I almost woke up I almost threw her out.

Trudy was in her early 70s and reasonably healthy for her age, but she had developed acute cholecystitis, an infection of her gallbladder due to gallstones, several weeks prior.  I had removed her gallbladder laparoscopically and had sent her home the same day.  Everything had seemingly been going quite well when she came to see me for her followup visit one fateful day exactly two weeks after her surgery.  But when I walked in I saw something unmistakable sitting on her purse:

A notebook.

I hate notebooks.  I really hate notebooks.  It seems like a rather innocuous item, one that shouldn't inspire such awesome dread and ire.  But these notebooks that are brought to my office all have one thing in common: they are filled with questions.  

Oh, the fucking joy.

I tried to ignore the notebook and instead asked how she was doing, and she reported some minor digestive difficulties (mainly gas and mild bloating), which isn't terribly uncommon after gallbladder surgery.  She wasn't having any pain or nausea, and her appetite was ok, but she was having a lot of gas and cramping after eating.

Her incisions looked perfect (if I do say so myself), and her abdominal exam was completely benign.  But the look on her face quite clearly told me that she felt uneasy about . . . something.  I always finish my followup visits by asking if my patients have any unanswered questions, and this time was no exception, but I did it with obvious trepidation.

"Oh, oh yes I do," Trudy said confidently as she reached for her notebook.

Sigh.  Ok, let's just get this the hell over with.

"Well," she started, turning to page 1, "I was wondering why I've been having so much gas discomfort after eating.  It's really very strange, because I've never had this problem before.  Is this normal after surgery?"

While gas and diarrhea can certainly happen after gallbladder surgery, my Inner Pessimist told me that something else was going on.  I asked if she was eating and drinking normally.  Her face went into a slight scowl.

"No, I've been eating mostly vegetables.  I stopped eating chicken and fish and bread and eggs and milk and sugar and all the other things I usually eat."

My Inner Pessimist started laughing.  He seemed to know something I hadn't quite caught onto yet.

"Why?" I asked her.  My Inner Pessimist started laughing even louder.

"Well, because I was reading online that you just can't eat that other stuff after having gallbladder surgery, and you need to just eat vegetables.  I was also wondering if I actually needed the surgery and if I should have just gone home and done a gallstone flush."

A flush?  Oh for fuck's sake.  Really?  She couldn't possibly have read the bullshit in Mercola.com, could she?  My Inner Pessimist was nearly peeing himself laughing now.

I very slowly and carefully explained that there's no such thing as a gallbladder flush, as I remembered an article I had discussed on Twitter recently about that exact thing.  Something about drinking a mixture of olive oil and something else I couldn't quite remember.  My mind was on that and trying to figure out the next thing to say when I heard her say,

"Oh my god, REALLY?  Because I read that olive oil and lemon juice can flush the stones out naturally without surgery!  Maybe I should have just done that."

Fuuuuuuuuuuuuuuck!  Shut the hell up, Inner Pessimist.

Lemon and olive oil.  While these two things are vital for cooking a piccata, they are not so useful for removing gallstones.  And by "not so useful", I mean completely and utterly useless.  

To explain I drew her a little picture of a 2 mm duct leading out of a gallbladder next to a 2 cm gallstone, and I tried to explain why it would be absolutely impossible to get that stone through that duct.  She kept shaking her head in disbelief.  I didn't know exactly where she had gotten her information, so I told her that most of the stuff she saw on sites like Natural News and Mercola.com was bullshit (though I think I used the term 'bunk') just as an example.  And I reminded myself to Tweet "Fuck you, Mercola" when I got home for good measure.

"NO, NOT DOCTOR MERCOLA!  I LOVE DOCTOR MERCOLA!" Trudy nearly screamed.

Fuck you, Mercola.

Yes, Trudy had actually gotten her medical information from noted quack and bullshit artist Dr. Joe Mercola.  My resultant myth busting with her went on for a full 10 minutes as I obliterated every question she had in her notebook in order.  "So I can really eat whatever I want?" Trudy asked finally.

"Yes," I said.  "You don't have to be careful with what you eat, you just have to be careful where you get your medical information.  Try Medscape and webmd.  And for god's sake avoid Mercola.  Oh, and Dr. Oz too."

Her eyes nearly bugged out of her head.

"OH MY GOD!  NOT DOCTOR OZ TOO!"

My Inner Pessimist shit himself.

It took another 10 minutes, but I eventually convinced her that while Dr. Oz was a brilliant cardiothoracic surgeon, his general medical advice was like homeopathy or a palm reading or a diaper pail: full of shit.  She seemed shaken but relieved at the same time that she could go back to eating normally.  She left about 10 minutes later with a smile on her face, probably looking forward to stopping at a fast food joint on her way home for her first opportunity in two weeks to eat some actual food.

She emailed me a few days later to inform me that her digestive issues had resolved pretty much immediately.  Shocking.

If you follow me on Twitter you know that I rail against "alternative medicine" regularly.  If you don't follow me on Twitter, why the hell not?  It's just like this but only 140 characters at a time.  Actually, Twitter is stupid and you probably shouldn't do it.  Just forget it.

Oh, and one more thing;

Fuck you, Mercola.

72 comments:

  1. Thanks so much for the laugh! I just left my dog at the vet to have her yearly check-up and get her teeth cleaned and was feeling sort of glum. Love my vet but the practice just hired a new vet who offers acupuncture!Holy Shit! I'm on leave from work as a RN, hands in a cast LRTI, but as soon as I'm back at work I'm going to print your blog posts to share in our employee lounge. The place is thick with WOO from nurses I normally consider to be smart and competent.Happy Halloween!

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    1. You haven't lived until you've seen acupuncture and massage therapy done on a horse.

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  2. there is, floating around the internet, a person who takes "dr" mercola's advertisements as gospel. she believes Celiac is an epidemic sweeping the United States, and that you have it causing leaks in your gut even if you are totally asymptomatic and all tests are negative.
    her solution to this is that everybody should be having chelations, and subsisting on "dr" mercola's catalog of vitamins and good oils, garnished lightly with brown rice and washed down with reverse osmosis water.

    she has posted her dietary regimen at multiple people in my acquaintance, and we would estimate it at about a quarter cup of pills per "meal"

    the person is so completely and utterly resistant to new information that despite having been taken to the hospital completely unresponsive, and nursed back to health by the drastic action of requiring her to eat food instead of pills; she insists that the hospital nearly killed her.

    the kicker - this person used to be a science teacher.

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  3. Hey Doc don't be afraid of notebooks. It is the only way I can remember everything I want to tell my doctor an ask him. I do use it from the beginning of the appointment instead of springing it at the last second. I also write down instructions for care given by my doc, cause I forget what he tells me when he walks out the door.

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  4. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)77083-5/fulltext

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    1. How very fascinating. For those who don't want to bother clicking the link, it's a letter to the editor of The Lancet written by a doctor/chemical engineer. He states his wife "treated herself for gallstones" by drinking a litre of apple juice daily for 6 days followed by a cup of olive oil (A CUP OF OLIVE OIL!), and miraculously her stool was supposedly full of gallstones the next morning.

      This is physically impossible for the reason I stated in the story. A single gallstone cannot make it through a tiny duct, let alone a gallbladder full of them. Stones can rarely go through, but it is a very rare entity full of complications.

      I will repeat for anyone still unclear on the subject: IT IS IMPOSSIBLE TO FLUSH GALLSTONES.

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    2. I think it would be impossible to drink a cup full of olive oil! I would barf.

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    3. A full cup of olive oil! Sounds like someone is pulling everyone's leg. Wouldn't that much oil do a couple of things. One like Mary C said barf. Two pancreatitis? I know a lot of oil will do that to a dog. And if you could keep it down. Oh my the diarrhea it would cause would be astounding.

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    4. For sure! One of the most basic "first aid" measures I learned from our long-time family vet many years ago was giving a small oral syringe filled with mineral oil to a cat who'd swallowed a small but inherently non-toxic object. The idea was to see if it would pass naturally within a few hours, before rushing into an emergency surgery. Worked just fine when one cat sucked in a small deflated water balloon, and another gobbled up some tinsel from a Christmas tree. Both unwanted objects "reappeared" in the litter box within two hours :)

      Disclaimer: This only works for small or very flexible *non-toxic" stuff that *can* reasonably pass through the digestive system without causing damage. So, if it *doesn't* get stuck somewhere, surgery can be avoided. But if the pet swallows something toxic or dangerous (a pill meant for a human, a button battery, anything sharp) get to your vet ASAP for X-ray and appropriate treatment.

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    5. a father somewhere, some years back, got a hundred dollars from America's Funniest Videos for tracking the progress of a coin his child had swallowed, with a metal detector.

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    6. Assuming that you're correct and that drinking olive oil/lemon juice/etc. doesn't work as a gallstone flush, then what in the world would someone who underwent such a regimen be excreting (besides the usual, that is)? I ask because a friend of mine claims to have "flushed" her gall bladder in this manner a couple of years back, and swore uphill and done that she passed a significant number of stones in the process. If they weren't gallstones, then what were they? (No, I didn't ask her if she smooshed her poo with a stick to see just how hard the "stones" were, but I'm reasonably certain she was telling the truth about passing something stone-like; I'm just wondering what the hell it could have been. As far as I know, she doesn't have diverticular disease; I do, and I don't recall ever passing anything that looked stonelike, although I haven't tried drinking large quantities of olive oil, either.)

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    7. interesting question. I'm curious to know the answer, too.

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    8. They were probably just small balls of poop. Regardless, what they most certainly were NOT were gallstones.

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    9. I'm thinking that ingesting an unusual amount of the olive oil would have an *extreme* laxative effect. Whenever that happens, the stuff that ends up in the toilet is likely to look significantly different than our usual daily output.

      Last year, I forced myself to drink, over a six-hour period, an entire gallon of sugar-free Gatorade mixed with a whole bottle of Miralax powder. After this ordeal, I finally got off the throne and into my bed around 3 AM. My last thought before falling asleep was, "Thank God I probably won't need another colonoscopy for 10 years."

      A co-worker of mine decided to try one of those colonic cleansing procedures, in the hopes that she could lose some weight and get rid of whatever evil toxins that those things are supposed to banish. The following Monday, she came to work and said, "I feel great! I think I got almost 8 pounds of waste out of my body!"

      Point being, if we overdose on laxatives with the intention of producing a specific effect, our interpretation of the result will likely be consistent with that expectation.

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    10. I have seen evidence to indicate the products sold for "colon cleansing" are specifically selected to make the result look unusual.

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    11. @ Ken - I didn't know that, but I'm not really surprised. Gotta make the folks think they're getting some "results" for their money.

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    12. the "cleanse: I am most familiar with used primarily psyllium husk and powdered bentonite.

      it did have some actual effect, though, since the regimen also forbade the user to use alcohol, tobacco, or other recreational pharma.

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  5. Wait wait wait, hold on. You're telling me, DocBastard, that someone, somewhere out there, used to believe in the bullshit that they read online and saw on TV, but by using logical reasoning and common sense you actually managed to change their mind?!

    There's actually hope!

    (I am only slightly exaggerating my reaction)

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  6. https://www.drfalk.co.uk/index.php/patients/diseases_and_treatment/gallstone_diseases/

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  7. https://www.ncbi.nlm.nih.gov/pubmed/9590398

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    1. Anon - Thank you for demonstrating your inability to understand what you read. That trial described injecting stuff into the gallbladder to dissolve stones, with a 70% recurrence rate. The "gallbladder flush" involves drinking various potions.

      Thanks for playing.

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  8. I was told by a chiropractor that he could have "saved" my gallbladder with adjustments. Lets just say I never went back! Thanks for the laugh (I'll leave my notebook home next doctor's visit)...

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  9. A friend went to a chiropractor and they put her on a special diet for the best health. They convinced her that a certain vitamin was really hard to get. Did a blood test to show her that she was indeed lacking this hard to get vitamin (I forget what it was, something harmless). Lo and behold they had a jar of vitamin supplements for her for a low price of $50 a bottle.

    The kicker? Her diet was set up to exclude that exact vitamin so it would show up low in the blood tests.

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  10. I know Scottsdale Osborne Medical Center is a trauma center. Do they also perform cholecystectomy there or do they transfer them to Shea Medical Center? Serious question.

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    1. Trauma centers are just hospitals that are specially equipped to handle traumas. Google informed me that in addition to being a level 1 trauma center, it is also a full-service hospital.

      So, yes.

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  11. Doc - I so enjoy your Twitter comments on David "Avocado" Wolfe's health advice. He really is a charlatan of the worst and most annoyingly smug kind.

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  12. Q: what do you call alternative medicine that has been proven to be effective?

    A: "medicine"

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    1. Sulforaphane is the same substance found in broccoli sprouts that shows promise in treating autism. I'm calling this the miracle drug of the century: http://www.hopkinsmedicine.org/news/media/releases/chemical_derived_from_broccoli_sprouts_shows_promise_in_treating_autism

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    2. Well done, Anon. You've 1) misunderstood the first article, 2) drawn a ridiculous conclusion not supported by the data, 3 extrapolated rat data to humans, and 4) declared something a miracle drug based on preliminary evidence.

      Congratulations.

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    3. Rats are used in medical testing because their genetic, biological and behavior characteristics closely resemble those of humans, and many symptoms of human conditions can be replicated in mice and rats.

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    4. Other benefits from sulforaphane (broccoli sprouts): https://www.ncbi.nlm.nih.gov/pubmed/20388854

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    5. You have exactly one chance to explain the relevance or else your off-topic comments will be deleted.

      And...go.

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    6. Hi! I'm a human, not a rat, here to share a bit of my real-life experience.

      1. Unlike many kids, I always liked my veggies, including broccoli and lots of other good anti-oxidant stuff.

      2. Despite eating a pretty healthy diet throughout my childhood and teen years, I suffered my first painful "attack" of gall bladder inflammation when I was 19. No gallstones visible, but my doctor gave me the usual advice about eliminating fats and junk food from my diet. I did that, though I wasn't actually eating much of that stuff anyhow. Had another inflammation about six months later, still no gallstones, so doctor wouldn't remove that pesky gall bladder, despite my pleas. Continued on the healthy diet, which was a bit of a challenge through my college years, since I drastically limited my consumption of burgers, fries, pizza, and other typical student fare. Not a big deal...that was a lot better than that horrific pain!

      3. I continued to enjoy all my veggies, including broccoli, and to avoid fatty foods, and had no more gall bladder problems for 20 years. Yes. 20 years.

      4. Woke up in excruciating pain in the middle of the night, on the eve of my daughter's birthday, and ended up in the ER. This time there *were* a few gallstones discovered. Finally, I had the chance to discard this pest! So, I did.

      Moral of the story: Keeping broccoli, and lots of other healthy veggies and fruits with anti-oxidant properties in one's diet, isn't a bad thing. But it sure doesn't prevent gallstones from developing.

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    8. Again you are misinterpreting and overstating. The study showed that it improved liver function after liver failure was induced. IN RATS.

      You may not throw around alt med terms like "sluggish bile flow" here.

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    9. It's a pre-clinical study. A stage of research done before clinical trials. I thought you knew.

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    10. For example. Evgen Pharma’s "Sulforadex" (sulforaphane) is currently in Phase II studies. It would take years before this drug becomes available to the public after the rat trials.

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    11. Thank you for the research lesson.

      Yet despite your obvious overwhelming knowledge of science, research, and medicine you call this "the miracle drug of the century" based on a pre-clinical trial.

      Absolutely astounding. Do tell us more. No, on second thought, don't.

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    12. Incidentally, U.S. patent applications have been filed by The Johns Hopkins University for inventors Smith, Talalay and Zimmerman for their methods and compositions in treating autism: https://www.google.com/patents/WO2013067040A1?cl=en

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    13. This would be an excellent investment tip for anyone interested. I know where I'd be putting my money.

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    14. ooooh, a patent application. Anybody can apply for a patent on anything, including some truly ridiculous things. Drug patents are no different, and in fact are probably worse in some ways. The number of drugs that have patents or just patent aps is astonishing, and most of them are not worth the filing fees.

      http://patents.stackexchange.com/questions/5204/method-of-swinging-on-a-swing

      (btw, without the attention given to the patent as it was used to ridicule the patent office and patent procedure, it would still exist in the patent office.)

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    15. Comparing a patent for a swing set vs drug patent? I don't think so. This will be one of the world's greatest invention next to penicillin and vaccines, and they all went through the same clinical trials. I hope you're not against vaccines. Just a thought.

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    16. your critical reading skills are why you should probably not advise people about investing. It wasn't a swing set, it was a methods patent for a method of swinging, you know, the back and forth motion we all know?

      throwing in that a patent ap has been made for anything as a mode of legitimizing something is as silly as a patent for a method of swinging, though at least in the later case, a father actually taught his son something about patent law.

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    17. This was the actual patent on the link that you posted: https://www.google.com/patents/US6368227

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    18. in plain english, the only thing that having a patent application means is the filers think they can make money on it.

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    19. Is that it? Holy agility! I thought he was trying to sell his swing set.

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    20. I actually write patent applications for drugs and I can tell you with some certainty that there is a long way to go between getting that granted and actually having a licensed drug!

      There is a reason that European countries have "supplementary protection certificates" to allow some drug patents to be extended beyond the normal 20 years - by the time a drug has gone through all of the clinical trials required, those 20 years are often nearly exhausted.

      If they have filed an application then there is probably some evidence if an effect but that does not need to be anything like the standard of a peer-reviewed scientific paper.

      If you are investing in this, I would not start planning your early retirement just yet.

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    21. Incidentally, my favourite medical-related patent ever:

      http://www.google.co.uk/patents/US3216423

      Just don't ask me to clear up afterwards!

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    22. No. This would be a long term form of investment:http://www.dailymail.co.uk/health/article-3047386/Patients-incurable-breast-cancer-benefit-new-cocktail-drugs-hailed-exciting-breakthrough-scientists.html

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  15. I hate broccoli sprouts (sulpharafane).

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  16. WebMD recommends olive oil for gallstones: http://www.webmd.com/digestive-disorders/understanding-gallstones-prevention

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    1. Sort of. It states that there is some evidence that a small amount of olive oil, such as the amount used in cooking, may help to prevent gallstones. It does NOT state that olive oil can be used to "flush" the gallbladder.

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    2. Exactly.

      "Recent studies have shown that moderate consumption of olive oil (about 2 tablespoons a day) may actually lower your chances of developing gallstones. An ingredient in olive oil evidently helps reduce cholesterol levels in the blood and gallbladder."

      Makes sense...anything that reduces the accumulation of "bad" cholesterol in the body *might* help prevent gallstones, and might also help avoid clogging up the arteries. (I said *maybe* because I've never had cholesterol issues evident in blood tests, and continue to get compliments from my doctors on being better than average in that area, but obviously ended up with gall bladder issues anyhow). It won't cure a problem that already exists.

      Same thing applies to foods that contain antioxidants or anti-angiogenesis substances. I remember when the claims were going around, a few years ago, about pureed asparagus "curing" various forms of cancer. Sure, it's a healthy food. And, even for those who don't like their veggies, consuming a few tablespoons of pureed asparagus each morning would surely be much less bothersome than going through surgeries, radiation, chemotherapy, or any of the other "traditional" treatments that have been proven to be effective. But...it doesn't really work as a *cure.*

      http://www.snopes.com/medical/disease/asparagus.asp

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    3. No,it's not a cure it's preventive medicine.

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    4. It *may be* preventive. Do not overstate.

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    5. which is statistically the same as saying putting a plastic ball on your car antenna may be preventative of the car being struck by lightning.

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    6. There's no such thing as gallstone flush. However, there is considerable evidence that patients with gallstones suffers from inflammation and absorption in the mucus membranes of their gallbladders. In cases like this, it makes sense to include veggies that contains high antioxidants in their diet as alternative: https://www.ncbi.nlm.nih.gov/pubmed/23495001

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    7. As Doc says, *may be* is the operative term here. Besides my personal experience with the gall bladder thing, there are other real-life situations that can't be easily attributed to following "unhealthy" lifestyles, or having "known risk factors" for a particular condition.

      Two of my relatives died from lung cancer.

      My sister-in-law had been a teacher since her graduation from college. She taught elementary school for about five years, and developed cancer when she had been teaching junior high for almost 15 years.

      My cousin's working years were spent in office admin-type jobs, first at large health insurance company, then in the medical records department of a hospital. Both were "no smoking" offices by company policy, long before our state made it the law.

      Neither one of them was a smoker, ever lived in a household with someone else who smoked, or worked at jobs that exposed them to second-hand smoke or other known respiratory hazards and irritants. Neither had a family history that included *any* form of cancer.

      Then there's the other extreme. Maybe some readers here have known someone like my paternal grandfather, who was a heavy smoker all of his adult life until he was afflicted with Alzheimer's at the age of 89. He passed away peacefully in his sleep a year later. And, no one who ever lived with him and all that smoke (my grandmother, or Dad or any of his six siblings) ever developed any respiratory issues.

      Sure, "healthy" habits can minimize our risks. But there are no *guarantees.*

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  17. This... It's terrifying to me as someone who had my gall bladder removed because it was full of one huge stone ( I have pictures of you don't believe me ). Imagine someone being determined to flush a stone the size of a shooter marble out with some olive oil or Apple juice or any other foolish thing. Gah. What do they think surgeons are for?

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  18. fwiw, I always have notebooks with me. It's what I do. I'm not spending all that time in a waiting room without a good book and a few notebooks. Granted, I don't use them for medical questions. I do have one book with my current prescriptions and dosages in it as my pronunciation is so ridiculously bad that it's much easier if I can just hand the page to the person making the inquiry.

    Mostly you folk are pretty good at describing what's happening and why, or the alternative theories and how to lean more towards one cause than the other. So far, none have involved olive oil and citrus.

    Will also say that I do use a back-cracker specifically to crack my back after a competition. I also use a massage therapist for the same reason - to deal with post competition aches and pains that didn't cripple me back when I was 20 (amazing how that's changed over the years - used to be just a bit of smelling like Ben-Gay was the key. Now it takes a back-cracker and a massage therapist to make walking tolerable).

    Do have a high school friend who, late in life, became a chiropractor. He's been advocating sending kids to him for their annual physical and having people change from their PCP to him. Have gotten into more than one debate with him about the value of that advice - in his state he may be able to order basic blood tests, but that doesn't give him the medical background to adequately interpret them. Also makes me wonder if he endorses the anti-vac point of view, and is encouraging people to not get vaccinated or vaccinate their kids, and that scares the crap out of me. And no, not like DocBastard's inner pessimist.

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  19. imagine a patient with questions and the organization to actually write them down. I mean doctors always explain everything with such clarity. wow. you are something else

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    1. Yes, I am "something else". I'm a doctor who listens to his patients, encourages them to ask questions, and will not let them leave until their questions are answered yo their full satisfaction. I'm also a doctor who knows what that notebook is for - it's for asking a series of (usually) silly questions, not for writing down the answers.

      Does that make me a bad doctor? I don't think so, but perhaps you could enlighten me as to why it does. Go ahead. I'll be right here waiting.

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    2. I think he or she was responding to the previous commenter.

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  20. Was reading alternative medicine sites on gallstones removal. One site list using Olive oil on your skin where your gallbladder is along with heat. Said makes the olive oil seep into the gallbladder to dissolve stones. Does anybody really believe this????

    http://www.gallstones-treatments.com/how-to-flush-gallstones-at-home/

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    1. This reminds me of those psychic surgery/faith healing videos that were circulating maybe 20 years ago. The "healer" perpetrated the illusion of penetrating the patient's body with bare hands, then used fake blood, globs of butcher shop waste, etc. to make it look like some horrific foreign mass was being "removed" from the body. Then there was the miraculous grand finale...the patient's skin was shown, with no evidence of any incision.

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    2. Psychic surgery is real. Just look: https://m.youtube.com/watch?v=-5D126gL_AE

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    3. youtube, now THERE'S an unimpeachable reference.

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    4. Lots of helpful instructional videos, too...

      https://www.youtube.com/watch?v=-ElzxjoLbmo

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