Can you make the diagnosis?

Taylor works construction, and lately he has been having back pain from his job.  He has started carrying a bottle of Tylenol with him, and taking it periodically during the day.

After work most evenings, he stops at a local bar with his coworkers for a few drinks, which helps him relax after his demanding job.

One morning Taylor wakes up and feels very nauseated and fatigued.  When he goes to the bathroom and looks in the mirror, he notes that his skin color looks off.  Looking more closely, he sees that the whites of his eyes look yellow.  He decides to call in sick for work.

What does Taylor have?

  1.  Hepatitis A
  2.  Acetaminophen overdose
  3.  The flu
  4.  Gallbladder problems


If you guessed acetaminophen overdose, you are correct.  Acetaminophen (Tylenol) overdose can occur intentionally as a suicide attempt, or can occur accidentally when over ingested.  Liver damage can result for acetaminophen overdose, causing yellowing of the skin (jaundice), or of the eyes (icterus).

In Taylor’s case, he has been taking excessive Tylenol, but also ingesting alcohol, which increases his risk of liver injury.

Acetaminophen toxicity can be diagnosed with a blood test.  There is an antidote for acetaminophen overdose called NAC, or N-acetyl-cysteiene.

Acetaminophen overdoses result in 100,000 deaths in the United States per year.

Hepatitis A is a good guess, but is usually associated with vomiting and diarrhea, and there may be a history of ingestion of contaminated food or water.  The flu would be unlikely to cause yellowing of the skin or whites of the eyes.  Gallbladder problems or liver disease  can result in jaundice.  A CT scan or ultrasound can show if the gallbladder has stones or if the liver has an abnormality.

Man with jaundice:


Is there a single food you could live on your whole life?

Is there a single food that you can live on without any problems?  Unfortunately the answer is no.  There is no single food (other than breast milk for infants) that can sustain all of our nutritional needs.

However, the potato actually comes closest to being a perfect food!   Potatoes have an unusual amount of protein and wide variety of nutrients.  However if potatoes were the only thing eaten, a human would still have nutritional deficiencies.

Potatoes have protein, potassium, vitamin B6, magnesium, and actually have 70% of the amount of Vitamin C you need per day!

Recently, an Australian man ate only potatoes for one year.  He included sweet potatoes to get more vitamins A and E, iron, and calcium.  He did reasonably well for one year and lost weight.  However researchers note that this diet would not prove enough B vitamins and zinc.


Does melatonin really help you sleep?

We’ve all heard about melatonin as a sleep aid.  Many of us have tried it.  Americans spend $400 million for melatonin a year!  But does it really work?

Melatonin is a natural hormone in our body, and is secreted by the brain’s pineal gland.  It regulates our sleep and wakefulness.

A large study however found that people taking melatonin fell asleep only 7 minutes faster, and slept 8 minutes longer than those not taking it!  However it has been found to be safer than some medications (such as clonazepam, a benzodiazepine) for those over 55 with insomnia.

Fun melatonin fact:  In babies, melatonin release doesn’t become regular until about age 3 months, which is when babies start sleeping better!  And in teenagers, the release of melatonin is delayed, leading to later waking times.

Some food naturally contains melatonin!  Wine, beer, rice, wheat, corn, barley, oats, cherries, bananas, and walnuts can raise melatonin levels.

It has been advised not to drive the day after taking melatonin as it can cause grogginess.


Can you make the diagnosis?

John and Sara are spending a weekend in their cabin in the woods.  They plan to go cross-country skiing tomorrow, but tonight are enjoying sitting around their wood-burning stove and having a glass of wine.

Later that night, John starts getting a headache, and takes two Advil.  Sara sees him taking the Advil and asks for some as she also has a headache.  They both feel very sleepy by 8 pm and decide to go to bed early.

That night John wakes up and feels nauseated.  He runs to the bathroom to vomit.  He calls for Sara to bring him a washcloth, but she only mumbles and falls back to sleep.

What do John and Sara have?

  1.  Influenza
  2.  Food poisoning
  3.  Carbon monoxide poisoning
  4.  Alcohol intoxication.



If you guessed 3, carbon monoxide poisoning, you are correct.

Carbon monoxide, or CO, is found in fumes from car engines, stoves, lanterns, grills, fireplaces, wood burning stoves, gas ranges and furnaces.  When CO builds up in an enclosed space,  it can cause CO poisoning.  Symptoms include headache, weakness, nausea, vomiting, chest pain, and confusion.  Each year, more than 20,000 Emergency Department visits and  400 deaths result from unintentional CO poisoning.

Influenza can cause symptoms similar to carbon monoxide poisoning.  But whenever two people have symptoms at the same time, carbon monoxide must be suspected.  Food poisoning symptoms again can be similar to carbon monoxide poisoning, though a headache would be unusual, and food poisoning is typically associated with diarrhea.  Alcohol intoxication is a possibility, but in this case the couple had not consumed a large amount of alcohol.

wood stove.jpeg

What is the Wuhan virus?

The Wuhan virus is a new virus that is started in China. It began in December 2019, when a cluster of people who worked at a seafood market suddenly came down with pneumonia.

So far 570 people have been sickened with the virus, and 19 have died.  The virus has spread to Thailand, Hong Kong, South Korea and Japan. The first case in the United States just occurred in Washington State in a traveler from China.

The Wuhan virus is believed to be a new type of coronavirus. The virus likely started in an animal such as a bat or a pig, then mutated and spread to humans. It is spread from person to person through respiratory droplet, such as by coughing.

Symptoms include fever, body aches, runny nose, headache and cough. There is a test that can diagnose the Wuhan virus, which is important as the symptoms are similar to the regular flu.

Good hand washing and avoiding anyone who is ill is important.  Those who are sick should stay home and not travel.

There is no specific treatment, but patients should drink fluids and take a fever reducer.   Antivirals such as Tamiflu may be helpful but it is not known for sure yet. There is no immunization for Wuhan virus to date.



How accurate are those home DNA ancestry tests?

There are many types of home DNA ancestry tests now available for purchase.  But how accurate are those tests?

To complete the test, a swab is used to obtain a sample of saliva, then the sample is shipped to the company for testing.  The tests range from $60-$80.

In one study, saliva from a single patient was sent to two different labs.  The labs had conflicting results.  For example, one lab said a patent was 70% British, but the other lab said the patient was only 5% British.

Another study was performed on identical twins.  Their DNA ancestry should be identical, but study results showed that their ancestors came from different countries! This would be genetically impossible.

To date, researchers have found that up to 40% of the testing performed on home DNA ancestry testing is inaccurate.


Are there any actual health benefits to getting a massage?

Every year, 60 million people in the United States get a massage.  The average cost for a one-hour session in the United States is $75.  The massage industry has become an $18 billion dollar per year industry!

But besides relaxation, are there any real health benefits to getting a massage?

Peer-reviewed medical research has shown the following benefits from massage:

Pain relief — A large study found improvement in pain levels from musculoskeletal injuries.  There is also some evidence that massage can provide short-term improvement for patients with back pain.

Anxiety and depression relief  — Massage can provide transient improvement of anxiety and can reduce depression.

Headaches — Some studies have shown benefit in migraine patients with reduction in number of headaches.

Sleep — Studies have shown benefit with sounder sleep after massage therapy.

Blood pressure — research has found temporary reduction of blood pressure and heart rate.

Arthritis — Patients with knee osteoarthritis who had massage had improvement with pain, stiffness, and function.