From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: You guys are gonna hate me for this
Date: 14 Jul 2005 23:38:16 -0700
Message-ID: <1121409496.784017.160970@g43g2000cwa.googlegroups.com>

John Schutkeker wrote:
> So, if we cynically assume that hopeful starlets aren't going to give up
> vomiting any time soon, we can at least get to work on the problem of how
> to keep them from ruining their teeth.
>
> My proposal is that they should drink some Maalox, Mg(OH)2, before they
> throw up.  That should reduce the acid in their stomachs before it comes
> into contact with their teeth.  It won't solve the bulimia issue, since I
> contend that would be tilting at windmills, anyhow.  But it should slow the
> rate of erosion of their teeth.


COMMENT:

Even better, put them on a proton pump inhibitor. Not only would it
save the teeth, but it would go a long way to keeping them from dying
of the terrific acid-base disorders they get into from vomiting out all
that acid and chloride.

When I was at Harbor General many years ago, a well known bulemic
without teeth used to come in with a pH of about 7.7 and a serum bicarb
level higher than his chloride level. This is remarkable, and not
usually survivable, but there he was. The interns and residents would
have to mark their little chart diagrams for chloride and bicarbonate
levels explicitly, to tell them apart (usually you just write the
numbers, since it's obvious which is which). I suggested once that they
give this guy acid-blockers to keep his electrolytes from going so
badly out, and the answer I got was that it had been tried, but he was
crazy (go figure) so never took them.

Of course, even acid blockade doesn't fix the potassium problem and the
volume problems of bulemics. One night our prize bulemic came in on the
watch of a resident rotating from UCLA who didn't know him. Usually
he'd been treated gently with saline hydration, and fixed himself over
days. This night the resident nor the intern knew this history, and
charts could be hard to retrieve at Harbor in the middle of the night.
Computers had not arrived. So the resident took a look at the bicarb
and pH and freaked. He just had to give the guy a bicarbonate-wasting
diuretic, and I think the sudden pH change finally did the guy in. That
was the story we got the next day, anyway. One more argument for better
medical records.

And also "tincture of time" treatment if it's worked before. If you
don't know what to do in medicine, sometimes it really is better to
just stand there and do little or nothing.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: You guys are gonna hate me for this
Date: 17 Jul 2005 09:25:19 -0700
Message-ID: <1121617519.016724.196900@g14g2000cwa.googlegroups.com>

John Schutkeker wrote:
> Steve Harris <sbharris@ix.netcom.com> wrote in
> news:1121409496.784017.160970@g43g2000cwa.googlegroups.com:

> Is the potassium problem hyper- or hypo-kalemia, or something else?

It's usually hypokalemia, as gastric fluids contain potassium, and
these people are generally on very poor diets.



> > the resident took a look at the bicarb
> > and pH and freaked. He just had to give the guy a bicarbonate-wasting
> > diuretic, and I think the sudden pH change finally did the guy in.
>
> Is this kill the only one that particular resident had on his score sheet,
> or did he freak out at other times, and make more hasty choices?


COMMENT:

I didn't hear any suggesting he wasn't a good resident (they don't take
bad ones at UCLA). Rather, just one with an emergency-appearing problem
of unusually rare magnitude, the "fix" for which was not available in
textbook or ring-manual or other form easily accessable in 1984. We
forget how much medicine has changed in a generation. You couldn't just
get on Medline at the hospital computers terminals then, because there
weren't any at Harbor General (at least not any on the wards that
accessed MEDLARS). Medline existed, of course, but you generally
couldn't get at it except through some library (like the one at UCLA 20
miles way) during daylight hours. And even then you had to have a 2
hour course on how to do it, or else wait a day for the librarian to do
it.

In the bad old days, doctors at night looking at rare problems had
cookbook care manuals, standard texts in a library (always available
even at night, even if the librarian wasn't) and a set of basic medical
journals which was nearly worthless without a Britannica-sized filing
glossary called Index Medicicus. You had to go down to that set of
tomes and look up topics, year-by-year. You had to get the topic right,
and the year of course was by guess. And then your hospital had to have
the right journal, and the right edition. It worked (sort of) for
research, but was not much use in emergencies involving odd problems.

SBH

From: Mark & Steven Bornfeld <bornfeldmung@dentaltwins.com>
Newsgroups: sci.med
Subject: Re: You guys are gonna hate me for this
Message-ID: <uvwBe.9032$jh4.5832@trndny09>
Date: Thu, 14 Jul 2005 16:35:38 GMT

John Schutkeker wrote:
> Mark & Steven Bornfeld <bornfeldmung@dentaltwins.com> wrote in
> news:4xgBe.4589$Om4.3172@trndny07:
>
>
>>     If you can diagnose bulimia by looking at the facial surfaces of
>>     their
>>teeth on a TV screen, you're a better man than I, Gunga Din.
>
>
>
> I don't get the Gunga Din reference.  Is that Kipling?
>
> Of course, I wouldn't be so cavalier about making a diagnosis over the tv,
> if it weren't already common knowledge there is an epidemic of eating
> disorders in Hollywood.
>
> It also helps to be addicted (koff, koff) to Leno, Letterman, Conan O'Brien
> and Craig Ferguson.  But if that weren't enough, just yesterday, The
> Insider had an interview with Gene Wilder, in which he unashamedly
> discussed Gilda Radner's bulimia.  As he said this, the editors showed an
> extreme close up of her face, and there were the giant, misshapen choppers,
> as big as nickels.
>
> The signature deformity is that spaces down by the roots of the teeth are
> larger than they should be.  Once you've got the trained eye it stands out
> like a sore thumb.  Next time you see a hot starlet on Leno, look closely
> at the spaces between the bases of her teeth.  I guesstimate 19 out of 20
> chances you'll see that they're much larger than what would be considered
> ideal.  Check out three or four hot chicks in a row, and you'll see that
> they all have the same dental pathology.
>
> It really is an epidemic, and there's a fortune to be made by the first
> dentist to invent a way to cover it up.

	I don't doubt that bulimia is common in Hollywood.  For that matter
it's hardly uncommon anywhere in the US.  One would expect it to be
especially common in pursuits that put a high premium on slimness
(acting, dancing, modeling, certain athletic pursuits).
	I have seen the effects of bulimia, and the erosion is by far most
pronounced on the palatal surfaces of the upper incisors, and less so on
the lingual surfaces of the lower incisors, and less so on the
lingual/palatal surfaces of the posterior teeth.  Frequently the enamel
on the labial/buccal surfaces of the teeth are remarkably untouched.
	If the incisors are eroded severely enough there may of course be
chipping and cracking of the upper incisors, particularly if there are
pre-existing fillings in these teeth.  But I would guess this would be a
relatively late presentation.
	I might also point out that there are both many other possible reason
for the front teeth to be in poor shape, and also that many of the same
pressures for a particular appearance that tend to lead in susceptible
individuals to eating disorders are also likely to put pressure on these
women to have their damaged teeth repared as soon as possible.  This is
sometimes difficult, but certainly not out of the question in this
population with lots of money.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001