Holiday Heart (Marin IJ)


Twas the day after Thanksgiving, and all through the house, not a creature was stirring, not even an over-sized spouse. The empty bottles lay strewn all around without care, a sure sign that black out Friday was already there. When inside your chest there arose such a clatter, an odd pounding of the heart, which seemed to mean something was definitely the matter. Up from bed you flew in a flash, and off to the cabinet for the aspirin stash.  And then, with a palpitation, you recall what’d your heard, of an irregularly irregular heartbeat louder than a large bird. The answer buzzed in your head and turned you around, in your chest a case of ‘holiday heart’ had surely been found.
To the phone you went, moving none to quick, as you knew in that moment that you must phone Doctor Tick. More rapid than hummingbirds, his answers they came. And he whistled, and sniffled, and called the possible rhythms by name!
“Could be Afib! Or Flutter, or rapid rate due to Hyperthyroidism! Could be PVC or SVT, or much less likely something secondary to pulmonary embolism! But the cause of the problem, yes the cause of it all, is most certainly, yes most certainly, your excessive intake of alcohol.”
After this information settled and you’d stifled a cry, you took a deep breath, and asked Doctor Tick…Why? So ear to phone, you listened as his answer it flew. Not too sure, he said, could be changes in body stress hormones, or effects of fatty acids too.

And then, in a twinkling, you heard his voice, reciting epidemiology, and you had no choice.  Atrial fibrillation, that is Afib, he said, is the most common by far. That common rhythm caused by an irregular atria, is often picked up at a bar! The numbers in studies jump all around, but up to a 35% linkage of new Afib and alcohol use has been found.
So there it was, the diagnosis as clear as day, and now all that was left was to ask Doctor Tick how you could make it go away. It may pass, he said, it may pass real soon, but I’m afraid my friend that you must listen to my cautionary tune.
“Now fluids, now rest, now abstention and healthy meal-fixing. On aspirin, on pulse monitoring, on moderation and no cocktail-mixing. To the ER you should go if your chest feels tight. Or if you have difficulty breathing, dizziness or your palpitations last all through the night! And recall my friend, that your body handles holiday stress when it is at its best: exercise, eat well, and get plenty of rest.

And as he was speaking, as quick as whistle, away the flutters flew like the down of a thistle. And I heard Dr. Tick say, in my head ‘ere that night. Happy Holidays to all but for alcohol and holiday heart, let’s say good night!

Author’s notes; First, a hearty thanks to Clement Moore for setting the metronome for this column. Second, holiday heart refers to a diverse population of heart arrhythmias – some benign and some more sinister.  The most common of these is atrial fibrillation – a widespread arrhythmia that has many possible causes and triggers, of which alcohol is just one. Among the other causes; abnormalities with the arteries or valves of the heart, acute infections, disruption of hormonal mechanisms like the thyroid, and, as we learned recently, coaching an NFL franchise. Thus, those suffering from an irregular heartbeat, especially one associated with chest pain or shortness of breath, should not wait long before consulting a physician.  



Brain Freeeeeeeze (Marin IJ)



It’s popsicle-o-clock at the Ballard house and everyone is content… until a horrible shriek reverberates through the home. The perpetrator is three-year-old Holden and his tribal yell quickly morphs into a plaintative wail of “brain freeeeeeeeezzzzze.” In a moment, the pain (for all of us) recedes and our daughter, removing her hands from her ears, asks, “Dad, what causes ‘brain freeze?’” Until recently I would have answered: “Popsicles.” But now, thanks to new evidence, I can instead tell her, “vasodilatation of the anterior cerebral artery.”

This past April, Jorge Serrador of Harvard Medical School and colleagues reported the results of a small study suggesting an explanation for the bodily processes (physiology) involved with brain freeze (known in medicalese as sphenopalatine ganglioneuralgia.) Now, I know what you might be thinking – with autism unexplained and cancer uncured, aren’t there greater priorities for medical research than a painful yet benign experience like sphenopalatine ganglioneuralgia? And, you would be absolutely right. However, there is a bit more to it, and some have long posited that the physiology of brain freeze might be related to that of other (less temporary) conditions – such as post-traumatic and migraine headaches. In fact, prior studies have suggested that migraine sufferers are more likely than other folks to experience brain freeze. So, with that in mind, let’s get back to the research at hand.

Serrador and colleagues recruited thirteen healthy adults willing to suffer through brain freeze in the name of science (and I’m guessing there were other inducements as well). While researchers monitored the blood flow in their brains with transcranial Doppler (ultrasound), the volunteers sipped ice water through straws pressed against their upper palates. Then, they raised their hands to signal the freeze and thaw of brain freeze. Brain blood flow under these conditions was then compared with that of the same volunteers sipping warm water. The results of the study were presented at the Experimental Biology 2012 conference in San Diego and were notable in that the researchers observed that one particular artery, the anterior cerebral artery, dilated rapidly and flooded the brain with blood in conjunction with the freeze sensation. Soon after this vasodilatation occurred, the same vessel constricted (tightened) as the volunteers' pain receded. Now, remember, this was a small study and it’s results have yet to complete the rigorous peer review process associated with manuscript publication. Nonetheless, there do seem to be some important implications in these findings.

1)     Migraine headaches. These are thought to be caused by abnormal dilation of arteries in the brain, and many existing treatments attempt to modulate this process. These results then, support this concept and may lead to greater focus on migraine treatments that prevent dilation in the first place. And, for people with friends or family members with migraines, this study provides us with a way to relate to their pain. For some with migraines, the headache must certainly feel like one long brain freeze. Ouch.

2)     The suddenness of sensation matters. We’ve all heard about the frog that will jump out of a pot of boiling water but will stay in a tub slowly brought from ambient temperature to a boil. One of the aspects of brain freeze that makes it so uncomfortable is the rapidity and severity of its onset. This principle is worth keeping in mind for other situations. Take, for example, removing a bandage. The conventional wisdom is that pulling it off quickly is better, as it gets the pain over and done with. But some researchers, such as Dan Ariely, the author of the fascinating book Predictably Irrational, contend the opposite; the quicker the pain the more severe the pain, and thus the greater the overall discomfort. So perhaps very slowly removing a band-aid is actually more comfortable than yanking it right on off. That’s a topic to be exposed more thoroughly some other time.

3)     Now,I can turn Holden’s occasional freezathon into a spelling lesson for his sister. Ok, here we go, let’s try “sphenopalatine ganglioneuralgia.” S...P...H…