Sarcoidosis is known for its deep swirls of inflammation called granulomas. This rare disease is probably due to a disruption of the immune system, either by a virus or toxin, and it certainly runs in families. Black people are affected at least three times more often than whites, (35 cases per 100,000 compared to 10 cases per hundred thousand), and this health disparity is most disturbing in terms of outcome, with 13 times more deaths in blacks.

This is because sarcoidosis, which can involve the lungs, lymph nodes, eyes, and brain, tends to affect black people at a younger age (comedian Bernie Mac got the disease in the 1980s), and is far more likely to be chronic or recurrent in blacks, as it was with the famous comedian. Despite Mac’s publicist’s assertion that his sarcoidosis was in remission and hadn’t sickened him since 2005, and despite his statement that it wasn’t a factor in his deadly pneumonia, I find this difficult to believe.

My take is that Bernie Mac most likely fell in the group of 20 to 30 percent of sarcoid patients who end up with severely scarred lungs with little reserve lung capacity left. I think Mac’s more than two decades battling the disease (the mainstay of treatment is the steroid prednisone) speaks to the probability that his lungs were no longer in shape to fight off bacteria.

Pneumonia doesn’t usually kill a 50 year old unless the patient has badly damaged lungs to begin with. In that case, an infection can quickly rifle through the scar tissue and fill what’s left of the lungs with pus and fluid. The lungs die, and the patient does too.

I suspect Mac would have wanted his death to serve as a wake-up call for early diagnosis and treatment of chronic lung diseases. Most sarcoidosis can be suspected by the findings on a simple chest x-ray, and though the majority of cases go away without treatment, it still makes sense to be vigilant.

I remember when a physician, Dr. C., came to see me for a routine physical, and the swellings in the center of his chest x-ray made me immediately suspicious of sarcoidosis. When I uttered my concern, he became so anxious that he fainted and fell off his chair. Luckily, he wasn’t hurt in the fall, and though he did turn out to have the disease, he was also in the majority group (which unfortunately Mac was not) where it remitted spontaneously.

Dr. C’s case, like Mac’s, was a reminder to me that sarcoidosis is a puzzling, unpredictable, scary disease that needs to be approached rationally rather than emotionally.

Marc Siegel MD is an internist and associate professor of medicine at the NYU School of Medicine. He is a Fox News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of False Alarm: the Truth About the Epidemic of Fear (Wiley 2005) and Bird Flu: Everything You Need to Know About the Next Pandemic (Wiley 2006). Read more at www.doctorsiegel.com

Recently, two Montreal psychiatrists Drs. Ian and Joel Gold, who are also brothers, revealed the clinical histories of five patients they said suffered from a new condition: “The Truman Show Delusion.” The patients believed their lives had ceased being spontaneous and were being scripted and broadcasted as reality TV shows to viewers around the world.

The name of this new condition derives from the 1998 movie starring Jim Carrey, “The Truman Show.” In the film, Carrey’s character, Truman Burbank is a happy-go-lucky guy – until he finds out his entire life is the subject of a reality TV show, his friends are actors and there are hidden cameras everywhere.

Psychiatrists have long known that psychosis can include “ideas of reference,” in which patients believe they are the subjects of intense special interest by others, including strangers. But the Gold brothers correctly noted in their patients the belief had gone global and specifically involved the notion that others knew of them because they had essentially become stars of their own TV shows.

While these patients are the extreme, I’ve noticed elements of the same breaking with reality (in favor of TV-inspired fiction) in several patients, too. For example, a young man I recently treated dismissed my concern that his grades were plummeting, his family relationships were straining and he had been arrested for driving under the influence by stating, “Yeah, but I’m kind of like that guy in that show, the one who works in the restaurant, who’s got his whole life coming down on him, but ends up making it all happen for himself, anyhow.”

I actually had to remind him that that actor was playing a role, while on the other hand, he was living a real life. I reminded him of this many times during our work together.

In these cases, there has been a ceding of the person’s own life story to the notion that it’s all a drama, all entertainment. A DUI arrest thereby becomes an episode in a story that doesn’t really touch its protagonist, because it’s all part of an act, anyhow.

Perhaps the data suggesting that self-esteem in young people is increasing, as their performance levels on aptitude tests actually decline, is also linked to this phenomenon. The scores don’t matter. Truth doesn’t matter. Perception matters. And that detachment from oneself and others increasingly feels, to some of my patients, a lot like watching a reality TV show.

This concern about the bending of reality went national in this country in an unlikely place: Presidential politics. Senator John McCain’s advertisement linking Barack Obama to Paris Hilton and Britney Spears (whether or not you agree with the idea) suggested that Obama is a candidate merely playing a candidate–like that Escher drawing of a disembodied hand drawing a hand, with no end to the fantasy.

McCain’s assertion that Obama is “acting,” not genuine, occurs against the backdrop of the mortgage bubble bursting and the banking crisis unfolding. That’s why his advertisement may have hit home. We Americans are learning the hard way what happens when our institutions bend reality.

One thing is for certain: A delusion cannot be maintained forever. The truth always wins.

That’s why the Gold brothers were talking about their patients, not fascinating, happy folks they had met on the street. Ultimately, the price of pretending is psychological pain. And, always, the road back to well-being is a road that ends in coping with reality and making one’s life or one’s nation everything it can truly – truthfully – be.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com.

Markets move not just on financial realities, but on perception.  Our hearts, not just minds, determine which stocks rise or fall, whether banks stay viable because we stay confident in them, or close because we rush to empty our accounts.

Now, more than ever, it seems the future depends on our collective optimism or collective pessimism about our standing in the world, the creativity and resourcefulness of our people, and the underlying strength of our financial institutions.

Here’s the truth:  We are in a better position than in recent memory to rely on our institutions as the delusions that created the housing bubble and propelled flawed investment banking strategies get wrung out of our system.  The pain being endured by those who turned their personal finances or business financials into fiction is sure evidence that we are headed back to solid ground.

Make no mistake:  The ground in America is still crisscrossed coast-to-coast by economic highways paved with gold.  If you read the story of this nation from its first page to the page we are now turning, you will understand that tides have surged and retreated, but our riches have only grown.  That predicts they will continue to, especially now that we are editing the fake stuff out of future chapters.

Here’s how to use psychology to recover faster.  It’s called True Confidence, and it has a self-fulfilling force of its own:

– Plan a trip, even if it’s 12 months from now. 

– Put something you don’t really need, but really want on your shopping list for Christmas — and buy it now. 

– Open a tiny stock account for your kids. 

– Start looking for a house that will make you happy; your income and prices will ultimately make your dream a reality. 

– Think about how to take your performance at work to the next level, as economic tides start to turn for the better. 

Take note of the fact that with all the criticism of America, a Democratic African-American senator and a maverick Republican former-POW senator are squaring off to lead us to better times.  We should be hopeful about that and everything it says about who we are and where we are headed.

This economy needed a detox from the intoxicants of false financials that made us euphoric.  But it is an economy that turns out to be one that self-corrects, because it is ultimately based on market forces that have real and genuine power.

If America is a stock, believe me:  People are going to buy again.  Ladies and Gentlemen, start your engines. 

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com.

Living the Truth (LTT) stems from this belief: Humans have the capacity to dramatically change their lives (for the better) by honestly looking at the past events and relationships that have contributed to their present thoughts and behavior patterns.  
 
This unearthing of key lessons about who we are deep in our souls also unlocks the most important secrets to what we can become.  Because when we feel authentic and grounded, when we feel, we dream with true hearts and clear minds. Then, we can become what we want to be.  

LTT also is founded upon the certainty that humans underestimate their own capacity for self-knowledge and needlessly fear their core thoughts and feelings, when those very thoughts and feelings have the power to liberate them from self-defeating behavior patterns.  That’s why one of the LTT mottos is: “Everything you need to change your life is already inside you.”

One of the ways LTT gives you access to your internal wisdom is by helping you bring into awareness the most important “pages” and “chapters” of your life story, elements of which almost all of us keep from consciousness because we think of them as painful.
 
Creating your own MyTruth page is a good way to begin this process.  It is also an excellent way to connect with others engaged in a journey of self-knowledge, who can help you with your own.

Here are some success stories of LTT:
* A 44-year-old woman who, in the past, continually chose controlling men, none of whom made her feel loved. She finally realized her father was controlling in many ways, and she did not feel loved as a child. Reclaiming her reality allowed her to stop “living” in the past and start acting as an empowered female – so that next time, she can pick a man who treats her as an equal.

* A 37-year-old man felt isolated and was addicted to alcohol. He realized he was dulling the pain he felt from losing his sibling when he was a teenager; he had never fully grieved. Allowing himself to feel emotions he denied for decades, he freed himself from the need to anesthetize himself and take a chance again on a close friendship.

* A 29-year-old man with panic disorder, whose symptoms included debilitating heart palpitations and a sense of impending doom, recalled how frightened and powerless he felt when his father was diagnosed with cancer – also at the age of 29.  By “connecting the dots,” his anxiety medicine suddenly begins to work, because it is now powered by more than chemistry.  Insight has taken hold.

* A 24-year-old woman binged and purged food as a way to distract herself from her core emotions. She realized those emotions included deep sadness about having moved from three separate cities and schools and groups of friends as her parents tried to find stability in their own lives.  She embraces how alone she felt at times, how she has come to distrust interpersonal connections and how she has kept a man she loves at a distance, fearing he will “move on,” too. Feeling more and more helps her binge and purge less and less.  She starts to believe in herself and in others and sees her relationship flourish.
 
The four core principles and eight-step programs that form the foundation of LTT were developed by me, Dr. Keith Ablow.

My clients have included celebrities, politicians and Fortune 500 business leaders, but they have also included people from every walk of life.  What I realized in the course of working with so many people was that we all have a remarkable ability to create success for ourselves, in our personal and professional lives, but only once we achieve personal authenticity.   
 

I realized this authenticity is well within reach for each and every one of us.
 
People needlessly hold up shields against internal truths that could be empowering, life affirming and even life saving for them.  These shields can include distracting, tumultuous relationships, overeating, overspending, overusing alcohol, smoking, using illicit drugs, gambling, and on and on.
 
 LTT helps individuals put down these shields, and look past them into the mirror, which reflects their true selves. Then, they can build authentic and powerful existences, putting their dreams within reach.

Over the course of the next eight weeks – every Friday – I will bring you the eight steps you need to “Living the Truth.”

There will be real-life examples, insights, stories, goals and, above all, hope.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com.

Cody Willard, the affable charismatic FOX News Business “Happy Hour” anchor, is a financial genius. So it came as no surprise to me when Cody pointed out, in the midst of a dramatic recovery from a bout of acute Neuro-Lyme Disease, that he’d been doing a lot of reading about the topic, particularly about the enormous costs in treating a disease that is both over- and underdiagnosed.

Willard is one of the “lucky” ones.  His right-sided facial droop (Bell’s Palsy) was preceeded a few weeks earlier by a hike in the woods with his dog, who had come out covered with ticks. And Willard himself, though he found no ticks on his body, developed a bright red oval rash on his leg, profound fatigue, and when he came to see me (referred by Frank Raphael and Maurice Tunick of Sirius Satellite Radio) he had a drooping mouth and difficulty closing his right eye. Lyme disease was clearly a plausible explanation for Willard’s problem.

Unfortunately, not all physicians respond the same way to this constellation of symptoms. Calling this Bell’s Palsy and ignoring the probability of Lyme or treating it quickly with oral antibiotics without performing a spinal tap is part of the undertreating and underdiagnosing of Lyme disease that Willard was referring too. Chronic Lyme can develop from a delay in diagnosis or inadequate use of antibiotics. In Willard’s case, a spinal tap revealed over a hundred white blood cells, an elevated protein, and a low glucose level, all characteristic of an acute infection. He was started on intravenous ceftriaxone right away, and by the time his Lyme titre came back overwhelmingly positive a few days later, he was already well on the road to recovery.

Watch him on “Happy Hour” this week, and you won’t even be able to detect a problem.

But not all cases of Lyme are this clearcut. The bright red rash with a lighter center (erythema migrans) occur in only two thirds of cases, and the rash can also be missed or misconstrued as due to an another insect or skin condition. Serological laboratory testing for Lyme disease is far from 100% accurate, and it is often negative in the early stages of the disease. The characteristic symptoms of headache, fatigue, and subsequent joint aches, are not specific for Lyme and are often mistaken for other problems. As Willard realized, the longer you wait for a diagnosis the more expensive both medically and financially. Chronic Lyme disease, which can include severe arthritis, heart problems, and marked cognitive difficulties, is very difficult to eradicate and expensive to treat. And fear of chronic Lyme in people who don’t really have it also creates a great health care expense.

Lyme disease, caused by the bacteria Borrelia burgdorferi, is spread to humans by the bite of infected blacklegged ticks (the most common culprit, a deer tick, generally has a tiny white spot on its back). The tick has to be in the skin for over 24 hours to cause infection, and the vast majority of ticks do not carry Lyme. Still, Lyme is on the increase, with almost 20,000 cases in 2006, a national average of 8.2 cases per 100,000. Lyme is especially prevalent in 10 states.

Resources:
CDC: Learn More About Lyme Disease
Clinical practice guidelines for Lyme disease from the Infectious Disease Society of America

Marc Siegel MD is an internist and associate professor of medicine at the NYU School of Medicine. He is a Fox News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of False Alarm: the Truth About the Epidemic of Fear (Wiley 2005) and Bird Flu: Everything You Need to Know About the Next Pandemic (Wiley 2006). Read more at www.doctorsiegel.com

Dr. Bassett

Allergy season in many areas of the US has had a big impact on all of allergy sufferers, particularly on children.  As children often spend a larger amount of time outdoors during the summertime they may be more so affected by the onslaught of daytime seasonal pollens and mold spores.  

 If one parent has allergies there is at least a 25 to 33 percent chance of the child developing allergies and the risk goes up over 50 to 75 percent if both parents are allergic sufferers.  So family history is a key factor in whether or not your children will develop seasonal allergies, indoor allergies and/or asthma.

 Recent studies have looked at impaired sleep as a result of poor breathing due to congested nasal and sinus passages during the night.  This may have a direct impact on daytime behavior and performance in the classroom.  Fatigue and daytime drowsiness may also be a sign of sleep disturbances that occur due to poorly controlled allergies.

Some suggestions I typically discuss with the parents of children suffering from seasonal allergies are:

  * Change clothes after spending time in the park where pollens are plentiful

  * Washing hair and taking a bath later in the day after being outside on a “high pollen day

  * Pre-treat to prevent daily symptoms during peak seasonal pollen periods

  * Vacation at peak allergy times by a body of water such as a lake, river or by the beach, where pollen levels are typically lower

* Ask your pediatrician or allergist if your child should be on “anti-inflammatory” nasal sprays to reduce congestion from seasonal allergies that may assist in better quality sleep at night

Be proactive and develop a sensible allergy management program for your child to successfully combat seasonal allergy triggers!  Learn more at www.acaai.org and www.aaaai.org.

 Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended to diagnose or treat any condition.

The late Heath Ledger’s performance as the Joker in the newest Batman saga, “The Dark Knight,” helped push the movie into the record books, with a first-weekend take of more than $155 million.

Critics and audiences agree that Ledger brought life to the Joker as no one has before, making a comic book character seem real. That’s good news for Warner Brothers, the studio that made the movie.

That is good news for the movie industry, in general. And it is touted as good news for the Ledger family—whose grief might be tempered with understandable pride for an actor whose gifts will likely now be compared with another great artist who died tragically — James Dean.

 There is one problem, however, with all of the excitement. Ledger didn’t do nearly as good a job in his real-life role as a boyfriend and father, it turns out, as he did as an actor. His death has been ruled an accidental overdose of the anti-anxiety agents Valium and Xanax, the sleep aids Restoril and Unisom, and the painkillers OxyContin and hydrocodone (the active ingredient in Vicodin). This accident took place in the setting of Heath reportedly abusing these drugs—kind of like crashing into a wall while driving 100 miles an hour.

We don’t know why. We don’t know the demons that inhabited the conscious and unconscious parts of Ledger’s mind. But those demons require real courage and character to face and overcome. You can’t act your way around them.

Whatever painful dramas roiled Ledger’s psyche, he wasn’t willing or able to insulate his little daughter Matilda Rose from the grief now written into her life story. And there will be no audiences to applaud her performance in dealing with the loss of a parent, no Academy Award for how well she plays the role of brave girl and young woman, no $155 million in tickets to her wedding without a dad to walk her down the aisle.

In real life, you have to own your own suffering and come to terms with it in order to win the awards really worth winning — real self-possession and self-esteem and the certain knowledge that you have brought the best of yourself to those you love.

The entertainment industry understandably wants to turn Heath Ledger’s death into a kind of heroic poetry, a journey through a hall of mirrors in which an actor with demons plays a villain with demons and is lost forever in the maze. But that poetry misses one critical fact: In his role as a father, Heath Ledger walked off stage a long time ago, leaving a little girl to cry tears of grief that not even a Joker’s palette of makeup could turn into a smile.

A DVD of her dad’s full-screen image, maybe one with a colleague tearfully accepting the Oscar for him, might be something she can hold onto – but it won’t be the same. She won’t have a dad to hug and to hold.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com.

The videotape of Omar Khadr, then 16-years-old and being interrogated at Guantanamo, is difficult to watch.  Who among us with a heart, certainly any of us with a child, could help feeling badly for Khadr?  That is a tribute to our capacity as human beings and as Americans to care for others, especially given the facts that Khadr is now 21 and about to stand trial for murdering one U.S. serviceman and blinding another.

The tape, however, reveals more than Khadr’s desperation and more than our capacity for empathy.  It also reveals facts that should be reassuring to Americans, even amidst complex and pressing questions about how we should detain and how we should treat prisoners in a time of war.

Khadr was not physically abused in the tape.  He was not threatened with death.  He was not made to endure uncertainty about whether America will seek retribution on his family.  He was clothed.  He was told honestly that his questioners could not trade his cooperation for his freedom.

Khadr was not hallucinating.  He inflicted no harm upon himself.  He did not plead for his life or beg for food or for the beatings to stop.  Perhaps most revealing, he did not seem afraid of his interviewers, and seemingly had the capacity to withhold from them the information they seek.  Instead, he pleaded for medical help—when he had already been successfully treated for nearly lethal wounds sustained in combat.

Khadr’s lawyer reportedly stated that his client was psychologically abused at Guantanamo by being deprived of sleep and moved from cell to cell every three hours for weeks.  If he presents evidence to that effect in court, along with other evidence about Khadr’s detention, we will know more about the stress his client endured. 

This Guantanamo tape itself isn’t, however, the smoking gun many portray it to be.  While it makes us—as fathers and mothers and as Americans—feel for the young man accused of murder, it doesn’t prove that he was tortured.  What it does prove is that the war has been terribly painful, that it has brought suffering to millions of families and that we Americans have not lost our capacity for empathy in a time of war—even for our enemies.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com.

A Canadian woman died last year after stepping barefoot on several caterpillars, doctors reported in a teaching case published Monday in the Canadian Medical Association Journal.

The 22-year old woman from Alberta died 10 days after stepping on five caterpillars while on a trip to northeastern Peru.

The woman felt immediate pain in her right foot, which spread to her thigh, and later developed a headache. The pain in her leg was worse when she walked on it.

The leg pain and headache disappeared within 12 hours so she did not seek treatment while in Peru, the doctors reported in their case study.

Doctors in Peru removed knives, nails, screws and other objects from the stomach of a metal-eating man, the Daily Mirror reported.

Luis Zarate, 38, went to doctors with severe stomach pain. Doctors were stunned when an X-ray revealed that the man had swallowed a knife, nails, screws, a watch and even barbed wire.

“There were 17 strange objects found at the level of his stomach and colon,” said Julio Acevedo, who performed Zarate’s surgery. “The objects had caused his stomach to expand.”

Zarate is recovering at the hospital in Trujillo, a coastal town in northwestern Peru.