By Dr. Billy Goldberg and Mark Leyner

We see a great deal of severe head trauma in the ER. Amazing survival stories, however, are few and far between.

For every headline-making tale of survival you hear about – a man is fine after being accidentally shot in the head with a nail gun or a boy completely recovers after a butter knife is lodged in his skull – most cases of head injury don't have happy endings.

The recent tragedy of welterweight Oscar Diaz is typical. The 25-year-old boxer is in a coma after collapsing in the ring on July 16. According to news reports, there was no sign that anything was wrong with Diaz until he grabbed his head and cried out just before the 11th round. Doctors think he will survive after surgery for bleeding on the brain, but whether he'll have a normal life is unclear.

When it comes to head trauma there's a weird phenomenon we often see in the ER — nothing turns out like you'd expect. Some people will suffer a simple fall and conk on the head and have horrendous injuries while others suffer brutal blows and come away unscathed.

Sure, there was the gang member shot four times in the face who didn't even lose a tooth. But on the other side is the innocent bystander hit by the bullet who dies instantly, or the grandma who trips going to the market to buy cat food and experiences life-threatening bleeding in her brain.

You can't talk about surviving a traumatic brain injury without mentioning the most celebrated head trauma patient of all time, Phineas P. Gage. In 1848, near Cavendish, Vt., an explosion blew a 3-foot iron rod through the head of Gage, a railway construction foreman. It entered his left cheekbone, passed through his skull, and exited out the top of his head.

Despite a few convulsions immediately following the accident, Gage remained alert and lucid, and recovered completely. There was one problem, though. Once an extremely polite, hard-working, compassionate man, Gage became a foul-mouthed, selfish, erratic, lying hooligan. Gage's accident helped provide science with insights into how the prefrontal cortex controls decision-making and personality. 

According to the Brain Injury Association of America, 1.4 million Americans will sustain a traumatic brain injury each year. Of those cases, 50,000 die and 235,000 are hospitalized. The Centers for Disease Control and Prevention reports that there are approximately 5.3 million U. S. citizens with a disabling brain injury. The costs of caring for the traumatized totaled $60 billion in 2000.

What determines whether someone walks away from a head injury and ends up on the TODAY show or ends up in a coma, or worse? There is a cynical ER saying that the key to is to be a drunk with a seizure disorder.

Seriously, it's all about which structures in the brain are injured and how severe the damage. Damage to the frontal lobes can cause changes in mood and personality or emotional instability. Injury to the area of the brain responsible for motor control can cause weakness. Temporal lobe damage can cause difficulty with language and trauma to the occipital lobe can cause blindness.

Another interesting result of head trauma can be anosmia, or the loss of smell. Approximately 5 percent of all head trauma patients exhibit total anosmia and around 30 percent of patients experience some decreased smell. Anosmia is usually due to shearing of the olfactory filaments at an area at the base of the skull.

Yamilet Leon, 7, is one of the lucky ones. The young girl was playing near a park in Sacramento, Calif., on July 3 when her brother heard gunshots. Yamilet complained of pain and doctors found the cause: a .22 caliber bullet just beneath the skin just above her temple. She's now recovering from surgery to remove the bullet.

Then again, how lucky are you if a bullet hits you in the head?

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By Linda Dahlstrom

Some things aren't always black and white. Then again, sometimes they are – like the twin sons born July 11 to a German couple.

The first baby that was born, Ryan, has light skin and blue eyes. His brother, Leo, is dark-skinned with brown eyes.

"None of us could believe it," the maternity ward's head doctor, Birgit Weber, told one news source. "Both kids have definitely the same father."

Stephan Gerth is German and white. His wife, Florence Addo-Gerth, is from Ghana and has dark skin.

It was "a real surprise," Gerth told the German newspaper Die Welt, adding that the most important thing to him isn't color, but that everyone is healthy.

VIDEO: These brothers are a very rare pair

The odds are one in a million, say doctors, but it can happen with fraternal twins due the genetic soup in our backgrounds. Peter Propping, former director of the Institute for Human Genetics at Bonn University, told Die Welt that the black mother may have had some white ancestors, or that the white father may have had black ones. Very occasionally, the roll of the DNA die may cause the baby of biracial parents to inherit only the genetic coding for one color.

Rare though they are, the German twins do have some company. In the past few years, at least three mixed race couples have welcomed twins who were also black and white. 

• In  2005, British couple Kylie Hodgson and Remi Horder, both born to mixed-race parents, had twin girls – one who is blond and fair-skinned and one who has dark coloring.
• In 2006, Kerry Richardson, who is of Nigerian and English descent, and her partner, who is white, gave birth to twins who were both born light-skinned. But as they got older, one got darker while the other got lighter. 
• Natasha Knight, of Australia, welcomed a blue-eyed blond baby girl and her sister, who has brown hair, eyes and dark skin in 2006. Knight's older daughter has blond hair, blue eyes and light olive skin. Knight is of Jamaican and English descent; the father is German.

In 1993, another set of black and white twins was born to the Dutch couple, Wilma and Willem Stuart, but it turned out to be a case of an in-vitro mix-up. The parents, who are both Caucasian, were mystified when the twins were born, but fell deeply in love with both of them. However, after about a year, genetic tests revealed that while one of the twins was biologically related to both parents, the other twin was not.

The hospital called it a "deeply regrettable mistake." It soon became apparent that a device similar to a large eyedropper had been used twice, causing another man's sperm to be mixed with Willem's. The couple remembers two other couples in the waiting room the day of the procedure. One of them was black.

Being of different races and coming from different fathers hasn't stopped the Stuart boys from closely bonding. While the dark-skinned boy did eventually meet the man who was his biological father, the brothers consider themselves full twins. In 2005, they attended a twins festival and proudly won the "Least alike twins" award."

"For the two boys, being celebrated for their differences finally answered all the questioning looks, nasty teasing, and outright expressions of disbelief they've endured all these years," Wilma Stuart told Dateline, which has been following the family since 1993.

Stephan Gerth and Florence Addo-Gerth, the parents of the newest set of "black and white" twins, know they'll face some incredulous stares.

"I imagine sitting in a playground where the other mothers will call me crazy when I tell them the boys are twins," Florence told www.peacefmonline.com.

Like all siblings, their differences are more than skin deep. The twins also have distinctly different personalities, say their parents. Leo, the dark-skinned baby, is quieter; Ryan, his light-skinned brother, is temperamental. "When he's hungry, he's hard to stop," said the mother.

She says her children were born looking exactly as they should. "God has decided that my children should have different skin colors," she says.

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By Melissa Dahl

Does all that exertion on the elliptical machine make you nauseous? Have you ever been convinced that if you spend even one more minute on the treadmill, you will actually die? Maybe it's not all in your head.

A few people are actually allergic to exercise, and in very rare cases, a sweaty workout could be enough to kill them.

Exercise-induced anaphylaxis is a fairly rare condition which can cause hives, fainting, vomiting and difficulty breathing during a workout, and the symptoms can last up to four hours after it. In some cases, it can be triggered by certain foods eaten before exercise, like peanuts, shellfish, eggs or even, in two reported cases, celery. But this isn't just your average food allergy, an expert explains.

"These are people who will not have this reaction unless they exercise right after eating this food," says Dr. Jacqueline Eghrari-Sabet, an allergist in private practice in Montgomery Village, Md., and a spokeswoman for the American Academy of Allergy, Asthma and Immunology. "Eating shellfish and sitting there? Nothing. But eating shellfish and exercising? For these people, it's bad news."

As you exercise and your heart rate speeds up, your blood starts whizzing through organs much faster, and therefore more frequently, than it normally does. With every trip your blood takes to your stomach, it's picking up more, say, celery bits. For those with exercise-induced anaphylaxis, the normal amount of celery antigens picked up by the blood isn't enough to bother them. But while exercising, the extra celery bits their blood is picking up causes an allergic reaction.

Running and jogging are the most likely to trigger an attack, but other strenuous activities like dancing, volleyball, skiing and even yard work can also cause a reaction.

Since the 1970s, only 1,000 cases of exercise-induced anaphylaxis have been documented – and among those cases, one death. Experts believe that's because many people with this condition are able to recognize the symptoms quickly and keep it under control by waiting a couple hours after they eat to work out and bookending their workouts with a slow warm-up and cool-down.

"It'll usually happen when you're really exercising," says Eghrari-Sabet. "I don't think you're going to get it when you're bowling. But if you're doing cardio or a hip hop class, then, yes."

Others suffer from the less serious exercise allergy cholinergic urticaria, a common type of heat rash, which differs from anaphylaxis in that it starts and ends with the skin reaction – no nausea or difficulty breathing for these folks. Ten to 20 percent of the population will experience some form of it during their lives. Besides exercise, sun exposure, spicy foods or even getting too emotionally worked up can cause an itch attack.

The condition can strike spontaneously, so even if you've been exercising all your life with nary a rash, you can unexpectedly break out in hives. Even some marathon runners have suddenly come down with a bad case of the itches after jogging, explains Eghrari-Sabet. Women are most susceptible to the condition, and the average age for its first appearance is 16. (A handy way to get out of gym class?)

Unfortunately for people seeking an excuse not to break a sweat, most dermatologists and allergists send their patients with exercise-related allergies right back to the locker room.

"If they come to me, I'm not going to tell them not to exercise," says Dr. Bruce Robinson, a Manhattan dermatologist.  Instead he advises patients to pick a less strenuous regimen or a cooler place to work out.

Because the itchy sensation happens when body temperature suddenly rises, it can be eased by warming up and cooling down slowly, before and after every workout. Or try swimming for your normal cardio routine, which will keep the body temperature cool. If a food allergy is the culprit, don't eat for a couple of hours before your workout.

Although serious side effects are rare, some experts believe, that exercise-induced anaphylaxis often goes undiagnosed. So if you start to feel itchy while working out, watch out. It's probably best to avoid death by treadmill at all costs.

For more on exercise allergies and other workout quandries, read our Smart Fitness column.

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By Mark Leyner and Dr. Billy Goldberg

No matter how careful we think we are, we're all prone to doing some pretty stupid things to our bodies. Some of us take responsibility for our own actions. Others blame their defective thongs.

Remember Macrida Patterson? She's the Los Angeles traffic cop who sued Victoria's Secret for an eye injury that occurred when a heart-shaped metal fastener in her underwear snapped, popped into her eye and injured her cornea.

The case of the hazardous thong got us talking about the fact that people typically look for some excuse or someone else to blame when they get hurt.  Nowhere is this more evident than in the emergency room.
 
Just this past week, Billy was working in the ER and he saw a classic example of a poor decision gone haywire. It was a busy Monday evening and the ER was filled with your usual assortment of injured, infirmed and intoxicated. Alcohol is usually involved in most of the ER's most brilliantly dumb accidents. In fact, from 1992 through 2000, researchers found that there were an estimated 68.6 million emergency department visits related to alcohol, almost 8 percent of the total ER visits during that time period.

We have to assume that some intoxicant was involved in this particular case, but by the time Billy got involved, it was too late for questions. A middle-aged man had apparently needed to urinate and used a nearby plastic bottle. After inserting his penis in the hole, he found himself unable to extricate his now swollen member from the grasp of this plastic vise. It is unclear what attempts he made on his own, but by the time he arrived he was trapped and had been unable to relieve himself. After a hefty dose of morphine, two young residents and a junior attending physician unsuccessfully tried to free him from captivity. By the time Billy arrived, he was screaming in pain.
 
Doctors refer to objects that are swallowed or inserted as "foreign bodies." There are countless stories of various things removed from patients' stomachs, noses, ears, rectums and vaginas. The bottle doesn't quite qualify as a foreign body (as it's the entrapper not the entrapped), but a search of medical literature revealed similar cases of "penile entrapment in a plastic bottle." In these situations, the danger is that prolonged strangulation of the penis can lead to gangrene and even result in the amputation of the affected part.
 
Watching reruns of MacGyver would probably be more useful than medical school in a case like this. A ring cutter that ER doctors use to cut through metal was slowly making its way through the hard plastic, but the patient kept struggling and howling.

After a heavy dose of sedation, a carefully placed metal blade between the bottle and the penis provided the leverage needed to cut through the plastic. As the bottle was being removed, the patient was finally able to urinate and, unfortunately, sprayed all over poor Dr. Billy.

In the ER, no good deed goes unpunished.
 
As the patient was sleeping off the sedation, the ER staff went back to their routine business. We never found out the precise details of how this occurred, but keep your eyes on the local papers. You may come across a story about a certain gentleman suing a bottle manufacturer.

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  By Diane Mapes

We've all had that creepy feeling that something is crawling on our skin, scurrying across our scalp, scuttling around the base of our neck.  Usually, it's our imagination, but for a woman in Levittown, N.Y., that creepy feeling was all too real.

Nina Bradica, 45, was quarantined June 6 after she became infested with bird mites, tiny insect-like parasites that normally live on birds.

The mites entered Bradica's home through a wild bird's nest in her bathroom vent. The nearly-invisible bloodsuckers took over her bathroom and swarmed onto Bradica when she took a shower. Before long, her body was covered with red bumps and welts from their bites. The bugs crawled into her nose, her ears, her mouth and "other places," according to her daughter.

While bird mite infestations in humans are rare, they do happen, says Dr. Richard Zack, associate professor and chair of the department of entomology at Washington State University. The most common infestations occur in people who work in the bird and poultry industry, but the creatures will flock to anybody if the circumstances are right.

"Nesting birds or small mammals carry their own set of parasites and although those parasites don't normally feed or interfere with humans, if something happens to the mice or the birds that are nesting in your house, the parasites will look for an alternative food source," he says. Unfortunately, that alternative food source can be you."

When it comes to pesty infestations, Zack says humans can play host to chicken mites, northern fowl mites, tropical fowl mites, tropical rat mites and house mouse mites. For more information or tips on dealing with mites, contact the Centers for Disease Control and Prevention or visit birdmites.org, bitingmites.org, or buginfo.com.

Dust mites can cause serious problems for those with allergies, although they live in our bedding rather than on our bodies, says Zack. But watch out for the itch mite, Sarcoptes scabei, better known as scabies. Also of note is the face mite, or follicular mite, a microscopic bug that lives at the base of hair follicles – including, shudder, our eyelashes.

"Upwards of 90 percent of all people have these mites living on their body on a permanent basis," says Zack. "As far as we know, they don't cause any problems. There's even speculation that they're a beneficial parasite."

Not so beneficial — or easy to ignore — are lice, the scourge of mothers everywhere.

Head lice stick to the head and the nape of the neck, while pubic lice (commonly known as crabs) live anywhere there's coarse body hair – beards, moustaches, armpits, and, of course, points further south. The body louse is more of a "commuter" bug, says Zack. It feeds on your body but actually lives – and lays its eggs -- in your furniture or carpeting.

Another popular drop-in guest is the bed bug, which crawls out from behind pictures, peeling wallpaper, or wooden molding in order to feast on its favorite midnight snack: human blood.  

Ticks and fleas will jump aboard for a quick meal, as well. Chiggers, too, will live on our bodies temporarily, although they don't feed on our blood, but rather inject us with their spit which liquefies our skin cells which they then suck up through a tube.

All of which itches like no tomorrow.

The creepy crawly contingent doesn't stop there. Millions of Americans, primarily in Appalachia and the South, are currently infected with worms and parasites, according to a new study.

The most common human worm infection is ascariasis, caused by a parasitic roundworm that lives in the intestine and can grow to a horrifying 12 inches in length. Human infection takes place after the accidental ingestion of ascaris's egg-infected feces. Once the eggs hit the host's stomach, they hatch and immature worms are carried to the lungs and then to the throat where they're swallowed. The larvae travel through the body to the intestines, where they develop into adult worms, lay eggs, and the whole cycle begins anew.

Other "helminth" or parasitic worm infections include toxocariasis, a roundworm parasite which infects between 1.3 and 2.8 million Americans, and strongyloidiasis, a type of threadworm that lives throughout the body and infects 68,000 to 100,000 Americans.

Platyhelminth infections (i.e., flatworms or tapeworms) also love to make themselves at home in the human body.

Although these infections can wreak havoc for many, particularly those living in poverty, the majority of Americans don't have to worry about the yucky squirmers. However, they may encounter "worm therapy" in the near future. Some scientists now believe worms may actually help the human body fight off allergies and immune diseases. Researchers are conducting tests with various parasites in the hopes of developing alternative treatments.

But that's a whole different can of worms.

 

 

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