By Mark Leyner and Dr. Billy Goldberg

Imagine an accidental bop on the head changed your accent from the grating stridence of Fran Drescher to the dulcet, euphonious tones of, say, Kate Winslet. Or if you're a man, what if a whack to the forehead transformed your speech from something out of Homer Simpson's pie-hole to the adorably urbane voice of Stewie Griffin from "Family Guy?"

That kind of bizarre voice change happened for real to a woman from Washington's Olympic Peninsula. Recent newspaper reports and a cable TV show featured CindyLou Romberg, who split her head from front to back after falling out of a moving car in 1981. Despite the serious brain injury, after her awful headaches and lingering back pain abated, she resumed a normal life as a caregiver and motorcycle enthusiast.

Until her back started bothering her again about a year ago.

After visiting a local chiropractor, Romberg soon began speaking gibberish.When she began speaking normally again, she had a German accent, tinged with what some friends thought was vaguely French or Russian. This strange accent was coming from an American woman who had never studied a foreign language, nor been to any foreign country, except Canada.

Romberg was diagnosed with Foreign Accent Syndrome, a neurologically-based speech disorder most probably caused by her traumatic brain injury. Although this particular diagnosis is rare — only 50 or 60 cases have been verified worldwide — other problems following traumatic brain injury, such as aphasia (the loss or impairment to use or comprehend words) or stroke, are not uncommon. The delay of so many years before the appearance of symptoms makes Romberg's case especially unusual.

We recognize that traumatic brain injuries can cause myriad personality changes in patients — everything  from paranoia, nihilistic delusions, lethargy, mania, impulsiveness, a tendency towards various kinds of disinhibited behavior like sexual promiscuity and frenetic gambling. The wife of a patient treated at the Johns Hopkins Brain Injury Clinic reported that after her husband eventually recovered from the brain injuries he suffered from a serious motorcycle accident, he became unusually cheerful, talking nonstop, and spending excessive amounts of time in karaoke bars. He was also uncharacteristically preoccupied with Internet pornography.

But there's something uniquely and irresistibly fanciful about the story of CindyLou Romberg. It has almost a fairly tale quality to it. Go to sleep as a normal American, wake up as an exotic European.

What really happened to her? According to a recent article in the Journal of Neurolinguistics, "foreign accent syndrome" is something of a misnomer. Following a stroke or severe brain injury, these patients don't actually manifest a speech pattern that corresponds to any particular language. What's going on is that they are displaying changes in the rhythms, stresses and intonations of their speech that listeners mistakenly ascribe to a new and different accent. Most cases of "foreign accent syndrome" are associated with injuries to the left hemisphere of the brain, which is associated with language.

Even the voices we hear in our heads after an accident can develop speech impairments. A medical journal recently reported a woman who, as the result of a brain injury from a bicycle accident, developed aphasia, rendering her able to only speak in very short sentences and single words. She also began having audio hallucinations of voices that shared her very speech problems. The voices she hallucinated expressed themselves in short sentences or single words.

Neuroscience is an endlessly fascinating field, and there is so much about the brain that we are only beginning to understand.  The neurological source of Peter Sellers' accent as Inspector Clouseau in the "Pink Panther" movies and, most spectacularly, Al Pacino's bizarre dialect as Tony Montana in "Scarface" ("Say hello to my little friend!") remain profound mysteries.

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By Mark Leyner and Dr. Billy Goldberg

Attention all campers! You no longer have to bother dipping your bunkmate's hand in warm water in an attempt to make him pee in the bed. If you want to know how to terrorize that kid who picked on you on the kickball field, all you have to do is get inside his dreams. Through his nose.

German researchers have found that sleepers exposed to an unpleasant smell will have negative dreams. The opposite is also true. When subjects were exposed to the smell of roses, their dreams were predominantly positive. These olfactory observers used rotten eggs in their study, but we are sure that a stinky gym sock, left perched on the pillow of your enemy, would work just as well. While we're fairly certain that the researchers didn't plan to have their findings used in this manner, there are always unintended (and sometimes dastardly) consequences of scientific breakthroughs.

Because our sense of smell involves such a sensitive and neurologically complex function, and because it's so powerful in its influence on our behavior, it's not surprising at all that so many scientists have studied the effect of different scents on emotion, memory, appetite, energy, and sexual arousal. The sense of smell is known to be closely linked to the same area of the brain which handles memory and behavior, which is why a familiar scent can trigger a vivid memory or feeling about the first time you got a whiff of it. Scientists have also found that our sense of smell intensifies when we sense a dangerous smell — such as a fire — sparking our brain's fight-or-flight response.

It certainly seems logical that there would be a strong connection between smell and stimulation, but you might be shocked to find out what the most sexually "intoxicating" fragrances actually are.

To test the effect a scent has on arousal, Dr. Alan Hirsch, a nationally recognized smell and taste expert and the founder of the Smell & Taste Treatment and Research Foundation in Chicago, chose 30 pleasant odors and hypothesized that these enticing scents would stimulate more than just the nose. He measured penile blood flow while exposing men whose eyes were covered to various scents. The winner, by a nose, was lavender and pumpkin pie, with a 40 percent average increase in blood flow to the penis. The smell of doughnuts and black licorice came in a close second with a 31.5 percent increase in penile blood flow  Cranberry finished dead last, so you may want to leave that off the seduction menu.

Hirsch also studied the effect of odors on women and measured their sexual response. The winners: the combo of Good & Plenty candy and cucumber with a 13 percent increase in vaginal blood flow. Baby powder tied with a lucky 13 percent boost. Pumpkin pie and lavender also seemed to stimulate the ladies, coming in second at 11 percent.

Now, you're probably ready to radically alter your choice of cologne and aftershave, right?  After all, who needs Chanel No. 5 or Boucheron pour Homme, when it's apparently so much more provocative to slather a hunk of pumpkin pie across your neck or daub a melting Twizzler behind your ears? 

It's said that humans are able to distinguish over 10,000 different odor molecules. We do this by simply breathing in. That whiff of air goes up the nostrils and makes its way to the roof of the nasal cavity where it hits a tiny area called the olfactory epithelium. The olfactory epithelium contains millions of olfactory receptor neurons.  On the surface of these neurons are odorant receptors that pass the smell information to the olfactory bulb (just underneath the front of your brain) and then on to the olfactory cortex in the temporal lobe of your brain.

Confused? Well, so are scientists. You see, humans have only about 400 odorant receptors on the surface of those sensory neurons. The otherwise humble mouse has approximately 1,200! Yet we olfactorily challenged humans can still detect thousands of odors.

Because the power of human sense of smell is so greatly underrated, the great and profound enigmas of scratching-and-sniffing remain to be solved.

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By Mark Leyner and Dr. Billy Goldberg:

Is it true that our noses actually grow ever longer as we age?

Wouldn't this be yet another depressing indignity heaped upon all the other depressing indignities that accompany getting older? Well, there's good news and bad news.

The good news: No, our noses don't grow longer. The bad news: Our noses DROOP. 

Gravity is the villain here. As the collagen and elastin in our skin break down, our skin loses its strength and suppleness and the pull of gravity wreaks all manner of havoc upon our bodies. It causes the tips of our noses to droop, our eyelids to fall, our ears to elongate and our jowls to form. It causes our boobs and our scrotums to sag.

Gravity even causes those lovely, purplish varicose veins. Normal veins work against the force of gravity. Over time, as the vein walls weaken, the pressure of gravity causes veins, especially in the legs and calves, to enlarge and bulge.

Gravity is like the hand of fate. It's like the hand that reaches out of the grave and grabs Amy Irving in Brian De Palma's "Carrie." It will grab you and pull and won't let go.

A pox on gravity! Who wants a saggy scrotum?  Wouldn't it be nice not to have any?  (We mean not have any gravity, not scrotums.)

Not really. First of all, without gravity, we'd all be unceremoniously flung off the earth – never mind the fact that Kobe's 3-point jump shot at the buzzer would never come down, and those wonderful Olympic synchronized divers would plummet, not gracefully down towards the surface of the pool, but straight up into the infinite cosmos in perfect eternal bilateral symmetry.

Is there any way to elude gravity, to be weightless, to avoid the relentless downward pull on our bodies? Any respite from the Big G would help reverse such accelerated aging, no? The moon's gravity is one-sixth that of the earth, but who the hell wants to vacation on the moon? For those of you considering space travel as an avocation, the gravitational force on Jupiter is 254 percent that of Earth. Imagine the pendulous ball-sack you'd have up there after a few months. 

There are those Zero G flights – the ones where the pilots perform a series of parabolic flight maneuvers that counter the forces of gravity and enable passengers to float and flip through the cabin at zero gravity. But at about $5,000 a pop for a total of seven or eight minutes of reduced gravity, it doesn't seem like a feasible way to prevent jowls or sagging boobs.

Let's try to look at this calmly and from a medical perspective. We, as human beings on this planet, have evolved to accommodate and thrive in gravity, specifically, our planet's gravity. The mechanical receptors in your muscles, tendons and joints and the vestibular apparatus in your inner ear have evolved so that you can maintain your orientation, your balance, agility and strength in this particular environment. Similarly, your body's hydrostatic pressure has evolved to keep your fluids and your blood plasma evenly distributed in our environment's specific gravity. Our anatomies and physiologies are as customized for our planet's unique gravitational field as they are to digest proteins and carbohydrates or metabolize vitamin D from sunlight.

It's easy to see why prolonged weightlessness – which is such an unnatural a condition for our bodies – would have all manner of deleterious effects. The sense organs in our inner ears begin to respond differently to motion and when altered sensory input confuses the brain, resulting in disorientation and nausea. Fluids migrate to the chest and head causing sinus and nasal congestion, a puffy face and bulging neck veins. Loss of blood plasma causes anemia. Weight-bearing bones and muscles deteriorate. Fluid redistribution shrinks your legs. Your kidney filtration rate increases resulting in kidney stones.  It's a mess!

Over the course of millennia and in our own brief lifetimes we are both formed and deformed by gravity. As we slide toward senescence, our complicated relationships with gravity – that most fundamental force of nature – goes distinctly south. Along with our noses and our boobs and our scrotums. It is, in the end, the price we pay for being Earthlings.

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By Dr. Billy Goldberg and Mark Leyner

In the great drama that is medicine, there are obvious villains: cancer, heart disease, trauma. And there are glorious heroes: vaccines, antibiotics, artificial hearts, etc.  It's easy to wax poetic about such august matters. But we prefer the bit players on the medical stage – the unsung, largely forgettable conditions. Of these, nothing is as gloriously mundane as earwax.

Earwax – or cerumen, as it's known in the biz – is made up of keratin (the stuff of dead skin) along with fatty secretions, a mix that protects the ear canal from water and infection.

There are two types of cerumen: wet and dry. Wet cerumen, which is light or dark brown and sticky, has a relatively high concentration of lipid and pigment granules. Dry cerumen, which is grey or tan and brittle, tends to have less fat and pigment. The wet wax tends to be most frequent in Caucasians and African Americans, while the dry version is found in the ear canals of Asians and Native Americans. (We're surprised that no enterprising screenwriter has come up with some nightmare, doomsday scenario in which the world is ultimately Balkanized into two warring camps, The Wet Cerumens and The Dry Cerumens, whose internecine battle results in the destruction of the planet.)

Speaking of Hollywood, who could help but be overwhelmed with sympathy for poor Keanu Reeves. Whereas some stars suffer the indignity of being photographed with a big rock of cocaine hanging out their noses, Keanu was recently photographed leaving the Crown Bar in Los Angles with an enormous hunk of earwax protruding from his ear. (Perhaps Keanu could have used this ancient gold earwax spoon that was found in a sunken Spanish galleon off the coast of Key West, Fla.)

But don't judge Keanu too harshly. If he were to have gone digging for gold in his own ear, he would be violating the new national guidelines for earwax removal issued today by the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF).

As an ER doc, Billy has a great deal of personal experience with ear cleaning. Many people come to the ER for a good aural irrigation. In fact, approximately 12 million people a year in the U.S. seek medical care for impacted or excessive cerumen. It is surprisingly rewarding to treat these patients as they often are suffering from hearing loss, and you can't imagine how happy someone is after you've unpacked their ears and they can hear clearly again.

In the ER, we don't just reach for a cotton swap or a gold earwax spoon. Usually, we break up the plug with a cerumenolytic (wax dissolving agent) such as hydrogen peroxide, mineral oil or docusate sodium (colace), a stool softener.

But, as the new guidelines advise, don't try this at home. Cotton-tipped swabs tend to pack the wax in and cause impaction.

Of course, none of us wants to end up like Keanu, with gunk literally falling out of our ears. So, if you need to use a Q-tip, be sure to only swab the visible, outer portion of the ear. Treat the ear canal itself like a self-cleaning oven.

The new rules also come out against ear candling, a practice in which a hollow candle is inserted into the external auditory canal and lit. The theory is that the combination of heat and suction is supposed to remove earwax. Unfortunately, candled patients often end up with more wax in the ear or even burns to their ear canals. People sometimes do the strangest things.

While we're heartened that the AAO-HNSF has issued guidelines about earwax impaction, we're a little perplexed about our government's indifference to the potential exploitation of the substance, especially given our current debilitating dependence on foreign oil. Why hasn't the Department of Energy or DARPA investigated how to turn earwax into fuel? It's available in enormous quantities and is eminently renewable. Keanu himself could probably produce enough to light a small Midwestern city.

Many creatures excrete precious substances. Oysters produce pearls. Ants produce formic acid. Civets produce musk. Wouldn't it be a glorious irony if the humble and oft-maligned human earwax turned out to be the great global panacea?

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By Mark Leyner and Dr. Billy Goldberg

What if you could simply swallow a pill and become a buff, shredded, aerobic dynamo all without having to spend one sweaty second in the gym? Wouldn't an instant fitness drug be great? Maybe not.

We were both mighty intrigued to learn that scientists had developed not one, but two "Mighty Mouse Drugs" that endow mice with all the benefits of having worked out furiously, without the effort of actual exercise. Researchers at the Salk Institute in San Diego reported that a drug called Aicar increased mice's endurance on a treadmill by 44 percent after just four weeks of treatment and helped them burn more calories and have less fat than untreated mice.  A second drug with the catchy name "GW1516," when combined with exercise, boosted the mice's endurance by a whopping 75 percent! 

Both drugs activate PPAR-delta protein which produces more high-endurance Type 1 muscle fibers in the body. Aicar actually mimics the effects of exercise, convincing cells that they've burned off energy and need to generate more. As one of the researchers said: "It's pretty much pharmacological exercise." The researchers contend that it's reasonable to assume that these results will apply to people.

A dream for couch potatoes? Watch video

Nevermind that researchers claim they'd use Aicar for diabetics or other sick people who are unable to exercise safely. The phenomenal interest in this drug is about the ability to get buff without getting off the couch.

Once the "wow" factor subsided, the two of us each reacted with our respective ambivalences. Leyner, the inveterate gym rat, bristled at the notion of Adonis-like bodies achieved without the grunting iron-pumping of which he's almost perversely enamored.  "It's cheating," Leyner muttered with a hint of moral superiority.

Billy, whose hectic hospital schedule includes long, exhausting hours in the ER and complex administrative responsibilities, and who lovingly contends with the obligations of a brand new infant at home couldn't help but be intrigued by the possibility of a pill that would preclude the need to spend hours at a gym.

But we both share a feeling that perhaps something might be lost here. 

Will bench presses, curls, crunches, treadmills, ellipticals, and butt blasters go the way of the blacksmith shop? Will we stand someday with our children and nostalgically watch actors work-out in reconstructed gyms in historical theme parks, the way we watch candle-makers in Williamsburg, Virginia? What will happen to the likes of Jackie Warner and Body By Jake?  Isn't the impending obsolescence of Richard Simmons enough to cause some serious soul-searching?

Neither of us are Luddites by any stretch of the imagination. We are acutely aware of the monumental effect various miracle drugs have had on the health and well-being of humanity: antibiotics like penicillin, tetracycline, and streptomycin; drugs like Cyclosporin which prevents the rejection of transplanted organs; and neuroprotective drugs now in development like Rember and Dimebon that could possibly stall or even reverse the dementia associated with Alzheimer's disease.

But we're becoming a society that believes all our shortcomings and foibles can be pharmaceutically eradicated. Wanna get smarter? There's a cognitive enhancer like Modafinil for you. Wanna become more empathic, trusting, generous or altruistic? Take some oxytocin. Are you promiscuous, a compulsive gambler, eater, or spender? Too shy? Pop a Prozac, Zoloft, or a Paxil. Wanna be an Iron Man in the boudoir? No problem, bro. We've got your Viagra, your Levitra and your Cialis right here.

It's lazy for us to crave the goal without the effort, without the journey. The philosopher Martin Heidegger said: "Seeking itself is the goal."

Exercise offers unique and sublime pleasures – all sorts of kinesthetic sensations and endorphin-releasing exertions and intensities that enable us to exult in our physicality. If you seek fitness in a pill, you forego the divinely liberated, creative, meditative forms of cognition that frequently accompany vigorous exercise. There is something inherently satisfying in hard work.

We lose something by seeking these pharmaceutical shortcuts. Our poignant determination to remain vital and sexually attractive and dignified in the face of looming mortality really is life itself.

And what about these mice?  At labs all over the country, we're gorging mice on Aicar and GW1516, on experimental cognitive enhancers like D-cycloserine and T-588, and on life-expectancy enhancers like Resveratrol (which mimics caloric restriction) and DEHA (diethylhydroxylamine).  Maybe we should be a little more concerned about Mighty Mouse Blowback. Someday, we're going to be forced to confront marauding hordes (or at the very least, sleeper cells) of supermice – immortal rodents with six-pack abs who can play grandmaster-level chess.

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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 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 Dr. Billy Goldberg and Mark Leyner

We hope that those of you who share our insatiable appetite for pungent biomedical fodder heard about a health clinic in Arkansas that was evacuated recently after more than 30 people were sickened. The staffers and some patients were hit with symptoms that included nausea, dizziness and uncontrollable drooling. A hazmat unit from the National Guard ran precautionary tests, and health officials are looking into whether the outbreak might be connected to an exterminator's visit.

msnbc.com

Uncontrollable drooling?! Surely there's a disaster film in the making here. Imagine scores of hapless villagers borne away on a tsunami of drool!!

It makes good sense that a hazmat unit was called in because the toxic effects of pesticides – and nerve gasses, for that matter – may include excess salivation with drooling.

But before we tackle the fascinating subject of excessive drooling, which in polite society is more properly known as sialorrhea, how about a quick tutorial about saliva? Drool School.

Spit is one of those disreputable, often reviled bodily fluids that doctors – like chivalrous knights on charging steeds – feel an obligation to rescue from misperception.

Saliva is a clear, viscous fluid secreted from the mucous glands of the mouth. What a magical fluid! The WD-40 of our squeaking bodies.

It contains two major types of protein secretions aiding in digestion and lubrication, as well as several antimicrobial components. Our salivary glands produce about 2 to 4 pints of drool a day. 

All babies drool, especially when teething. But as children get older they usually learn to control their saliva and most kids beyond 4 years of age stop their drooling. Children who suffer from disabilities that impair the nerves or muscles in their throats and mouths may continue to drool past this age and may require treatment which can include speech therapy, biofeedback, medication and even surgery.

Pregnant women can also become big-time droolers. Their salivary glands may become swollen, their cheeks puff up and they can have difficulty swallowing and speaking. Sometimes they even have to constantly wipe their mouths to prevent saliva from dribbling down their chins. Ah, the blissful indignities of impending motherhood!

Breathing through the mouth while sleeping also can result in drooling, especially after a few alcoholic drinks.  

Not having enough spit can be equally uncomfortable. There are over 1,800 drugs that can make your mouth feel dry. Eighty percent of the top 10 drugs may cause oral dryness, including drugs prescribed for high blood pressure, anxiety, depression, allergies, weight loss or pain.

If a patient complains of sialorrhea – excessive drooling  –  various associated signs and symptoms need to be explored. Is there also a sore throat, difficulty swallowing, chewing, and speaking? Does the patient have pain or stiffness in the neck or muscle weakness in the face?  Has there been any exposure to pesticides? Are there bite marks?  (Excessive drooling can result from rabies.) 

Why so many questions about too much drool?

In the presence of other symptoms, it can be a sign of trouble. Drooling with fever may indicate abscesses in the head and neck area, tonsillitis, mononucleosis, strep throat or epiglottitis. If accompanied by dysphagia (difficulty swallowing), weight loss or facial weakness, persistent drooling can point to an esophageal tumor, Ludwig's angina or myotonic dystrophy. With Bell's Palsy, for instance, drooling often accompanies the gradual onset of facial hemiplegia (partial paralysis).  And drooling is a common complication of Parkinson's disease.

Now that you're slobber-savvy, you can meditate upon several saliva conundrums. Did you ever wonder where all that excess saliva that's sucked out of people's mouths at dentists' offices around the country ends up? If your suspicion is that tens of billions of barrels of frozen saliva is being stored in top-secret tanks under the Antarctic Ocean, awaiting the development of cars that can run on saliva — thus freeing us from the yoke of foreign oil dependence— you  might be on to something. 

What about kissing? Isn't it strange that for all the derisive things people say about spit, sharing it with other people is considered one of the sublime pleasures in life? 

A study recently conducted at the State University of New York at Albany found that men prefer wetter kisses. The authors of the study hypothesize that "kissing styles that maximize salivary exchange provide subtle information about a female's reproductive status since saliva and breath odor changes across the menstrual cycles."  The scientists speculate that "male preference for salivary exchange could function to introduce substances such as hormones or proteins into women's mouths that may influence their mating psychology, and even make them more sexually receptive."

So, in the end – as ruthless as it may sound – romance may all boil down to the Saliva of the Fittest.

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"For each ailment that doctors cure with medications (as I am told they do occasionally succeed in doing) they produce 10 others in healthy individuals by inoculating them with that pathogenic agent 1000 times more virulent than all the microbes - -the idea that they are ill."?
-- Marcel Proust, "The Guermantes Way"

Dr. Billy Goldberg:
This quote came to mind after a particularly grueling weekend in the ER.  You see, I am just getting over a brief yet vicious bout of nosophobia. Nosophobia refers to a morbid fear of contracting a disease. In my case, I was terrified of about 37 different ailments that might strike me or one of my family members down.  It didn't help that when I got home from the hospital I had to spend an hour convincing my sister that she didn't have thyroid disease, liver failure or metastatic cervical cancer.  My sister and I both share a genetic predisposition towards worrying that isn't exactly helped by my practice of medicine.

Surprisingly, most doctors aren't hypochondriacs.  But medical students often go through a phase of thinking they have everything they learn about in school. I can recall sitting in a genetics lecture with a pregnant friend and watching her cringe and rub her belly as we learned about every horrendous ailment that might affect her unborn child. This condition has been called "medical student's disease," "hypochondriasis of medical students" – and best of all, "medical studentitis." 

Some studies suggest that as many as 80 percent of med students suffer from unfounded fears of illness. The prevalence of true psychiatric hypochondriasis among regular folks has been estimated to be as high as 10.7 percent. This number strikes me as low, probably because it doesn't include people like me who have occasional episodes of hyponchondriacal thought.

Most medical students recover from their "medical studentitis" and join the legions of doctors who ignore their own medical illnesses and scoff at their patients who have unfounded fears. Unfortunately, I am prone to relapse.  Where does all this leave me? I have no idea, but I sure would like to forget my sister's fears, that 5-year-old who came into the ER with newly diagnosed leukemia and that funny lump that I have on my own leg.

Mark Leyner:
Hypochondria is a Möbius strip to me.  I can't tell where it begins or ends, or, conceptually, what's the inside and what's the outside of it. So, it produces a kind of vertigo. Or maybe I just think I have vertigo.

Isn't there a profound truth to thinking that we're sick all the time? The reality is that once we've outlived our prime procreative days, we begin to inexorably degrade. Our very bodies become constant reminders of our own mortality.

Isn't hypochondria, actually and paradoxically, an illness in and of itself?  It's included in the category of somatoform disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the reference handbook used by clinicians to guide the diagnosis of mental disorders. Some experts argue that hypochondriasis shares many features with obsessive-compulsive disorder or panic disorder and would be more appropriately classified with the anxiety disorders.

So, thinking you're sick when you're not is … sick.  Hmm.

Our society's ingrained hostility to hypochondriacs clearly demonstrates how arbitrary cultural judgments can be. Certain delusions are more disreputable than others. We denigrate hypochondria – the delusion of being ill when one is well. But we laud sick people who think they're well – it's evidence of a brave and gritty optimism. Stupid people who maintain the delusion that they are smart tend to be intolerable. But smart people who insist that they are stupid display wonderful humility and charm. And even in the pecking order of bogus invalids, hypochondriacs rank above the malingerers, who knowingly feign illness or other incapacities in order to avoid work.

As a child, I was elaborately schooled in the fine art of hypochondria.  Hypochondria was to my family what skiing or folk-dancing was to other families – a traditional pastime that stretched back for generations. Dinner conversation inevitably turned to someone's bloody sputum or lumpy testicle. It was like a never-ending borscht-belt production of Munchausen syndrome (the epic Wagnerian version of hypochondria).

Here are some of the conditions, diseases and tumors I've thought I've had just over the past two months:  oligodendroglioma, arrhythmia, bladder cancer, skin cancer, cirrhosis of the liver, syphilis, Crimean-Congo hemorrhagic fever, Creutzfeldt-Jakob disease, anaphylactic shock from dust-mite allergies, some teratological malformation of the alveolar ridge, and bronchiolitis obliterans (Popcorn Worker's Lung Disease).

The consummate achievement in the art of hypochondria goes considerably beyond merely thinking that you're sick. The ultimate form of hypochondria is thinking you're dead. A person who thinks he's dead, but consents to a sort of feigned life is to be enormously admired.

Here we can see how this ultimate hypochondria can be a profound expression of bushido – the traditional code of the Japanese samurai.

This is how Yamamoto Tsunetomo, a 17th-century samurai retainer of the Nabeshima Clan, described the proper attitude of a warrior: "Every day without fail one should consider himself as dead. There is a saying of the elders that goes, 'Step from under the eaves and you're a dead man. Leave the gate and the enemy is waiting.' This is not a matter of being careful. It is to consider oneself as dead beforehand."

Now there's an eminently healthy attitude, if I ever heard one.

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Dr. Billy Goldberg:
What ever happened to good old-fashioned romance? Oysters and champagne are passé as people reach for more exotic aphrodisiacs. The pursuit of a sex boost had a deadly result for one New York man after he ingested an aphrodisiac made from toad venom. This poor soul ate a product meant for the skin, and unfortunately it contained a chemical that had effects similar to the heart drug digitalis, which can cause irregular heart rate, nausea and vomiting.

What a terrible way to go.

Aphrodisiacs are by no means a new invention. The name comes from Aphrodite, the Greek goddess of love and beauty, and throughout history many products have been believed to stimulate sexual desire – from rhino horns to snails to the beetle-derived "Spanish fly." Viagra is mistakenly thought of as an aphrodisiac, but rather it's a treatment for ability (impotence), not desire.

Unfortunately modern pharmaceutical companies have yet to find that magic little potion to increase sexual desire. Just this month, a highly touted compound, Bremelanotide, originally known as PT-141, was shelved as an aphrodisiac by its company Palatin Technologies. This nasal spray showed remarkable promise stimulating the desires of both men and women, but it also raised their blood pressure. Don't give up hope. The company has another compound, PL-6983, that they're banking will take its place.

In the meantime, you will have to rely on the old standards such as alcohol, chocolate, roses or Barry White music. A search of the word aphrodisiac in my medical database revealed 197 scientific articles. But after reviewing several, I realized that there is very little data demonstrating that many of the herbal preparations available work in humans.  I will admit that a variety of things such as Cihuapatli, the Mexican zoapatle (Montanoa tomentosa) or Curculigo orchioides rhizomes (Golden-eye grass) have created some pretty horny lab rats.

Once, in Jamaica, I tried a roots-based tonic, Baba Roots, that claimed to be a "front-end-lifter," but I can't say that I felt any "lift." John Layfield, a former professional wrestler turned Fox News business commentator, is embracing this Caribbean folklore as he peddles Mamajuana Energy, his own version of an herbal elixir from the Dominican Republic.

Don't bet on it. However, if you are feeling really adventurous, you could travel to Beijing and visit the Guolizhuang restaurant, where chefs specialize in a range of penis and testicle dishes derived from dogs, donkeys, sheep, horses and seals  -- all thought to boost libido.

I think I'll stick to the oysters.

Mark Leyner:
I have to confess that I'm absolutely baffled by this subject. The whole idea of aphrodisiacs is so alien and remote to my life as a man that I wonder if I can conjure up even a single insightful thing to say. Ingesting toad venom to get an erection? I think about sex about 10 trillion times a day. It is mind-boggling to me – as sex-obsessed as I am – that I would ever take something that would cause me to think even more about it.

Who needs toad venom?

There's not a single part of a woman's body that doesn't arouse me. I don't even need to see or think about the standard erogenous zones. Every inch of a woman is erotic to me, including the internal organs. How many thousands of hours did I squander as a teenager, shuttered up in my room, lecherously ogling my transparent female figurine, with all the incredible libido-inflaming anatomy and viscera visible to my hungry eyes?  The lungs, the pancreas, the sigmoid colon, the adrenolumbar vein…  Yikes!

I actually think I need some sort of "anaphrodisiac" – something that would actually inhibit my libido.

For most men, thinking about their grandmas – dead or alive – should usually result in an almost instantaneous decrease in tumescence. 

But when I think about my grandmother, the image of mah-jongg tiles immediately comes to mind. And along with the memory of those tiles, comes the memory of the fleshy, heavily freckled arms of the buxom women – my grandmother's friends – shuffling those tiles in the brutal sun in front of their cabana at the swim club…  Obviously going down that road will do me no good at a time like this.

I did see a psychiatrist once about all this. More out of curiosity than any alarm. After 45 minutes of regaling him with an anecdotal history of my libido, he concluded that, to an unusual degree, I cathect everything – that is, I inject almost every object in the world with libidinal energy.  He ventured the opinion that I might be stuck in some infantile stage of polymorphous perversity.

As he was talking, I was absently fondling a golf ball I'd found on his desk.  The ball was inscribed with the word "Effexor." It was one of those promotional trinkets left behind by some pharmaceutical sales rep.  Rolling the ball in my hand, I couldn't help but picture Jang Jeong or Meena Lee or Shi Hyun Ahn or any one of the many South Korean lady golfers who've become such a dominant force in the LPGA.

Even typing the words "dominant force in the LPGA" is highly arousing to me right now.

Toad venom?  For me?  I don't think so.

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 By Dr. William Goldberg and Mark Leyner

Is it just us, or does it seem like everyone is either searching for that little something to get a competitive edge or simply struggling to keep up?

Americans are 24-7-365. We are both guilty of swilling espresso as we burn the candle at both ends to finish our new book.  But that doesn't disturb us nearly as much as the overwhelming amount of highly caffeinated "energy" products being marketed to help stimulate our competitive kids. Snack food maker Mars has even released a new "Snickers Charged," so even candy can now give you an extra nudge.

The pharmaceutical industry is, of course, lurking right there with a whole slew of cognitive enhancers to push our bodies and brains to their max.

As a society, we tend to reflexively deride and often morally condemn the instant fix (while at the same time scrambling for it). But what about drugs that can instantly improve your cognitive functioning? Not good, right? They're unfair – like steroids for the brain.  Until you consider the pilot who's flying your plane for the next 10 hours or the neurosurgeon operating on your mom. Maybe a hit of Provigil doesn't sound like such a bad idea. 

There's nothing earth-shattering or radical about the idea of "cognitive enhancers." Caffeine and nicotine are two old-school boosters. Many studies have proven that both help maintain attention, heighten alertness and, of course, keep people awake. Research has also shown that caffeine possesses cognition-enhancing properties that can enhance higher cognitive functions like short- and long-term memory and perceptual sensitivity.

But a java jolt isn't enough for those seeking the the new "smart drugs" or "nootropics," many of which were originally developed to treat neurological or mental disorders such as Parkinson's disease.

"Two of the drugs which are now being used as cognitive enhancers, donepezil and tacrine were originally approved in the United States for treatment of Alzheimer's . A study published in the journal Neurology found that commercial pilots who took 5 milligrams of donepezil for one month performed better than pilots on a placebo when asked to fly a Cessna 172 on a flight simulator. There was a significant difference between the groups in the effectiveness with which they dealt with emergencies.

"Then there's Ritalin, the drug of choice on college campuses for sleep-deprived students struggling to pull all-nighters, complete term papers, even boost concentration during exams.
Drugs like Ritalin and Adderall are commonly prescribed to treat attention deficit hyperactivity disorder (ADHD). At recommended doses, these medications can accelerate the central nervous system, heightening concentration and alertness.

"But as a "smart drug," Ritalin may not be quite so smart. Never mind the fact that sharing prescription medicine is a felony drug offens in most states – taking excessively high doses of Ritalin can increase the risk for neurological and heart-related symptoms.

The current superstar of prescription stimulants is Provigil (Modafinil), first approved as a treatment for narcolepsy. A secondary indication was to treat something called Shift Work Sleep Disorder (SWSD), a sleep disorder that affects people who frequently work schedules that resist the body's natural Circadian rhythm, such as night shifts or rotating shifts. We both know doctors who regularly use Provigil.

Provigil can keep a person awake and alert for 90 hours straight, with none of the jitteriness, impaired concentration, "rebound effect," or risk of addiction associated with amphetamines or even coffee.

Not surprisingly, Provigil is reportedly popular with the U.S. Air Force, and has been used more than 150 times this year by bomber crews to ward off fatigue on missions of more than 12 hours.

Barbara Sahakian, professor of neuropsychology at the University of Cambridge, who has conducted extensive research on Provigil has found that it results in greater concentration, faster learning and increased mental agility. "It may be the first real smart drug," she has said. "A lot of people will probably take [it]. I suspect they do already."

Provigil seems to safely bolster alertness for days at a time with few side effects, but its long-term effects have not been sufficiently studied to completely rule out all potential problems. 

A couple of final points. We're both fathers. When conversations turn to cognitive enhancers, the issue of "fairness" invariably comes up. For instance, do you want your kid taking the SATs and competing with a bunch of other kids who are tweaking on Provigil? Hopefully, we will have instilled in them an awareness of the profound difference between the ability to perform well on standardized tests and the capacity for intellectual discovery, innovation and creativity, and humane conduct.

But we may be in the minority. The "customized" man is looming and there may be little we can do about it.

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By Dr. Billy Goldberg and Mark Leyner

 

Dr. Billy Goldberg:

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