The Impossible Love

-“Doctor…I think of him all the time—sadly our love was not meant to be.”

Victoria X. is a successful and enchanting middle-aged lawyer that has a beautiful family of five, a loving husband and four gifted children. However she still longs for that older man that seduced her while she was a college student with his wits and poise; they had a tumultuous love affair but it ended when he refused to leave his wife for her. Hr own Impossible Love.

Considering that I have heard many similar stories during my medical practice, I decided to use that concept in my novel “Madame D.C.” as one of the plot drivers. Maurizio, one of the three main protagonists, is being coached by a uniquely mellifluous counsellor that camouflages as an innocuous bank clerk in Coral Gables. The maliciously manipulative character aims to give him a unique emotional compass in the treacherous path to reach Emily’s heart so he would become inevitably, tragically beholden to “it.”

“Maurizio entered the cavernous lobby of the Coral Gables bank at ten in the morning, barely one hour after it opened, with no customers in sight. Mr. Roth’s secretary had left him a message the day before, telling him that his loan had been approved and that he had to come to sign the paperwork.

Maurizio could not believe that the fastidiously staid bank would take that risk with someone like him devoid of any significant credit track record. In fact he had filled the application forms expecting a negative outcome.

It turned out differently. He had a friend inside with unusual powers.

After he was done signing, Maurizio thanked Mr. Roth’s secretary and went out to the main lobby to cash a check for his weekend expenditures. Everybody seemed to be either taking care of a sudden wave of customers or taking their breaks, for which he stood in line for the next available clerk.

-“Psst… Maurizio, come here,” said a voice carried by a rare scent.

He walked up to the far window where Lucy was waiting. “Are you free?”

Lucy smiled broadly. “I only show up for VIP customers like you—”

-“Thanks. Just want to cash this,” he said passing the check across the ledge. -“Got my loan finally…. Thanks for putting a good word for me.”

-“Don’t know the half of it… Roth first rejected it but a top dog overruled him…He owes me ‘cause I helped him get rid of his rabid mate. Sad story.”Maurizio put the dollar bills in an envelope and was ready to leave.

-“Thanks… It’s time to go back for the lunch—”

-“Wait a minute…How come you don’t have a girl-friend yet?”

-“I don’t know…Funny that you’ve asked because I just met a nice girl.”

-“Well, then don’t let her go away…Grab her…Fast… Give her what every woman secretly desires in her heart and only a few can obtain—”

-“What? A nice car? She has a Jaguar already.”


-“What? A diamond ring? She has a rock already.”


-“Mmm…What can she possibly want? I know—a Falcon jet.”

-“NO…It’s the illusion that has prodded women to go through the travails of procreation for ages…And toil so hard for their children and spouses.”

-“Don’t play that sentimental card with me.”  Maurizio twinkled his nose.

-“Er…I’ll tell you in exchange for a tiny winy favour… Deal?”

-“Sounds fair…Okay. What does that rich uptown girl covet?”

-“An Impossible Love—the more twisted, the better….Colonize her mind, hijack her dreams, confiscate all her hours—put some poetry in her life.”

Maurizio was left speechless by the logic of his Caribbean Celestina.”

What do you think? Please tell us.

Don’t leave me alone?

The PURE study

In modern nations the importance of consuming fruits and vegetables in order to prevent cardiovascular diseases has been studied extensively. However the same does not hold truth for the rest of the nations until the “Prospective Urban Rural Epidemiology” (PURE) study, a prospective cohort study that involved 135,335 participants aged 35 to 70 years without cardiovascular disease in 18 low, middle and high income countries. Dietary guidelines recommend a minimum of 400g/day of fruits and vegetables but it has not been truly achieved on a global basis due to the cost limitations.

Victoria Miller et al. enrolled participants between January 2003 and March 2103 that responded to standardised questionnaires about socio-economic, lifestyle, personal health and family histories. They studied outcomes like major events related to cardiovascular disease (myocardial infarction, stroke, heart failure) and mortality rates produced by those conditions. Cox models were created to study the association with fruit and vegetables consumption. Potatoes and other tubers, fruit-vegetable juices were excluded; the legumes were beans, black beans, lentils, peas, chickpeas and black-eyed peas.

The authors wrote: “during a median 7.4 years (5.5-9.3) of follow-up, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex and centre…Higher fruit, vegetable, and legume consumption was associated with lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375-500 g/day)”

The researchers also found that participants that consumed more fruits, vegetables and legumes had higher education, higher levels of physical activity, lower rates of smoking, and higher energy, meat consumption and were more likely to live in urban areas. There was an 11% lower risk of major cardiovascular disease for the highest fruit intake category compared with the lowest category intake; there was a minimum benefit from a higher vegetable input. The authors hypothesized that given that vegetables can be consumed raw or cooked, the latter might have degraded nutrient contents.

What do you think? Please tell us.

Don’t leave me alone.

Il Panettone

The leavened cake made with a base of water, flour, butter, eggs plus the addition of dried fruits and nuts is a traditional staple in the Italian—and by extension the Italian-American—tables during the Christmas season. We have all watched our dear grandmothers and mothers bake it at home or in modern times accompany them to our favorite bakery to buy them.

What is the origin of this simple yet delicious accoutrement of festivities? There are two major legends and both arise from Milano in the Middle Ages.

The first legend says that the cooks preparing a big banquet hosted by Ludovico il Moro, the powerful duke of the city, had forgotten to take out the dessert from the oven, which ended up as pure carbon. A humble kitchen helper called Toni prepared an impromptu cake with the kitchen leftovers. The head cook was reluctant to present that novelty in the master’s table but he finally agreed, hiding behind a curtain to peek at the guests’ reaction. Everybody loved it including Ludovico who inquired who had prepared it. The cook came out of hiding, saying: “L’è ‘l pan del Toni”, i.e. il panettone.

The second one tells the passionate love that a young nobleman called Ulivo degli Atellani de Futi, a.k.a Toni, had for Algissa, the gorgeous daughter of a baker from the quarter of Contrada delle Grazie. Observing that the girl was permanently courted by many aspiring lovers that she invariably rejected, he devised a novel plan to seduce her. Camouflaging himself as a humble man, he was hired by her father to tend the wood oven in the early dawn, One day he mixed the best flour he could find with eggs, butter, honey and sultanina grapes and he clandestinely prepared the dough; then he baked it in the oven. When his boss came to check on his work, he was very impressed by it; he put it for sale in his stalls, becoming an instant success for the establishment.

When Algissa found out what he had done, she became infatuated with him. Except for the occasional gold-digger only interested in material goods, most women would appreciate that noble, original gesture inspired by his strong affection for her.

As the great playwright Jean Baptiste de Poquelin (Molière) sagely told us: “La grande ambition des femmes c’est d’inspirer l’amour.”

What do you think? Please tell us.

Don’t leave me alone.

The compulsive gambler

-“Doctor…My husband is addicted to gambling—he’s destroying us.”

Maria X. is an educated and charming middle-aged lady with a caring husband and two teenage daughters; unfortunately the successful car dealer likes to visit almost daily all the gambling options available in South Florida to try his luck. He has won big several times but his losses are even greater. Slowly he is eroding the good financial standing of the whole family and only the firm determination of his wife prevented him from mortgaging their colonial style mansion in South Dade to pay off some outstanding debts.

The basis of this addiction is that gambling stimulates the brain’s reward system like drugs and alcohol, being closely related to some personality disorders like highly competitive, restless or easily bored individuals. Sometimes it is only another behavioural manifestation of mental health disorders like depression/anxiety, bipolar disorder, obsessive-compulsive disorder, attention deficit/hyperactivity disorder or substance abuse. It used to be much more common in men but women are catching up quickly; it appears in middle age but when it does in later stages, it worsens rapidly.

As we have already discussed in our previous articles about alcohol abuse and compulsive shopping, the addicted individual needs to increase the amount he/she/sie invests in order to maintain the same level of satisfaction. Oftentimes it is an escapist attitude to cope with family or work problems that cannot be easily shared with the individual’s intimate circle. When the addicted persons try to control or stop this addiction, they feel restless and irritable with the inevitably nefarious social and professional consequences. In a consumerist society like the USA with plenty of physical and virtual opportunities to wager on almost any kind of sports or gaming tables, this addiction is fast becoming not only a personal but also a public problem.

There are some American civic personalities that are questioning the spread of state-sponsored lotteries with the purported aim of funding education; they claim that they prey on the poor and gullible without helping them.

What do you think? Please tell us.

Don’t leave me alone.

The first man that listened to women

Sigismund Schlomo Freud—born on May 6th 1856 in Pribor, Moravia and passed away on September 23rd 1939 in London, England—is one of the most respected and at the same time debated physicians in modern medicine. He was one of the earliest founders of Psychoanalysis and his pioneering work in the intricacies of the Unconscious mind still perturbs us all deeply.  He was definitely the first man that considered women as human beings with their own particular sexual desires and listened eagerly at what they said.

If you peek briefly at our screen presentation, you will see a depiction by Brouillet of a theatrical class by Jean-Martin Charcot in the Neurology clinical ward of the Pitié-Salpetrière hospital of Paris, where he had showed the power of the techniques of hypnosis to extract information from “hysterical” women that expressed neurological symptoms. Charcot dismissed the sexually-related complaints of women—“la chose genitale”—as not relevant to the therapy. But there was one Austrian physician in the public that, after spending time studying with Charcot, went back to Vienna and teamed up with Joseph Breuer to design the free association and interpretation of dreams. The recall of the early psychological traumas uncovered the origin of clinical neuroses.

In the puritan social atmosphere of early 20th century Vienna, Freud was considered a dangerous, rebel practitioner and he struggled to make a living. Even today he still has many ardent detractors that view him as nothing more than a clinical impostor that has been unfairly idealized by the public. Frederick Crews writes in his book “The making of an illusion” that we must strip Freud of his perennial image as “a lone explorer possessing courageous perseverance, deductive brilliance, tragic insight, and healing power.”  He even claimed that Freud had plagiarized the data of Pierre Janet, a French psychologist, in his articles, which is refuted by the fact that Freud gave due credit to his colleague in his early writings about the origin of neuroses.

Keenly trying to disparage him Crews writes about Freud’s experimentation with cocaine, a new drug then, his Victorian views of women and even his purported affair with his sister-in-law. He questions his whining about being a “lone outcast” dismissed because he was a Jew, considering that 20 % of the student body in his medical school class were Jewish, even though only 10% of the city population professed that faith. As a member of the Italian-American community, I understand how Freud wanted to assimilate while at the same time  keeping a resilient sense of “not belonging.”

What really flustered me when I was reading this book is that the author claimed that Freud had little contact with patients and that he fabricated his clinical data. In the Library of Congress, we can see Freud’s 1886-1889 patient record book where it shows that he treated almost 500 of them regularly. There is no way that Freud could have learnt so much about women and their ideation without going through the slogging task of actually listening to them. I know. I have been there. In a humble physician’s office like Freud’s inner sanctum.

What really prodded me to write about women’s emotional frustration in my novel “Madame D.C.” and in my 2nd manuscript, is that, after stoically listening to them in my office for years, something has percolated through my brain. In our male-dominated society, that caring predisposition to really listen to them can make you a lot of enemies.

What do you think? Please tell us.

Don’t leave me alone.





Crying alone in the bathroom

-“Doctor…At nights I hide in the bathroom—so my children can’t hear me cry.”

Veronica X. is a nice, attractive, intelligent and hard-working mother of two small children who has had to shoulder the entire burden of her household all alone as her husband is serving a two years-sentence for a minor offense. Her family cannot help her economically and only her mother is pitching in. Oftentimes feeling overwhelmed by all her responsibilities, she puts her kids to bed, finishes her household duties and then locks herself in the bathroom to well up at ease. It is an almost daily ritual that she needs to go through in order to decompress her strained psyche and get some needed sleep.

When she was telling me that anecdote in my office, I immediately felt the surge into my conscience of a stampede of sweet-sour childhood memories. In 1965 my father Mario—God bless his soul—was arbitrarily jailed for a few months to force him to pay an outstanding debt—a barbaric maneuver. My dear mother Gladys became extremely depressive and our grandmother Yolanda took us in her large suburban home so she could rest and recover. My brother and I were only 10 and 11 years old at the time but we knew that something was sorely amiss, especially when we heard her crying in the loo late at night. Those memories were painfully seared in our subconscious.

Modern women, who are employed full-time in demanding jobs, usually have to return home to complete the family tasks with little or no help from their live-in partners; to make maters worse they might not have the support offered by the female friendship. They decided to stoically hide their deep feelings of angst from impressionable children and from some relatives that might not completely share her opinions. In our digital age where most of the rooms in a house are invaded by a pinging or noisy device, they have to retrench to the bathroom as the improvised refuge for a safe, solitary exteriorization.

As sons and spouses of these most devoted women there is something we can do. We can wait until they get out of their hiding place and hug them tenderly in silence. We can tell them how much we appreciate their work and what a difference it makes in our lives. We can give them a lot of affection and moral support. And yes, we can offer to share more of the burden of homemaking with her. Chose the way you want to help (I love to cook for example) but do not ignore her suffering and extend her a hand. She’s waiting.

What do you think? Please tell us.

Don’t leave me alone.

Clinical challenges in Transitioning

There is a dearth of clinical knowledge and expertise in the slowly yet surely evolving field of Transgender Medicine as only lately most practicing physicians have honestly  acknowledged that they know little or next to nothing about Transitioning for these patients. But many enthusiastic and honest professionals are starting to study the clinical challenges posed by these patients and trying some specific, practical steps.

Considering that Transgender people are usually receiving treatment with exogenous hormones that alter their metabolism, the established treatment protocols might not be entirely appropriate and they must be adjusted. Moreover since the hormonal schedules are often changed in composition and dosage, the treatment of chronic ailments must be adjusted accordingly.

The use of Testosterone in the female to male transitioning schedule could worsen a previously existing endometrial neoplasia. The use of estrogens in the male to female transitioning schedule can stimulate the appearance of blood clots. The use of hormones can affect chronic neurological diseases like Epilepsy. Some studies have suggested that there is negative interaction of Estrogen with antiepileptic drugs but its extent has not been established. The control of seizures becomes more difficult as new hormones are added.Transgender people have a higher rate of HIV infections and use retro-viral medication, which can interact with the hormones in still unforeseen ways.

Sadly one of the commonest reactions of clinicians who encounter treatment difficulties in their Transgender patients is that they must immediately stop the use of hormones until further notice. The subconscious in their minds still resists the idea that Transgender people are different and they need their hormonal treatments to become fully identified with their gender of choice. The only way to surpass this obstacle is to maintain good communications between the clinicians and the experts managing the hormonal treatments. Trans patients occasionally complain that some drugs are promoting a faster metabolic degradation of the hormones in their livers, for which they cannot benefit from their full metabolic effects in their Transitioning protocols. Instead of just dismissing those complaints, physicians should find solutions.

What do you think? Please tell us.

Don’t leave me alone.