Musings from the Disenchanted Doctor: an unscientific blog






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Glorious Fourth



As to what I did for the holiday weekend: Not all that much. Went out to the suburbs to visit my folks; swam; priced refrigerators at Sears (Really. I need a new one. My current fridge is maybe 20 years old and is on its last legs); saw Transformers II; and bought an iPhone.

Yee-haa! I have an iPhone! I'm still in the process of programming it, but I have one.

As regards the Transformers movie, it was remarkably bad. What can you say about a movie that uses a dog-humping joke three times (once with a robot)? I can't say it was worse than any other big, dumb summer movie I've seen in the past... Independence Day and The Day After Tomorrow come to mind. Mainly I went because part of it was filmed on location at my alma mater and because I'm a fan of a couple of character actors who were featured in it - John Turturro and Glenn Morshower. This sort of film always has to have a couple of competent actors to anchor it. It also had a lot of neat location shots of Egypt and Petra, Jordan. Having been there six months ago, the travelogue bit held my attention.

Other than that, not much happened and that suited me fine. Just having three days off in a row was enough.

Labels: The Doctor's Life

posted by Dr. Alice at #

 
Best Excuse Ever

For the most part we docs are reluctant to prescribe antibiotics without seeing patients. The ever-present specter of drug resistance plays a large part here, not to mention the low (but possible) risk of side effects associated with antibiotic use such as allergic reactions, antibiotic-associated colitis and yeast infections. Sometimes, though, we don't have a choice. Such situations usually arise when we're on call and have no choice but to assess symptoms over the phone; after all, you can't send people to the emergency room for everything. In these cases you take a history over the phone and do the best you can.

The most unusual case for antibiotics that I have ever heard was fairly recent, a patient calling on a Friday night with symptoms of a respiratory infection and a history of recurrent sinusitis. After sharing all this he added: "I'm going to swim with the beluga whales tomorrow for my birthday and I know I'm going to get worse after being in the water. And it's too late to cancel our reservation, we'll still have to pay for it."

My mouth fell open. "You're going to what? With what?"

"Swim. With belugas." He sounded entirely rational, but to me this made as much sense as saying "We're going to fly with pink elephants tomorrow." Apparently it's possible to make reservations at Sea World, or some such place, to swim with beluga whales.

I gave him the antibiotics. Even if the guy were lying through his teeth I felt he deserved points for originality.

Labels: Los Angeles, Medicine

posted by Dr. Alice at #

 
Overdue Update



I've been feeling bad for a while now that I have not posted more on this blog. But pretty much all I have to talk about is work, and I don't want to be posting about other people's (which is to say patients') travails. It's bad form to reveal someone else's personal tragedies. Listing is one thing, details another.

Though I haven't written about it, much has been happening here in Feet First Land and not all of it good. Back at the start of the year I went on a lovely trip which I still intend to post about more someday... but I returned to several other changes: my two former office partners have left -- one moved to NYC, one moved just down the hall -- and I now have two new partners. I will refer to one of these two new partners as The Thorn In My Side, or TTIMS, because that's what he is. TTIMS is, at a rough guess, 35 years older than I am. He's a nice enough fellow but he seems to have graduated from a residency program circa 1912. Lest you think I am exaggerating, I will tell you that he calls all female MD's he works with "honey" and "babe" and squeezes their arms -- not meaning to be creepy but affectionate. I can deal with that (just), but there's more. He also micromanages (in the sense of holding a magnifying glass over his secretary) his office, but apparently to little effect: He sees about half the number of patients that I do. The biggest problem is that he perpetually complains but refuses to change anything about his office arrangements. My motto has always been "Don't complain unless you're willing to take action," but this is exactly what he won't do.

In addition, and more saddening, is the almost endless parade of bad news among my patients. A new patient with mental status changes turned out to have a glioblastoma (brain tumor) and died within a month. I've had several new diagnoses of lung cancer, brain cancer, myeloma and a probable amyotrophic lateral sclerosis. And a beloved relative has been diagnosed with a serious illness, is now undergoing chemo and will need further aggressive treatment later this summer (I have been signed up as caregiver when relative begins this treatment). In short it's been a difficult six months.

The good news: I think I have finally found the impetus to begin the novel about primary care medicine that I've always wanted to write. Who knows if anything will come of it.

Labels: Medicine

posted by Dr. Alice at #

 
Man In the Mirror


I'm always going to wonder what Michael Jackson was thinking about when he sang these words:

I'm looking at the man in the mirror
I'm asking him to change his ways...
And no message could've been any clearer
If you wanna make the world a better place
Take a look at yourself and make that change

I had a chat with one of our pediatricians this afternoon after the news broke. We agreed that children everywhere could probably sleep better now. Sadly, the man had talent to burn and he was one of the world's great dancers; he was also completely screwed up.

He also left us a legacy of whacked-out wedding videos... we will be watching wedding parties reenact "Thriller" for a long time.

Labels: Los Angeles, Pop Culture

posted by Dr. Alice at #

 
Pixar Aims High, Doesn't Miss


I saw Up this weekend, which means I've already seen two more films this summer than I saw last year. Here's your real short film review: it's excellent. Go see it.

Long version: last week after seeing Star Trek my friends and I went to dinner, during which I whined: "What is it about screenwriting today? Why doesn't anybody realize it's about the characters, and the dialogue, and the plot? I mean, look at those trailers we watched!" (G.I. Joe and Transformers II, in case I have to remind you).

One of my friends who has a fair amount of screenwriting experience responded with reasonable answers (the amount of money invested in films today, the value of toy rights, video game rights, etc.) I know he's right, but in all but the most exceptional case you wind up with crappy, unwatchable films with the sound of things blowin' up for two hours. Oh, and perhaps the hero and heroine getting it on for a couple minutes, just for a change.

Pixar has miraculously managed to avoid this pitfall. They consistently come up with brilliant, imaginative, watchable films featuring characters that the audience identifies with. Up is no exception; in fact I would say that Pixar has outdone themselves with this film. From reading reviews on IMDb I got the impression that the people who had issues with Up thought it was either a) too sad or b) had too much comic relief. Me, I thought they hit just the right balance.

Let me be honest and say that you probably don't want to take a little kid to this film. It deals with the Big Scary Stuff like aging, death and having your parent desert you. But Up touches lightly on these heavy themes and gives us a healthy dose of imagination and adventure to sweeten the bitter undertone, and sends you out of the theater feeling uplifted. So to speak.

I will just give you a few of the highlights that struck me. The montage at the beginning of the film, which tells the audience about Carl (the protagonist's) life, is brilliant and will in fact move you to tears. What really hit me was a split second shot during the wedding scene. The camera viewpoint moves from the bride's family, madly applauding and happy, to the groom's family - tightly smiling and tepid. That's all we need to know about why child Carl is so monosyllabic and why he is the way he is as a senior citizen. Brilliant.

The dogs: some of the commenters in IMDb felt they were crappy comic relief. I couldn't disagree more. They don't literally "talk," but wear translator collars which turn their thoughts into English. This was another incredibly imaginative idea, as it allows for lots of humor when the collars malfunction (Alpha Dog's collar keeps doing this) and gives the dogs an interesting cadence in their speech. It's slightly stilted and the syntax is a bit off - in short, they don't sound like people, they sound like dogs. Also, I give the film major points for avoiding butt-sniffing jokes, "dogs marking their territory" jokes and so forth. They don't have to go there: they're Pixar.

Ed Asner does great voice work as Carl Fredricksen, and it's a delight to hear Christopher Plummer as bad guy Charles Muntz (his character resembles Errol Flynn crossed with Charles Lindbergh). His character's name is a bit of an inside joke, as Walt Disney's original backer was named Charles Mintz. He later co-opted the rights to Disney's first hit character, Oswald the Rabbit. Disney responded, of course, by coming up with Mickey Mouse.

Long story short, this is probably the best movie of the summer. It'll make you laugh, it'll make you cry, it'll make you think (but not too hard). It has travel, adventure, life, death and talking dogs. Go see it.

Labels: Pop Culture

posted by Dr. Alice at #

 
Get Your Trek On

Star Trek premiered on first-run TV when I was just a tad, and though I have a few memories of the show in its original run I never really watched it until I went to college. My freshman dorm had a lounge with a television -- what, have your own television in your room? That's crazy talk! -- and the local TV station showed reruns of Star Trek every night at 10:30 pm. (In those days it wasn't referred to as TOS, since there were no other shows from which to distinguish it.) I forget now what drew me down there in the first place, since I never had really watched the show, but I know what kept me coming back: the sense of community. The audience was mostly guys who had watched the show so many times that they could tell you from the opening shot of the Enterprise circling a planet which show it was. In fact, they would compete to see who could shout out the name of the episode first.

I still have happy memories of those evenings in the lounge. For one thing, even though the gender makeup of the audience was about 80 male/ 20 female, there was no misogyny, no sense of anyone hitting on anyone. People were there to share their love for the show, and that was it. All attendees were welcome. For another, the fans' affection for ST was not blind hero worship but rather ironic. I was introduced to all the tropes of the show early on (i.e., Captain Kirk sleeps with alien girl and converts her to the cause of the Federation). My favorite moment may have been the bit when the crew was hiking up a mountain and somebody yelled "Dammit Jim, I'm a doctor, not an escalator!" After an evening of panicked studying, it was a refreshing break.

Years later when I was in medical school along came Star Trek: The Next Generation. You may not remember how eagerly this show was awaited at the time: Trust me, I sat in a lecture hall with Trekkies every freakin' day and I can tell you it was a hot topic. It was pretty good, actually, though the earnest PC premise of the show wore thin after a while. My real issue with it was the persistent theme that everything, everything, would be solved in the future. I'll give you an example. In one episode Captain Picard is complaining of a headache, and what's her name the Betazoid empath replies earnestly, "Something must be wrong. No one in the twenty-fourth century has headaches any more." I'll tell you what my response to that was: BULLSHIT.

Fast forward to residency. Deep Space Nine premieres. I'll tell you, as far as I am concerned this was the best Trek show ever. It had character development, conflict, drama, and the show wasn't afraid to develop plot arcs that took more than one season to resolve. This is almost unheard of in television even today; fifteen years ago it was an absolutely revolutionary idea. It also had Garak, the tailor/spy/refugee from Cardassia, and the most morally ambiguous character since Captain Renault in Casablanca. Oh, and did I mention the brilliant writing? Okay then.

I am finally getting to my point, which would be the recent Star Trek movie. I had not intended to see it, assuming it would be terrible, till I read a couple of glowing reviews online. Last night a couple of friends (who had already seen it once) invited me along, swearing I would love it.

They were right. It really is that good. It's true to the spirit of the show and the writers get the essence of the characters, but it doesn't take itself so seriously that it adheres fiercely to every bit of the backstory. And there's a good reason for this which is worked into the plot very nicely. The words "alternate reality" may make you cringe, but in this case they shouldn't - it works. What I really liked, in fact, is that "alternate reality" is usually just a toy for the writer to play with, but in this case you see the implications (very serious implications: the loss of a parent) play out. These implications are a bonding point for Kirk and Spock, who can't stand each other to start with.

All the characters get their moment in the sun. McCoy is a hoot, Scotty is a joy, Uhura is hot and smart. She and Spock appear to be getting along quite well by the end of the film, and I can't wait to see what happens with them next. If you're looking for small nods to the audience, the film has them: Kirk's commanding officer is Christopher Pike, and at the end of the movie he shows up in a wheelchair - you have to have seen a particular episode of TOS to get this. When we first see Scotty he's got a pet Tribble in a cage. And so forth.

Suffice to say my expectations were low, mainly because I have a deep distrust of movies that rely on special effects rather than character development (we had to sit through trailers for G.I. Joe and Transformers II, which are exactly the sort of dreck I am talking about). Star Trek does not make that mistake. You don't have to be a raging, con-attending Trekkie to enjoy this movie; despite my comments above, I don't fall into that demographic. Go and enjoy.
posted by Dr. Alice at #

 
Minty Fresh Oxygen



For nearly a week I've been down with some sort of horrible respiratory problem. I started with a persistent cough and then, gradually, a fist closed around my lungs and I started wheezing as well. Not wanting to take off work I resorted to raiding the sample closet and treated myself with an albuterol inhaler and cough medicine. I left work early on Friday, thinking that a day or two of rest would help, but it got worse. Saturday night I nearly went to the emergency room because every few minutes I'd have to pop upright to catch my breath. I have no history of asthma, by the way.

Sunday morning I decided to visit the after hours clinic run by The Firm and one of the docs there checked me out. I was wheezing badly enough that he offered me oral steroids - which I declined - but did give me a steroid inhaler and antibiotics, and told me sternly not to show up for work today. I followed his advice. I felt better a few hours after starting the new meds and am a lot better today.

Possible interesting side note: as an experiment this morning, I decided to try drinking coffee (an old home remedy for asthma; the caffeine has an effect similar to theophylline). I hadn't had any coffee for two days, as I usually lose my taste for it when I get sick. All I can say is, IT WORKS. I noticed the difference in my breathing by the time I had finished my first cup. I did develop some shakiness, probably due to the caffeine-albuterol combo, but I didn't care. All I could think was "Oxygen! Minty fresh oxygen!"

As I said above, I have no history of asthma, but I did have an infection similar to this about eight years ago. This one was worse. I really can't explain the wheezing or bronchospasm (I don't smoke, either). I do have a lot of empathy for people with chronic respiratory problems: this was no fun at all. Hopefully it won't come back any time soon.

Labels: Medicine, The Doctor's Life

posted by Dr. Alice at #

 
What's Your NPR Name?

I'm Alrice Troncones. Go here to figure out what yours is, then post in comments.

Labels: Pop Culture

posted by Dr. Alice at #

 
The Noble Art of Medicine

...and here we are at the ACP meeting. V. and I are roommates this time around and are sharing my computer (she brought hers but can't seem to get the wireless access to work). Philadelphia is beautiful at this time of year, though the budding trees are giving her allergies.

The national meeting of any medical specialty is always fun, giving MD's a chance to catch up with old friends from residency and/or medical school and two or three days of luxurious learning without having to worry about patients and phone calls. So far today I have attended lectures on insomnia, dementia, neurologic examinations and pain management. Tomorrow will include wound care and renal disease. This may sound dreary, but it's not; the speakers here are the best in their fields. You don't get an invitation to speak at a national meeting unless you're really good.

I haven't been to the sponsors' hall yet (drug companies, medical data management companies, locum tenens companies and so forth) but V. has. She came back with all sorts of goodies: a T shirt, travel coffee mugs, pencils, a flashlight and hand disinfectant. I plan to go there tomorrow and see what I can get.

I ran into one of my old cardiology professors from med school. He remembered me, and I was greatly flattered. Also, I took V. for a cheesesteak today and we toured the Reading Terminal Market, which she greatly enjoyed. We're both beat due to jet lag but it's going to be another early day tomorrow - lectures start at 7 am.

Labels: Medicine, The Doctor's Life, Travel

posted by Dr. Alice at #

 
24: Back in the Saddle


I first started watching 24, the show that features the wildly violent and incredibly entertaining escapades of Jack Bauer as he strives to thwart terrorists, three years ago at the start of Season Five (a.k.a. Day Five). I liked it immediately and posted my impressions at the start of that season, but never mentioned that I became steadily more hooked as it went along. By the end of the season I was madly in love with 24; it's the first time I ever watched an entire season of any show without missing an episode. A lot of that was due to the fantastic acting of the guest stars that season, including Sean Astin and Peter Weller, but most especially the duo of Jean Smart and Gregory Itzin, who played President and Mrs. Logan. In all honesty, I've never seen better acting on television. Smart and Itzin were both nominated for Emmys but, sadly, did not win (I maintain they were robbed).

Then came Day Six. It was awful, probably the biggest disappointment of any season of the show from what I've read on the TWOP boards. Nevertheless I kept watching, due to sheer determination I suppose - plus Keifer Sutherland does a consistently great job as Jack Bauer.

Day Seven was delayed for a year due to the writers' strike but has been worth waiting for. It isn't any more realistic than last season was - a major plot point involved a takeover of the White House by a dozen terrorist frogmen who swim from the Potomac and drill their way into the basement of the White House! But the characterization has been better all around, and the plot has been a lot tighter. The idea of getting rid of the CTU, Jack's former employer, and moving the action to the FBI actually worked, not least because it turned Jack and his former CTU compatriots into a plucky group of outsiders fighting pervasive corruption in the government. Also, the actress (Cherry Jones) playing the President this time is a heck of a lot better than whiny Wayne Palmer was last season. She was clearly pitched as a Hillary Clinton lookalike but has grown into the role really well. I always enjoy the scenes in which she faces down the (all-male) joint Chiefs of Staff. I was looking forward to watching Colm Feore as her husband, but sadly he wasn't given much to do as First Gentleman. Currently his character is recovering in the hospital after being kidnapped, tortured and shot. All sorts of lousy things happen to the characters on this show!

The writers wound up going back to the tried-and-true and recycling a lot of plot points from previous seasons, but I don't care. Even the creaky device of bringing a major character (Tony Almeida) back from the dead worked, once you get past the initial ridiculousness of it. This is due to the great chemistry between Sutherland and Carlos Bernard. What I can't wait for is the showdown between Jack and Tony, now that we've learned that Tony's a bad guy - as revealed at the end of the last episode when he murdered an FBI agent. Yes, Tony's not only Zombie Tony, he's Evil Zombie Tony! You can't beat that. And Glenn Morshower, as retired Secret Service Agent Aaron Pierce, was brought back and has made a solid contribution this season. Since all the other agents seem to be either incompetent or corrupt, I applauded the good sense of the President's daughter (she pulled him out of retirement to protect her). I'm hoping to see more of Aaron in the last several episodes.

I know this recap makes the show sound ridiculous, but you can't really criticize 24 for that. By which I mean not that it's above criticism, but that critiquing it is a pointless exercise. You're either caught up in the plot twists and wondering what's going to happen next, or it doesn't grip you at all.

Lastly, I'm including a hilarious video made by a fan who decided to see how 24 would work as a silent movie. The captions are great: take a look.

Labels: Pop Culture

posted by Dr. Alice at #

 
Conversations With My Father


I am sure I am not the only one faced with this situation, but my dad (though I dearly love him) is what you might call behind the times. I herewith submit a few examples of this fact.


Conversation One

Dad (apropos of nothing): I was listening to the radio driving home last night and this guy came on. And he talked, and he talked, and he talked. And then this band came on, and they played pretty good, but then the guy came back on and he just wouldn't stop talking!

Me (after I think for a minute): Was he talking about a place called Lake Wobegon?

Dad: Yeah, I think that was it.

Me: Dad, that was Garrison Keillor. People pay to hear him talk.

Dad: Well, I wanted to hear him shut up.


Conversation Two

This took place about ten years ago, back when Dad was still practicing medicine and when specialists could pay for fancy holiday parties.

Dad: Dr. X (a cardiologist) had this great party last weekend. He had a band that was like the Beatles, I guess. Your mother and I danced ourselves silly.

Me: Young Beatles or later Beatles?

Dad: Huh?

Me: Did they have short hair and wear suits?

Dad: Yep.

Me: Young Beatles.


Conversation Three

Dad (again apropos of nothing): What the hell is a blog?

Me: It stands for 'weblog.' It just means that people have, like, this journal or diary on the Internet. I have one.

Dad: You do??

Me: (sigh) Yes. Didn't Mom show you?

Labels: Pop Culture, The Doctor's Life

posted by Dr. Alice at #

 
Guys With Time on Their Hands

You're a bunch of guys in a rural area of the UK. Your resources: sheep, dogs and lots of Christmas lights. What do you do?

Would you believe Sheep Pong?



Great video. Hat tip to this fellow (who writes great stuff, BTW).

Labels: Pop Culture

posted by Dr. Alice at #

 
True Talent

If you have not yet seen Susan Boyle's performance on "Britain's Got Talent," go watch her here on YouTube. She won everyone over, including Simon Cowell, and for good reason. You don't often hear a voice like that, let alone from a totally unknown performer.

Labels: Pop Culture

posted by Dr. Alice at #

 
STD Screening



Via Yahoo!, I bring you a report on chlamydia screening which indicates that many women are still not getting tested for it. Would you like to hear a disturbing fact? Some insurance plans won't pay to test women for this disease. (I'm looking at YOU, Blue Cross PPO.) Unlike gonorrhea, which is not subtle, chlamydia is often clinically silent. It can scar up the fallopian tubes and induce infertility, and the infected person can transmit the disease to their partners without knowing that they are infected.

My advice: even if you have to pay for it, get tested. If you can't afford the test, find a free clinic and get it done there. And, of course, avoid infection by limiting your number of sexual partners and using condoms.

Labels: Medicine

posted by Dr. Alice at #

 
Tea and Taxes

Millions of Americans are paying their taxes today; in addition, thousands are participating in Tea Parties across the land to protest government spending and tax increases. Glenn Reynolds' essay today in the Wall Street Journal points out some interesting facts about the tax protests. This is a true groundswell movement which has just come into existence in the past few months. Without the Internet's ability to allow ordinary people to organize, a cross-country protest like this could never have happened. A few paranoiacs suggested the tea parties had been dreamed up and bankrolled by some large political group or other, but no one has enough money or organizational skills to mount something this big.

It will be interesting to see what happens next. As Reynolds points out, the movement could get bigger, give birth to a third political party - or flame out if everyone loses interest. I don't somehow think the last option is going to happen, at least not as long as the federal government keeps saying that spending mind-boggling amounts of money is the answer to all our problems.

Labels: Money, Politics

posted by Dr. Alice at #

 
"I Didn't Know it was Loaded!"

According to this report, it's becoming more common for patients to inject themselves accidentally with EpiPens. EpiPens are preloaded syringes of epinephrine which can be prescribed to patients who have severe allergies (i.e., bee stings or food allergies such as peanuts). The epinephrine is supposed to reverse the effects of anaphylaxis, ease breathing and give the patient time to get medical help. While undeniably useful, I have often wondered if these pens are over prescribed - I get a lot of requests for them. Surely not everyone is that allergic to bees? At any rate, the study reviewed 26 reports on accidental autoinjections, culled from medical journals over the past twenty years.

About 94 percent of these injections went into the thumb or finger instead of the thigh, where they are supposed to go. Fortunately not a lot of side effects were noted, "pins and needles" sensation being the most common. I was wondering if there had been any episodes of blood loss to the finger! I was always taught that using epinephrine to a "dead end" part of the body like the finger was a no-no as it could compromise the blood supply. No such complications were mentioned in the article, however.

If you are severely allergic to something, you probably need one of these pens. My preferred treatment, though, is liquid Benadryl (diphenhydramine). It's easy to swallow and gets into your system faster than the pills. I often recommend it as part of a travel medicine kit.

Labels: Medicine

posted by Dr. Alice at #