“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler






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Happy Birthday

Well, this was a memorable one. I got to meet Tim Blair Saturday night - which also happened to be my birthday. He was in town, having been in New York for the Pajamas Media launch and then heading on to L.A. More details later, but I wanted to get a quick post up this morning. I'm back on the hospitalist grind this week, so you may not be hearing much from me.

UPDATE: I'd describe Tim as "nice" and "courteous" as well as "a great conversationalist" but I'm afraid he'd sue me. He's great fun at a party. I will uphold his wild-man reputation by revealing that in the course of the evening, Donny Osmond records were played and critiqued. Now that, my friends, is a debauched party. Many thanks to Matt Welch and Emmanuelle Richard, the hosts of the evening - and I have to give props to Matt for his record collection. Anybody who owns the K-Tel album with "The Theme from S.W.A.T." is okay by me.
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Let's Get Shopping

Hoping to buy out the stores the day after Thanksgiving? Go check out Black Friday 2005.com for all the latest info on coupons, rebates, and holiday sales. They cover electronics, toys, and department stores. (Their tip: WalMart good, Office Depot bad - from the sales point of view, that is.) Thanks to Ernie for the link.
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On the Importance of Getting Your Hearing Checked

I had just done a pre-op physical on my tiny, sweet 85-year-old patient. Walking down the hall, I heard her say behind me, "Do you think I can get laid?"

With my eyes bugged, I turned around to see her standing on the office scale.

... weighed ...
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Image Test




Wow, Blogger really has improved. I never used to be able to figure out how to post images (that probably says more about my incompetence than about Blogger's). I picked this image because this is probably the most true-to-life reaction Rex Morgan has ever had: forget his troubled patient, all he really cares about is mac and cheese. His limp-wristed point in that second panel is a classic example of the deterioration of the serial strips; the art in these things used to be much better.

Oh, and on the topic of food, happy Thanksgiving everyone!
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He's Still Dead

Generalissimo Francisco Franco died November 20, 1975 - thirty years ago today.
(Idea stolen blatantly from Best of the Web Today.)
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Another Food Blog?

I'm afraid so. (Perhaps I should give up this pretense that this is a blog about medicine and just come out of the closet. It's a food blog! With bits about healthcare!) But this was just too good not to post: The Traveler's Lunchbox. It combines travel and food, two of my favorite things. If I can find a blog that combines these two plus photography, I'll be all set. Thanks to Peggy for linking it.

If you're sick of food blogs, or if you are on a diet, I give you Steve, Don't Eat It. Warning: do not read this if you are eating or drinking anything or if you are the slightest bit queasy. Hmph. I've never been desperate enough for a blog entry to consider eating silkworm pupas out of a can - and if you think I'm kidding, go read it.
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Not Good

China Confirms First Human Bird-Flu Cases

Well, it was bound to happen sooner or later.

The Chinese government announced plans Tuesday to vaccinate all the country's 14 billion domestic fowl.

Good luck with that.

Such vaccination programs are "the right thing to do," said David Nabarro, the U.N. coordinator for bird and human flu. The virus is so entrenched in China's birds that simply slaughtering them will not work, he said. The best plan is to vaccinate and then slaughter when there are outbreaks, he said at a conference on bird flu in New York.

China's prompt response to bird flu and the scale of its anti-disease effort have been in striking contrast to its handling of severe acute respiratory syndrome in 2003, when it was criticized for its secrecy and failure to respond to foreign pleas for information and cooperation.

Nobody wants to be blamed for triggering a pandemic. I find this report reassuring, actually. We know the disease exists, we know how to track it and the host country has had experience in how NOT to deal with outbreaks of respiratory disease. Now we have to see what happens next. If transmission is bird-to-human only there will be more sporadic outbreaks; if human-to-human transmission is possible the number of cases will increase very quickly.

State television showed workers at industrial-scale poultry farms jabbing chickens with injector guns.

I hate public television...
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Hard Times at the Times

The L.A. Times appears to be struggling to maintain readership. In the past week the board made a decision to fire editorialist Bob Scheer, known for his strongly liberal views; L.A. Observed reviews some of the fallout here. They've also fired their (conservative) editorial cartoonist, Michael Ramirez - though he will continue to publish in the Times till the end of the year. There was a protest at the Times offices yesterday over the Scheer decision. Scheer himself, at last report, appears to have flounced off to the San Francisco Chronicle.

I quit reading the Times years ago, myself, so I have no real opinion on these decisions, though I am sad to see a once-great paper headed down the tubes. It shifted to "soft news" years ago and simply isn't readable any more. I'm also stunned to see that there will no longer be an editorial cartoonist on staff at a paper that has won several Pulitzers for its cartoons (first Conrad, then Ramirez). I'm not sure what the administration of the Times is thinking, but I think they need to stop worrying about the editorial page and start focusing on their news reporting.
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Email From Down the Hall

Got the following Idiocy of the Day report from V. last week, which I forgot to post.

My patient, in all seriousness, discussed what her psychic nutritionist recommended. I almost had
to walk out of the room.

I'd rather like to know what sort of advice psychic nutritionists actually give. Is tofu more spiritual than steak? Is this a twist on macrobiotics, where foods are classified in the "yin" and "yang" category? We may never know.
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First Bird Flu Death in US

Look at the picture carefully. :)
(via VodkaPundit)

... and if you're in the mood for a twisted yet hilarious reengineering of an old comic (the venerable medical serial "Rex Morgan, M.D."), click here. It's even funnier if you go to the archives to compare the originals, though I will give the writers credit that they're now tackling the issue of injured war veterans. (via Josh)
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Quote of the Day, and a Recipe

From What I Cooked Last Night:

A naked man stuck in his back yard at four thirty in the morning holding a redhot baking tray containing a kilogram of carbon with a cat themed teatowel would be wrong on so many levels.

(Also known as the Set the Oven Timer Principle. Me, I use my microwave to time cooking, even in the conventional oven; I just find it easier to use.)

This seems to be a good lead-in for the recipe I promised you yesterday. The original name was "Cheesecake Supreme" but I just call it "Green Cheesecake." My mother got the recipe decades ago from a family friend who worked as a hospital administrator. It was served in the Doctors' Dining Room for dessert (so you know it has to be good). My mother hadn't made it in years, but a few years ago I requested the recipe for an office potluck and it was a smash hit. I also make it annually for V.'s Saint Patrick's Day party. Caveats: it will dirty every mixing bowl in your house, and you have to find some green creme de menthe before you start making it. Try a specialty liquor store. If you aren't fond of mint flavored desserts, try it anyway; there is just the faintest whisper of mint in the background when it's done. It keeps pretty well. I make it the day before it's needed, and it is good for a couple of days after that if there's any left.

Ingredients:

1 small pkg lemon jello
1 cup boiling water less 2 Tbsp
2 Tbsp green creme de menthe
3 Tbsp lemon juice (I use fresh but bottled would be okay)
5 drops green food coloring
1 stick butter, melted
1 (6 1/2 oz pkg) vanilla wafers, crushed (I usually use more)
1 cup chopped fine walnuts (optional)
3 Tbsp powdered sugar
1 8-oz pkg softened cream cheese
1 c. granulated sugar
1 Tbsp vanilla extract
1 20-oz can pineapple (in its juice, not syrup), drained
1 can evaporated milk (chill can, beaters and bowl before whipping)

Okay. What you do here is make a crumb crust, and then make three different mixtures and combine them for the filling. I find it works best to do it in this order:

1. Get the evaporated milk, beaters and bowl into the fridge several hours in advance - the day before is okay too.

2. Put the cream cheese out to soften before you do anything else. It takes a while.

3. Combine the jello and boiling water and whisk like mad (so you don't get gelatin seeds on the bottom). When the jello is completely dissolved, add creme de menthe, food coloring and lemon juice. You will now have a lovely kelly green mixture that smells slightly minty. Put this aside to cool. It will start to thicken so keep an eye on it.

4. Make the crust. Pour the cookies into the blender or Cuisinart and pulverize. Mix with the powdered sugar, melted butter and nuts if using. Reserve some mixture for topping and pour the rest on the bottom of a large pan (I use a 9x13 inch baking pan, the original recipe calls for a "sheet cake pan" which is larger and shallower).

5. Use the largest bowl of the bunch for this part. Mix the (hopefully now softened) cream cheese with the granulated sugar and vanilla till combined. DRAIN the pineapple well and add that too. Do not pour the juice in or you're in trouble.

6. You're almost done. Get out the milk, bowl and beaters and whip the milk - it really will whip though you won't get peaks - then set it aside and whip the jello into a froth (you don't have to clean the beaters first if you do it in this order).

7. Now add the whipped jello to the cream cheese mixture and combine well. Then add the whipped milk and combine again. Pour the mixture into the crust and top with reserved crumbs. Now for the cook's treat: get a spoon and lick the bowl. When you taste this you will realize why you went to all this trouble.

8. Cover the pan with plastic wrap and set in the fridge. Grit your teeth and clean up the kitchen.
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IQ and Seat Belts?

Interesting study on Yahoo! today: Smarter Kids May Live Longer

The study, which followed elderly adults deemed gifted by childhood IQ tests, found that the higher their early IQs were, the longer they lived -- up to a point, at least. The survival advantage began to plateau after a childhood IQ of 163, an intelligence level few people reach.

Though the reasons for the link between IQ and longevity are not clear, it does not appear to be merely a reflection of income and social position. As children, the participants were from affluent families and most were white. Yet childhood IQ was still a factor in their lifespan.

Similarly, in an earlier study of Americans with more varied childhood IQs and family incomes, Martin found that IQ was related to health problems independently of socioeconomics.

To quote an old redneck joke, I'm betting that none of these people's last words were "Hold my beer and watch this!" That may have something to do with it.
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Brief Post

before dashing off to the ER for an admission. I'm on call tonight.

First: Wacky Patient does, indeed, have osteomyelitis. She's bought herself six weeks of antibiotics and a vascular study of her legs to check her circulation. I hope she doesn't wind up needing surgery for this.

Second: Our office had its annual Thanksgiving Potluck today; it's a tradition of The Firm that each office gets one. Ours is much earlier than usual this year - usually they wait till just a few days before the holiday. I guess the administration wanted to get it over with. Everybody signs up to bring something, usually their same specialty every year. V. brought her sweet potato casserole, which is several cuts above the usual marshmallow-laden goop. Hers has apples and just a touch of brown sugar - it's excellent. I brought my green cheescake (sounds weird but tastes good; I will post the recipe later). It's one of those retro-type desserts with jello and cream cheese, green creme de menthe and green food coloring. I loved it as a kid, decided to make it for the potluck one year and haven't been allowed to stop making it since.

As always, we ate too much and then had to suffer through a long afternoon of seeing patients. I had a brief conversation with one of our medical assistants regarding this:

MA: "I'm so full, doc. I can't take it no more!"

Me: "Let me get you an ipecac. Or a toothbrush handle."
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"This Is Not a Drill"; Cold War Relics in Los Angeles

I've read one or two articles over the years about the system of air raid sirens built in Los Angeles in the 1940's and 1950's. They were supposed to provide a warning in the event of a missile attack. You can still see them all over the city today; they stand, rusting, at busy intersections or seen from a distance amid city buildings. If you didn't know what they were you'd probably pay no attention to them. The system was deactivated years ago and no one tests the sirens any more - I doubt that most of them even have working electrical connections. I see one occasionally as I drive around the city. I haven't started taking pictures of them yet, but other people have. I am proud to present the following photoblog site of air raid sirens for your perusal and entertainment, and doubly glad since it once again validates my belief that you can find anything on the Internet.
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L.A. Stuff

New links: The Daily Nosh, for those of you locals looking for someplace good to eat in the Eagle Rock/Pasadena/Silver Lake area. This guy is quite fun to read. Also in the links sidebar is the Great L.A. Taco Hunt, a quest dear to my heart.

Update on Wacky Patient from yesterday: she returned today after her spouse called me and said: "Oh, she has this big callus on her foot I forgot to tell you about." Since a) the patient is diabetic and b) her powers of denial are formidable (she blithely ignored a huge tumor on her neck for months, but that's another story) I said "COME IN NOW."

When they got here, I took one look and ordered an X-ray: She had a nasty open lesion at the side of her big toe with a sinus tract (draining hole) in the center. The X-ray showed a scabby-looking metatarsal joint - I think she has osteomyelitis (a deep bone infection). Off to the podiatrist she goes.

Sometimes I don't know which patients are more trying, the worried well or the blithe deniers... but I know which group scares me more, and deniers have cost me sleep many a time.
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Perfect Timing

On the day when one of my wackiest patients came in for an unrelated problem and casually told me that she had had "some trouble seeing" with her left eye for two weeks, only for me to test her and find that she was totally BLIND in that eye...

On the day I had three pre-op physicals in one afternoon...

The day I got my latest patient census figures, showing that I currently have 1902 patients in my practice (and that's just the managed care, not PPO or Medicare!)...

The day after I came back from a few days out of the office, still straining to keep my head above water...

... is the day I found, hiding below a state disability form I had to fill out for a patient, an interoffice memorandum with the title "PHYSICIAN SATISFACTION SURVEY."

Oh, for God's sake. Where do you want me to start?
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"Dr. Alice?" "Present, Sir!"

Yep, I'm not dead. The last two months have been hellishly busy, and I just haven't been able to post. The only reason I'm doing it now is that V. is standing behind my chair with a baseball bat (just kidding, V!).

I do have news and updates to share, like how I managed to break my left elbow for the second time in two years - did that a month ago, it's much better, thanks - but right now I've got to buzz off to the garage and pick up my car. I dropped it off this weekend and it turned out to have things wrong with its innards of which I was unaware.

Remind me to share with you the story of how I spent ten days babysitting my sister's three kids while she and husband were on vacation. (see, I told you I'd been busy.)

More either this evening or tomorrow am.
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