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“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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    Tuesday, July 21, 2009
    101 Ways to Get Your Veggies

    Hooray: NY Times food writer Mark Bittman has come out with another 101 list, this time of 101 salads for summer. I've only glanced at it so far but it looks delicious. Bittman also recently published a collection of many of these lightning-fast recipe ideas as Kitchen Express, a fun read and a great source of ideas for cooking last-minute meals.


    Friday, July 17, 2009
    Julius Shulman

    A well-known Los Angeles photographer, he died July 15 at the age of 98. This is perhaps his best-known picture, a case study of a house in the Hollywood Hills. Architecture was his specialty.

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    Sunday, July 12, 2009
    On Dramatic Structure

    This weekend I saw the L.A. Theatreworks production of The Physicists by Friedrich Durrenmatt. If you live in Los Angeles and have never seen one of their productions, I highly recommend them. These plays are recorded for radio rather than being performed conventionally and are broadcast on NPR. Theatreworks also sells recordings of the plays, which are great to listen to while you're driving. During performances the audience sees the sound effects engineer create the sounds of doors opening, wine being poured into a glass and so on. The actors sit and wait until it's time for their characters to speak, at which point they come forward to the microphones and read from their scripts (being careful not to rustle the pages!) There are no sets or costumes as such, although the actors may choose to dress in a style reminiscent of their characters if they choose. At this weekend's performance some did and some did not.

    The Physicists is a message play, the message in question being that Nuclear Weapons are Bad. It was first performed in 1961 and was written in German - our production was a translation, of course. It's a comedy-drama with an absurdist tinge to it and I found it a pretty typical example of this sort of thing. It was really the actors (Bruce Davison, John De Lancie and Gregory Itzin) who made the performance enjoyable. Their acting and the sound effects in the background combine to make the set almost coalesce in front of your eyes: it's amazing. It's such a pleasure to watch gifted character actors doing their thing. I find they're usually much better than A-list "movie star" actors, who seem to make careers out of playing the same basic character over and over again.

    These message plays, though, all seem to have the same basic structure. They open with the whimsical, slightly absurdist setting and the audience getting to know the characters. Plot twist at end of first act! Second act opens with the ramifications of the plot twist. The characters' reactions segue into the Twenty Minute Lecture, as I call it, where the action comes to a grinding halt so that the playwright can air his thoughts and opinions and the audience just has to sit there and take it. Then the characters pick up their roles again and the play comes to some sort of resolution which may be hopeful, depressing or indefinite. A really classic example of this sort of play would be An Inspector Calls, which masquerades as a murder investigation but is really an anticapitalist polemic. I enjoyed it, but after the first ten minutes you know exactly where it's going to go.

    This sort of play bugs me, but it isn't the message that is the problem. Good theater should challenge its audience, after all. It's the Twenty Minute Lecture that I dread: it ruins the flow of the play. I think the only playwright capable of getting away with this sort of thing is George Bernard Shaw and it's because his characterization and dialogue are so good. When his characters debate you believe they're having a debate, not that the playwright is arguing with the audience. Durrenmatt's characters are good enough at the beginning but turn into straw men, only there to expound on their creator's theories.

    One could argue that blogs are guilty of this same crime, but I think most people read blogs specifically to get the writer's take on things. Besides, if the reader finds the post boring he or she can always click on to something else... now wait just a minute. Get your hand off the computer mouse! I'm not done ye

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    Saturday, July 11, 2009

    Not Tonight, Dear...

    Recently I got an email from a patient noting that he had been getting really severe headaches during sexual intercourse. Naturally, he was concerned about this and was wondering what might be causing it. This is a well known phenomenon in neurology sometimes called benign explosive sexual headache. It's more common in men than in women. I can state that I have seen several patients who had this problem and they all were male. (This is called anecdotal evidence.)

    Most episodes of this type of headache are, as the name suggests, benign and can be controlled with medication. It seems to be more common in people with a prior history of migraine. In a few cases it can be an early sign of brain aneurysm but this really is not common; when I see someone with this complaint it is not my first impulse to get a brain MRI. It's a good idea to get a family history of aneurysm or polycystic kidney disease, though.

    If medication is required, your best bet is a beta blocker. (Which, in its turn, may induce erectile dysfunction, but we can't have everything.) Another option would be taking a pain medication, such as ibuprofen, before intercourse. Once the headache starts, taking meds doesn't seem to do much good. You just have to wait for the headache to wear off.


    Monday, July 06, 2009
    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.


    Sunday, July 05, 2009
    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.

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