“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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So Here We Are 

Labels: Los Angeles, Medicine, Science, The Doctor's Life, Twenty-First Century Crap

posted by Dr. Alice at #

 
So this morning I pulled out my credit card and made a hefty payment to my new orthodontist. In my mid-fifties, I apparently need my teeth straightened... forty years after the last time I endured it. I have a widening gap between the two front teeth in my upper jaw ("incisors," or as Ortho Guy refers to them, Eight and Nine) and crowding of the teeth in my lower jaw. Estimated time for treatment: fourteen months. 

Labels: Science, Technology, Twenty-First Century Crap

posted by Dr. Alice at #

 
There Was No Gilligan, But There Was a Mysterious Dude.

I was converted to the concept of the e-reader (eBook, whatever) by my roommate on my Guatemala trip several years ago. Another busy physician, her specialty was family practice and we bonded over finally having the time to read without guilt, since there was nothing else to do in the evenings after the clinic closed for the day. She was glued to her Kindle every night. I was jealous that she never seemed to run out of reading material, whereas I zipped through my book and two magazines in nothing flat.

So when I got home I knuckled under and bought one. At first I wondered if I would ever download enough to justify the purchase, but that really has not been a problem. Have I bought more books? Yes, I have. But did you know that there are a lot of free books available for the Kindle? Yes, free. FREE. If you subscribe to Amazon Prime it gives you access to the Amazon Library system; there are a ton of books that you can obtain on loan. The limit is one per month, but if you are an avid mystery reader it's great to have access to all the paperback cozies you want without having to spend $7.95 on a book you'll never read again.

(Incidentally, what is it with mysteries these days? When did cozies start to incorporate recipes, scrapbooking, witchcraft, knitting and God knows what? I still read them, all right, but I'm starting to hate myself. The heroine/detective usually spends more time enthusing over her cats or her latest yarn purchase than she does solving the crime. I mean, Philip Marlowe would NEVER.)

But back to Free. I had heard that there was a big self-publishing market on Kindle, but I didn't realize how big until I started reading a prepper/homesteading blog in which the author used to publish a daily list of free books available on Kindle. I'd link to it, but the author then made the list available by subscription only. The books focus on topics of interest to preppers and homesteaders, such as homeschooling, working from home, religion, food storage, agriculture, etc. I have downloaded some of them, all of which were self-published, and the quality varies widely. Some are better than others.

But then I thought: What if I just type in 'free' on my Kindle? I tried it, and realized that on any given day there are thousands of free books available. Many of them are classics which some deserving soul has laboriously transcribed into a Kindle compatible format. Jane Eyre, Pride and Prejudice, Tom Sawyer - I felt as though someone had set me loose in a candy store and told me to grab everything I wanted.

And that is how I came to be reading Jules Verne's The Mysterious Island.

I love Jules Verne. Around the World in Eighty Days is still one of my favorite books, and one of my daydreams is to someday take three months off to go around the world. I also loved Captain Nemo, the self-exiled main character of 20,000 Leagues Under the Sea. Mysterious Island (published 1874) is commonly called the sequel to 20,000 Leagues, but that's not all it is by a long shot. I would rather call it a stand-alone novel which incorporates a character from his previous novel. Verne started with this premise: if a group of people are marooned on an island with nothing but fortitude, knowledge and the clothes on their backs, can they survive?

 The book is set in 1865 and focuses on a group of Americans, prisoners of war in Richmond, Virginia (they are Yankees). They escape from Richmond via a hot-air balloon which I guess someone carelessly left sitting around, are caught up in a storm over the open ocean and are forced to throw everything they own out of the balloon to reduce its weight before eventually crashing on an island. Captain Cyrus, the leader of the group, is an engineer; the other characters include his servant, a free black named Neb; Pencroft (a sailor); Herbert (the teenage ward of Pencroft whose hobby is natural history); and a journalist named Gideon.

It's interesting to read the book from a twenty-first century perspective. Our heroes have no qualms about exploiting every resource they can lay their hands on. They even wind up dynamiting part of the island to form an indoor shelter (it's a large undersea cavern, and the explosion allows them to drain part of the water out). The island just happens to contain clay, iron ore, nitrites, etc. etc. and the engineer figures out how to smelt the ore, build a kiln to make pottery and so forth. One running joke is that Pencroft is constantly hungry. Every time they find a new species, his question is: "Can you eat it?" Environmentalists everywhere would scream reading this book.

When the group initially lands on the island, of course, they have absolutely nothing. One of their group gets into trouble and then is mysteriously rescued; then they discover a chest of clothing and supplies sitting on the beach. Pretty soon they figure out that they aren't alone on the island...

The Mysterious Island is a good read, though somewhat stiff by today's standards. The adventure parts are interspersed with pages of straight-up chemistry whereby the engineer explains how the group is going to make gunpowder, why he knows the island contains iron ore and so on, which absolutely kills the suspense. But you can skim these parts. It's kind of like reading Tom Clancy where you blip over the parts describing tanks and aircraft in loving detail.

To get back to my initial point, I've been completely converted to the concept of e-readers. I continue to buy and read print books, and I don't think print will ever go away - nor should it. But the equipment is inexpensive and lasts a long time. I've had my Kindle for four years and it's still going strong. It's an older model to be sure, but I have not felt the need to purchase a new one. If you have been considering the purchase, or have bought one but aren't sure what to do with it, the free options alone are worth it in my opinion. Give it a shot.

Labels: Books, Random Thoughts, Science

posted by Dr. Alice at #

 
Plunged Into Caregiving

About four months ago my mother asked me to call my father's cardiologist to get clarification on something - "He wants us to do some testing. Is this really necessary?" So I did.

"Your father has aortic stenosis," the cardiologist said without preamble (he knows I'm an MD), "and it's pretty significant."

My attitude when we opened the conversation had been doctor-to-doctor. Now suddenly all that vanished and I was repeating, in a very small voice, "Dad has aortic stenosis?"

The gist of the conversation: yes he did, and furthermore it was getting worse, and the cardiologist wanted to do an angiogram. One angiogram later, Dad had a stent in his right coronary artery but still no clear word on the valve. Cardiologist #1 suggested that we see his pal, Cardiologist #2, an expert in aortic valve problems. By a stroke of luck #2 works at my hospital, Tertiary Care Medical Center.

This guy is hardcore. He has a large office in the very newest building on the hospital campus. Each room has a chair that looks a bit like a recliner, which doubles as a scale. Yes, they press a button and the chair raises a few inches off the ground and they weigh the patient sitting in the chair. He also has a fleet of nurse practitioners and technicians, high grade office equipment and the ability to perform echocardiograms in the exam rooms. The tech clearly knew what he was doing but still could not get a clear picture of Dad's valve. He pressed a button on the room's intercom, ordered a bag of contrast and this was infused through a vein, right in the exam room, by a nurse who appeared out of nowhere.

It's wonderful what money can buy. I guarantee you that no internist or primary care doctor has facilities like this.

After this, we found that the AS was really quite bad indeed. Dad needed a valve replacement as soon as possible. We all agreed that the traditional method (aka "cracking the chest") was not a good idea as Dad is not in the best medical condition. He has a history of several strokes and some dementia. Cardiologist #2 specializes in valve replacement via the femoral artery. How he does this I have no idea, but overall it is less stressful and risky than open chest valve replacement.

Today we go for the final round of preoperative assessments and tests. He is having more of a workup than average because he's been entered into a study wherein the surgeon places a filter in the aortic arch before doing the valve replacement, which should lessen the risk of additional strokes. Tomorrow, if all goes well, he has the procedure.

I have been in charge since the workup started: transport to the hospital, spending the night in the hospital with Dad postprocedure and translating developments to the rest of the family. I now really empathize with patients who get confused and lost, and who complain about having to go to the doctor all the time; I am learning exactly how that feels. As you can imagine, I've had to do some canceling and reworking of my office schedule, but I really don't care. All I want is for this to work.

Wish us luck.

Labels: Family, Medicine, Science

posted by Dr. Alice at #

 
A Sense of Perspective


I highly recommend the HubbleSite if you're looking for a background image for your computer desktop. They have great pics of planets, nebulae and galaxies for you to get your geek on, it's easy to use - and all free! Plus on a bad day at work, gazing at the wonders of the universe may put your bad day in perspective. Unless you're Zaphod Beeblebrox, of course.

Labels: Science

posted by Dr. Alice at #

 
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

Labels: Los Angeles, Politics, Pop Culture, Science

posted by Dr. Alice at #

 
Space Station Flyby

Per L.A. Observed, the space station will be passing overhead tonight about 5:21 p.m. Here's a diagram:




UPDATE. V. and I stood out on the balcony for ten minutes watching for the ISS to pass overhead. Never saw it.

Labels: Science

posted by Dr. Alice at #

 
Spies on the Radio


Clicking around on Wikipedia this weekend, I came across an article about numbers stations which I found fascinating. Turns out there are several websites, and even a Yahoo! group, devoted to this phenomenon.

Numbers stations are stations on the shortwave radio band which broadcast transmissions consisting of nothing but strings of numbers being read aloud. They first appeared on radio bands as far back as World War I, were at their highest activity during the Cold War, and have decreased in number since then. The generally held theory is that the numbers stations are used for espionage. Transmissions may also contain tones or data bursts. The transmissions may begin with music, or a set phrase to alert the listener that data transmission is about to begin. The numbers may then be decoded with one-time-use code pads, which have also been around for many years (the one-time pad was patented in 1919). This is all very low-tech, but it's reliable and it works. Interestingly, it's rare that other governments make any attempt to "jam" the stations, though it has been known to happen.

One of the best known numbers stations is the "Lincolnshire Poacher," so-called because the station uses snippets of music from a folk song by that name as an interval signal. It is thought to be operated in Cyprus by MI6, the British secret intelligence service. There is also a station that transmits messages using the phonic alphabet instead of numbers (i.e., Charlie Foxtrot Tango... etc.), which is thought to be Israeli and run by the Mossad. And there's one located in the New Mexico desert near Albuquerque, which is probably military. This station is known as "Yosemite Sam" because, oddly, the transmissions always end with a clip of the cartoon character Yosemite Sam shouting "Varmint, I'm gonna blow you to smithereens!"

If you're interested in hearing what the transmissions sound like, many of the links above have audio clips you can download; and for further reading there's an article from Wired magazine here which is quite good. Finally, if you just can't get enough of numbers stations there are even recordings for sale at this site, as well as a T shirt.

UPDATE: I found a very odd series of stories here about phone numbers, advertised on Craigslist, being used as numbers stations; fortunately it turned out to be a hacker prank. Oh, and Salon Magazine did an article about numbers stations several years ago; it's here.

Labels: Pop Culture, Science

posted by Dr. Alice at #

 
The Terraforming of Mars

I think this is pretty cool:





This is an artist's visualization of what might happen if we were able to melt the polar ice caps on Mars and render the planet's atmosphere more hospitable to Earth life. It's one of Wikipedia's Pictures of the Day (they have a terrific series of pictures, by the way, on every conceivable topic).

Labels: Science

posted by Dr. Alice at #