Feet First

“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, December 31, 2002
    Here's a couple of downer stories for ya:

    Wall Street ends third straight year down. Yep, down. So much for my retirement fund:

    Weighed down by terrorism, accounting scandals and fears of war, Wall Street ended its third straight losing year Tuesday � the longest such streak since Franklin D. Roosevelt was in the White House.

    And the other:

    2002 A Year of Anxiety for California

    Some of the most chilling news in 2002 centered on a seemingly constant stream of stories of abducted, murdered children and of priests accused of molesting young parishioners.

    Oh that'll put us all in the party mood, all right...

    Monday, December 30, 2002
    This post tells you what doctors talk about after work. Beware.

    Today was my first day back at work and it was a "total nightie" [nightmare], as my sister would say. I spent three hours on Sunday going through backed-up stuff and was constantly either on the phone or seeing patients today, but still I'm stuck with a backlog of lab results on people I have to call. In need of a break, I headed down the hall to see my good friend from work - let's call her V. V. is an endocrinologist but also does basic internal medicine, like me.

    As I walked in, I saw V. on the computer playing with a Bob the Builder spelling program sent to her by her husband. The idea is, you get a picture and a three- or four-letter word, usually with one letter filled in to help you start. You click on a letter and move it to one of the open dashes. You get instant feed back from one of the cartoon characters via a word balloon ("Superb! Fantastic! Terrific!") Needless to say, this program is for beginning readers... but after watching this for about ten seconds, I said, "I need that. Something I know I can do that will stroke my ego."

    "I'll email it to you," said V. After which I showed her my Christmas pictures of my niece and nephews. Then we got into a discussion of what a crappy week it was at work. The holidays are slower than usual, but we also have to cross-cover for each other. V. is following a patient in the hospital who belongs to one of our co-workers. He is hypernatremic (running a high sodium level) and is somewhat dehydrated, and not very responsive due to these problems.

    "Let's fill him with fluids and watch his brain swell like a sponge," I suggested idly. [Note: not recommended]

    "I'm doing it a little more gently than that," she responded mildly. After which we both went back to watching that hypnotic Bob the Builder spelling program. She was debating moving up to the six-letter word level when I left to go back to my charts.

    Federally Mandated End-of-Year Posts:

    You have a choice. Dave Barry's recap of 2002 is always good for a giggle. Then there's Tim Blair's predictions for 2003... I find this hilarious. Enjoy.

    Sunday, December 29, 2002
    Here is a post of Chuen-Yen's Christmas experiences. I'd wager they were vastly different from most of ours:

    Happy Holidays!

    Home is where the heart is. Rather than spend the holiday in comfortable Blantyre, most workers will return to their villages. My houseboy Gift is no exception. He was so euphoric when I gave him ten days off that he rashly invited me to visit his family. He never fathomed that I would take him up on the offer.

    During the expedition, I was subjected to the benefits of inequality, which Malawi�s masses whole-heartedly embrace. Each bus rushed us to the head of the cue. We were given the best seats. Items were snatched from Malawian customers and handed to us if I showed the slightest interest. Most disturbingly, Gift persisted in addressing me as �Master�.

    The main stretch of our journey began aboard a dilapidated bus destined for Gift�s village of origin � Mikwasa. It did not budge from the congested dirt terminal until we had loaded far more than the posted maximum capacity of 48 seated and 52 standing. Weighed down by its excessive cargo, which included not only too many people, but also livestock, bundles of clothing and furniture, it crawled smoggily through the picturesque landscape of natives toiling on foreign owned plantations. The trip consumed 4 sweaty hours. Halfway through, I began to think my bladder might explode. When I finally did reach a �toilet,� an odiferous pit swarming with flies, I decided not to drink any more water until home.

    At Mikwasa, Gift�s siblings navigated several kilometers of obscure dirt trails from the bus stop to their adobe house. While we picked mangoes, �The mother,� always referred to by that moniker, prepared small rations of greasy foods over a smoky fire in a dark, poorly ventilated room. Actually, the entire house was dark due to soot and lack of electricity. �The father,� blind from glaucoma, sat on a stump lamenting his plight.

    Prior to dining, all hands were cleansed in a bowl of water fetched from a nearby stagnant pool. As one of those utensil-using foreigners, I was offered a serving spoon, which could never fit into my mouth. A tour of the barren farm ensued. Gift, ashamed of his village, repeatedly apologized because �White people cannot be in a place like this.�

    For Christmas, I gave Gift a mosquito net and a few hundred Kwacha. His family received 5 kg of rice and 2 kg of dried beans. Everyone was delighted.

    Having already appreciated the big bus, I squeezed most of my body into a minibus for the trip back to Blantyre. I, and fourteen other seatbelt-less passengers, clung to the upholstery as we tore down the treacherous one and a half lane road. Once home, I promptly enjoyed electricity, tap water and a flushing toilet.

    Have a great Christmas.

    Whew. I have been off work and a visitor to Kiddieland all this week. My sister was in town for the holidays with her husband and three kids - four, two and six months. As I have no children myself, this was quite an experience. I love the kids, and they're good as kids go, but the amount of attention they require is tremendous - especially as my parents' house cannot be described as "childproof" by any stretch of the imagination; to the contrary, I believe it would qualify as what is legally known as an "attractive nuisance." Then there is the inevitable infighting between the four- and two-year olds: They never want to share anything. I mean, anything. The six-month-old had a mild case of colic and still refuses to eat solid food. He won't touch cereal or veg. We got him to eat three spoons of pureed pear baby food the whole week, and that was a major triumph. He looks healthy though.

    The baby had a major vomiting episode Christmas Eve - I was holding him at the time and let's just say I had to throw everything I was wearing in the washer.

    But there were compensations of course, watching the kids open their presents Christmas Day, playing with the kids, taking my niece to the library (which she loved). My two-year-old nephew Mitchell is particularly cute - he's just started talking and listening to his speech is great fun. All winged insects are "flybees." He doesn't like them.

    All my clothing had food or spit-up on it when I got back and is now in the washer. But I miss them already. Sigh.

    Sunday, December 22, 2002
    This Sunday afternoon has been a busy one, as they always are right before Christmas. After church this morning (fourth Sunday of Advent!), we spent an hour in the ice-cold sanctuary rehearsing the procession for the midnight Mass of Christmas Eve. If you're not Episcopalian, you may not realize the intricate etiquette of this process. All participation in church services requires training, especially a big feast like Christmas Eve; the only bigger one is Easter Sunday. My church is fairly high (a "high" church would be closer to the Catholic end of the specturm, a "low" church more Protestant), and we like observing the formalities. I was not raised in this tradition but it's congenial to me, and I enjoy being in the procession. I am to hold the banner, a heavy and awkward thing, and follow the priests, with half a dozen lay eucharistic ministers (aka "chalice bearers") behind me. The church is going to be packed.

    I usually stay and help decorate the church for Christmas, but this year I had to leave early as I had to go to a nursing home, visit the office to get some work done (I am taking a week off) and then go home, pack, and drive to my folks'. So off I went to the nursing home, to visit a patient of mine who had a stroke after having surgery for colon cancer. The facility was brightly decorated, as it always is for Christmas - lots of tinsel garlands and plastic poinsettias. As I was sitting at the nurses' station writing my note, I suddenly realized that in the common room one of the aides was leading the patients in Christmas carols:

    Oh come, let us adore him
    Oh come, let us adore him
    Oh come, let us adore him,
    Christ the Lord.

    I spent some time discussing my new orders on the patient with the nursing staff and then got up to leave. I walked to the entrance of the dayroom to observe the proceedings: one of the wheelchair-bound patients was wearing a Santa hat. The aide was still bravely leading them in carols:

    Noel, Noel, Noel, Noel,
    Born is the King of Israel.

    I didn't find this sad or pathetic. As I looked at these people, I saw hope: no matter how old or sick we may get, we'll always be able to take pleasure in Christmas.

    I hope your holiday season is a good one.

    Wednesday, December 18, 2002
    I think this is really interesting. It's an article in the New York Times about a sonar-mapping project of the Hudson River that has uncovered every ship thought to have sunk there in the last 400 years. The scientists running the project also think they have found a series of walls, clearly of human construction, that date to 3000 years ago.

    Check out the whole article, it's great reading. This is what the Internet is for, by golly.

    Tuesday, December 17, 2002
    One of the doctors in my office emailed me today about a patient:

    today, when asked what medications he's allergic to , said "all generic medications".....
    "oh , I see" was my only reply......

    My emailed response:

    My favorite was the patient who said she was "allergic to cheap jewelry." I knew she meant a nickel allergy, but my response was "aren't we all?"

    Whew. It's been pretty busy - please excuse the anemic posting. I hope to have something good for you later this week. In the meantime, I can report that all my Christmas shopping is done (hallelujah) and nearly all my wrapping. I still haven't gotten lights on the tree though - it's sitting there naked.

    The end-of-year surgical crush is upon us, so I am doing pre-operative physicals like crazy. Patients have met their deductibles and now want to get their surgeries done before the end of the year, when the clock resets and they have to pay all over again. Now that we have more managed care we don't see so much of that, but some patients' insurance plans still have deductibles, where you have to pay out a certain amount of money ($250 or $500) before the insurance coverage kicks in.

    Managed care, meantime, is not without its issues; my elderly patients, many of them, have met their drug capitation for the year and are now subsisting either on samples, paying cash, or doing without their expensive but necessary meds until January. It never fails to amaze me how we manage to cobble together some sort of support for these people, at least most of them. Their generic drugs are covered, but brand-name drugs have a $2000 limit. (This is Secure Horizons we're talking about, the only senior plan we take.) Next year it will get worse. Pacificare (the parent company of Secure Horizons) thinks we're too expensive, due to the fact that our hospital contracts are with Cedars and Midway (a Tenet-owned hospital). They're right, we are too expensive. I will omit the long backstory and merely state that at Cedars, the cost for an outpatient surgery averages nearly twice the cost of an outpatient surgery anywhere else in town. So, to put the squeeze on the helpless elderly patients, they now will have to pay a $25 premium every month if they want to stay with us, plus no brand name drugs will be covered - just generics. I think we're going to lose a lot of patients, some of whom have been with the group for ten years.

    I will keep you updated on this situation as it develops. We have begun to refer to this particular company as "Insecure Horizons."

    Monday, December 16, 2002
    Here is another of Chuen-Yen's vignettes of life in Africa:

    Happy 3rd week of December!

    I just returned from mushrooming. The impetus for this outing was that I impulsively purchased a finicky tortoise.

    Two days ago, I spotted a feeble old rogue waving the little reptile wildly in the air. Sensing my curiosity, the salesman approached, shaking it even more violently. After learning how to stew tortoise, I bought the tasty creature for 150 Kwacha. In reference to the reason for her (three out of five voted that it is female) purchase, she will be known as �Enigma.�

    Once home, Gift promptly informed me that the �kamba� (Chichewa for tortoise) should only cost 50 Kwacha. As usual, I was ripped off because, �Madame, the dark ones see that you are White and know you have very much money.� He then asked how I would like the kamba prepared. To his dismay, I instead converted the bathtub into a temporary testudidine habitat, which I lined with a smorgasbord of food. Being a true Malawan, she voraciously consumed a lump of mgayiwa and nothing else. After getting over his incredulousness that the non-human had a name, Gift hypothesized about my new pet, �Madame, I think you have malaria.�

    Mushrooms, apparently the favorite delicacy of kambas, are a rare commodity in Blantyre. Gift and I just made a two-hour mushroom mission through brush and garbage dumps on the outskirts of town. Our tenacious efforts paid off when, 1.5 hours into the trek, we discovered 3 immature tan boletes. We gently extracted the precious fungi from some waste, wrapped them in large leaves and, with satisfaction, headed home.

    Back at the hospital, the dentist reported that mushrooms are easy to find. They grow in front of the union headquarters adjacent to my house. Amused with our endeavors, he scolded us for not asking him where to hunt before embarking our low yield quest. I still don�t know why I should have known to ask him. Across the parking lot, we found, as described, a plethora of boletes. We picked a few and laid the offerings in front of Enigma. She lunged, as fast as a tortoise can lunge, for the local mushrooms and glared disdainfully at the laboriously imported ones. Gift silently potted the rejects and placed them in the window.

    Merry Christmas from Enigma.


    Saturday, December 14, 2002
    MST fans will love this (from Shauny, who runs, I kid you not, the most awesome weblog. Please go and check it out right now):

    We were equipped with only an apple, a bottle of water, a dog, and a warning to watch out for snakes. Then we were dumped at the railway line with a few hundred sheep.

    In case you're not an MST fan, the key phrase is "watch out for snakes."

    Thursday, December 12, 2002
    Hamsters. Mmmm.

    On cold nights like this, I agree with Rebecca:

    Would you not like to tumble into a pack of sleeping Huskies and cuddle up and be all warm and toasty in their dogpile? That is where I need to be at this moment. Sleeping with dogs. Or a bunch of hamsters, if they moved as a single group consciousness wave whenever I moved so I wouldn't squish one by accident. Mmm, hamster duvet.

    Today I am going to share one of those special, warm holiday moments you only get when you have two doctors in one family.

    My father was helping me set up my Christmas tree recently. For the record, I have an artificial tree - I got it several years ago. I have taken plenty of guff from my siblings about my "fake tree" - they still swear by the real thing - but when you live alone and you have to maneuver a tree up a steep flight of 20 or so stairs, you quickly learn the merits of having the other kind. I can set it up as early as I choose and leave it up as long as I want, and I don't have to water it.

    Anyway, this particular tree has flexible metal strips covered with fake greenery as the branches. As you set the tree up you bend each large branch away from the trunk and then manipulate the smaller branches into the shape that you want.

    As my father and I struggled with the tree, he said:

    "Kind of like a penile implant, isn't it?"

    "Yes," I said, "exactly."

    Wednesday, December 11, 2002
    The perfect gift for someone you don't like: the body fat analyzer from Red Envelope. And it's only $64.99!

    Let me append to this that if you have a health and fitness fanatic in your family, it might be a great gift. But that wasn't my first thought as I contemplated this entry in the online catalogue.


    Anybody out there got any favorite computer games that they would recommend? I'm thinking of buying some for home entertainment purposes. Or, if you have a game system like PS2 or something, what do you think of it? Do games systems hook into your TV, your computer or what?

    As you can see I know very little on this subject, but I'm redoing my basement and a home entertainment system is going to be part of what goes in there. I am not planning to spend a fortune or to end up with a home movie theater, but any info you can suggest I'd appreciate. I am not a fan of the shoot-'em-up type games, if that helps any. I love Freecell and I used to be a big fan of Minesweeper and Taipei - still am but I got tired of them. I have a PC, not a Mac.

    OK. Let the advice pour in.

    Tuesday, December 10, 2002
    Tonight I called a patient of mine about her mother, who is also my patient. I'd seen Mother (age 85) last week for a blood pressure check. Her BP was sky high as usual. I asked her if she'd been taking her medication and she admitted she hadn't been. I asked her why not: "Well, doctor, I have to confess I've been a naughty girl. I just stopped taking it."

    Internal monologue: "I asked you WHY NOT, you wizened elf, ANSWER ME!"

    Out loud: "Well, when did you stop taking it?"

    Mother: "Oh, it couldn't have been that long ago. There's still four in the bottle."

    I look at the bottle. I last saw her September 20. I gave her 30 pills. That means she's only taken 24. She's been out of it for a month and a half. To doublecheck, I call the pharmacist (the number's on the bottle) and he confirms no refills.

    IM: "You stupid widget."

    OL: Firm lecture. "I'm calling your daughter. I want her to make sure you take your pills from now on."

    Mother: "Oh, doctor, that really won't be necessary."

    OL and IM: "Oh, yes it will. Now I want you to get back on these pills and I'll recheck your pressure in a month."

    Not mentioned above is the fact that Mother is deaf as a post, so I have to repeat all of my remarks at least three times in a very loud voice.

    So tonight I finally reach Daughter and tell her this story. She reacts with shock. She tells me she's asked her mother every morning if she was taking her pill and her mother told her yes. I believe her - I think Mother just doesn't want to take the stuff.

    Daughter: "Do you think there may be some problem with confusion? Her memory?"

    I tell her that whether there is or not, we have to get her mother's blood pressure under control before we do anything else. Interesting medical fact: a large percentage of dementia cases are not Alzheimer's but seem to be related to uncontrolled BP - multi-infarct dementia from multiple strokes is one such scenario, but hypertension alone over time seems to have damaging effects on the brain. One study took Alzheimer's patients with high blood pressure, treated their blood pressure and their confusion got better. So did their memory.

    So always take your blood pressure medicine, boys and girls!

    I have to admit, though: as I hung up the phone some part of me felt like I'd won, like when you get the last word in some petty argument. What kind of bitter, burned-out bitch of an internist would exult in scoring over some old lady?

    I WOULD.

    Music To Get Your Groove On

    This is a list of the top ten songs that the British like to make love to:

    Death metal, gangsta rap and contemporary Christian were not represented in the top 10 songs British people like to make love to, according to a survey released yesterday.

    Someone must have had a lot of fun writing that sentence.

    This Guy Is an Idiot, Part Deux

    I can't believe a vicar did this:

    Youngsters at a Christmas carol service were devastated when the Reverend Lee Rayfield told them Santa Claus was dead.

    Even parents at the service in Maidenhead, Berkshire, were shocked to hear Mr Rayfield say it was scientifically impossible for Father Christmas to deliver so many presents so quickly.

    He said this to an audience of FIVE-YEAR-OLD KIDS. Say goodbye to ever becoming Archbishop of Canterbury, pal.

    (From Instapundit.)

    Monday, December 09, 2002
    "These Guys Are Idiots"

    No argument here:

    IRVINE, Calif. (Reuters) - They thought they had stolen vicious pit bulls but instead they wound up with purse-sized Chihuahuas known for their timidity.

    The men were caught after bringing the dogs, which had ID microchips implanted under their skin, to an animal clinic in a PetSmart pet supply store for an examination and vaccinations.

    The store manager said she sensed that the pups were victims of a severe case of mistaken identity. "They asked me, 'What is this?'" Morgenthaler said. "I told them it looked like a Chihuahua mix. They said, 'No way, it's a pit bull.' They didn't believe me. They wanted to ask the veterinarian."

    When the men brought the puppies back to the clinic for an exam and shots two days later, Morgenthaler was prepared.

    "We said we were going to take them into the back to cut their nails and take their temperatures, and we called the police," she said. "It was pretty scary."

    During the examination, the men repeatedly asked the veterinary staff what breed the puppies were, and again insisted that they were not of the diminutive Mexican breed.

    "They were pretty perturbed that the puppies they stole were not pit bulls," Morgenthaler said. "They thought they were stealing pit bulls. These guys are idiots."

    This sounds like a pretty good argument for implanting microchips in your pet to me. But who could look at a tiny tremulous yipping puppy and think "pit bull"?

    Sunday, December 08, 2002
    Chuen-Yen sends her latest update from Malawi:


    Another Malawian week has elapsed. I now have a bad haircut, compliments of my houseboy Gift. And with this coif, I will appear on Television Malawi tonight.

    My folly was to seek a local coiffure in the open-air market, not an expatriate salon. I enlisted Gift to take me to �the place where black people go.� He said it was �close, very close.� The half hour short cut passed by Gift�s house, which he shares with two brothers. The house is a room, about 8 feet by 8 feet, divided in half by dismantled cardboard boxes suspended from the roof. Magazine images of ideal White people plaster the walls. On one side of the cardboard divide is the boys� bed, a bamboo mat sans linens. On the other side is an all-purpose crate / table and a line on which their wardrobe hangs. The kitchen, communal with two adjoining one-room abodes, is an even smaller, unventilated room. When I visited, it contained a bucket of water and a fire. Suffocating smoke was wafting into every living space, obviating the source of many people's scents. A typical heap of garbage, waiting to be incinerated, loomed over two short rows of immature maize plants. The brothers, feeling luxuriant in their domicile, are expecting another sibling to move in soon.

    From the house, we traversed a steep dirt trail, darted across a major two-lane thoroughfare and descended into the dusty Mbayani Market. Gift promptly warned me, �White people (I am considered White as the only other option is Black) never come here.� We slid down several rocky paths, passing innumerable rickety wooden stands, piles of waste and hordes of languid people, to the heart of Mbayani Market where a cluster of hair-cutting stands summoned. Stylist after stylist refused my business. Most stated that my hair was �too soft.� I also heard, �I cannot cut White people hair.� And, �My tools will not work on your kind.� Back at home, Gift cut my hair.

    Later in the week, the TV Malawi people called to inform me that we would be shooting our Children�s Broadcasting Day show in less than 24 hours at some local school. When the time came, the pupils were suddenly unavailable. So, we opted to use my stuffy little exam room as our backdrop. And I borrowed a seven year old from the hallway. Due to the changes, we discarded the intended script and brain-stormed up some health questions. A cursory search for props ensued. Then I looked into the camera and answered our queries with whatever came to mind. After this, we demonstrated how to wrap an ankle and sling an injured arm. No second takes. I think the finished product will be worse than a home video.

    I�m glad none of you can get TV Malawi.


    Thursday, December 05, 2002
    Today I heard on the radio that Saturn has come out with a new model, the Ion. Excuse me, the ION (that's how they spell it). I was delighted to hear this - finally, a good, 21st-century, vaguely-sounding-sci-fi-ish name for a car! Isn't it about time? Enough of these outdated, mid-century Mustangs, Pintos and Chevettes!

    Just hearing the name evokes the opening of a second-rate science fiction story: "It was after the Apocalypse. I was chugging along in my beat-up old '03 ION, hoping I had enough gas to make it home, when I spotted the Martian hitchhiking by the side of the road, twelve miles up the coast from Santa Barbara."

    You take it from there.

    Wednesday, December 04, 2002

    I am filling out a discharge summary for a patient at one of our SNFs (skilled nursing facilities, also known as "nursing homes"). This particular patient had end-stage cancer and died of pneumonia while at the SNF. She had a long and varied history with our group: I only acquired her as a patient about three years ago, when she decided she had tired of her original physician (whom she had been seeing for several years) and wanted a change. I think she was also annoyed with this other physician when she developed lung cancer, just as the other doctor had told her she would, after smoking for decades and refusing to quit. She was a rather difficult woman, but as seems to happen with any patient I have who is dying, I developed quite a bit of respect for her. Stubbornness is not always a bad character trait - it's helped a lot of people survive major illnesses.

    At any rate, she had a lung resection, which appeared to be curative, and did well for a few years before developing back pain about a year ago that just wouldn't go away. I thought she had a disc problem, but the MRI showed nothing. Then in April her blood tests came back markedly abnormal, and we finally diagnosed multiple myeloma. This is a cancer of the white cells in the bone marrow, similar to leukemia but not the same thing. She didn't handle chemotherapy very well, was admitted to the hospital for dehydration, generalized weakness and low potassium and calcium in September, was finally discharged and then developed pheumonia three weeks later. Her blood counts remained extremely low from the chemo and finally she was made a hospice patient and died a week later.

    So now I have to fill out this piece of paper - not an unusual task. Admitting diagnoses are listed. I have to fill in the discharge diagnoses (pretty much the same), summary of course of stay, and condition on discharge. It's this last category that suddenly gives me the mad desire to write something surreal. The fact that she's deceased is already listed at the top of the page: so what IS her condition at discharge?

    "Pretty good, considering."
    "More pleasant than when she arrived."

    And her prognosis? "Swift decomposition" comes to mind. I find myself seized by hysterical giggling... then I chicken out, quickly write "Deceased" and get the form off my desk before I can change my mind.

    Tuesday, December 03, 2002
    Full body scans, I have always felt, are not a good idea. It's nice to see someone backing me up:

    Full-body CT scans -- widely promoted in advertisements as a way to give yourself peace of mind -- frequently find harmless abnormalities that lead to invasive, anxiety-producing follow-up tests, researchers say. And they may be a waste of money for patients under 40, who run a low risk of serious disease, the study suggests.
    "This got pushed to the public before any of the research was done," said Dr. Giovanna Casola of the University of California at San Diego. "They're saying do it for your peace of mind, do it for your wellness, for your family. Nobody's saying, `Half the time we're going to find things that you're going to worry about,"' sometimes needlessly.

    The article goes on to say that 46 percent of all scans done showed abnormalities (this could include some innocuous cyst somewhere or something similar) and that 37 percent of all participants were advised to have follow-up tests! That's a lot! In other words, to use the language of statistics, these tests are quite sensitive but not very specific. Most of their findings turn out to be benign. Also, it's easy for the imaging centers to blithely advise their clients (I refuse to call them "patients") to go back to their primary care doctors to get these abnormalities worked up... they aren't the ones who have to bear the expense of ordering these tests and chasing down all the results. And thus the cost of medical care goes up due to these unnecessary tests, and the cycle continues.

    I think that for someone who has a strong family history of coronary artery disease, especially before the age of 50, the high-speed CT scans of the heart are a good idea. This is a high risk population. When you screen a cohort of people for a given disease who are at greater than average risk for getting that disease, the sensitivity and specificity of any test will increase. On the other hand, high speed CT scans of the lung to screen for lung cancer are not as good an idea. Quitting is better. The scans do pick up tumors at a smaller size, but you need to keep getting the scans year after year, even after you quit smoking. The people who continue to smoke and get these scans as a prophylaxis, and I know they're out there because I see them, are kidding themselves.

    Rant over for today.

    Monday, December 02, 2002
    How British Are You?

    According to the Britquiz, I am 100% British. Take the quiz yourself and find out!

    Sunday, December 01, 2002
    World AIDS Day

    December 1 is World AIDS Day. Please don't forget.

    I never really saw AIDS until I landed in San Francisco for my residency, in 1990 - when the epidemic was at its height. I went to med school in Philadelphia in the mid to late 1980's and we just didn't see much of it there at that time. It's a horrible disease.

    Here in the US and other industrialized countries, we have the benefit of advanced retroviral therapy and effective AIDS prevention programs. Not every place is so lucky. The average person who is HIV positive is now an African woman. AIDS is now running rampant on the African continent; if you don't believe me read Chuen-Yen's posts.

    There is a program called GAIA, which stands for Global AIDS Interfaith Alliance, which is trying to combat AIDS in Africa. If you are looking for a good end-of-year charity to donate to, I would recommend them.

    And please remember: SAFE SEX.

    Black Beans and Rice

    Mmmm. One of my favorite things.

    Today I decided to do a little experimental cooking based on a recipe I found in "Outlaw Cook," a book by John Thorne. This guy knows his food; he and his wife have run a subscription magazine called "Simple Cooking" for about 20 years now.

    This particular recipe was for black beans and rice. The kicker was the side dish served with it. John Thorne and his wife adapted a recipe for beans and rice which originally called for baked deviled eggs served on the side - they simply chopped hard-cooked eggs and put them in a curried white sauce, served with the beans and rice. Me, I love deviled eggs, so I thought that simply serving chilled deviled eggs alongside the main dish would work. It did.

    The recipe:
    Soak 2 cups of black beans overnight, then put them to boil in 10 cups of water (I used 8) with a bay leaf, 2 stalks of celery cut in large chunks, a bunch of parsley and a ham hock (I used a cup of ham scraps/pieces donated by someone who had ham for Thanksgiving along with their turkey). Skim off the scum from the beans in the first 10 minutes before adding the celery, etc. Then turn down to a simmer. Cook for one hour, or until beans are tender. It may take longer. Then fish out the bay leaf, parsley and celery and discard. If you used ham pieces, chop them up and return them to the soup. If you used a ham hock, cut off the meat and dice it, then return meat and bone to the soup.

    Now add the following flavoring mixture: 1-2 onions (depends on how large), chopped; 3 cloves garlic, chopped; 1-2 tsp each of cumin and oregano (I used 1 of cumin and 2 of oregano); and one dried hot red pepper, seeded and minced, or a tad of cayenne pepper if you don't have a dried one (I used about 1/2 tsp of cayenne). Saute all this in 1-2 tablespoons of olive oil and then add to the beans. Now add salt to the beans - 1/2 tsp at a time, be careful. Then let simmer another hour.

    While the beans are simmering, get the rice ready - cook as usual: 1 part rice to 2 parts water is the rule. Also, hard cook 6 eggs and devil as follows, once they are cooled and peeled. Slice eggs in half, remove yolks and sieve or mash. Add 2 tablespoons mayonnaise, 1 tsp vinegar (distilled white is fine), 1/2 tsp or less of salt (be careful here too), dash white pepper, 1/4 tsp paprika, and 1 tsp prepared mustard (dijon is nice if you have it). Blend and stuff back into the egg halves.

    Put the cooked rice into hot bowls, add beans and cooking liquid, and serve the eggs on the side. This is GOOD.