“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






Email Dr. Alice

 
If You Eat Sushi...

which I don't, by the way... you might be able to use this handy Sushi Finder.

Don't say I never did anything for you.

(Via Kate)

posted by Dr. Alice at #

 
Mister! Tambourine! Man!

Shatner To Release New Album

'Nuff said.

posted by Dr. Alice at #

 
It's About Time

And on a more medical note:

U.S. Bans Ephedra, Drug Linked to Deaths

I. Hate. Ephedra. The stuff should have been taken off the market before this. It's also known as ma huang, the original Chinese name of the herb. It's a powerful amphetamine-type drug, which will curb the appetite but will also increase one's blood pressure and heart rate. I've seen people come in with full-on atrial fibrillation and sky high blood pressure due to this stuff, and that's if they're lucky. Some have had strokes and heart attacks.

Remember, people: just because it's a "supplement" doesn't mean it's safe. Same goes for anything "natural." (A well-remembered med school professor of mine used to have a favorite riposte to this argument: "Poison ivy's natural, but that doesn't mean it's good for you!")

If the FDA doesn't pass it, I don't trust it. Granted, that's not a perfect safeguard either (anyone remember Baycol?), but it's a hell of a lot better than nothing.

posted by Dr. Alice at #

 
Jean-Luc Picard Fans...

And you know who you are... click here.

And it's all done in ASCII characters!

If you find this interesting, you can find plenty of others at ASCIIbabes.com.

(via Ernie, again)
posted by Dr. Alice at #

 
After Hours

Well, the cold-and-flu season is definitely upon us. Tonight the after-hours clinic overflowed into the hallway, and I stepped over to see a few patients with the residents and keep traffic moving. Everyone I saw had the same thing: upper respiratory infection, congested, paroxysmal cough till you gag. I prescribed a lot of decongestants and codeine.

One thing about this time of year, you may be busy but it's not that difficult. At least sixty percent of the patients you see all have the same thing.

posted by Dr. Alice at #

 
Interesting (Achoo!) Website

I just found a website dedicated to the common cold. A company called CommonCold, Inc. seems to be behind it, but I can't find any pharmaceutical sponsors. It appears to be meticulously researched and there's a lot of information there - but I can't help wondering who would spend that much time researching colds.

posted by Dr. Alice at #

 
Pediatrics 101

How not to check a baby's diaper, via Ernie.
posted by Dr. Alice at #

 
A Christmas Poem

... from Dave Barry that is worth reading. Also, Best of Tim Blair 2003 - but don't start this unless you have an hour to spare, because you won't want to stop.

posted by Dr. Alice at #

 
Uh, Sorry, Guys

It's been a whirlwind holiday season. I was out of town from the 23rd to the 25th (and, yes, air travel is hell right now). Came back to find I'd been made acting medical director because everybody else is out of town. This means I get to keep my beeper on 24 hours a day instead of only twelve.

But the POWER! Muhaha! I've been promising my staff raises and extra time off; fortunately they realize that this is delusional and I need my medication.

More later. Hope your holidays are wonderful.

posted by Dr. Alice at #

 
Heartwarming 1950s Christmas Stuff

Ah, good. Blogger is finally accepting my posts again. What was the problem this time? Who knows? Anyway, I thought to get you in the Christmas mood you might like to take a look at some cute, old-fashioned holiday decorating ideas. Most of them come from McCall's magazine, in the days before Rosie O'Donnell got her big mitts on it and sent it spiraling into bankruptcy.

Quick bit of history here: for decades there were seven main women's magazines published in the US, known as the Seven Sisters. They were Better Homes & Gardens, Women's Day, McCall's, Family Circle, Ladies' Home Journal, Good Housekeeping and Redbook. They were much alike, consisting of a mix of recipes, crafts ideas, short fiction (these magazines kept a lot of women writers going) and housekeeping hints. This formula worked well for awhile, but the last thirty years or so have been a different story. Still, all seven of them maintained at least a precarious existence until this year. McCall's became Rosie, and now I think it's gone for good.

Still, thanks to the Internet we can regress for a bit and take a look at what the hot Christmas decorating ideas were for 1952. I liked the mobiles.

(via Keri Smith)

posted by Dr. Alice at #

 
Dexter Must Go
or: Lord, Preserve Us from Awful Children's Sermons

I may or may not have told you that the rector of my church (I'm Episcopalian) was recently elected the new Bishop of Arizona. He's a good guy and we'll be sorry to see him go, though we're all very happy for him.

But last Sunday I realized that every cloud has a silver lining. You see, the second Sunday of the month at our church is always "School Sunday," dedicated to the children of our parish school. On School Sunday the adult choir gets the day off, the children's choir sings for the 10:30 service, and many more students and parents attend than on an average Sunday. This means that the sermon is, of course, guaranteed to be a (shudder) children's sermon.

Remember children's sermons? You know you do. Remember getting called up to huddle on the altar steps, feeling like an idiot, as the minister took the handheld mike, got down from the pulpit and started wandering around like Mike Douglas or Dr. Phil? Too often, children's sermons get sappy ecclesiastic leftovers instead of, you know, some intelligent theology. I swear to you, I still remember my former minister declaring, from a kid's sermon in the 1970's, "How do we know God has a sense of humor? Look at zebras! Look at giraffes!" Oh, the horror...

Well, I've heard some good children's sermons from time to time, but last Sunday's wasn't one of them. You see, our rector has a secret weapon that gets him through those times when he has to preach a children's sermon. That weapon's name? Dexter. Dexter is a ventriloquist's dummy.

No, you didn't misread that: a ventriloquist's dummy. And our rector is many things, but he is not a good ventriloquist. He also isn't very good at telling jokes, and a Dexter sermon is guaranteed to start off with two or three jokes usually involving really bad puns. Exhibit Number One would be Dexter's name. The rector uses his right hand to animate the puppet: Dexter. Get it?

Last Sunday I was verger again, so I had other things on my mind. When the sermon started I was actually relieved, because it meant I had ten or so minutes to relax - then I noticed the director of the children's choir exiting rapidly into the side hallway where I was. He's a good friend of mine, I've known him for years, and we both hate Dexter. When I saw the expression on his face, I knew what was coming.

We stood in the sacristy, hearing every word, cringing at Dexter's smarmy puppet voice and every lousy pun. "At least this is the last time we'll ever have to hear this," I said, suddenly feeling much happier. As we waited, we recalled the plan we'd concocted about a year ago to kidnap Dexter and leave his charred, smoking frame in the parking lot. Why we didn't go through with it, I'll never know - too chicken, I guess. But knowing this was Dexter's last stand made up for it.

The one thing that worries me is this: what happens if the rector decides to bequeath Dexter to one of the other priests? If that happens I will find some way to destroy that loathsome creature. Better dust off the parking-lot plan.

posted by Dr. Alice at #

 
Morning-After Pill

Looks like we're getting closer to having "Plan B," one version of the morning-after pill, sold over the counter. I don't have concerns about safety with this - it doesn't contain estrogen, just norgestrel (a progesterone). This means that the drug doesn't have the risks of blood clots and other estrogen side effects. However, I am concerned about the possibility that women will attempt to use it at other times than within the 72-hour period that is recommended. I do get questions about this from patients even now: "But are you sure I can't have it?"

If this goes through, the marketing campaign will have to emphasize the importance of timing. It has to be used within 72 hours of unprotected intercourse, and sooner is better even within the 72 hours (i.e., it's more effective at 24 hours than at 48).

posted by Dr. Alice at #

 
Updating the Classics

Apparently, the newest entry in the Lord of the Rings film trilogy has a really awesome car chase scene.

::ducking::

posted by Dr. Alice at #

 
Some Guy Named Hussein

I think it's a federal mandate that if you have a blog, you have to comment on Saddam Hussein's capture. Well, first, I'm late, and second, there are hundreds of bloggers who have done so and done it better. But I'd like to post one quote that I really liked, from Josh Chafetz:

Brokaw on Saddam: "He was literally a rat trapped in a hole." No, he was figuratively a rat trapped in a hole. He was literally a former dictator trapped in a hole.

Yes, yes, yes! I hate it when people misuse words like that. This guy is a national journalist and he doesn't know what literally means? Give me a break.

(via InstaPundit)

posted by Dr. Alice at #

 
Patient Etiquette

GruntDoc has some great tips for patients who wind up in emergency care. I'd like to add that these apply to your primary care doc, as well.

posted by Dr. Alice at #

 
The General Synopsis at Midnight

(Isn't that a wonderful phrase? I just love it.)

There's a British sitcom currently rerunning on PBS called As Time Goes By which stars Judi Dench and Geoffrey Palmer. It's an understated romance between two middle-aged people, and I find it really enjoyable. One of the characters in the series, Mrs. Bale, is an eccentric housekeeper (like Mrs. Danvers in a way, but more user-friendly); her hobby is listening to the BBC's Shipping Forecast. She has a habit of breaking into unrelated conversations to inform her hearers of gales off the coast of Iceland, and so forth.

I bring this up because I have a confession to make: I, too, am a weather geek. I watch the Weather Channel to relax; I have the NOAA weather site bookmarked on my computer; and, yes, I too read the Shipping Forecast. On particularly stressful days, I even listen to it (you can play it right off the site). In fact, the title of this post is taken from the Forecast. Mrs. Bale's hobby seems completely reasonable to me.

Why do I, who live in Los Angeles where the climate almost never varies, fixate on weather? I have come to believe that it's a combination of reasons: the fact that I am not responsible for it the primary one, no doubt (so restful! It's not my fault!), but the sheer drama of it all playing a part as well. Floods, tornadoes... it's the Old Testament come to life. Then there's the pleasure of reading weather forecasts for places I used to live and congratulating myself that I don't live there any more. Severe weather alert in Philadelphia, eh? Gee, too bad.

The announcers read so nicely, too. No matter how fiercely the gales may blow or the rain come down, their voices never vary. You can't tell from their tone whether we're in for another nice day or a hurricane warning. One could doze off, soothed and comforted, in front of the Weather Channel, snug in the realization that the bad stuff is all happening to somebody else, and in fact I have been known to do exactly that.

And, lastly, I must say that if I ever write a novel, the title will undoubtedly be "The General Synopsis at Midnight," no matter what it's about.

posted by Dr. Alice at #

 
Tired Doctor Rant

So you wanna know how my day went? I'll tell you how my day went:

I get a 7:30 am page from the doctor on-call that one of my patients had presented to the ER at 2 a.m. with a seizure, and his wife was throwing fits because a) she didn't like the hospital and b) he was too agitated to get into the CT scanner, and "how are we going to know what's going on if we can't scan him?"

There was nothing I could do about the hospital; it's flu season and the guy's contracted hospital (let's call it Big Tertiary Hospital) was closed to ambulance patients. It's full, not a bed available. So we had to keep him at Community Hospital. I tried to reassure the wife that Community Hospital was, indeed, conversant with 21st century medicine and that they would not try to trephine him to let the evil spirits out of his head.

So I call the hospitalist (I also had to explain to the wife that we have a hospitalist who sees our patients) but, being a busy guy, it takes several hours for him to get over there, during which time the wife calls me AGAIN. He's still in restraints but his vitals are stable, etc. so I keep trying to reassure her that he's being observed in the ER and things are OK.

Now, this guy has some medical problems. He has vascular disease and diabetes; it's possible he could have had a stroke. So I understand the wife's concern, it's just that there really is nothing different to be done. If the patient is too unstable (or agitated) to scan, he's too unstable to scan, and that's it.

Finally the hospitalist gets there and proceeds to tell me that the patient is a boozer and had had about eight beers with his brother the previous weekend! (He'd denied heavy alcohol use to me, and his liver function tests were OK when I'd done a checkup on him.) Oh, and he had a urine test which was positive for marijuana, too. And he was threatening to walk out against medical advice. Fortunately, he waited till his wife showed up at the hospital to leave.

So that's how Mr. Party Boy ruined my ENTIRE DAY. Hmmmph.

posted by Dr. Alice at #

 
Yum Yum

Check out this article for street food recommendations in NYC, San Francisco, Chicago, Philadelphia and Austin, if you happen to be in any of those places. (Sadly, no Los Angeles recommendations included.)

(Via Philly LunchBox)



posted by Dr. Alice at #

 
FDA Alert

Here's an interesting piece of news from PDR.net regarding food dye:

FDA Alert Issued for FD&C Blue No. 1

The FDA has issued an alert for healthcare professionals regarding reports of toxicity, including death, associated with the use of FD&C Blue No. 1 (Blue 1) in enteral feeding solutions. In these reports, Blue 1 was intended to help in the detection and/or monitoring of pulmonary aspiration in patients being fed by an enteral feeding tube. Episodes of blue discoloration of the skin, urine, feces, or serum were reported, as well as serious complications such as refractory hypotension, metabolic acidosis and death. Seriously ill patients, particularly those with a likely increase in gut permeability (eg, patients with sepsis), were reported to be at greater risk for these complications. A causal relationship between systemic absorption of Blue 1 and the reported serious and life-threatening patient outcomes (including death) has not been definitively established.

Now, for those of you who don't know, use of the blue food coloring in enteral feeding (tube feeding solution) is absolutely routine. As the excerpt states, it's used to identify the feeding solution in case the patient chokes or you have reason to think they are aspirating chronically. My question is, with use of this stuff so ubiquitous (at least in California) wouldn't this have been picked up sooner if it were truly a problem? And the article itself states that no definite association has yet been established.

In addition, this population is extremely ill and at higher than average risk for having complications to start with. The tube itself has the potential to cause problems (insertion site infections and so forth). I'd really have liked to be able to see the data on this. That said, even a low risk should be avoided if there is an alternative. (Green, anyone?)

If anyone has more info on this, I'd be very interested to hear it.

posted by Dr. Alice at #

 
Save This For Your Lunch Hour

It's time once again for the annual Dave Barry Gift Guide.

posted by Dr. Alice at #

 
Make Mine American Cheese, Mushrooms and Onions

This article may have limited appeal, but I found it charming. Having lived in Philadelphia for nine years, I am an avid cheesesteak fan - how could I resist an article about an eighteen-year-old whose senior project became a quest to find the best cheesesteak in the Philadelphia area? If you like cheesesteaks, Philadelphia, and/or food writing, give it a look.

(Via Philly LunchBox.)

posted by Dr. Alice at #

 
Interview With The Scammer

From Tim Blair comes this interesting piece about one of the perpetrators of those Nigerian emails promising millions of dollars in windfalls. The writer interviwed a mechanic who was recruited by a friend of his to participate in the scheme.

Personally, I can't believe people are still falling for this, but apparently they do.

posted by Dr. Alice at #

 
"Oh, the Herbanity!"

The Goodyear Blimp has crashed into a plant nursery in Carson, CA. No one was seriously hurt, thank goodness.


posted by Dr. Alice at #

 
More Random Non-Medical-Related Links

First 2 via Ernie... third one is via Jack.

1. Take a couple of these to bed with you and you won't need to turn the heat on all winter.

2. For the computer geek who has everything... except maybe good taste.

3. Well, I take it back. This one is sort of medically related, but it's really weird.

posted by Dr. Alice at #

 
What She Said

I completely agree with this:

You know who I don't get? I don't get the people who say, "Oh, I love when Lileks goes on about Target and Gnat, but I hate when he gets political." Or the opposite--"I love when he gets screedy, but I hate all that girly shit about Target!" Personally, I love both. I read Lileks because I want to "hear" Lileks. Imagine if you went out with some friends and the minute they branched off into a discussion you didn't care for, you said, "You know, I really like when you talk about work, but I hate when you talk about your girlfriends. You're really boring me." Your invitations out would dwindle pretty rapidly if you kept going around doing that.

Read the whole thing. This is why I don't write about medicine only (I know, sometimes I don't write about it at all); there are other weblogs that do that, and they do it much better than I do. I don't have time to analyze and write long, thoughtful articles; I wish I did. You get what I have at the end of the day or between patients. It's Short Attention Span Blogging. Many times I can't think of any medical topics that I find interesting, or by the time I get around to writing something (like Medicare, for instance) it was covered by somebody else days ago.

So I write about other stuff. Something I find funny, or that I heard that day, or whatever. Vodkapundit mixes political commentary and recipes. It works for me.

So there you have it. Ilyka verbalized my position much better than I did.

posted by Dr. Alice at #

 
A Phrase I Could Go a Lifetime Without Hearing Again

"Given the number of eggs there, there's about 300 hookworms in my guts."

I'll give this guy credit - he's studying himself. Dr. Alan Brown, the man quoted above, claims his hay fever completely disappeared after he became infested with hookworms while traveling in the Third World. This article also mentions a woman with ulcerative colitis who is voluntarily drinking a solution with worm eggs in it to control her colitis symptoms.

The gist of the article - and it is interesting - is that since humans evolved with a chronic level of parasite infestation, and that parasites in developed countries really have only been eradicated in the last fifty to sixty years, the lack of parasites may explain why our immune systems are turning on us to cause diseases like asthma and autoimmune problems. It's quite an argument.

The article also discusses the toxoplasma parasite, which usually infects the central nervous system (i.e., the brain) and is thought to control behavior in some animals which get infected, like rats. I quote:

The main way we get it is by eating undercooked meat (which is why 80% of the French are estimated to have it, with their love of rare meat).

Well, that explains a lot...

For years scientists thought it had no effect on our behaviour, but now the parasite's changing their minds.

AIEEE! Toxo is turning scientists into zombies! Oh, wait, it's just a badly constructed sentence. Anyway, read the article.

posted by Dr. Alice at #

 
The Bad Sex in Fiction Award

No, it's not going to Jacqueline Susann. It's still worth reading the article, though; and Sting is presenting the award! Priceless.

posted by Dr. Alice at #

 
Thanksgiving Dialogue

I staggered into the kitchen at 7:00 Thanksgiving morning to find my mother and sister already busy cooking and their pecan pies in the oven. My niece and nephew (ages five and three) were standing on stepstools, peering into the sink, raptly contemplating the 21-pound turkey resting therein.

As I absorbed some coffee, I listened to their commentary:

"Is this his neck? Aunt Alice, look!" (Waving turkey neck in the air.) "How'd they cut it off? Did it hurt?"

My nephew lifted the wing: "What's under there?"

"That's his armpit," said my niece, knowledgeably.

"Is this his bottom? Mommy, does he poo? Which end is his bottom?"

"Well, honey, he doesn't have his guts anymore, so he can't poo," I tried to explain. "They took them out, see?" At which point the bag of giblets came into play.

Let's just say these kids will never join PETA. They were having a great time.

posted by Dr. Alice at #

 
Ivan Denisovich, M.D.

So we're back at the gulag today. I wish I had more time to write, but I just don't. I'm getting sandbagged with physicals and strep throats. So here's a little filler for you, and I will try to do better later this week.

First: here, via InstaPundit, is a really interesting article about Bill Watterson (remember Calvin and Hobbes?)

And second: a funny and vaguely obscene picture of Dick Gephart, via Dave Barry (of course).

posted by Dr. Alice at #

 
Not Thanksgiving Day, But Still a Day of Note

Hi there. Quick check-in for you.

Multitasking this morning: I'm blogging and I'm on call and I'm waiting till it's time to leave for the airport and I'm celebrating my birthday. Seems emblematic of the past year: I spent most of my time doing something while simultaneously doing something else. This is probably why it seems so unimportant that I'm turning the big 4-0 today.

(Question from the peanut gallery: If it's so unimportant, why do you mention it? Answer: To have something to blog about, of course.)

Seriously, I managed to spend the last few months barely cognizant of the fact that said birthday was approaching. Boards will do that to you. I ponder it at odd moments, like while brushing my teeth, and of course when inputting my age on the elliptical trainer at the gym. I know it's none of its damn business how old I am, but it's just trying to help. It also comes to mind when my sister calls me up, as she did last night, and leaves messages like "This is the last time you'll be thirty-nine!" Nevertheless, I say bring it on. Give me a fresh new year, better than the old year.

I have requested scuba diving lessons from my family for my birthday: I want to start making some inroads on that "life goals" list I drew up a few months ago. I want to challenge myself. But fear not, I have no intention of taking up skydiving... the idea of being thirty feet underwater and possibly confronting a great white shark is more than enough for me. (Note: I also have to stop visualizing worst-case scenarios.)

Well, that's it for now. I will clock in again after the holiday - happy Thanksgiving to you all in the States, and for those of you not in the States, have a great rest of the week and weekend.

posted by Dr. Alice at #

 
Yuletide Sign of the Apocalypse, Part II

See for yourself.

posted by Dr. Alice at #

 
Oh My God

If this doesn't qualify as a Yuletide Sign of the Apocalypse, I don't know what does.

posted by Dr. Alice at #

 
Ancient Habitrail?

This article brings back memories of my mother yelling, "Alice, take care of that hamster cage! That poor animal hasn't had its cage cleaned in 17 million years!"

posted by Dr. Alice at #

 
Midnight Caller

I was fathoms deep in REM sleep when the pager went off. I usually snap awake within a couple of seconds when this happens, but that night it took nearly a minute to shake off denial, pick up the phone, and dial my voicemail number.

I recognized the voice of the woman leaving the message. She's a nutcase (I know this is judgemental and un-PC and all that, but I'm going to be honest) who has called many times in the past, always requesting antibiotics on slim grounds. Fortunately, she's not a member of my practice; she belongs to one of my partners who is known for having a large stable of wacko patients. While I was listening to her message and trying to write down her phone number, the pager went off again. Same woman. Total time elapsed between pages: maybe four minutes.

She wanted antibiotics again, despite just having completed a course of antibiotics. She was coughing, you see.

"Are you taking anything for your cough?" I asked.

Of course not, she didn't need cough meds, she needed antibiotics, she replied.

I begged to differ. This led to a discussion that lasted a good ten minutes (that's par for the course with this woman). I told her I would call medicine for her cough and call her primary care physician the next day, but that I didn't think she needed another course of antibiotics one day after finishing the previous one.

Another time I got a phone call in the middle of the night from another patient (also a member of Doctor X's practice) who left a long, semi-hysterical message on the voicemail about how she couldn't sleep and she was going nuts and she really, really had to sleep. So I called her up and, lo and behold, she had a prescription of chloral hydrate sitting in her house all ready to use; she just wanted to talk to somebody first. Half asleep, I told her yes, yes, just take the medication.

On my next call night, she pulled the same trick again at one-thirty in the morning. Same hysterical message on the voicemail.

This time I dialed her up and, when she answered, I hissed, "Don't you ever do that again!"

I never heard from her again.

posted by Dr. Alice at #

 
Holiday Shopping Tip

(Obligatory disclaimer: I have no interest, financial or otherwise, in the website listed below.)

Need help shopping for your boss, neighbor, in-law, or "friend who has everything"? (How many of those do you know? I can't think of one, frankly.) Well, agonize no more: Dr. Alice is here to save your hide.

There's a company called cafepress.com which specializes in personalized items (T shirts, coffee mugs, bumper stickers, etc.) for many different websites. The one I'd recommend is Ideogear. Ideogear will take a word and supply you with the kanji, or Chinese ideogram, for that word. (I gave one friend a coffee mug marked "doctor," another a mug with the kanji for "prayer.")

The options are limitless: pick your recipient's hobby, profession, or other interest and give them something personalized with the corrresponding kanji. And you can order online, and they'll deliver.

There. Don't you feel better now that all that gift-giving pressure is gone?

posted by Dr. Alice at #

 
Is It Friday Yet?

I've been a bad blogger... neglectful of my duties. The last few days I've really had nothing to say. Well, not nothing, exactly. I just didn't feel like inflicting every little gnat-like thought floating through my cerebral cortex on you, my patient readers.

BUT. Our monthly physicians' meeting has been canceled, leaving me with time on my hands and an urge to communicate.

The weather in LA has changed significantly since last month's fires; it rained hard Halloween night and it's been cool ever since (into the forties at night). I was delighted to return from Mexico's hot and humid nights so that I could enjoy curling under the blankets again. Years ago, many houses used to boast a sleeping porch - a tradition I'd like to revive. Every year at this time I wish I had one; maybe someday I'll add one on.

This Sunday is the feast of Christ the King - the last Sunday of the liturgical year, which starts over again with the first Sunday of Advent (on November 30 this year). It also marks my debut as verger at St. James'. Yep, I get to wear the robes and carry the stick. I just hope I can get through the service without screwing things up... wish me luck. (Fortunately, I'm being trained by our head verger, who's been doing this for years and knows absolutely EVERYTHING.)

And, last but not least, my birthday's next week. I got an anxious call from my mother asking what I'd like to mark the occasion. And it is an occasion... I'm turning forty.

I can't believe this. Internally I think I'm still, I don't know, 29 or something. I don't think anyone actually visualizes themselves turning forty, or fifty, or sixty.

I had more to say on this subject, but I'm getting buried in the Friday-afternoon rush, so will stop here and pick up on the topic later.

posted by Dr. Alice at #

 
Bad Baby Names

I must, must, must give props to Ilyka for this one: unbelievably bad, real-life baby names. You'll laugh, you'll shudder, you'll roll your eyes.

posted by Dr. Alice at #

 
Whoa, This Is Worrisome

Microsoft fires worker over weblog

This is one of the reasons why I try not to give too many details about my work. Unless, of course, they're too funny/juicy/unbelievable to pass up. Caution always pays, though. I wonder if HIPAA covers weblogs? Our risk manager would probably have a fit if she knew about Feet First.

Well, I have no plans to change anything for the time being - just to try to change any identifying details in stuff that I post, as I always have.

In other news, the Leonid shower is tonight. V. and her husband and I will be trying to catch a glimpse of a falling star or two. L.A. is probably the world's worst place to try to starwatch, though. If a giant meteor were to land in Southern California, my last words would probably be "Hey, I think I see someth..." KAPOW!

posted by Dr. Alice at #

 
New Dr. Who

Could you see Rowan Atkinson as the next Dr. Who? Or even... Eddie Izzard?? It could happen.
posted by Dr. Alice at #

 
Koo Koo Roo Entree Lookalike

Click here. Then try to tell me I'm wrong.

Oh, and I love where they pinned his competitor's number, don't you?

posted by Dr. Alice at #

 
Hi, I'm Back

What did I do on my vacation? I went to Mexico, sat on the beach, and read till my eyeballs fell out. I was also lucky enough to be offered a ticket to The Phantom of the Opera by a friend who had a spare (thanks, Mary!) I'd seen it before, but not for years - I'd forgotten how much fun Phantom is. Bring on the hidden passages, the subterranean lake and the great music! I'm not that much of an Andrew Lloyd Webber fan, but his music for Phantom really holds up well.

Various and sundry links for your viewing pleasure:

A very funny article in the Onion - Mom Finds Out About Blog - and the response, via Blogger.

The trailer for Harry Potter and the Prisoner of Azkaban is viewable here. Looks good. The movie is scheduled for release in June 2004.

And then there's the Church Sign Generator, for those of you who have not already seen this. This could be particularly cathartic for any Episcopalians coping with the Impending Schism situation right now. ("Bite me, Griswold!")

posted by Dr. Alice at #

 
Off Track

In the LAUSD [L.A. Unified School District] these days, you often don't get the traditional September-to-June schedule anymore; they teach all year round to get more use out of the existing school facilities and serve more students. Teachers and students still get time off in six-week blocks, but they now call it being "off track." When you're working, you're "on track."

Well, I've been on track a hell of a long time and now I'm going off track for a week. If you want to know where I'm going, click here. I'll see you in a week.

posted by Dr. Alice at #

 
What If You Were Only Born With Middle Fingers? and Other Questions

I think you'll enjoy this post from Paulapalooza. If you know any six-year-olds, or have ever been the parent of a six-year-old, or have been forced to answer question after question from a six-year-old, all on the same subject, you will definitely enjoy it.

posted by Dr. Alice at #

 
The Boards

In case you're wondering, I have proof that there is a God. The proof? Out of four hundred candidates, it was V. who was assigned to sit next to me during the Boards exam. For those of you who don't know, V. is my best friend at work. She's an endocrinologist/internist. We both had to recertify (she in Endo, I in General Internal Medicine) and we both had the jitters.

The recertification process is relatively new. Only docs who were board-certified after 1989 have to do this; in other words, V. does not have to recertify in Internal Medicine, only in Endocrinology (she finished her Endo fellowship after '89). I sat the Boards the first time in 1993, which means that I'll have to go through this once a decade for the rest of my professional life. Having done it, though, I can say that it's no longer something to be dreaded. Hopefully it will eventually become a relatively routine process, though it will always be a pain. By the end of the whole thing, V. and I were thinking about what would be going on in our lives next time around:

"The next time we do this, David [her son] will have his learner's permit." So will my niece, for that matter.

We took the test in Pasadena, in the city's big Exhibit Hall; her husband's office is five minutes away. We each had to complete three modules, each lasting two hours consisting of sixty questions. When we were done, we staggered out and drove to Bob's office, where he took us to a Mexican restaurant a block away and we consumed margaritas and a platter of appetizers.

At least it was only one day; the first time you certify it's a two-day test, eight hours each day. That was bad.

posted by Dr. Alice at #

 
I Wasn't Embarrassed To Admit To Being a Californian...

until I read this.

posted by Dr. Alice at #

 
You've Probably Already Seen This...

but just in case you haven't, they found Nemo.

posted by Dr. Alice at #

 
YEAAAA

It's over!!
More to follow.

posted by Dr. Alice at #

 
Bummer, Man

Per L.A. Observed, our local news station KNX has axed its nightly hour of old-time radio drama. The final episode aired last Friday night; fittingly for Halloween, it was "War of the Worlds." This saddens me. I didn't tune in every night, but it was great to hear some of those old shows - "Gunsmoke," "Dragnet," and "The Lone Ranger" among others.

Some nights when I was either on call and coming back from the hospital, or just leaving the office really late, I'd turn on the radio to KNX and drive slowly, listening to the sound effects, corny music and snappy dialogue. Radio really is a "Theater of the Mind," as they say... it's amazing how wrapped up you can get in the action, driving along. Some nights I'd pull into the garage and sit there for another five minutes, waiting for the show to end.

My dad used to do the same thing; KNX has had a "Drama Hour" for decades. He'd sit in the driveway, too, waiting for the Lone Ranger to track down his man and bring him in, or for Marshal Matt Dillon to solve the problems of the town and have a chat with Miss Kitty on the side. (Incidentally, did you know that the actor who played Matt Dillon on the radio was William Conrad?) The first time I heard that, I almost lost control of the car, I was laughing so hard.)

If I ever want to hear those shows again I'll probably have to buy them on tape or CD or something. Unless we, the radio audience, get lucky and some other station decides to pick up where they left off.


posted by Dr. Alice at #

 
"Click the Refresh Button, or Take a Cold Shower and Try Again Later"

Via Ernie:

The 404 Porn Not Found button. No, it's not particularly dirty, just funny.

posted by Dr. Alice at #

 
Smallpox: The Musical

Somebody has actually come up with these lyrics:

The halls are awash, with the sound of mucus
And everyday ills, are now shown the door.
'Cause deep in our hearts, what has so confused us, is fevers and pustules and festering sores

Catchy, eh? Armageddon, musical style!

posted by Dr. Alice at #

 
Again With the Dilbert

Those of you who know me will find this cartoon very funny. Alice is definitely my favorite Dilbert character.

posted by Dr. Alice at #

 
Update

Well. I thought I�d take a few minutes on my dinner break to fill you in on my life before I go back to hitting the books:

1. Boards are in three days. I think I�ll be okay � I think. I just need to keep studying a bit longer. I now realize that I should have started sooner, of course; ten years from now (if I�m still in practice then) I�ll begin this process at least a year ahead of time.

2. The latest complication in this recertification farce is that two of my home-study modules have been fired back at me; apparently I failed Rheumatology and Cardiology. (Ironically, I had a cardiologist helping me with most of the answers to the damned test!) So I have to get those done and resubmitted before the end of the year � the saving grace, though, is that I don�t have to redo a new sixty-question booklet, just the ones I got wrong. The Board tells you which answers you got wrong, so it should be easy enough to go back and fix them. I�ll get to that after the test is over.

3. I almost got denied access to the stupid test because the Board managed to lose my admission card in the mail. The only reason I found out about this in time to do anything about it is because my friend V. is taking her Endocrinology recertification exam on the same day and called to ask if I�d gotten my card. (�What card?" Cue the panic.) I called and begged for a new card to be sent to me and only received it yesterday. God bless V. She�s the only bright spot in this ordeal. We�ll both be in Pasadena all day on Wednesday � wish us luck.

4. Hmm, so Gene Robinson got ordained. I had been following this whole issue with interest until about a month ago, at which point Test Panic overtook me and I turned into the most self-centered person on earth. Screw the ordination� what about my test?? At this point, I�ve more or less elected not to think about anything controversial or distracting for the next 72 hours. As always, Jack has an impressive number of links handy if you�re interested in following this issue. I will say this: it�s not over. Any optimists who thought the ordination of Gene Robinson would put an end to the controversy, think again. It will be interesting to see what happens within the ECUSA and the Anglican Communion as a whole over the next six to twelve months - but in much the same way that a train wreck is interesting. No, I'm not leaving my church. I have no desire to; more importantly, I feel I was called there and that's where I belong. If tensions arise locally - and I must say, so far I've seen no signs of that developing - I hope I can help in some way. Constructive, not obstructive; that's my motto.

That's all, folks. Back to the books.

posted by Dr. Alice at #

 
Dilbert

On a lighter note, check out Dilbert today on the subject of cholesterol. Made me grin.

And as I was going through board review questions last night, I found a case history giving the patient's name as "Dil Cubicle." I guess somebody at MedStudy has a sense of humor.

posted by Dr. Alice at #

 
Unbelievable

Today I was seeing a patient with a lot of complaints - bowel problems, irregular menses, trouble sleeping - and she said that she was sure stress had a lot to do with it. I asked was she under particularly severe stress, and she said yes.

What was the stress? I asked.

A friend had recently died, her boyfriend had walked out on her, and then - dear God, I don't want to write this - she told me that her sister's abusive boyfriend had attacked her two small children with a knife. My patient said her niece was dead, and her two-month-old nephew had been stabbed in seven places but would survive. He had required reconstructive surgery on his arm.

What do you say when someone tells you something like that? Besides "I hope the bastard rots in hell," I mean.

I tried to take more time than usual, talked her through things, and told her to call me if she was getting worse or needed any help. I hope it gave her some relief to talk to me.

posted by Dr. Alice at #

 
E-Mail Trouble: A Cautionary Tale

Herewith the transcript of an actual email from last week. Heed the warning.

First, perhaps I should explain that my friend V. and I have a habit of emailing each other back and forth at work. One of our favorite things to do is to take one of the mass administrative emails that we're sent every day, alter it in some disrespectful fashion, and forward it on to each other. It's our act of revenge upon these useless announcements that pad our computer memories like foam packing peanuts.

Original email:

Please join us at a farewell reception for
XXX XXX
Sr. Vice President, [generic administrative title]
on Tuesday, October 21
etc., etc.

I appended the following comment:

Will there be food and booze? If not, forget it!

and forwarded it on to V. At least, that's what I thought I did. Until I received the following response:

Uh, no.

I then looked at the address in the heading and realized that instead of forwarding it, I had hit Reply and sent it right back to the exchange administrator!

I did the only sensible thing: looked her up in the Microsoft Outlook directory program, called her, and apologized. Fast. She was quite understanding about the whole thing: "We occasionally get these. I usually just send a little message back so that people know they went to the wrong place."

"It was a joke, I swear. Just a joke," I explained about four times. I could tell she was amused about catching a doctor stooping to this sort of immature behavior.

But the story's not finished: I sent the whole thing on to V. with this explanation:

I'm an ass. I called to apologize, fortunately she was very nice about it. I meant to send it to YOU.

And got this back:

Ooopsie!!!
Hey, you made me laugh out loud. Not bad for a post-call Monday!

posted by Dr. Alice at #

 
The Mystery of the Disappearing Calcium

Sorry, again; busy again. I spent the weekend studying and freaking out about the fires, the Boards, then the fires, then the Boards... ad infinitum. I actually was looking forward to Monday and the discipline of work, hoping it would get my mind back on its tracks.

We shall see.

Presented here is a post from Paula, an internist like myself; it's all about her experience of acute hypocalcemia and tetany during a colonoscopy. It's very well written and I'd like to take this opportunity to recommend her blog in toto, but the other reason I'm linking to it is that thanks to this post I finally understand calcium metabolism.

Briefly, Paula is a vegan (at least, she was for a while. I don't know if she still is after this experience) who went for a colonoscopy as a regular screening procedure. Prior to this sort of test, you must ingest a "colon cleanser" (read: extremely powerful laxative) so that the MD can see what he/she is doing and whether there are any lesions in the colon. Most colon cleansers are heavy on the phosphate. Phosphate binds with calcium and precipitates it out of the bloodstream. If you have normal calcium levels, this is not a problem - but if you are vegan, meaning you don't eat dairy, and you work from dawn to dusk and never see the sun (and therefore don't have any Vitamin D in your system), you wind up with osteomalacia or "adult rickets." And then, after ingesting lots of phosphate in the colon cleanser, your calcium goes into the basement and you get tetany or cramps and spasms all over your body.

Thanks, Paula. I get it now.

posted by Dr. Alice at #

 
Poison Hangman??

So I have this patient who may have cognitive dysfunction due to a toxic exposure of some sort, and I went on the Web to search for info about poison control centers so that I could talk to someone about this problem and get more information about testing and treating her.

What do I find?

Poison Hangman!

Yep, that's their idea of educating the public. Quote: "Don't forget, all the words are poison related!" Which is a total lie, by the way, because the first word I got was "failure." (Yes, I played it, and I got the first word in under thirty seconds. I rock.) Will somebody tell me how the concept of failure relates to poisoning? Mommy failed to keep the toilet cleaner away from the baby? The ipecac failed to do its job? I don't know, I'm just asking.

posted by Dr. Alice at #

 
Hi, It's Monday

I've been working on a long post which I've just deleted because I realized it was nothing but a boring, whiny epic. Therefore I will spare you the story of the Demented Patient With Two Dueling Relatives Who's Now a Ward of the Court, But She's Dying, and Can I Make Her a No-Code? She's on Hospice for Crying Out Loud, and the Patient's Attorney and Temporary Custodian Both Say Sure You Can, But We Can't Put It in Writing, and One of the Relatives Has No Freaking Clue and Wants "Everything Done," God Help Us All.

There.

Boards in three weeks. Bleah.

Arm is better - I can get my left hand up to my nose again, which is useful if you're trying to blow your nose. I can't brush or style my hair with my left arm yet, though, so my hair continues to look weird - but not as weird as it looked the first week when I had to sleep on my back, because side positions were too uncomfortable. I wound up with the worst case of Bed Head you've ever seen; I thought I was going to get a bald spot on the back of my head just like babies get.

I can't think of anything else to share at the moment. This blog will probably become more and more incoherent over the next three weeks. Just thought I'd warn you.

posted by Dr. Alice at #

 
He'll Be Taken Out and Shot Forthwith

China's first astronaut has blown a myth by admitting the Great Wall of China cannot be seen from space.

posted by Dr. Alice at #

 
Urgent Dave Barry Update

There's a whole string of posts at Dave's blog linking to real estate salespeople with names that could possibly be construed to have a crude double meaning. (It started with Gaye Males and just snowballed from there.) It's funnier than it sounds; after looking at six of these in a row, you start snickering helplessly.

At least, you do if you're me.

posted by Dr. Alice at #

 
"I'm Sure Everyone Who Made This Game [Space Invaders] Is Dead by Now"

This is a great article from Electronic Gaming Monthly about the reactions of a group of 9- to 12-year-olds to some classic early electronic/arcade games. Wait'll you see what they have to say about Pong.

(via Ernie)
posted by Dr. Alice at #

 
You Learn Something New Every Day

"I thought I knew every expression existing in the French language for self-gratification, including the crudest ones known to man."

(via Dave Barry, who is celebrating the Marlins' win by coming up with anagrams of the name of their pitcher Tim Spooneybarger)

posted by Dr. Alice at #

 
The Life You Save May Be Your Own - Or Your Mom's

MedicMom has a great post you ought to read, especially if you have health problems or have an elderly friend/neighbor/family member who may need to call 911 some day.

Check your house and mailbox today and make sure your house number is clearly visible from the street. It makes things much easier for the paramedics when they're trying to locate the person who made the call.

(via GruntDoc)
posted by Dr. Alice at #

 
Somebody Give This Poor Woman Some Iron, STAT!

From the Ananova news service:

Chinese Woman Eats Dirt

A 78-year-old Chinese woman has reportedly eaten approximately 10 tons of soil over the past 70 years.

Hao Fenglan, from Zhangwu county, northern China, began eating mud and dirt at the age of eight.

She says she feels physical discomfort if she does not eat dirt at least once a day, reports the South China Morning Post.

The diet has done her little apparent harm and she is in good health.

This phenomenon is called "pica." It is a symptom of anemia. I'd be willing to bet this woman has been anemic her entire life. I don't even want to think about what her parasite load must be after 65 years of eating dirt in China...

posted by Dr. Alice at #

 
Patient Complaint of the Day

"Kicked in chest by horse."

The patient came in today although the injury happened three days previously. She was still having a lot of pain and wanted to make sure she hadn't fractured anything; I was more concerned about the possibility of cardiac arrhythmia (she'd taken two hooves to the sternum and was thrown across the horse's stable).

"He didn't mean it," she said. "He's just six months old, he's still a baby!"

"You sound like Sigfried and Roy: 'He didn't mean it!'" I replied. She grinned.

Fortunately, nothing was fractured, she didn't have a pneumothorax and she denied any palpitations; her heart exam was normal. I gave her some codeine and sent her out. Happy ending.

posted by Dr. Alice at #

 
Ralph Nader, Get a Life
or: Why Hasn't He Protested the Cookie Monster?

Take a look at this. Then tell me why these people are listened to, or even employed:

The Public Broadcasting System's Sesame Street has come under attack from a Ralph Nader group demanding that the popular children's show cease airing McDonald's corporate-sponsorship message before and after each program. (emphasis mine)

So they weren't airing footage of Bert and Ernie feeding each other Big Macs, or Big Bird eating fries... just a typical corporate sponsorship message. Meanwhile, Cookie Monster is stuffing down partially-hydrogenated carbs on a daily basis and this is OK? Where is the outrage?


posted by Dr. Alice at #

 
Worrisome News from Rarotonga

A few weeks ago I posted a link to a series of stories in the L.A. Weekly about a couple who moved from Los Angeles to Rarotonga, a small island in the South Pacific, with their two young children (the youngest an infant).

They're not on that island anymore; they've moved on to New Zealand (the baby got very sick with the flu and needed better medical care). Read these stories in order:

1

2

3.

Sigh. This is why you can't go around the world in 80 days with young children - the risk is too great if they get sick. I think the baby is going to be OK, though.

Sorry, again, about the light blogging. It's very busy in the office and with the boards coming up in three weeks my contributions will continue to be few and far between. I do have an idea or two for some longer posts and hope to get to them later this week.

posted by Dr. Alice at #

 
Google Calculator Function

Thanks to Richard Winters who points out that you can use Google for lots of things other than web searches - I was not aware of this!

posted by Dr. Alice at #

 
I Really Like the Concept

The new $20 bill, folks.

(via Dave Barry - of course)

posted by Dr. Alice at #

 
Amusing Comic

This week in Bizarro Dan Piraro has been experimenting with using the same punchline in every comic strip. (These actually appeared about three weeks ago but they are only now becoming available online.)

The scenario is always the same: at a funeral, two mourners are viewing the body. The quote is: "He/she looks so natural." The only thing that varies is the appearance of the coffin depending on the job of the deceased (the Invisible Man's funeral, magician's assistant's funeral, etc.) At first I thought it was carelessness on the part of either Piraro or his editor, but as the week went on it got funnier and funnier. I don't recall a comic artist doing something like this before. Hope you enjoy.

posted by Dr. Alice at #

 
Scary News?

Bookmakers Drop Odds on Arnie Becoming U.S. President

The article does not quote odds of Mr. Schwartzenegger winding up in the Senate, however.

Now that Arnold is in Sacramento, I have a great idea for his first project. How about an early morning exercise program, hosted by Arnold, broadcast daily all over the state? Ideally we'd have monitors installed on our TV's to ensure 100% participation (remember the scene in 1984 when Winston Smith gets bawled out by the woman leading the exercise program?)

In five years there wouldn't be an obese person in the state. I can see it now: "Drop and give me fifty! I mean you, Dr. Alice!"

posted by Dr. Alice at #

 
"Bloody Sticky Wicket" Indeed

That was the title of an amusing article in the Wall Street Journal last week (sorry, no link) that caught my eye. The subhead read: "The Urge to Fit In Can Leave Real Britons Chortling." Subject of said article: fake British accents acquired by Americans resident in Britain. (Exhibit A would be Madonna.) It seems that Americans who stay in Britain for a prolonged period of time often wind up either voluntarily or involuntarily developing what is known as a "mid-Atlantic accent" which doesn't please anybody who hears it.

This quote is what really caught my eye:

The irony, says Khalid Aziz, a British communications specialist, is that "the British actually quite like American accents and find it quite highly associated with success in business." His company recently completed a survey that found that 47% of British business directors interviewed considered executives with an American accent more successful than those from many British regions. "What we advise Americans to do is not try to give up their American accent but stick with it," he says.

The moral of the story? It's nothing new: Be yourself.

posted by Dr. Alice at #

 
Forty Wooded Acres and an Old Train Car

This sounds like exactly the sort of place I'd love to own someday: not too far from the city, not crowded, with its own source of water and a neat relic from the past thrown in. My idea of a "vacation home" is not some condo at the beach. It's somewhere quiet without TV, where you can kick back and relax, and you don't spend a lot of time or money getting there.

What I enjoy about this series of articles is the down-to-earth stuff like finding and installing a new pump motor for the well, and the GPS survey of the property lines. And cleaning the rat droppings out of the railroad car. (I enjoy reading about it, not doing it.)

posted by Dr. Alice at #

 
Cat Town

Ernie, whom I have never met but I speak of him as if I know him, has a positive genius for finding really, really freaky web sites. To back up this assertion, Exhibit A would be Cat Town. Please do go and view this. It's quite disturbing, not to mention hilarious.

posted by Dr. Alice at #

 
Various and Sundry Items

Ooh, I just found out how to Googlesmack somebody. Inflicting passive-aggressive insults on one's fellow bloggers sounds like a frighteningly good time to me; I plan to give it a try. The posts above the Googlesmacking post are also eminently worth reading, as they refer to a new chick-lit book called Jemima J which is apparently absolutely horrible, and from the readers' comments on Amazon I believe it. It's a story about an overweight British woman who has no life until - magically! - she goes on a diet, goes to the gym, and loses 80 pounds just like that, at which point life becomes perfect and she gets a sexy new boyfriend! I love to defend chick lit (scroll down for previous post on this subject), but I have nothing to say here: The author should be put in the stocks for this one and pelted with copies of Bridget Jones.

While on the subject of female writers, apparently somebody is planning to trademark Jane Austen's name for the purpose of selling Jane Austen brand teas and coffees: an odd idea. Yes, yes, it's an insult to our dear Jane to do this, but looking at it from the capitalist point of view it really doesn't make a lot of sense to me. I don't infallibly associate Jane Austen with tea and coffee, do you? I don't see her as a selling point. Maybe it's one of those British things.

posted by Dr. Alice at #

 
Happy Blogbirthday To Me

Yep, it's been a year. I am greatly enjoying myself writing Feet First and hope you're enjoying reading it. This week I was thinking how many better blogs than mine there are out there, but reminded myself that there are many worse, too; there's always room for improvement and I hope to get better in the coming year. Also, I have been lucky enough to find some regular readers who have become friends.

Blogging has already changed the world and I think it will continue to do so. Who knew there were all those talented people all over the world dying to share their lives, opinions and experiences with other people? It's like getting fifty pen pals all at once, and you don't have to pay for postage.

So here are some links, as my birthday present to you:

Cartoons: Bizarro

I love this one-panel comic, written by Dan Piraro. The artwork is outstanding and his ideas are pleasingly off-the-wall. He has a great, detailed website.

Timewasters: The Lego Treasure Hunt

Starring Jim the Lego Pirate. Arrr!

Humor: Dave Barry

Blogging is the reason Dave Barry was brought into the world, IMHO. This site is hilarious. Where do you think I get all my wacky links from? Currently there is a hot debate going on at Dave's site regarding urination and men's underwear. Go see for yourselves.


posted by Dr. Alice at #

 
Hurray!

The orthopod took me out of the splint today. I don't need a cast, nor do I need surgery. He wants me to do range of motion exercises and call him back in three weeks. (As I said to my boss, "He's one of those holistic orthopedists.")

I am thrilled to get that klunker of a splint off my arm and to be able to wear clothes without having to wrestle them over it. My range of motion is about thirty percent of normal right now, but I hope and expect it will improve.

posted by Dr. Alice at #

 
MRI: Never Again

Well, I had an MRI yesterday and there is indeed a fracture. For you docs out there, the radius is fine but the capitellum (the tip of the humerus, or upper arm bone) is fractured. I have also apparently torn the ulnar and medial collateral ligaments (ulnar completely, medial partially). Put another way, I screwed up my elbow big time.

I see the orthopedist tomorrow; we'll see what he makes of this.

I had never had an MRI before yesterday; since I'm fortunate enough not to suffer from claustrophobia, I thought it would be no big deal. Wrong, wrong, wrong. To fit my bulky splinted arm in the MRI tunnel, they had to strap it above my head. They then proceeded to take twice the usual number of pictures (because, the tech later explained, the radiologist wanted details of the humerus as well as the radius). Imagine having your arm strapped above your head, bent at the elbow, for 35 minutes and not being able to move... it was excruciating. By the end, I was doing yoga breathing, the Jesus prayer, counting the seconds and begging the tech please for the love of God to let me out, and I'm not exaggerating.

I hope that I will not need surgery or to be casted for very long, but I'm not sure what to expect since ortho is not my strong point. (Thanks, Allen, for your input!) More updates tomorrow.

To leave you on a more cheerful note, check out this amusing website put up by Alaska Airlines. It's the airline from hell! I especially enjoyed their Global Baggage Tracker - check it out.

posted by Dr. Alice at #

 
Dr. Alice Copes With Adversity

Good news: this website has broken the ten-thousand visitors' mark in just under a year (Feet First's birthday is Thursday).

Bad news: I've broken my arm. I think. I'm sitting here with my arm in a splint, typing one-handed. I tripped and fell yesterday with my arm out in front of me -- fortunately for me, it was my left arm (I'm right-handed). The ER doc, a charming gentleman whom I actually used to work with in a previous job, peered at the X-rays and said he thought it was an occult fracture of the radial head, just below the elbow. Since it really wasn't showing up on the films, this means I will have to get an MRI to verify.

More later...

posted by Dr. Alice at #

 
Life Stories

When you're on staff at a hospital, one of the things you occasionally get asked to do is to "proctor" physicians who are applying to the hospital for staff membership. This generally involves reviewing a sample of their case notes and history and physical writeups. The goal of this assessment is to make sure that the physician is capable of evaluating a patient, to see whether he or she orders appropriate tests and uses the medical data to create a logical treatment plan.

Recently I was asked to proctor an internist who works for the hospital's hospice program; since the goals of hospice care are (obviously) different from the usual treatment plan, I reviewed his hospice assessment notes instead of history and physicals. In this case, the doctor was evaluating patients who had already been admitted to the hospital to assess whether they were candidates for comfort care as opposed to aggressive treatment.

So I started reading the notes. At first, I read rather by rote - diagnosis? is the med list there? the medical history, assessment, plan? All were there, yes, this guy knows what he's doing. Then the drama of these stories started to grip me: a person's entire life, encapsulated on one page. What is this person's profession? Does he/she have any family, and is the family involved in their care? What is their disease?

And the big question in the back of my mind as I read: is this person still alive? Maybe, maybe not: the most recent of the notes was dated three months back.

Not all hospice patients have dramatic diseases like cancer, I'm glad to say. I say this because I think hospice should be considered for patients other than those with imminently terminal diseases. Take this gentleman, for instance:

A 92-year-old man with generalized debility, weight loss, and declining function generally. He has chronic back pain due to disc disease and just doesn't want aggressive medical therapy anymore. Social history is telling - "daughters in conflict about care." No major findings on physical exam.

This doctor didn't change much about this man's treatment regimen except for stopping one of his medications, but the notes indicate that he spent more than half an hour counseling the patient's daughter about what she could expect toward the end of her father's life and answering her questions. That thirty-minute investment was probably exactly what was needed in this case; I hope it helped.

Then there was the case I couldn't stop thinking about.

Patient Age: 36 (36?? Holy shit!)
Chief Complaint: Metastatic Breast Cancer

This patient had recently undergone a last-ditch effort to treat her with chemotherapy, but she couldn't tolerate the side effects.

Social History: 4 children. Spanish speaking only. Family member acting as translator.

She was diagnosed with the cancer while she was pregnant. The notes indicate that she is withdrawn, depressed and worried about her kids, the youngest of whom is only one year old.

Treatment: counseling, work on treating her symptoms, get the social worker involved to help the family... there's not too much that can be done. I keep thinking about this woman and her family: that interview was six months ago and I don't know whether she's still alive.

posted by Dr. Alice at #

 
Poetic Justice

I know you're probably getting bored with this, but here's a little more on the telemarketing brouhaha:


Supporters of the [telemarketing bill] had barely begun to celebrate an overwhelming vote Thursday in Congress to counter a federal court ruling when they learned that another judge had blocked the list from taking effect next week.

"It puts a little damper on the party," said Ken Johnson, spokesman for Rep. Billy Tauzin, R-La., chairman of the House Energy and Commerce Committee. "But we're still confident of prevailing in the end."

Tauzin led an effort in the House to pass a bill making clear that the Federal Trade Commission has the authority to enforce the do-not-call registry. The legislation was prompted by a ruling Tuesday by U.S. District Court Judge Lee R. West in Oklahoma City that said the FTC lacked the power to create and operate the registry.

But late in the day, U.S. District Judge Edward W. Nottingham in Denver blocked the list, handing another victory to telemarketers who argued the national registry will devastate their industry and lead to the loss of thousands of jobs.

Nottingham said the do-not-call list was unconstitutional under the First Amendment because it does not apply equally to all kinds of speech, blocking commercial telemarketing calls but not calls from charities. "The FTC has chosen to entangle itself too much in the consumer's decision by manipulating consumer choice," Nottingham wrote.

The list, which would block an estimated 80 percent of telemarketing calls, is supposed to be effective Wednesday, but it's unclear whether legal issues will be settled by then. Even after Bush signs the legislation, the FTC must win in court for the list to move forward.

West rejected an FTC request to delay his order, saying the agency offered no additional evidence that would make him change his mind. The FTC immediately appealed to the 10th U.S. Circuit Court of Appeals in Denver.

While it was unclear how West's order would affect the FTC's plans, the second ruling more directly prohibits the government from enforcing the do-not-call list. The constitutional issues raised also may not be solved as easily.

Since issuing the ruling, West's home and office have been bombarded with calls from angry consumers. His numbers were posted on the Internet and people were encouraged to call.

Late Thursday, Nottingham's phone numbers began to surface online as well.

That'll teach 'em.
posted by Dr. Alice at #

 
The Empire Strikes Back

From Yahoo! today:

House Votes to Launch Do-Not-Call List

The House approved legislation Thursday aimed at ensuring the national "do-not-call" list goes into effect as scheduled next week to help consumers block unwanted telemarketing sales pitches.

The House voted 412-8 after less than hour of debate. Lawmakers from both parties blasted a decision by U.S. District Judge Lee R. West, who ruled Tuesday that the Federal Trade Commission lacked authority to create and operate the registry.

Will the telemarketers get it now? We hate you so much that our elected representatives couldn't move fast enough to enact legislation to stop you! They knew what would happen to them if they didn't do something -- and we're not talking getting voted out of office; we're talking evisceration and burning at the stake.

posted by Dr. Alice at #

 
When Scientists Watch Too Many Reality Shows

"This is the dream - we're going to get this sensational footage of the giant squid trying to do obscene things with the camera."

posted by Dr. Alice at #

 
What the Hell Were They Thinking?

I just found this article on Yahoo!:

Court Rules Against Do-Not-Call Registry

A federal judge has ruled that the Federal Trade Commission overstepped its authority in creating the national "do-not-call" list against telemarketers.

The ruling Tuesday came in a lawsuit brought by telemarketers who challenged the list of 50 million people who said they do not want to receive business solicitation calls. The list was to go into effect Oct. 1.

Here's my favorite quote:

Direct Marketing Association Inc., one of the plaintiffs, said it was happy with the ruling, even though it "acknowledges the wishes of millions of U.S. consumers who have expressed their preferences not to receive telephone-marketing solicitations � as evidenced by the millions of phone numbers registered on the FTC list."

In other words, Screw you, consumers.

The court found that the FTC did not have the authority to institute such a list, but the article doesn't explain why. I wonder if Instapundit will have a legal explanation... nope, nothing yet. I'm sure though that either he will, or he'll link to someone who does. I'd love to see the court's logic on this one.


posted by Dr. Alice at #

 
Peace and Quiet

Well, yesterday was interesting. The telephone lines and computer system went down midmorning and stayed off until 5 pm. Whatever went wrong affected the whole building, not just our phone lines; every office had the same problem. (I bet some fumble-fingered janitor hit the main phone line while cleaning in the basement.)

To be honest, I was overjoyed. No distractions! It was one of the most productive workdays I've ever had. I was able to make a few outgoing calls using either my cell phone or the emergency phone lines in the office (which use a separate circuit). I scoffed when the emergency phones were first put in - they are red and look like the Batphone - but I must admit installing them was a great idea; this is the second time we've had to use them.

Today will be hell, but it was worth it.

In other news, I have a book to recommend. (I rarely recommend books to other people, so pay attention!) It's called The Cunning Man, by a writer and former actor named Robertson Davies - actually the late Robertson Davies; this was his last book. I actually came across it at a nursing home as I was waiting in the day room for the staff to bring out a patient: I picked it off the shelf which functions as their library, could not stop reading it, and took it home with me. That reminds me, I have to return it.

The Cunning Man impressed me to the point that I'm going to track down Davies' other books. As to what it's about, it surprised me by seeming to start as a mystery novel and then turning into something much less straightforward. You could call this book part fictionalized history of Toronto, part memoir, and part mystery. It begins with the narrator, Dr. Jonathan Hullah, remembering the death of an Episcopalian priest who dropped dead during Mass on Good Friday many years before, but that turned out to be only a small part of the book.

The medical descriptions are fascinating. Hullah practices as a holistic physician and earns the title "The Cunning Man" for himself (this is an old English village term for the local wise man who could work cures). Long story short, get the book. It's a leisurely read, but it never gets boring.

posted by Dr. Alice at #

 
Sort of Pirate Related

For you armchair travelers out there, I found a nice site called Islands.com. I particularly liked the description of the Whitsunday Islands, which turn out to be off the coast of Australia near the Great Barrier Reef. The diving looks spectacular. No information on buried treasure is provided, however.

And now I'm off; see you next week, ye scurvy dogs.

posted by Dr. Alice at #

 
Ahoy, Me Hearties....

It be Talk Like a Pirate Day, and Cap'n Sawbones had to pick today to be down in the bunk with a sinus infection. arrrr. But all is not lost, they say the ocean spray be a powerful reliever of blocked sinuses. (Okay, it's actually saline solution.)

Yer cap'n be off to landlocked Palm Springs for a company retreat - wait, do pirates have retreats? Why not? Every profession needs to get together once in awhile and swap sea stories, learn to be more efficient plunderers, and so forth.

Anyway, sorry about the light blogging this week and I hope to have better things next week. Now it's back to the Augmentin and the Sudafed.

posted by Dr. Alice at #

 
Dipshit Day

Yesterday on my first day back every dipshit in my practice decided either to show up or call me. Either way, it was their mission to make my life miserable and they succeeded. Ah, medicine... tell me again why I decided to commit to you, you cruel bitch of a higher calling.

However. Let's get past my personal issues and review The Wedding, shall we? For me the best part was where we stayed. The wedding was in Vermont, where the bride spent a large part of her childhood; very beautiful, but it meant that everyone in my family who attended had to travel cross-country. My mother had the forethought to rent a house for us instead of making hotel reservations, and there were ten of us there - seven adults and three kids (five, three and one year of age). The adults were me, my parents, my sister and her husband, and her husband's parents (who came along to help with the kids and because my niece and nephew were a flower girl and ring bearer, respectively). Breakfast became a luxury - coffee and conversation! I'm so used to living alone that I didn't realize how much I've missed meals with other people. I told my mother that it felt just like the Waltons, but she was not amused by my comparison.

The weekend was straight out of the Preppy Handbook, if you remember that. At the barbecue Thursday night that kicked off the festivities, there were men wearing blazers over aloha shirts. (Yes, people really do dress like that!) The reception was at the local country club, founded over 100 years ago. All the bridesmaids were slim, attractive and athletic... except me. I never do well at these things; I never feel that I know the proper bridal etiquette, that I'm not feminine enough, etc. Nevertheless, I made it through in one piece and it really was a lovely service. The reception was great, too.

Now, back to regular posts as soon as I get a chance; I now have my Boards recertification coming up in six weeks.

posted by Dr. Alice at #

 
I'm Back

Yep, we got the kid married off. Came back to find piles of charts and messages from patients screaming "Help me!" - so I gotta go. Will post more later.

posted by Dr. Alice at #

 
People Who Need Serious Help

What with the upcoming wedding (my brother's), I've been a tad frayed at the seams. I leave Wednesday, incidentally, so no blogging for about a week. Lately, though, I've run across a couple of articles that have restored my faith in myself. As an act of humanity, I'm going to share them with you:

1. The Disneyland Zombie Fan Army
Now, I grew up near Anaheim in Southern California, I've been going to Disneyland since I was two or three (that would be the late sixties), and I remember The Way It Used To Be. I like to go about once a year. In short, I am a fan of Disneyland - but I've never seen anything like this. Opening lines of the article:

Benji Breitbart doesn�t go to Disneyland every day.

�I wasn�t here last Thursday,� he says as we walk down Main Street. �I usually come six days a week.�



2. The Man Who Kept a Pony In His Bathroom

A Danish man who was inspired by a children's fantasy movie about a pony which lives in a flat has incurred the wrath of his neighbours - after attempting to copy the film.

Police say they were stunned to find a Shetland pony in Palle Brinch's apartment after his neighbours alerted authorities about a "rumbling ceiling and a manure-like stench".

There's not much you can add to that, really...

posted by Dr. Alice at #

 
Weekend Surfing

Check out McSweeney's list of lists; I ran across this today and it's addictive. Specific recommendations would include this one, this one and this one, but don't stop there.

For crafting taken to its illogical extreme, check out this article at GetCrafty. If any of you ever catches me decoupaging labels from bean cans onto notebooks, journals or anything else, feel free to have me committed involuntarily.

Have a good weekend, me hearties.

posted by Dr. Alice at #

 
Hurricane Who?

I certainly hope that everybody on Bermuda gets through Hurricane Fabian in one piece, but my first reaction when I heard the name of the storm was: when do we get Hurricane Tab Hunter?

posted by Dr. Alice at #

 
Public Announcement

Good Lord, they've changed the Blogger setup again. I wish they'd make their minds up.

Addendum
I just tried to sign into Blogger and it signed me into somebody else's blog. Let's see what else goes wrong today... still, it's free. You can't beat free.
posted by Dr. Alice at #

 
And For Gary Coleman, It's a Taquito

Got this out of Newsweek this morning: Taco Bell is running an "in-store gubernatorial Taco Poll" in California.

A crunchy beef taco counts as one vote for Arnold Schwarzenegger, and a soft chicken taco counts for not recalling Governor Gray Davis. If customers want Lt. Governor Cruz Bustamante, they should order a chalupa.

My sources tell me that a chalupa is "sort of a combination" of the above.

posted by Dr. Alice at #

 
Ahoy There, Ye Landlubbers!

Talk Like a Pirate Day is on the horizon! Start practicin', ye useless sons of barnacles, or ye'll be lickin' me fish-gut-covered boots!

(Can you tell I'm really into this?)

Dave Barry has done his bit for this valuable national holiday by supplying some hints and tips for talking like a pirate. (My favorite: "Turn your head and cough, me hearties!") Go there or get a taste of the rope's end! Arrr!

posted by Dr. Alice at #

 
Bridget Jones Don't Get No Respect: A Literary Critique

I recently ran across this rant against chick lit, and though this sort of thing usually doesn't stir my blood enough to respond, I found myself roused to action for once. Let's begin with the money quote:

The doyen of chick lit, the Brit �migr� currently ensconced in LA enjoying all things razzle and dazzle, Helen Fielding herself, the Darth Vader of Chick Lit - she responsible for B****** J**** (I�m sorry, I can�t bring myself to say the words - it�s like actors and Macbeth - Fielding and her scatty heroine are the benchmark for all that is horrible in the world of books) - she has a new book coming out. [snip] Speculation is mounting as to whether she has written a �James Bond in tights . . .� I believe Charlie Brown put it best when he said �Good Grief . . .� Picador are paying Fielding seven figures for this stuff. What a world . . .

Now, apart from the fact that this guy is way too fond of ellipses, I have several objections to his comments.

1. Since when is it illegal for a Brit (or anybody else) to move to L.A. if they strike it rich? I live in L.A., thank you very much, and I sure as hell would rather live here than in England. Nothing against England, but it's incontestable that we have better weather, for one thing. If Ms. Fielding decides to pull up stakes for a bit, who are we to quibble? And what does this have to do with her writing ability?

2. "Fielding and her scatty heroine are the benchmark for all that is horrible in the world of books." Come again? Look, I'm the first to admit that Bridget Jones is not exactly Shakespeare, but I found it an enjoyable read. I would even argue that "chick lit" as a whole -- my, you can almost hear the sneer in this guy's voice, can't you? -- is a not unworthy genre. People like to read about themselves. Single women like to read about single women. If the writing is good enough, lots of other people will like to read about single women, too. I realize this will probably mark me as a intellectual lightweight, but I've tried your Serious Literature, and you can keep it.

3. The writer of the comments above is a guy. Big surprise.

4. I've been trying to track down the exact source of this quote, and I can't, but somewhere in Jane Austen's oeuvre is the following ladylike rant:

"'Oh, it is only a novel!' says the young lady, tossing it aside; 'It is only Camilla, or Pamela'" - and then comes something to the effect of how tired the narrator (Ms. Austen) is of hearing novels demeaned and "serious writing," such as essays or scientific writings, extolled. I think Jane knew quite well what it was like to be pigeonholed as a "chick lit" writer in her day. It's especially ironic when you remember that Bridget Jones's Diary was based on Pride and Prejudice.

posted by Dr. Alice at #

 
Update

Blogging will be light for awhile, as I have a wedding coming up (my brother's getting married next week) and the Boards are looming over my head with two months to go.

I spent this weekend studying, shopping for clothes for the rehearsal dinner and seeing nursing home patients - fun, no?

I do have a few minor events to tell you about. Last week, on my half-day, I was looking forward to a quiet afternoon of phone calls and leaving early. However, fate intervened in the form of an elderly, demented patient of mine who had come in to see our dermatologist; I had seen her for a routine visit at the nursing home the week before and noted an early skin cancer on her right cheek. In came the secretary, Barbara (a.k.a. She Who Must Be Obeyed), thundering, "Why'd those nursing home people drop off that patient without anyone to watch her? She's in the waiting room throwing up and she's about the color of that wall." [i.e., stark white]

I dashed off down the hall to find the patient indeed diaphoretic, cool, BP 80/50 and vomiting. My best guess is that she got syncopal strapped in the wheelchair, fainted, and threw up. I was afraid she had aspirated (choked), so as soon as the dermatologist had removed the skin cancer (holding her nose all the while), we took her over to the emergency room across the street. Since our hospitalist was tied up with a bunch of other admissions, I finished her exam and took care of the admission orders and history and physical - I took her off the hands of the ER docs as well, since she was basically just sitting there being monitored and waiting for a bed. And that, kiddies, is how I spent my "afternoon off."

In other, vaguely related news, I noticed this article on Yahoo! today:

Future Doctors Favor Lifestyle Over Money

An increasing number of medical students are picking their specialty based on the lifestyle it permits, including more time to spend with family, rather than such traditional factors as pay and prestige, according to a study published on Tuesday in the Journal of the American Medical Association.

The finding points to potential shortages of doctors in specialties such as family practice, surgery, and obstetrics as medical students shun fields where they are required to be on-call during many off hours, the report said.

"We're going to have person-power shortages in the next 10 years in critical areas. Where are the primary care doctors going to come from?" said Rutecki, a physician and professor at Northwestern University.

Where indeed? Why go into a field where you have to spend a lot of time away from your family, get called out in the middle of the night, and don't get paid for your time? In some ways I think this is a good thing as it indicates a healthier attitude toward work and the value of the family... but it may leave the patients up the creek.

posted by Dr. Alice at #

 
I'm Talking About The Cat!

Because I have an immature sense of humor, I thought this was hilarious. It's also cute.

Oh, and I felt compelled to explain that the headline from this post is taken from an old Steve Martin routine, in case you don't remember.


posted by Dr. Alice at #

 
Movie Review

Why yes, I am back. I had a lovely four days off, thank you, doing absolutely nothing. Now let us return to a sorely neglected feature of this blog: the gym movie review!

Let me recommend They Won't Forget (1937), starring Claude Rains with Lana Turner and Elisha Cook, Jr. I caught this on TNT Tuesday morning; it's the story of a murder of a young girl in a small Southern town. Until I checked IMDb, I didn't realize that this is a fictionalized treatment of a real-life murder: the murder of Mary Phagan. (The victim is named Mary Clay in the film.) From what I have read on-line, in the real-life case the defendant was basically railroaded because he was Jewish. In the film this is played down; the town is prejudiced against the defendant and his wife because they're "Northerners." I didn't pick up on this code while I was watching the film.

It's a good movie with an excellent perfomance from Claude Rains as the district attorney, firing up a cigar in almost every scene. His Southern accent isn't bad either. In the film, the victim is a student at a local business college and the defendant is one of the professors; in real life, she was a factory worker and the accused man was the manager of the factory. The acting was good all around, and Rains is better than good - you see his ambition to ride this case into a political career, but he also seems to be making an effort to arrest the right man.

Unfortunately I can't tell you how the film ended, as I had to hop off the Precor machine and go do something else - but I plan to catch it next time it's on TV to find out. Recommended.
posted by Dr. Alice at #