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, August 31, 2004

    Take a few days off the blog, come back and there's freakin' spam everywhere. Sorry. I have pruned the offending comments.

    Botox: Owie!

    Interesting report on a lawsuit over Botox here:

    Jury selection began Tuesday in the case of a former Tri-Star Pictures executive and his wife who sued a doctor and the maker of Botox, alleging she suffered numerous ailments after being treated with the wrinkle-reducing agent.

    Mike Medavoy, a former chairman of Tri-Star, and his wife Irena, claim Beverly Hills dermatologist Arnold Klein gave her three injections of Botox, manufactured by Allergan Inc., in March 2002 to treat migraines.

    The couple alleges the headaches continued as Irena Medavoy developed upper respiratory problems, fever, fatigue and severe muscle pain as a result of the treatments.

    One of the docs in my group is married to a neurologist. He's apparently seen several patients suffering from severe, recalcitrant burning pain after undergoing several injections of Botox. Apparently you can get nerve inflammation from it. Now, I don't think all her other symptoms are likely to be related to the Botox, but I certainly would think twice before getting injections of this stuff. You may wind up with more trouble than you started with.


    I'm always telling patients to use sunblock. Perhaps this will convince them to do it.

    (via GruntDoc)

    Thursday, August 26, 2004
    Must Read


    Aah, I love Rumsfeld...

    Good Catch

    ... if I do say so myself.

    Hyperparathyroidism is a subtle disease. Once or twice, I've missed early signs of it and the patients were not diagnosed until they became overtly symptomatic. (Yes! I admit it!) It's caused by overactivity of the parathyroid glands - as you might guess from the name, they are located in the neck near the thyroid. There are four of them, two bracketing the thyroid gland on each side. Their function is to control the calcium and phosphorus balance in the body. Parathyroid hormone pulls calcium from the bones and raises the calcium level in the bloodstream.

    So a patient who needed minor surgery on her finger came in for a pre-op exam and labs. Her calcium level came back slightly high. I looked back a few years in her chart - it had been creeping up over the last few years. Ionized calcium - elevated. Parathyroid hormone level - over 140! Definitely high. She's off to see the surgeon; hyperparathyroidism is treated by removing the glands.

    It isn't often that you see this disease in general practice, but it does crop up every once in awhile. Earlier this year I had a patient who died of it. (Disclaimer: he was 102 years old and the family and I elected not to put him through extensive neck surgery he'd never survive. We put him on hospice instead.)

    Just goes to show: you never know what you might pick up on a preop exam.

    Tuesday, August 24, 2004
    Here We Go Again

    If you saw my office right now you would plotz: Charts, charts everywhere. I was here till eight-thirty last night and I'm still snowed under, but I've got to leave now 'cause I have to go to a nursing home and see one of my patients.

    The office happening of the month has been a bird nesting in the tree outside one of the exam rooms (we're on the second floor). We stop by several times a day to watch the mama and papa birds take shifts, feed the babies, etc. Today I watched one of the babies get fed: the parent stuck its beak down the baby bird's gullet and proceeded to regurgitate food for it. Ugh. My comment to the nurses was: "I've got your child support right here - BLURGH!"

    The other happening I wanted to let you know about is that I'm moving up to a corner office! YEAH! The MD who's been there for 16 years is moving to a different satellite office across town and I'm next in the pecking order. I feel so special.

    More later. Sorry to be so brief.

    Thursday, August 19, 2004
    So Post, Already

    Sorry to sound like a broken record, but I've been busy. Let me cast a few links in your general direction and I'll try to do better on the weekend.

    Jeanette Winterson has an interesting review of the new version of The Stepford Wives (warning: it's chock full of spoilers, to the point where I'm wondering if this is the first time she's ever reviewed a movie). She's a feminist writer - an excellent one - and this naturally informs her take on the film. She liked it.

    Here (via Bookslut) is an article from Flak Magazine reviewing some of the best books of the 1990's, but with a different take: best cover, best use of punctuation, best paragraph and so forth. The writer's explanations for said awards are good, too. In other literary news, via The Captain, a great interview with J. K. Rowling in which, among other things, she reveals the title of the next Harry Potter book!

    Lastly, V. contributes this telephone message she received from a patient (V. is known for having some of the wackiest patients in the practice - she's a nut magnet). Verbatim:

    Re: I think I'm having a respiratory infection. I just came back from Asia and I'm never sick, it is very unusual, I'm having chronic stomach pain. I could be dying a slow painful death. Please call me.

    I told her, "If you ever needed an incentive not to call, it's right here."

    For Those Who Want the Details

    Here is the CDC's fact sheet on West Nile Virus.

    Friday, August 13, 2004
    Julia Child Dies In Sleep

    Story is here. I'm sorry to see her go. Apparently she worked as a spy in WWII - I wasn't aware of that.


    She wrote, "Dining with one's friends and beloved family is certainly one of life's primal and most innocent delights, one that is both soul-satisfying and eternal."

    Amen to that.

    Wednesday, August 11, 2004
    Mo' Money

    Gaaah. Two twelve-hour days in a row. I've been working shifts in Urgent Care, our after-hours clinic, to help pay off the massively incredible load of debt I've incurred due to the Batcave project (which, as I keep telling everyone, is "almost done"). The carpet is ready to be installed and the painting is nearly complete - except for the part that they're going to have to do over. Enough said.

    I didn't intend to work tonight, but one of the doctors forgot that he had been scheduled to be here; after brief negotiation, I took his place. I did not have to have my arm twisted very hard to agree to this, because this afternoon I was regretfully informed by the nice gentleman working on my hard drive that it was terminal and could not be resuscitated. (It's over six years old. I thought computer hard drives would just go on merrily computing indefinitely; apparently I was wrong.) So, I'm going to get a nice new twenty-first-century hard drive, but it's going to cost about $700.

    I'm tired. Hasta la vista.

    Tuesday, August 10, 2004
    Thunderbirds Are Go!

    It's August, and there just hasn't been that much going on. I am coping with calls from anxious patients convinced that they have West Nile (they don't), and enjoying the summer. (No meetings!) The only happenings have been minor - my boss has moved to a new house; one of the secretaries has a new grandkid; the air conditioning in the building has finally been fixed, and now we're all too cold instead of too hot.

    This weekend I stopped off at V.'s house to swim - this has become a fairly regular happening - and her son excitedly invited me to watch their newest DVD: a collection of Thunderbirds episodes. Yep, the show with the puppets. A rousingly good time was had by all, it's a surprisingly fun show to watch. I was impressed with the production values and surprisingly elaborate sets.

    That's all the news for now. More thrilling updates as they happen (heh).


    Christopher Buckley has a new book coming out in September and the Atlantic interviewed him to discuss it. If you haven't read Buckley, you should - he is hilarious. Thank You for Smoking is a classic.

    (via Bookslut)

    Friday, August 06, 2004
    "That's not a Moon, It's a Space Station"

    Well, actually it is a moon... one of Saturn's moons, to be exact. But it's hilarious how much it looks like the Death Star.

    Monday, August 02, 2004
    The Epic of the Irrational Bride

    ... is a must-read.