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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    Thursday, April 23, 2009
    The Noble Art of Medicine

    ...and here we are at the ACP meeting. V. and I are roommates this time around and are sharing my computer (she brought hers but can't seem to get the wireless access to work). Philadelphia is beautiful at this time of year, though the budding trees are giving her allergies.

    The national meeting of any medical specialty is always fun, giving MD's a chance to catch up with old friends from residency and/or medical school and two or three days of luxurious learning without having to worry about patients and phone calls. So far today I have attended lectures on insomnia, dementia, neurologic examinations and pain management. Tomorrow will include wound care and renal disease. This may sound dreary, but it's not; the speakers here are the best in their fields. You don't get an invitation to speak at a national meeting unless you're really good.

    I haven't been to the sponsors' hall yet (drug companies, medical data management companies, locum tenens companies and so forth) but V. has. She came back with all sorts of goodies: a T shirt, travel coffee mugs, pencils, a flashlight and hand disinfectant. I plan to go there tomorrow and see what I can get.

    I ran into one of my old cardiology professors from med school. He remembered me, and I was greatly flattered. Also, I took V. for a cheesesteak today and we toured the Reading Terminal Market, which she greatly enjoyed. We're both beat due to jet lag but it's going to be another early day tomorrow - lectures start at 7 am.

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    Monday, April 20, 2009
    24: Back in the Saddle

    I first started watching 24, the show that features the wildly violent and incredibly entertaining escapades of Jack Bauer as he strives to thwart terrorists, three years ago at the start of Season Five (a.k.a. Day Five). I liked it immediately and posted my impressions at the start of that season, but never mentioned that I became steadily more hooked as it went along. By the end of the season I was madly in love with 24; it's the first time I ever watched an entire season of any show without missing an episode. A lot of that was due to the fantastic acting of the guest stars that season, including Sean Astin and Peter Weller, but most especially the duo of Jean Smart and Gregory Itzin, who played President and Mrs. Logan. In all honesty, I've never seen better acting on television. Smart and Itzin were both nominated for Emmys but, sadly, did not win (I maintain they were robbed).

    Then came Day Six. It was awful, probably the biggest disappointment of any season of the show from what I've read on the TWOP boards. Nevertheless I kept watching, due to sheer determination I suppose - plus Keifer Sutherland does a consistently great job as Jack Bauer.

    Day Seven was delayed for a year due to the writers' strike but has been worth waiting for. It isn't any more realistic than last season was - a major plot point involved a takeover of the White House by a dozen terrorist frogmen who swim from the Potomac and drill their way into the basement of the White House! But the characterization has been better all around, and the plot has been a lot tighter. The idea of getting rid of the CTU, Jack's former employer, and moving the action to the FBI actually worked, not least because it turned Jack and his former CTU compatriots into a plucky group of outsiders fighting pervasive corruption in the government. Also, the actress (Cherry Jones) playing the President this time is a heck of a lot better than whiny Wayne Palmer was last season. She was clearly pitched as a Hillary Clinton lookalike but has grown into the role really well. I always enjoy the scenes in which she faces down the (all-male) joint Chiefs of Staff. I was looking forward to watching Colm Feore as her husband, but sadly he wasn't given much to do as First Gentleman. Currently his character is recovering in the hospital after being kidnapped, tortured and shot. All sorts of lousy things happen to the characters on this show!

    The writers wound up going back to the tried-and-true and recycling a lot of plot points from previous seasons, but I don't care. Even the creaky device of bringing a major character (Tony Almeida) back from the dead worked, once you get past the initial ridiculousness of it. This is due to the great chemistry between Sutherland and Carlos Bernard. What I can't wait for is the showdown between Jack and Tony, now that we've learned that Tony's a bad guy - as revealed at the end of the last episode when he murdered an FBI agent. Yes, Tony's not only Zombie Tony, he's Evil Zombie Tony! You can't beat that. And Glenn Morshower, as retired Secret Service Agent Aaron Pierce, was brought back and has made a solid contribution this season. Since all the other agents seem to be either incompetent or corrupt, I applauded the good sense of the President's daughter (she pulled him out of retirement to protect her). I'm hoping to see more of Aaron in the last several episodes.

    I know this recap makes the show sound ridiculous, but you can't really criticize 24 for that. By which I mean not that it's above criticism, but that critiquing it is a pointless exercise. You're either caught up in the plot twists and wondering what's going to happen next, or it doesn't grip you at all.

    Lastly, I'm including a hilarious video made by a fan who decided to see how 24 would work as a silent movie. The captions are great: take a look.


    Sunday, April 19, 2009
    Conversations With My Father

    I am sure I am not the only one faced with this situation, but my dad (though I dearly love him) is what you might call behind the times. I herewith submit a few examples of this fact.

    Conversation One

    Dad (apropos of nothing): I was listening to the radio driving home last night and this guy came on. And he talked, and he talked, and he talked. And then this band came on, and they played pretty good, but then the guy came back on and he just wouldn't stop talking!

    Me (after I think for a minute): Was he talking about a place called Lake Wobegon?

    Dad: Yeah, I think that was it.

    Me: Dad, that was Garrison Keillor. People pay to hear him talk.

    Dad: Well, I wanted to hear him shut up.

    Conversation Two

    This took place about ten years ago, back when Dad was still practicing medicine and when specialists could pay for fancy holiday parties.

    Dad: Dr. X (a cardiologist) had this great party last weekend. He had a band that was like the Beatles, I guess. Your mother and I danced ourselves silly.

    Me: Young Beatles or later Beatles?

    Dad: Huh?

    Me: Did they have short hair and wear suits?

    Dad: Yep.

    Me: Young Beatles.

    Conversation Three

    Dad (again apropos of nothing): What the hell is a blog?

    Me: It stands for 'weblog.' It just means that people have, like, this journal or diary on the Internet. I have one.

    Dad: You do??

    Me: (sigh) Yes. Didn't Mom show you?

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    Guys With Time on Their Hands

    You're a bunch of guys in a rural area of the UK. Your resources: sheep, dogs and lots of Christmas lights. What do you do?

    Would you believe Sheep Pong?

    Great video. Hat tip to this fellow (who writes great stuff, BTW).


    Thursday, April 16, 2009
    True Talent

    If you have not yet seen Susan Boyle's performance on "Britain's Got Talent," go watch her here on YouTube. She won everyone over, including Simon Cowell, and for good reason. You don't often hear a voice like that, let alone from a totally unknown performer.


    STD Screening

    Via Yahoo!, I bring you a report on chlamydia screening which indicates that many women are still not getting tested for it. Would you like to hear a disturbing fact? Some insurance plans won't pay to test women for this disease. (I'm looking at YOU, Blue Cross PPO.) Unlike gonorrhea, which is not subtle, chlamydia is often clinically silent. It can scar up the fallopian tubes and induce infertility, and the infected person can transmit the disease to their partners without knowing that they are infected.

    My advice: even if you have to pay for it, get tested. If you can't afford the test, find a free clinic and get it done there. And, of course, avoid infection by limiting your number of sexual partners and using condoms.


    Wednesday, April 15, 2009
    Tea and Taxes

    Millions of Americans are paying their taxes today; in addition, thousands are participating in Tea Parties across the land to protest government spending and tax increases. Glenn Reynolds' essay today in the Wall Street Journal points out some interesting facts about the tax protests. This is a true groundswell movement which has just come into existence in the past few months. Without the Internet's ability to allow ordinary people to organize, a cross-country protest like this could never have happened. A few paranoiacs suggested the tea parties had been dreamed up and bankrolled by some large political group or other, but no one has enough money or organizational skills to mount something this big.

    It will be interesting to see what happens next. As Reynolds points out, the movement could get bigger, give birth to a third political party - or flame out if everyone loses interest. I don't somehow think the last option is going to happen, at least not as long as the federal government keeps saying that spending mind-boggling amounts of money is the answer to all our problems.

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    Tuesday, April 14, 2009
    "I Didn't Know it was Loaded!"

    According to this report, it's becoming more common for patients to inject themselves accidentally with EpiPens. EpiPens are preloaded syringes of epinephrine which can be prescribed to patients who have severe allergies (i.e., bee stings or food allergies such as peanuts). The epinephrine is supposed to reverse the effects of anaphylaxis, ease breathing and give the patient time to get medical help. While undeniably useful, I have often wondered if these pens are over prescribed - I get a lot of requests for them. Surely not everyone is that allergic to bees? At any rate, the study reviewed 26 reports on accidental autoinjections, culled from medical journals over the past twenty years.

    About 94 percent of these injections went into the thumb or finger instead of the thigh, where they are supposed to go. Fortunately not a lot of side effects were noted, "pins and needles" sensation being the most common. I was wondering if there had been any episodes of blood loss to the finger! I was always taught that using epinephrine to a "dead end" part of the body like the finger was a no-no as it could compromise the blood supply. No such complications were mentioned in the article, however.

    If you are severely allergic to something, you probably need one of these pens. My preferred treatment, though, is liquid Benadryl (diphenhydramine). It's easy to swallow and gets into your system faster than the pills. I often recommend it as part of a travel medicine kit.


    Monday, April 13, 2009
    Answer of the Day

    Patient presents with cough and chest cold symptoms for a month. I ask her what her phlegm looks like. Her answer: "Phlegm."


    Sunday, April 12, 2009
    In Praise of Asparagus

    'Tis the season for asparagus, falalalala, la la la la...

    Forgive my transports. I love asparagus enough that I think carols should be written in its honor, and this is the high season for it. Bonus: it's on sale! Most supermarkets have asparagus at bargain prices this time of year.

    Let's say you hit a sale or two and are stocked full of asparagus, and are looking to do something with it besides just boiling and eating it. (Though there is nothing wrong with that.) I would recommend the following recipe, which I got off the Simply Recipes website - an excellent reference site, BTW. If you are lucky and also manage to get ricotta on sale, you have an inexpensive dinner for four or five people. If you aren't feeding four or five, leftovers are good for lunch the next day.

    1 1/4 lb thick asparagus, woody ends trimmed
    1 lb penne pasta
    1 clove garlic, peeled and mashed
    15 oz ricotta cheese
    2 T. olive oil
    2/3 cup grated Parmesan cheese
    salt, pepper

    Bring a 5-qt pot of water to the boil (you will use same water for cooking both the asparagus and the pasta). Add salt. Have an ice bath ready. Add the asparagus to the boiling water and cook about four minutes, till tender but firm. Remove asparagus and plunge into cold water to stop cooking. (I have a pot with a metal insert which makes this much easier: just pull out the metal insert and hold over the pot to drain. Tongs, however, are fine.) Drain the cooled asparagus and cut on the bias into 1/8 inch slices, leaving tips intact.

    Bring the water in the pot back to a boil and throw in the pasta (you can use a little less than a pound, if you wish).

    While pasta is cooking take the garlic and rub it all over the inside of your serving bowl; discard the garlic. Add the ricotta, olive oil and 1/4 cup of pasta cooking water to serving bowl and stir. Drain pasta when done (but reserve some extra cooking water). Add penne to the cheese mixture and fold in the asparagus and half of the Parmesan. Season with salt, pepper (white pepper is nice, if you have it) and several dashes of ground nutmeg. If too thick, add some of reserved pasta water.

    Serve pasta with remaining Parmesan on side to sprinkle over. Serves 4 to 8, depending on whether it is a first course or the main course. You can add a little zested lemon peel if you'd like.


    Friday, April 10, 2009
    Good Friday on Twitter

    Trinity Wall Street is Twittering the Passion of Christ today (begins in about ten minutes). It sounds odd, but could be useful if you want to follow the story in real time.

    I've become enamored of Twitter myself and unfortunately I've been posting a lot more there than here. It's less demanding, only 140 characters per entry are allowed.

    UPDATE: Whoever handled the Twitter at Trinity apparently can't count, as they kept overrunning the 140 character limit. Overall: eh.