Saturday, October 14, 2006

Alarm

I know I said I was taking a blog break, but hey, I'm Dr. A and I'm a blogaholic. Plus, I just had to share this short story with you. So, I'm on call. And, you know what that means: busy, busy, busy, tired, etc.

Usually after finishing rounds at the hospital, I stop at the office to try to catch up on some paperwork there. It's windy and cool here today, so I wanted to get inside quickly. So, I turn the key of the door and slip in.

The next thing I usually do is put my code into the security system keypad. I missed by one number and accidentally hit enter. Then, I panicked. For what felt like hours, although it was only less than a minute, I frantically tried to correct my error.

The alarm went off inside the office. I'm the only one here, so I kept working to try to enter the right code. I hear the phone ringing. It's the alarm system company. I tried to explain the problem, and seemed to solve the situation.

Relaxed, I walk down to my office and try to find a chart. Suddenly, I hear sirens get closer to the office. We're located right next to the hospital, so I figured it was an ambulance coming to the emergency room.

When I saw the police car rushing into our parking lot, my feeling of embarrassment grew. I went outside and saw that it was an officer who has done security for our soccer games in the past.

"Doc," he said smiling, "Forgot your code again, huh?" "No," I replied, "I missed one number and all this happened." "On call again, are ya?" "Yup."

Thought you would get a kick out of this. I'm sure some of you out there in blogland have done something funny and embarrassing like this before. What's your story?

Friday, October 13, 2006

Alzheimer news

Drug Denial: Early diagnosis and treatment of Alzheimer's Disease (AD) has been shown to slow progression of the disease. You'd think that everyone would want early treatment, right? Well, apparently not in the UK.

An article from Times Online reports that their National Institute for Health and Clinical Excellence (Nice) is denying medications like Aricept and Exelon to early stage and late stage patients.
Neil Hunt, the chief executive of the Alzheimer’s Society, said: "This blatant cost-cutting will rob people of priceless time early in the disease and later clinicians will have no choice but to use dangerous sedatives that increase the risk of heart disease and stroke.
I've talked about government interference with health care delivery before, so I won't belabor the point here. Suffice to say that from a disease treatment standpoint, I hope that Nice reconsiders its decision.

Ineffective Drugs: AD has limited drug treatment as it is. More advanced stages of AD are particularly difficult. Symptoms here include agitation, aggression, hallucinations, and delusions. Although no medications have FDA approval to treat the agitation symptoms of advanced stage AD, many docs have used psychiatric medications to try to control the symptoms.

An article from the LA Times reports a study conducted by the National Institute of Mental Health using two psychiatric meds commonly used to try to alleviate symptoms (Zyprexa, Seroquel).
Depending on the drug, 37% to 50% of patients discontinued their pills because they weren't working, and up to 24% stopped taking them because of side effects such as drowsiness, weight gain and confusion. All told, 82% of patients quit their drugs.
In my experience, I've found similar poor results in my assisted living and nursing home patients. I'm going to keep trying meds like Zyprexa and Seroquel, because there is very little else out on the market right now to treat advanced AD. Hopefully, there will be other treatment options in the future.

THC Treatment: The chemical name is delta-9-tetrahydrocannabinol. It is also called THC. If you don't already know, this is the active ingredent in marijuana. Some already use this to control side effects of cancer and AIDS treatments.

An article from The Age reports that the Scripps Research Institute in California performed a study which found that THC helps to decrease the formation of the protein plaques which cause AD.
THC is also more effective at blocking clumps of protein that can inhibit memory and cognition in Alzheimer's patients, the researchers reported in the journal Molecular Pharmaceutics.
I'm just imagining how they actually performed the study. "Dude, my memory is so much better." "Dude, I'm hungry, pass the potato chips." "Dude, pass the controller. It's my turn for the XBox." "No, it's my turn." "No, it's my turn."

Finally, am I advocating citizens of the UK to smoke pot since they have no access to prescription AD drugs? No, of course not. But, from a cost standpoint, pot is less expensive than Aricept or Exelon (at least that's what I've been told -- HA!) Maybe something for them to consider...

I'm on call this weekend, and I'm feeling a little blog burnout. So, I'm taking a few days off. Back next week some time. See you soon.

Thursday, October 12, 2006

Electronic records rant

It's no secret that I'm a news junkie. You can plainly see this from my blog. In addition to my patient rounds, I do my blog rounds and news rounds. I became really upset when I read this article from the Washington Post called, "Doctors Slow to Adopt E-Records for Patients."
About one in four doctors use some form of electronic health records, suggesting that a technology frequently billed as a way to improve the quality and efficiency of care has yet to win widespread acceptance, according to a study released yesterday.
As these type of articles in the media go, the following paragraphs build the case why an electronic record is a good idea -- it "collects patient information, displays test results, helps doctors make treatment decisions and allows health-care providers to document prescriptions and medical orders electronically." In addition, they "improve patient care, reduce errors, curb unnecessary tests and cut paperwork."

Yes, I get it. Even though I am one of the 75% of docs who do not use electronic health records (yet), I agree with everything that has been said above. I think all docs agree that going electronic is the future of medicine.

So, what's the hold up? Why isn't everyone using it now? There are two main hangups, in my opinion. The first one is covered later in the Post article, and it is who will have access to this electronic infomation? Also along these lines is who owns the information inside the computer?
"The big problem is that the vast majority of electronic medical-record systems do not give patients the right to decide who has access to the records," said Deborah C. Peel, a psychiatrist and founder of Patient Privacy Rights, an Austin-based nonprofit that wants greater safeguards. "They do not give patients the right to segment sensitive portions. . . . The electronic medical records in use now have been designed primarily for the convenience of physicians."
For example, if I'm talking with a patient and entering information into a laptop, and this information is stored on the hospital server three streets away from my office, who has access to this information - besides me? How comfortable would you be if I told you your medical data is on a hospital server and possibly backed up on an offsite server, while now, your information is in my paper chart under lock and key in my office? Just something to think about.

The BIG reason docs have not jumped on board is plain and simple -- COST! This is something that is never talked about in the lay press. The federal government has made a goal of most Americans on an electronic health record by 2014. Like a lot of other things from the federal government, this is an unfunded mandate.

Even for a small office like ours, the cost can be between 50-100 thousand dollars. But, hey docs can afford that, right, because I see them driving their expensive cars and have their expensive houses?

Medicare is a govenment program which is health insurance for people over 65 years old. As you all know, the number of Medicare patients is rising very day, because as a nation, we're growing older. Many physician offices depend on Medicare for a good portion of their income. In 2007, Medicare is slated to be cut by 5% unless Congress intervenes by the end of the year.

This cut will hugely effect docs across the country. Just as an example, here's an article from the Concord Monitor.
The New Hampshire Medical Society estimates that the cut will cost the typical family practice $20,000 next year, which could force some doctors to stop accepting new Medicare patients.

The association and its counterparts across the country have until December to persuade Congress to stop the cut. Lawmakers have, in years past, heeded similar requests, but local doctors remain worried.

"Primary-care doctors are really mom-and-pop shops," said Dr. Gerard Hevern of Suncook Family Health Center. "Most of us do it because we love it . . . but we do it on a shoestring. When you begin to erode that margin, it really impacts in ways that are profound."
So, bottom line, I totally agree that the electronic health record is the wave of te future, and all docs will eventually get on board. What the press neglects to cover is the real story of why this is not happening now. I know I'll continue to read articles like the one today in the Post, and I'll continue to get upset. But, here is the real story of why so few use electronic records now.

Addendum: Dinah from Shrink Rap has some additional thoughts and some great comments in her post entitled "For The Record." Check it out! Also, thanks to all of you reading via Grand Rounds this week. I invite you to check out the rest of my blog.

Unadopt

This week, I met a nice family of four who are missionaries and lived in South America for 10 years. This past summer, they visited friends who still live there. They were introduced to a four year old child whose family was killed earlier this year. Over the past few months, they have been undergoing the process of adopting this child and bringing him to our community.

I talked with the family and they told me of the very detailed process that they have to go through - endless paperwork, at home visits from state agencies/officials, etc. Even though it seems like a lot of hastle to me, the family is very happy that they are going to have a new edition.

Last night, I read a story about a Virginia couple who is trying to "unadopt" a child after caring for him for six years (BBC). The background of this child is troubling. His birth parents abused drugs. There were issues of physical abuse and suspicions of sexual abuse. All of these were believed to cause mental illness in the child which required medication treatment.

This foster mother stated that she became concerned three years ago when the child sexually abused a six-year old and a two-year old. She also states that this is when she learned of the child's troubled past. What's interesting is that she could have filed a "wrongful adoption" lawsuit, but did not. Instead, she has chosen to "dissolve the adoption" which requires the child's consent. The child has not consented.

This foster mom states that she was not informed at all of the child's troubled past during the adoption process. I find this difficult to believe. With the patients I have talked with in the past, all kinds of information about the foster family and about the foster child are learned, processed, and shared with everyone involved.

The concept of "dissolving an adoption" is fascinating to me. Can someone really divorce their foster child? How would that work? A child is in foster care and then a family decide to legally adopt the child. Then, maybe years later, the family decide to divorce the child? I'm really confused about this whole concept.

Update - Like a Foster Mom: I was talking about this Virginia story earlier today with someone at the hospital and she mentioned that pop star Madonna is in the African nation of Malawi visiting that impoverished nation. According to Times Online, Madonna and her husband just today have taken custody of a 13-month old boy and are going to adopt.
Malawian law does not allow for inter-country adoptions, and generally requires people who want to adopt to spend 18 months being evaluated by Malawian child welfare workers. But it seems even this is no obstacle for the Material Girl after Malawian officials, who refused to elaborate, indicated that such restrictions would be waived for the couple.
Don't get me wrong. I don't think this is a bad idea. In light of what I've learned today about adoption (thanks to your comments), I wonder what this child will be like 5-10-15 years from now. A Material Guy for the Material Girl? We'll see.

Wednesday, October 11, 2006

Smarter sex

First of all, I'd like to welcome all of you who found this post on a google search (and no I don't have a you tube movie that goes with this). Contrary to the title, this doesn't have anything to do with ED. HA!

But, since I have you here anyway, I wanted to share two interesting studies which pose the same question: Are men smarter than women? Before you start throwing stuff at me, just read below and decide for yourself.

A recent study of 100,000 high school students showed that men have a 4-5 point IQ advantage over women. (This was reported by the Financial Express) Matt Katz from the Lansing State Journal is very happy about this in his article called Are Men Really The Smarter Sex?
Whoooh-hooo! We're No. 1!

It has finally been proven that men are smarter than women. According to a study from Britain, men's IQ scores are five points higher than women's, and men are 5.5 times more likely to have a score of 155 (which means you're a genius).

Don't believe the British? In Canada, another study analyzing SAT scores found that males ages 17 and 18 are more intelligent than females.
Take that women! What do you think of that? Now, before I really started rubbing it in to everyone here at the office, I ran into an article from CNN.COM. Apparently, men are smarter, except then it comes to going to the emergency room during the big game.
A drop in the number of men going to the emergency room during sports broadcasts on TV is followed by a surge afterward, reports an ER doctor who reviewed case numbers over three years at the University of Maryland Medical Center in Baltimore.
Oh well. I'm so disappointed. I thought that I found the answer to this time old question of who's smarter. I guess the research and the debate will continue.

Surgery vs contacts

If I ask you which is safer: eye surgery or wearing contact lenses - you'd probably pick the latter, right? In an article from WebMD, researchers looked at the complications of the eye surgery called LASIK and compared them to complications of wearing contact lenses. The research will be published in this month's edition of the Archives of Ophthalmology. Gee, guess what the findings were? Bias? You be the judge.
Based on their review of several large studies, ophthalmologist William Mathers, MD, and colleagues concluded that daily contact lens wearers have about a one in 100 chance of developing a serious lens-related eye infection over 30 years of use, and a one in 2,000 chance of suffering significant vision loss as a result. The researchers calculated the risk of significant vision loss due to LASIK surgery to be closer to one in 10,000 cases.
The articles goes on to outline the bad habits of contact lens patients - whether it's not making sure your fingers are clean before inserting contacts (prevents infection) or sleeping with your contact lenses in. The big finish to the article is describing the advances in LASIK surgery over the past 15 years.

The bottom line is this. There are people who take good care of their contact lenses, and there are people who do not. Just like there are good surgeons who have low complications and not-so-good surgeons who have more complications. Do your own research before considering surgery or any medical therapy for that matter. That's your Dr. A Health Tip Of The Day. HA!

Tuesday, October 10, 2006

Grand Rounds

If you haven't already checked it out, Dr. Jon Mikel from Unbounded Medicine has Grand Rounds 3.3 this week. The graphic above is very creative as well. Sections include: Editors Choice, Physician Stories, Nurses Stories, Student Stories, Patient Stories, Public Health & Insurance, Humor and Volunteer. Very well done. Happy reading!

By the way, thanks so much for your feedback on the poll questions. I'm looking for any and all advice for my cholesterol presentation - whether you're a doc, nurse, patient, or anyone else. Great advice so far! And, I have some things to think about on this BAD idea. Still not sure what to do with that, if anything....

Poll question

Since it's four weeks before Election Day in the United States, I'm going to ask you, the faithful Doctor Anonymous reader, a poll question. Actually, two poll questions, because I'm seeking feedback on a couple of things.

A week from today, I'm going to be giving a talk at our local community hospital. The target audience are people who have heart and lung problems - ie, patients who have had heart bypass surgery and/or patients with lung problems like emphysema. Here's the topic: Dr. A talks about Managing Your Cholesterol. Now, mind you, I did not pick this topic. This was suggested by the group.

Serious Question: Here's what I'd like to know: if you were me, what information would you like these people to know about managing cholesterol?

Yesterday, my pal Penrick from I've got a few things to say, made this suggestion, in response to my post called Happy World Post Day, "You should start a Blog Anonymous Day yourself. You start discussing it a month before and let the word of blog spread." What? A worldwide Blogaholics Anonymous Day? Is this for real? Can this work?

Non-Serious Questions: If a worldwide Blogaholics Anonymous Day would actually happen, how would you promote it? I would imagine that I would ask people to post something about BA on their blog all on the same day - what would the topic be? What other things need to happen to make BAD (Blogaholics Anonymous Day) successful?

Thanks for any feedback that you have. I'm definitely doing the cholesterol talk next week. As for the BAD thing (isn't that a Chris Isaak song?), I'm not sure if I want to try to pull that off, yet. You'll have to convince me of that.

Monday, October 09, 2006

News briefs

Coumadin Black Box: Coumadin is a blood thinner that is used in a variety of health problems including blood clot prevention. Yes, you have heard right, technically, it is rat poison. Last week, the company that makes name brand coumadin issued a "black box" warning about "potential fatal risk of bleeding" in patients -- article from NewYorkBusiness.Com.

For those that may not know, some people consider the "black box" warning the highest warning that the US FDA issues to warn doctors and patients of potential medication problems.

Now, this is not anything mysterious. Everyone has known that coumadin has this potential for years. This is not another "FDA screwup." Here's the rub. Either take the coumadin and face potential side effects like bleeding. Or, don't take the blood thinner, and, for those that need coumadin, run the risk of blood clots which lead to things like stroke. I'm not sure what the answer is, but I do know that our phones here at the office have been ringing off the hook today with questions.

Total Lettuce Recall: The E.coli saga is continuing. The Mercury News is reporting today that a California company is voluntarily recalling some of its crops of lettuce after finding E.coli in a sample of irrigation water. First spinach, then beef, and now lettuce. As long as they don't recall Diet Coke and donuts, I think I'll be fine. We'll see what gets recalled next.

Cleveland doctor arrested in Cyprus: Yazeed Essa was arrested over the weekend as he attempted to clear customs is Cyprus. (CNN.Com)
Prosecutors have said they believe Essa, an emergency room doctor, was having an affair with a nurse and wanted to be free of his 38-year-old wife. Prosecutors characterized the killing as a "divorce substitute."
What's going on the world today? If you don't like your spouse, then just divorce her/him. What's up with murder (er, I have to say alleged murder)? If guilty, I hope this guy gets put away for a long time.

Happy world post day

Did you know that October 9 is World Post Day? Yup, you bet. It's a worldwide celebration of blogging and blog posts. Who knew that the blogosphere could have such a worldwide impact that an entire day is devoted to it.

Well, not really. This day is recognition of snail mail. Here are articles from the Universal Postal Union, South Africa, and Sri Lanka. The following quote is from the United Nations.
World Post Day is celebrated each year on 9 October, the anniversary of the establishment of the Universal Postal Union in 1874 in the Swiss Capital, Bern. UPU member countries across the world use the event to emphasize the important role of the postal sector in the daily lives of people and in the social and economic development of countries.
Oh well, maybe some day there will be real recognition for blogging and groups like Blogaholics Anonymous -- HA! Keep on blogging!

Blog chatter

I'm always flattered and humbled when I'm featured on another blog. And, this time is no exception. Mimi Lenox, one of the newest members of Blogaholics Anonymous, mentioned me in her Sunday Blog Chatter on her blog called Mimi Writes.
Now, if you'll excuse me, I'm going back over to Dr. A's and put my name on the BA map and make it unofficially official. It's time I admitted the truth. Which, of course, means that I have to tell my mother the sad saga of my secret addiction first. This could take a while since she doesn't even know what blogging is.

On second thought, this could wait a day or two. Couldn't it? Let's let her sleep in peace one more night.
Mimi has a second blog called Book Meme Central (where I'll also be featured *wink*). She describes this blog as the place where all Memes come to be immortalized. A comprehensive collection of book memes from across the globe. If you have a chance, check out these blogs. You won't be disappointed. Thanks Mimi!

Sunday, October 08, 2006

Health care coach

Hey, this should be your primary care doctor, right? This article from Forbes.com describes what they call "health care transition coaches," who can help reduce patient's hospital bills and rate of re-hospitalization.
The "transition coach" works with patients on four main areas: medication self-management; the creation of a personal health record maintained by the patient; obtaining timely follow-up care; and developing a plan to seek care if certain symptoms appear.

The program was created to solve problems -- such as conflicting medical advice, medication errors and lack of follow-up -- that often affect patients during periods of transition between sites of care.
This article doesn't say who these coaches are, who pays them, and how they get paid. These are probably agents of the insurance companies, who already dictate how health care is delivered in this country.

The idea of a "health care coach" just sickens me. These concepts are exactly what should be happening in the offices of primary care docs. Unfortunately, this is probably not happening, and that's why these coaches were created. Just another symptom of the broken US health care system. If we treat the symptom and not the overall big picture, the status quo will remain and the frustrations will continue to grow.

Make it so

So, I was at Christies auction house yesterday checking out all the Star Trek memorabilia. I know I've told Michael C this before, but, hey, I admit to being a Star Trek fan - just don't call me a trekie, HA! For those who may not know, this sci-fi series has been around 40 years. In this article from BBC news, the auction lasted three days and there were over 1000 items sold.

The item getting the biggest sale was a model of the starship enterprise which sold for, get this, 576 thousand dollars! Did I read this right? I mean, it's a model. It doesn't fly. It doesn't orbit the earth. It doesn't come with futuristic space babes. What's the deal? I guess some people are WAY more into Trek than I.

When I was done there, I went over to Bangkok, Thailand to see a guy set a world record. In this article from CTV.ca, it describes a "Thai snake charmer" attempting to set a world record by kissing, yes, that's kissing, 19 poisonous king cobras.
One by one, the cobras were released onto a stage set up in a Thai beach resort town, as snake charmer Khum Chaibuddee kissed each beast and then moved on to the next.

Four additional snake charmers flanked the stage at each corner and a medical team waited on the sidelines with serum in case one of the snakes snapped, said a statement from Thailand's Ripley's Believe It or Not Museum, which organized the event.
This sounds strangely familiar, but didn't Mark Foley do the same thing while he was in Congress? Thank you, thank you very much! *running out of the room*

Where's the beef

Who knew that spinach could be related to beef? Friday, a company in Iowa voluntarily recalled 5200 pounds of ground beef products from seven states because they could have been contaminated by the same E.Coli strain that tainted spinach - according to an article from the Houston Chronicle.
E. coli lives in the intestines of cattle and other animals and typically is linked to contamination by fecal material. It's believed responsible for about 60 deaths and 73,000 infections a year in the United States. The potentially deadly strain can cause bloody diarrhea and dehydration.

The Iowa recall is the first significant one involving ground beef since a Tennessee company recalled some 4,300 pounds in early August, also because of possible E. coli contamination.
This case is getting more and more interesting. Since there is a criminal investigation now taking place with the spinach California company, I wonder if that triggered this voluntary beef recall. I also wonder if other voluntary recalls will take place. Hmmmmm...

Saturday, October 07, 2006

Can you hear me now

The Nobel Prize in physics was awarded this week to astrophysicist George Smoot of Lawrence Berkeley National Laboratory and his NASA colleague John Mather. When Mr. Smoot got the call notifing him of the award, he thought it was a joke, according to this article from MercuryNews.Com.
Smoot, 61, who has an unlisted cell phone number, suspected a hoax when a caller with a Swedish accent told him about 3 a.m. that he had won the most coveted award in science.

``I just said, `How did you get my phone number?' '' the physicist recounted giddily for colleagues Tuesday morning at Lawrence Berkeley Laboratory. ``But the guy sounded really serious, so I thought I'd better take him seriously.''

Just to be certain, he checked the Nobel Prize Web site. And there it was: Smoot and Mather were being honored ``for their discovery of the blackbody form and anisotropy of the cosmic microwave background radiation.''
Uh, yeah. I know someone with a blackberry and a microwave, does that count? What's the lesson here? If you get a call at 3AM from someone with a Swedish accent, it may not be that annoying telemarketer. It may be the Nobel Foundation!

Exercise

I admit that I haven't worked out in months, even though I tell my patients to workout all the time - you know, for your health. So, I woke up this morning and told myself that I'm going to get my butt out of bed and head over to the local gym (which I think I pay $10/month for) and burn some calories.

I have no excuses why I don't follow my own health advice. I guess I rationalize things by saying what everybody else says: "Uh, I don't have the time to exercise," "I'm so tired when I get home from work," "I can't get up early in the morning," etc.

But, this morning, I've decided I'm going to do this. Go me! Where are my tennis shoes?

BA in South Florida: Don't forget to stop by Ms Bee's place sometime today or tonight for the Blogaholics Anonymous meeting. I'll be bringing the flu shots and the Diet Coke. However, the ladies, including you FD, are not allowed near the Diet Coke. Why? Because, I don't want to be blamed for your osteoporosis down the road. Read here. HA!

Anyway, Ms Bee was happy to get 53 visitors from six countries yesterday. We can do better than that! Click on over there right now and say hello. Let's break her bean counter today with our visits. See you there!

Friday, October 06, 2006

Perseveration

Ever get to a place where you just can't stop thinking about something? That is happening to me right now. I was expecting to hear some news today, which never came. It is something that has been lingering on my mind all day and all night. It's bothering me so much, I cannot sleep.

Anytime you apply for something, you put yourself out there - out there to be judged - out there to be accepted or rejected by someone else. I tell people all the time that trying to seek approval from others is probably not the best idea. As I put the mirror up to my face, I see the hippocrite staring at me. Self acceptance and self confidence go so much further than seeking approval from others, right? At least that's what I tell people.

I have worked hard to get where I am at right now in my career. I have worked hard during the application process. Now, I don't want to sound like I have sense of entitlement - because I hate that. Just because you work at a job for a certain number of years, or just because you worked hard during the process - this doesn't entitle you to be selected. Sure, there are selection criteria, but in the back of your mind, I ask myself, "What are the other criteria that I don't know about?"

Did the selection committee judge by merit, or was there some other factor in play? People always say, "It's not what you know, it's who you know." I never really believed that, that is, until today. Of course, the first reaction is to blame the process. Yeah, that's right. The judges were out to get me. I never really had a chance in the first place. Why did I put myself in a situation where I could be rejected?

Am I a sore loser? Maybe. Is this sour grapes? Maybe. Am I whining? Absolutely. But, it's my blog, right? I just had to blog about this emotion that I'm feeling. Yes, it's irrational. Yes, it's illogical. But, that's the core of emotion. And, that's where I'm at right now. Whew! I feel a little better blogging about it.

I think I just need to try to get some rest and move forward from this small bump in the road. Then, I can let this go. Tomorrow is a new day - a new day with new opportunities.

As I drift off to sleep, as all the consipracy theories are flying through my head, I cannot help but wonder if I am an innocent victim of a lie told in silence....


Thanks Cathy, for the opportunity to share my story.
Here are the other authors:

Mary Anne from "Life in Qualicum Beach"
Dr. Jordan from In My Humble Opinion
Wolfbaby from "Dreaming and Believing"
Moof from "A Moof's Tale"
Kim from "Emergiblog"
KT from "Kt Living"
Difficult Patient from "Ripple of Hope "
Jasmin from Shadow Writer
Empress Bee (Of the High sea)
PK from Pearls and Dreams
The Laundress from Dirty Laundry
The Wandering Author of The Unending Journey Of The Wandering Author
Amin from Write-Now
Who Wouda Thunk It From Another Day In Paradise
Brian from Truth is Freedon
At Your Cervix (R.N.) from At Your Cervix
Ipanema from Irish Cornwall
May From About A Nurse

Follow-up

Flu Shot Fiasco: Let the games begin! The CDC had their news conference Wednesday. And they state that there will be enough vaccine for everyone, according to this article from NPR.com. The phone calls to our office started Thursday morning. Of course, like many other doctors offices, we have not received our shipment yet, and we told our patients that. "But why are pharmacy x and pharmacy y having flu shot clinics next week?" Ahhhhh! (BTW, thanks Mary for the link.)

Blogaholics Anonymous meeting: Empress Bee (of the High Sea) has graciously volunteered to host the next BA meeting on Saturday. Thanks so much! You have to come, because Charlie has already cleaned up the place for us slobs to come over. We may have to keep it down a little bit, because we don't want to have them kicked out of their apartment. As always, it's BYOB - Bring Your Own Blog. See you Saturday!

An innocent victim of a lie told in silence: If you don't know what this is, click on over to Cathy's place and check this out right now. It's a fascinating concept. Instead of the typical song meme, or movie meme, or question meme, it's kind of a story meme. What will link them all together is that the last line of the story has to be "an innocent victim of a lie told in silence." I'll be posting mine in a few hours and about 20 people are going to be joining in on this. May's post is up already. Stay tuned for mine!

Thursday, October 05, 2006

Halloween meme theme

I was tagged my Morgan (gee, thanks) who started his own meme. What is it that I'm always the first person picked when a meme gets started? (Was that whiney enough for you?) Anyway, this is a 13 question theme that goes like this...

1. What's the scariest movie you've ever seen?
Howard the Duck. Just kidding. Ever see this movie? Nope, not many people did -- I think in grade school, they showed a dracula movie around this time of year. I couldn't sleep for days. I think it scarred me for life - really. *smile*

2. What was your favorite Halloween Costume from childhood?
I was a superhero guy. My fave was Superman. Had the cape, had the big "S" on my chest, had the tights. I was 18 years old - just kidding. But, my mom has pictures somewhere of me. Don't worry she has them carefully hidden and will only reveal them at the worst possible time for me, like when I make my long awaited guest appearance on Gray's Anatomy (playing myself of course).

3. If you had an unlimited budget, what would your Fantasy Costume be for this Halloween?
Without a doubt, I would be giving some love to Pluto. I mean the planet, and not the dog. It'll be part of my "Save Pluto" campaign.

4. When was the last time you went Trick Or Treating?
Last year, did you know, I went to a neighborhood and they were giving out iPods? Yeah right. The last time I remember was probably junior high. I remember because my friend went as Michael Jackson. That explains a lot about where he's at now in life.

5. What's your favorite Halloween Candy?
Any time of year, my fave candy is M&Ms. This time of year, of course, the Halloween colors. And, for giving out candy, the M&M minis. Is that too much information?

6. Tell us about a scary nightmare you had.
I was out of town without internet access. Oh yeah, that really happened. Read here.

7. What is your Supernatural Fear?
That slimy ghost from the Ghostbusters movies is going to get me some day. Who you gonna call?

8. What is your Creepy-Crawlie Fear?
Everyone who comes to my office stating they have a spider bite is always fearful of the brown recluse spider. Why? Because the bite injects a venom that literally eats away at your skin and has the potential (although rare) of causing a fatality. Scared yet?

9. Tell us about a time when you saw a ghost, or heard something go Bump in the night.
The first house I lived in following residency was in the woods. Beautiful landscape, although it was hard to maintain. Anyway, one night, I think it was in October I heard something on the roof. I was definitely freaked out. The wind was swirling and you could hear the leaves outside the window. What happened? Just some squirrels on the roof. Funny now, but not that night.

10. Would you ever stay in a real Haunted House overnight?
No. Let me think about that - No. Wait a sec --> Still no!

11. Are you a traditionalist (just a face) Jack O'Lantern Carver, or do you get really creative with your pumpkins?
Just a face. I'm not much more creative than that.

12. How much do you decorate your home for Halloween?
Decorate? What's that? I'm lucky to "celebrate the season" by wearing a Halloween tie to work. I'm kind of a minimalist that way.

13. What do you want on your Tombstone?
That's easy: I'm Dr. A, and I'm a blogaholic...

Tag time: Let's see. How about Ladybug, Lea, M, TundraPA, and The Curmudgeon. Join in if you like!

Ten million dollars

Did that get your attention? No, this is not the cost of my prescription drugs last month. And, this is considerably less than the $200 million powerball winning jackpot won by an Iowa couple. But, this is not about the money, it's about medical history!

What am I talking about? The X Prize Foundation, the people that brought you SpaceShipOne, is at it again. This time, the challenge is pretty simple. If you can map 100 different human genomes in 10 days, then $10 million is all yours. Here's a quote from msnbc.com.
“It’s like geeks are taking over the world,” [Craig] Venter [founder of Celera Genomics] said in an interview. “Who thought a scientists could get $10 million for coming up with a breakthrough technology?”
So, who's with me on this? I've got a computer and an old microscope (although it may need a new lightbulb). Of course, I don't know 100 people. So, we'd have to recruit them. Maybe I can get the Nobel Prize guys to help me. This is ten million dollars and medical history! What you do think? Deal or no deal?

Wednesday, October 04, 2006

Canadian drugs

Almost every day, I have a patient ask me what I think about getting prescription drugs from Canada. I have to admit that I'm really torn on this. I understand that the cost of prescription drugs is a major problem -- especially for my older patients (I don't want to get into why drugs are so expensive. That's an entirely different post.)

Formerly, the federal government, through the Department of Homeland Security, halted shipments of imported (Canadian) prescription drugs. According to an article in today's Los Angeles Times, this practice will be abolished and instead random searches will occur.
Popular medications such as Lipitor and Fosamax can be 30% to 80% cheaper from Canada and other countries, surveys have shown. But the U.S. government was confiscating as much as 20% of the shipments this year.
But, sometimes the integrity of these imported drugs needs to be questioned. This topic was covered on a recent episode of the CBS Evening News with Katie Couric.
“It sounds so good, cheap prescription drugs just a click away on the Internet,” said anchor Katie Couric as she introduced the September 20 “Eye on Medicine” report, but, “it could be really dangerous because you may not be getting what you think you are.”

Correspondent Jim Stewart told viewers of a federal bust of “11 people and an Atlanta-based company with a scheme to sell the fake drugs over the Internet.” Stewart noted that the phony drugs were manufactured in “a rented house in Belize” and the Web site peddling them told customers it was a Canadian pharmacy selling re-imported drugs.
I realize I may start a firestorm here with people pointing fingers at other people and groups. But, what's the answer here? I don't know. I do worry about the authenticity of imported drugs. I also worry that prescription drugs are expensive and my patients are doing what they can to stay as healthy as they can, even if they have to get their drugs from Canada.

Botulism

Now that you're able to have some spinach again, you thought that it was safe to head back to the store. Forget that, dude. Now, my carrot juice obsession is going to take a significant hit because the US Food and Drug Administraton (FDA) has warned consumers to avoid carrot juice products from a certain California company due to a fourth case of botulism linked to this company.

Most people have heard of the word botulism, but really cannot describe what it is or what the symptoms are. I had to review this myself, because the only place I've seen this disease is in a textbook. As a public service announcement to you, the Doctor Anonymous reader, here are the symptoms of botulism along with a great link to the CDC with more information. Look out for those carrot juice drinkers!

The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days.

Tuesday, October 03, 2006

Tagged

My good friend Sam at Blog, MD *cough* tagged me this afternoon. He started a blog meme of his own. How can you start a meme? I thought memes were one of those mysterious things that traveled around the world and around the blogosphere until you get the dreaded message that "you've been tagged." Oh well...

With Halloween coming at the end of the month, he calls his meme "dark and creepy." The idea is to pick five songs that you'd like played at your funeral. Quite odd, I thought, because I haven't really thought about that yet. But, hey, I'm game. Here are Blog, MD's top five.
The Top 5 Songs I Want Played (Over My Dead Body):
1. “When the Levee Breaks” by Led Zeppelin: Because “Stairway to Heaven” is so obvious.
2. “Dies irae” from Mozart’s Requiem: This piece speaks for itself. I’ve loved it for years.
3. “A Love Supreme” by John Coltrane: I consider this to be one of the greatest pieces of music ever composed. Coltrane’s “humble offering to God” in the “Acknowledgement” converted this tired agnostic.
4. “Steppin’ Out” by Joe Jackson: A fitting way to say adeiu.
5. “Non, je ne regrette rien” by Edith Piaf: No regrets. None.
Here are my Top 5 Songs I Want Played, well, you know...
1. Canon in D by Johann Pachelbel: In my past life as a med student, I played piano accompanyment along with two violinists during a memorial service. Very moving experience, have to blog about that sometime. (Only serious choice in this group)
2. Roxanne by The Police: My one and only karyoke song. That would get people talking!
3. Hit The Road Jack by Ray Charles
4. Good Riddance (Time of Your Life) by Green Day
5. 100 Years by Five For Fighting

In true meme fashion, here's who I'm tagging. Join in if you'd like:
1. The Thinker: Check out her blog. She's already in the Halloween spirit!
2. Morgan: Another blog with Halloween-y colors. HA!
3. Julie: It is meme Tuesday, isn't it?
4. Empress Bee: Wouldn't this be your first meme?
5. Little Student: This is not a boring meme.

Flu shot rant

It's the beginning of October in the northern United States. Usually this means that the leaves are changing colors symbolizing the fall season. The weather is starting to get cooler. Halloween is at the end of the month which means that the Thanksgiving and Christmas holidays are not far behind.

It also means that the annual flu shot fiasco is going to start soon. You've seen this before. Once flu shots are mentioned on the morning national newscasts, the office phones will ring constantly until December. These annual news stories usually have someone from the CDC asking how bad the flu season is predicted to be. Then, typically, questions about the rumored flu shot shortages that will take place.

Meanwhile, back to our office, our patients are demanding that their flu shots be given to them today. "Hey, all the local pharmacies have them. Why doesn't your office have them yet?" "Is your office going to forget to call me again this year?" "Is your office going to run out of flu shots again this year?" "Don't you care about all your patients and not those you classify as 'high risk?'"

Why does this have to happen every year? Why do people have to get so angry at our office and our staff? I have no control why the pharmacies get the flu vaccine before doctor's offices and nursing homes. No, it's not a conspiracy. I would sure like to find out why this happens.

Why does our office wait two and three weeks after the pharmacies have their flu shot clinics? Well, for business, it's good to be the first on the block to get your flu shots out there so that you can use up your supply and not have any extra inventory. From a medical standpoint, we wait just in case the flu season may last another two or three weeks longer than expected next spring. That way you're still covered.

Why do people insist that the flu shot causes the flu? It doesn't. The flu shot doesn't prevent the common cold, and that's what you probably have. Estimates are that between 10-20% of the US population are infected with the influenza virus each year -- About 100,000 need hospitalization and about 35,000 die each year from influenza. But, don't worry, that won't be you. And, no, I won't just give you a prescription for tamiflu, just in case - just get your flu shot.

I'm just getting ready for the annual anger and aggression that will take place over the next few weeks when I'm not able to give their flu shot -- on demand -- for one reason or another. Don't worry, I still think you're a good person, but one of my many patients caught up in the annual hype.

Oh by the way, in case I miss you this time, you can still get a flu shot in December and January. Flu season goes through spring. Better safe than sorry, right?

Monday, October 02, 2006

Perspective

As you know, I like golf. Ok, I admit it, I can't get enough of golf. No, I can't play golf, but I follow it through the year. And, yes, I watched Tiger Woods win his sixth tournament in the last three months yesterday - even though it was on tape delay from England, and even though I already knew the result hours before I watched it on television.

For those of you who don't follow professional golf that much, some would call winning six professional tournaments a decent career. Tiger won six tourament in the last three months and eight tournaments in all for 2006.

The sports press is using words like "domination" and phrases like "Tiger's best year as a professional golfer." But, during the winner's press conference yesterday, he called 2006 a "loss." These are not the words of a professional golfer always striving for perfection in his sport. These are words of a son mourning the loss of his father earlier this year.
"I mean, people asked me that there on the 18th [hole] here, how do you consider this year," [Tiger] said. "I consider it as a loss. In the grand scheme of things, golf, it doesn't even compare to losing a parent."
I admit that sometimes I put the sports superstars that I admire on a pedestal. So much so that I forget that they're people, too. Even though Tiger Woods is the best golfer of my generation, and arguably the best golfer ever, his statement yesterday made me admire him even more. After all the accolades, adulation, and admiration, thanks for reminding me about what's really important in life.

Blog hot or not

A little something different today for you. Someone sent me this link to bloghotornot. I thought it was kind of cute. I don't know what it is, but I feel this need to be liked by others - maybe a character flaw. Anyway, as you can see by my sidebar, I have this thing for numbers and rankings.

I'd appreciate it if you click on that little graphic in my sidebar and let me know what you think of my blog. And, of course, also feel free to leave a comment as well.

Numbers update: I'd like to thank everybody again for visiting my blog, I really appreciate it. My average daily visits have increased by 95.4% to about 380 visits a day, according to site meter and the truth laid bear. So, thanks again! I'm starting my 15th week of blogging. And, I'll work as hard as I can to maintain the quality of my blog, so you'll return again and again.

Sunday, October 01, 2006

BA in space

No, this is not an actual blogaholics anonymous meeting. It's just me being jealous. How cool would it be to blog from space? The topics would be endless. Well, this actually happened to Anousheh Ansari who is an American business woman.

According to the Sydney Morning Herald, she paid a cool $20 million to be a space tourist on a Soyuz vehicle. She touched down yesterday in Kazakhstan with her Russian cosmonaut counterpart.
[And] she wrote about the smell of space - at least the space inside the orbiting lab: "It was strange … kind of like burned almond cookie."
I read some of her blog, and it's interesting stuff. How soon will you and me get to check out space like that? Maybe sooner that you think, if Richard Branson has anything to say about it (according to this article from space.com). At the slightly cheaper price of $200,000, you too can spend time in space - about 2.5 hours which would include a more than a few minutes of weightlessness.
“If it was ready next week, I’d be there,” Alan Watts, who has traded in two million Virgin Atlantic frequent flyer miles for a ride on SpaceShipTwo, told SPACE.com. “I’m really looking forward to it.”
Trading two million frequent flyer miles for a chance to travel in space? Hmmm. Is this guy nuts? Does he know how many useless magazine subscriptions he could get for two million miles? Some people just don't think sometimes -- HA!

Saturday, September 30, 2006

Germ zone

I finally figured out where I got this cold I've been dealing with for the past week. It started last weekend when I was in DC. According to this article from this morning's Boston Globe, my hotel room could have made me sick.
When sick hotel guests leave their rooms, they frequently leave something important behind: the virus that gave them their colds.

During an overnight hotel stay, people with colds left viruses on telephones, light switches, and television remotes, researchers said yesterday at an infectious disease conference in San Francisco.
We've all heard about not coughing on people and not sharing cups with people who have colds. Now, apparently, you're going to have to ask if the people who had the hotel room before was sick. Wouldn't that be interesting? When it comes down to it, I agree with Dr. Owen Hendley, University of Virginia Health System, who led the research.
"It's an interesting study," he said. "But they haven't shown infectivity. I'm not going to go around opening doors with my elbows."

Friday, September 29, 2006

Big apple fat

Usually when you mention the word "trans" in New York City, you mean something completely different. But, right now, NYC's hottest "trans" is trans fat. Why? Because earlier this week, the New York City Health Department proposed a near ban on trans fat in NYC restaurants. As you already know, trans fat is found in fast food, cookies, cakes, and basically anything I think is good to eat.
"Trans fat causes heart disease. Like lead in paint, artificial trans fat in food is invisible and dangerous, and it can be replaced," New York City Health Commissioner Thomas Frieden said in a statement. (quote from Scientific American)
In the following quote from SFGate.com, by proceeding with a ban of one substance seen to have health concerns, this sets the precedent and opens the door to a laundry list of possibilites of future food bans.
There's also the issue of what should be banned. What about high fructose corn syrup? Sodium? Cases have been made that they're just as harmful as trans fats. Should we put a cap on the number of calories that people are allowed to order in a restaurant?
I always love when the government tries to legislate behavior. By making trans fat, in a sense, illegal, doesn't it then make it more attractive? This may seem silly, but I see drug dealers turning into trans fat dealers. They would hang out outside of NYC's swankiest (is that a word?) restaurants with one side of the raincoat with cheap Rolexes and the other side with illegal donuts to bring into restaurants. Sales of crack, heroin, and meth will fall off dramatically in favor of french fries.

The other thing I can't wait to see is "New York's Finest" food police. Can't you see the TV show right now? "Tonight at 8pm - Dr. A stars as Detective Emeril (BAM!) - In Cold Food Files." Bon Appetit, NYC. Pass the donuts!

Thursday, September 28, 2006

Resources

This story from the Hamilton Spectator kind of hits home for me. It talks about a small hospital and what hospital administration does to try to improve the hospital and the community.
Why wouldn't Hamilton Health Sciences (HHS) put more money into emergency rooms to attract and keep doctors? Why wouldn't HHS top up emergency physicians' salaries to ensure stability and appropriate levels of service? It makes good sense.
Especially for small hospitals and small communities like this one and like mine, there are limited resources and priorities have to be made on where and how resources are managed. I'm all for getting the best docs and building the best facilities, but there are consequences to that.
The problem with emergency staffing seems to be double-edged -- crummy working conditions and pay that's not great. HHS has chosen to address those issues to ensure adequate emergency services.
Don't get me wrong. I'm not trying to lead you down a path here - especially with my posting yesterday of paying docs more. Like I said above, my small community and my small hospital are going through this right now.

On the one hand, having the best and most modern facilities can attract docs and other medical professionals to our small town and hospital. Who doesn't want to work with the latest and most technological toys?

On the other hand, something has to give. Sometimes that means pay freezes and/or pay cuts to the rest of the staff whether it be nursing, respiratory, secretaries, custodians, etc. Or, short staff situations. This can have effects on patient care and hospital morale, and other areas. I don't have the perfect solution. I'm curious what you think.

Question: If you were CEO of a small hospital with very limited resources, how would you help insure the best medical care for your community?

Wednesday, September 27, 2006

Family Docs Rock!

I'm Dr. A, and I approved this message... (Story from WBAL-TV in Baltimore)

WASHINGTON, D.C. -- A rally was held in Washington D.C. Wednesday to bring attention to a shortage of family physicians.

The American Academy of Family Physicians said they want Congress to increase medical payments to family doctors.

They also said they want voters to question candidates about health care.

A workforce report by the group showed the number of family physicians has dropped by 50 percent as younger doctors opt for specialties that offer better pay.

Tuesday, September 26, 2006

Grand Rounds

GR 3:1 is hosted this week by Enoch Choi, MD from Tech Medicine. I wasn't aware that GR has been going now for 2 years. Congrats to Nick Genes. Anyway, Dr. Choi is kind of having a "Medical BA meeting" over there with appetizers and everything else. I'm under the "Who's Hot and Bothered" section.
Dr. Anonymous considers the FDA a bureaucracy without merit and next week's Grand Rounds host thinks clinical trials are sometimes without merit as well.
Got back home late from DC last night. Can't believe I'm back at work today. Oh well. Checked the site meter and it was over 400 yesterday, thanks to all of you! That's the highest it's ever been, at least for me. I haven't had a chance to review all the comments and my e-mail yet. Hopefully, I'll be able to do that in the next couple of days. However, I'm on call tomorrow. Sheesh! Thanks for coming to the DC BA meeting yesterday.

Monday, September 25, 2006

BA in DC

I'm Dr. A, and I'm a blogaholic. Welcome to the latest edition of the Blogaholic Anonymous meeting. What is Blogaholics Anonymous all about? Well, this is only for those who are hopelessly addicted to blogging. If you're not, then stop reading this right now! LOL

As you already know, this edition is from Washington, DC. I did not get to see everything here, but I will take you on my short walking tour - all I could do in a few hours. Below are some reflections as I walked around the city.

White House: I wanted to come here first. Regardless of your politics, if you've never seen this place up close, you must make a point to someday. The first observation I made was all the people. Just to be funny, if I was President (yeah right, like that would happen), one day, I would run out on the balcony, and yell, "Hey! All you people, get off of my lawn!" Maybe that wouldn't go over very well. I tried to take a tour inside, but they absolutely did not want any cameras in there. And, traveling by myself, I guess I couldn't go in.

Of course, there were the obligatory protestors. Don't get me wrong, not belligerent, just wanting to make a statement. It was nice to see some cub scouts doing some cleaning in the park across from the White House - wonder what those scouts were thinking. As I went from the north lawn to the south lawn, I saw more people. Even people playing football and soccer, "Yeah, let's meet up Saturday afternoon on the south lawn for our game." Very cool.

Washington Monument: This was my first sight as I was driving into the city Friday night. It is as majestic in the daytime as it is at night. You really don't know how tall this structure is until you're at its base. I did not get to go to the top of the monument because all of the viewing tickets were already given out for the day. This a good point to see a lot of the other monuments. Looking north, you see the White House. Looking south, you see the Jefferson Memorial. Looking east, you see the top of the capitol building. And, looking west, you see the Lincoln Memorial and the World War II Memorial. I guess I should have figured it out, but all the monuments are national parks. And, what do people do in the park, they play sports. An interesting sight seeing people play sports with the backdrop of the monuments.

World War II Memorial: I've seen this on television, but have never been there before. It's definitely a beautiful place with all the fountains and all the people talking about their experiences during the war. I saw many families there and many veterans talking to their grandchildren about their life experiences. What a perfect location between the Washington Monument and the Lincoln Memorial.

Lincoln Memorial: The reflecting pool lies between the WWII Memorial and the Lincoln Memorial. I even saw some airplanes in the sky above, as they go to Reagan National Airport. As I was walking to the monument, I imagined all the history that has taken place here throughout the years. Then, suddenly, I had my Martin Luther King moment. I saw him on the steps of the memorial and I imagined all the people surrounding the reflective pool. I had to pause - quite moving.

One of the things I didn't realize was all the steps to climb to get to the top of the monument. I realize I'm really out of shape, but I felt it was quite an achievement for me to get to the top of the steps. The first thing I did was look back east to see the Washington Monument, its image in the reflecting pool, and the capitol building in the background. Felt very patriotic at that moment, and a smile came across my face.

Vietnam Veterans Memorial: In contrast to the WWII memorial, where there was a lot of energy and noise, this place was very solemn and quiet. People have told me this before, but it doesn't really hit you until you're there. There's no glitz; there's no glamour; just names on a wall. Kind of felt like hollowed ground starting at one end of the memorial and descending to its midpoint and then walking up and out of the memorial again. People left flowers. People used pencil and paper to trace the names of their loved ones from the wall. Powerful sight to see.

Capitol Building: I just had to take a break after that. I got some water and made my way back past the Washington Monument and walked to the Capitol. This was a long way (for me), so I found a bench near the metro/subway station. As I sat there for a few minutes, it was interesting to see the people come up from the subway station, especially the children, as they saw the monuments for the first time. I also noticed many international people in the city. I heard a lot of languages spoken, and you could tell that they were happy and proud to be here - the home of democracy. Americans definitely take democracy for granted, and that was emphasized to me in observing these people from other countries.

Final Stops: Continuing walking east, I saw the Library of Congress and the Supreme Court. I didn't realize the size of the court door until I walked up all the steps and saw it for myself. There were some students gathered in front of the Supreme Court building talking about how to effect change and the impact of court decisions. Who says American students don't know anything about how their government works? I finally got some food at Union Station, which is a fully working train station for those who do not know. As I was having lunch, I saw travelers rushing into and out of the building, much like an airport. I was so tired, that I took the subway back to the hotel.

For the visual part of my essay, I encourage you to check out my Flickr file and leave some comments as well. I hope you enjoyed a quick walking tour of Washington. I'm on my way back home later today. Thanks for checking in!

Saturday, September 23, 2006

Oxymoron

Before I leave the hotel for my DC day, here's a quick news story. The US Food and Drug Administration could do a better job at reviewing drugs. No, that's not news.

Here's the news story: The Institute of Medicine, the people who stated that between 50-98 thousand people die each year from hospital errors, released a report Friday criticizing the FDA about how it reviews drugs, according to this report. Don't get me wrong, the FDA itself ask for the review.
Newly approved drugs in the U.S. should carry a warning that their safety isn't guaranteed, the medications should be reviewed in five years, and they shouldn't be advertised for two years, according to a report released Friday.

The report, released by the U.S. Institute of Medicine, said the Food and Drug Administration hasn't done enough to oversee new drug safety. The institute said the medications should carry a symbol, such as a black triangle, indicating they might not be safe. It also suggests agency rules be enforceable with fines.
Ok, let me get this straight. They want to put a warning that the safety isn't guaranteed? Why not put the same statement here that's on all herbal medicines: "This medication is not intended to diagnose, treat, cure, or prevent any disease." In fact, I believe that this puts more regulations than on herbal medicines.
"This report should be a watershed moment for FDA reform," said [Iowa Senator Charles] Grassley. "Public safety is at stake, along with the credibility of our nation's drug-safety agency."
FDA reform? Gimme a break. This is government bureaucracy. No one in this town that I'm sitting in right now has the courage and the political clout to do anything about it. The FDA is a good punching bag and the status quo will remain after all the hype. It's kind of like saying United Nations reform. Yeah right...

Friday, September 22, 2006

On the road

So, I've been in DC for about three hours already. I thought about walking around a little bit, but I was a little tired when I got here. For those of you with Google Earth, you can find my exact location. I'm at 775 12th street NW. Do you see me waving?

Some people detest driving longer distances. I thrive on it. I had my iPod going and I may have driven a little above the speed limit a few times *smile*. Plus, people may think I'm nuts, but I enjoy big city driving - except for all the one way streets. For those who are not familiar with Washington, DC, there is a huge highway that goes around the city called the beltway.

I'm from a small town, and traffic to me is driving around my town at lunch time where the one main street has cars all over. But, some people would say that the DC beltway is nuts. Cars and trucks everywhere - weaving in and out and across three lanes of traffic. For me, really a good time! Don't worry, I got here safe.

The first thing I had to do was blog about it. I do admit that I felt like quite the loser sitting in the bar virtually by myself having my chicken sandwich and beer. No sympathy, please. This is only night one. There are a lot of good times to come (I hope).

Tomorrow, I'm going to try to visit with some friends that I have here. If that doesn't happen, then I'll walk around the city a bit. I haven't been here since I was a little kid. Right now, instead of getting needed sleep, I'm going to check my e-mail now and read through some of my comments, which I have neglected for the past few days - I'm Dr. A and I'm a blogaholic. Thanks for everybody checking in. I appreciate it!

Wednesday, September 20, 2006

Grand Rounds

Grand Rounds 2.52 is up and running at Tundra Medicine Dreams. Actually, it was up and running yesterday, and I'm a little slow in posting this. The Tundra PA is from Alaska and has done a great job of organizing all those links and adding some fabulous pics from tundra land.

In case you don't know, Grand Rounds is the showcase of the medical blogosphere and it's posted every Tuesday. It's so good, I'm not allowed to post anything there. HA! Just kidding. If you've never experienced GR before, I encourage you to check it out.

As usual, on call was busy last night. If I'm up to it, maybe I'll bring a story to my blog later. Feel like I'm running on empty a little bit. Should be an interesting day. Is it the weekend yet?

Tuesday, September 19, 2006

Transplant

You're definitely going to think that I'm making this one up...

The Seattle Post-Intelligencer posted on their website the first successful penis transplant ever reported in a medical journal. This occurred in China and here's the quote from the article itself.
The Chinese doctors could not be reached for comment, and their report does not explain how the 44-year-old man lost his penis. It says only that "an unfortunate traumatic accident" left him with a small stump, unable to urinate or have sex normally.

Surgeons led by Dr. Hu Weilie at Guangzhou General Hospital performed the transplant in September 2005, a hospital spokesperson said Tuesday. The penis came from a 22-year-old brain-dead man whose parents agreed to donate his organ.
Update: MSNBC is now reporting that the transplant had to be removed because of "severe psychological problems experienced by the man and his wife." Oh well...

In a related story, Lorena Bobbit announced the opening of her first beauty salon in Beijing last weekend. When asked about the city's nightlife, she said, "I've had a great time here. The men in China are kind of kinky and I like that."

Hospice

Work has been especially tough the last couple of weeks or so, because I've had three patients who eventually requested and received hospice care. A very simplistic way of putting it is that hospice care is end of life care.

Sometimes there is an acute event, like a stroke, and sometimes it's a long drawn out illness, like dementia/Alzheimers. Trying to guide a patient and family through this process takes a lot of time, patience, and emotion. It's not an easy process, but a necessary one.

Not everything is wrapped up in 30 or 60 minutes like you see on television. In some cases, this process can take days and even weeks. I constantly have to remind myself to report the facts of the case. For example, "the heart/kidney function is improved or worse verses yesterday," or, "it is a significant stroke affecting motor and/or sensory and/or speech function."

I can't even imagine what my families are going through, because it's not my loved one in that hospital bed. My job is to stay as objective as I can in reporting the medical condition of their family member.

Things can get a little tricky when I'm asked something like, "What if this was your mother or grandmother, what would you do?" Or, "What if I was your mother or grandmother, what would you do?"

When the patient or family open the door for me, I try to be as honest with she/he/them as I can. Even though it may sound like I'm giving up when I recommend something like hospice, if I believe the long term prognosis is poor, they deserve to know that. If there is possibility for recovery from their illness, I'm honest and let them know that as well. Hospice is not appropriate for everybody.

It's even tougher when it's one of your long time patients whom you have seen slowly deteriorate or someone whom you saw last week in your office who had an acute event and no longer the person you remember. In most cases, a rapport was built so that I had an understanding of how heroic/aggressive the patient wanted to be close to the end of life. Obviously, one of the tougher parts of my job.

I do have the satisfaction in that for most of my patients I will do what they want me to do, because we've talked about it. My tribute to them will be to carry out their final health care wishes whatever they may be...

I'm on call today/tonight. You know the drill by now. I'll be back in a day or so to pick up where I left off. Keep on blogging for me. More soon...

Monday, September 18, 2006

Balance

Ran across this great post today from my new blog friend, The Curmudgeon, who is a lawyer. Imagine that, a lawyer and a doctor agreeing on something - call the papers. Anyway, he was wondering of striking a balance between blog life and real life.
Since I'm self-employed, there's no one except me to tell me to stop reading other people's blogs and get back to work. I have noticed that my productivity is not what I would hope it should be some days, especially when I read on too long, chasing link after link. (Of course, my productivity is never what I think it should be... and it's been like this for years, even before I ever heard about blogging... but, you see? I'm already digressing....)

Since some of you who've stopped by here recently are far more experienced at blogging than I, I'd love to hear how you balance blog life... and real life.

I'll hang up now and wait for your answers.
Great question - worthy of a BA meeting. I encourage you to stop by there and give Atty Curmudgeon some feedback. I'd rather you leave your comments over there rather than here. I'm curious to see what people say.

Error

Two premature infants died over the weekend in an Indianapolis hospital neonatal intensive care unit after receiving an overdose of a blood thinner called heparin -- this is according to a news report from the Indianapolis Star.

You're probably asking yourself, why would premature babies be on a blood thinner in the first place? (Apologies to those of you who already know this.)

Anyone who has an IV, whether it's an adult or child, has the potential for the IV to get blocked. To prevent this, it is standard procedure to inject heparin into the IV to keep it open. There are protocols for this and a small dose of heparin is used (especially for premature infants). For those in the intensive care unit, whether it be in neonatal or pediatric or adult ICU, patients usually has a number of IVs for things like medications, nutrition, etc.

Don't get me wrong. I'm not defending the hospital nor am I excusing their behavior. But, in reading the article, in cases like this, there is some kind of system breakdown to cause this tragedy to happen. I'm not looking to assign blame, I'm looking for a way to prevent this from happening again in the future. From the article:
Odle [hospital president/CEO] said the preliminary investigation showed a staff member, likely with the pharmacy department, placed a vial of the wrong concentration of the anti-coagulant drug heparin in a drawer of a drug cabinet at the nurses' station of the neonatal unit.

Subsequently, at least one other staff member -- probably a nurse or several nurses -- removed the vial from the computer-controlled cabinet and did not double-check to make sure the vial matched the concentration listed on the cabinet drawer before withdrawing the liquid drug into a syringe. The babies then were given an overdose.
My sympathies go out to this family. Obviously, this is something that should not have occurred. According to the article, police have ended a criminal investigation ruling it an accidental death. However, the family and the community will demand some kind of accountability. We'll have to see how this story plays out.

Yearly drug

Happy birthday, now take your medicine. Can you ever imagine saying this to someone? Well, it may actually happen. Swiss drugmaker Novartis announced over the weekend that it is in final development of a yearly medication to treat osteoporosis, according to this article from the Sydney Morning Herald. As you know, osteoporosis is a condition in which the bones become brittle and in some cases break or fracture.

I really try to keep up on this stuff. Because even though this drug is still in clinical trials and not able to be prescribed yet, I guarantee I will get questions about this in my office. Even though it sounds promising, here's the rub...
The most common side-effects associated with intravenous injection of Aclasta included fever, muscle pain, flu-like symptoms and bone pain. Most occurred within three days of administration of the drug and were resolved within three days of onset, Novartis said.
Potential side effects is one of the major stumbling blocks for drugs succeeding. There's already a drug out now for osteoporosis which you only take once a month. "Does this mean that if I have side effects, they will last a month?" patients ask me. I then quote them the info from the company, but the perception is there. Yes, it's good that you only have to take it once a month. But, it's bad if you have a problem.

The other major stumbling block is cost. No one knows how much this whiz-bang new drug is going to cost. I'm definitely sensitive to the cost of meds for my patients. In my practice, the typical patient who would get this drug will already be on between 5-8 other prescription medications, in addition to over the counter and herbal meds. The cost adds up quickly.

I understand that companies want to generate buzz and attention for new drugs in their pipeline. But, it does cut both ways. And, sometimes, the negative press can overwhelm anything positive. We'll have to see what happens with this medication.

Sunday, September 17, 2006

Play that funky music

Ouch! I've been tagged. What's up with that? I'm just here, minding my own business, just blogging, and Cathy comes up and tags me. Gee, thanks.

According to my instructions, I have to list seven songs. This actually perfect because I'm picking songs for my trip to DC. Health Psych will like this, because she has been trying to get me to put back up my iPod song list. So, here are seven songs at the top of my list going with me to DC.

"Waiting On The World To Change" by John Mayer
"Is It Any Wonder" by Keane
"Crazy" by Gnarls Barkley
"Chasing Cars" by Snow Patrol
"The Riddle" by Five For Fighting
"The Hardest Part" by Coldplay
"Tell Me Baby" by the Red Hot Chili Peppers

Next victims: *sinister laugh*
Carrie (I predict something by John Mayer, maybe even an English group)
FD (you can even pick Yaz if you like)
Jordan (and no, nothing my Shakira, just kidding)
Morgen (I don't even know what kind of music you like. Please enlighten me.)
Ladybug (by request, go for it!)

Here’s what you do. List seven songs you are into right now. No matter what the genre, whether they have words or even if they're not any good, but they must be songs you're really enjoying now. Post these instructions in your blog along with your seven songs. Then tag seven other people to see what they're listening to. (I know I was supposed to tag seven, but, oh well.)

Sunday

Kind of a lazy day today, which is good because I get so few of these. I'm going to admit up front that this post may not go anywhere. But, hey, I'm a blogaholic. I have no problem just writing about anything.

Had lunch with mom and dad. Mum's birthday is coming up this week and we went to one of her favorite restaurants. I don't get to see my parents that much these days, mainly because of schedules. I try to get to see them every couple of months or so, and call a little more often than that. They're going with some friends of theirs to Las Vegas next month. It's always enjoyable hearing my parents tell their stories -- maybe I was lucky enough to get some of those genes.

I do admit that I could not stay away from the office. There's always paperwork to do, so I went there for a couple of hours. I like to try to clean up my desk as much as I can before starting off the week.

Oh yeah, next weekend, I'm going to be going to Washington, DC, for a meeting. I haven't been there for a number of years. I'll take my camera and my laptop. Surely some things to blog about there. I'm looking forward to that.

Finally, did some more tinkering with my sidebar over the weekend, as I'm watching golf. Ahhh, how relaxing is this. I usually blog when I'm stressed or tired or both. Great to blog when I'm feeling pretty good. Hope you're having/had a great weekend!

Saturday, September 16, 2006

Crossed legs strike

You're going to think I am completely making this up, but bear with me...

The life of a Columbian gang member is hard these days. You go out and threaten people, launder money, and sometimes, have to shoot and kill someone. Work can sometimes be long days and nights. And, when you get home, all you want to do is relax, watch your 102-inch plasma TV with satellite hook up, have some drinks, and get a little somthin-somthin from your lady. That's all he asks.

But, NO! Forget that deal, Pedro. The women of the Columbian town called Pereria have taken things into their own hands, sort of. They have declared what they call the crossed legs strike, according to this story from CBS news. Apparently, when their men give up their guns, they will give them some lovin'.
One gang member's girlfriend said withholding sex was proving a powerful incentive. "The boys listen to us. When we close ourselves off a bit they listen to us. If they don't give up their weapons, then we won't be with them," Margarita told AP Television.

"They say that if we don't drop our weapons, they won't be with us anymore," said a local gang member, who called himself Caleno. "We need our women, and you'll change for your woman."
I've heard that the United Nations is really getting behind this initiative. Instead of the oil-for-food program, they're calling this, well, you can probably figure out the name yourself.

What kind of signs would be used for this protest? What would be the chants used? Strike organizers are plannning to go from bedroom to bedroom to bring their message to the masses. Maybe the Beatles were right: All you need is love (or lack of it) *cough*

Spinach frenzy

From a media perspective, it's been interesting seeing this story evolve over the past 2 days. Here are my initial thoughts on the topic. Now, the American press is in full panic mode. Maybe it's a slow news day, but the cable news channels are focused on this story this morning.

Here is the latest according to the Chicago Tribune. It started out in 8 states, now there are cases in 20 states. About 100 cases now with one fatality. It has been traced to a manufacturer in California and a voluntary recall is taking place.

I only understood the angle of the home consumer. I really didn't realize the potential impact on places like restaurants. People are going into these eating establishments and asking to have all spinach removed from their meals - which I don't blame them for.

If there's an amusing part, here it is. One of the commentators has been saying all morning that this epidemic is only hitting healthy people, because only healthy people eat spinach. The manufacturer implicated makes healthy and organic products. "So does that mean that organic products are not as healthy as we thought they once were?" the commentator asked. Duh! As a spokesman for the unhealthy people of America, all I have to say is - Please pass the donuts! The press amuse me so much sometimes.

Friday, September 15, 2006

Blog responsibility?

I've been following this story about the shooting in Montreal, Canada. Over the past 24 hours, the headlines have been stating that the shooter had a blog and there were comments made on that blog which can explain the shooter's attitude and behavior.

The response to these stories has begun. According to this item from CNews, the "online community," (don't you love how things are phrased) states that the actions of the shooter has nothing to do with the site.
Site owner Jethro Berelson, who goes by Jet online, insisted Thursday that Gill’s actions and comments had nothing to do with the site or goth culture.

“You know, I think people on the site are generally very friendly and nice, and don’t really do any crimes,” he said in a telephone interview from Brooklyn, N.Y.
Goth is a culture? I had no idea. But, here's the thing. What bothers me is the fact that this is not the first time this site has been linked with a murder.
[the site] came under the media spotlight in April after a triple murder in Medicine Hat, Alta. A 12-year-old girl and 23-year-old man accused of the killings were alleged to have profiles on the site.
Even though this Montreal story is new, it goes back to the same old debate: Does the media (movies, music, television, videogames, internet, blogs, etc) have a direct link to influencing a person's behavior? Does the media have a responsibility to society to prevent producing products that are deemed harmful?

Now, I don't want to get into a free speech and censorship debate with people. Yes, people have a right to say what they want to say, like, "Life is like a videogame, you gotta die sometime."

Montreal's Dawson College now has one less student and twenty wounded students. Could this tragedy have been prevented? Maybe yes and maybe no.