Chemo Brain

All cancer patients treated with chemotherapy swear that the very treatment which helps their cancer ultimately affects brain cells. Friends and family of chemotherapy patients describe neurological side effects like memory loss, dementia, and even seizure.

In an article from Thursday's BBC News, there is now scientific evidence that this is in fact the case. Patients call this syndrome "Chemo Brain." Researchers at the University of Rochester found, in lab tissue samples, that at high chemotherapy treatment doses, not only are cancer cells killed, but also a significant percentage of the normal brain tissue is destroyed.

Lead researcher Dr Mark Noble said: "This is the first study that puts chemo brain on a sound scientific footing, in terms of neurobiology and cellular biology."

The Rochester team carried out tests with three drugs used to treat a wide range of cancers: carmustine, cisplatin and cytosine arabinoside.

All three drugs were toxic to several types of brain cell whose job is to repair other cells in the brain - even at very low concentrations.

So, if you're a cancer patient who has received chemotherapy, how do you react to this news? Some may find solace in the fact that for the first time, there is solid scientific data confirming their suspicion of chemotherapy side effects on the brain. Prior to this, cancer patients had to wonder why their doctor did not believe them when they talked about neurological side effects.

For others who have not started chemotherapy, it may make them think twice about receiving treatment. To be honest, I hope that doesn't happen. Being given the diagnosis of cancer is devastating in itself. Treatment options include surgery, chemotherapy, and/or radiation - possibly a combination of these. All carry side effects. But, the alternative of no treatment (depending on the severity of the cancer), has it's own ramifications.

Hopefully, this newly discovered data will assist oncologist researchers to develop neuro-protective properties in chemotherapy agents. Cancer research has always been furious and technology is always changing. I have hope that more treatment options will be available for patients with cancer.

Childless

I had an interesting conversation with a patient this week. As you may or may not know, I'm the soccer doc for our boys high school soccer team. We got to talking about my experiences with the team when she said, "You know, I don't think I want to have children."

"Really," I said. "Now, doc, don't give me that look that everyone else gives me when I say something like that." We got to talking a little bit more. She's in her mid-30's, married, and she states that she's doing well in her career.

"Don't misunderstand, I like kids," she said. "I could be wrong, but I've never really believed that you could have it all - meaning both family and career - at least for women." She continued, "At least with the people that I know, when you try to go for both, then one suffers, and I never wanted that. I always knew I could be a good mom, but I didn't feel that I had the passion or drive to be a good mom."

Now, I know people out there in blog land are trying to figure out if I'm trying to make some kind of political statement with this post. I'm not. In talking with some of my female staff members at the office after this encounter, I guess this having children thing (or not having children) can be a divisive issue.

I did further research on this and found an article in today's Washington Post called Childless: Some by Chance, Some by Choice. The columnist begins the article by talking about how she had a stillborn baby. Soon after that, she and her husband divorced and the columnist chose to remain childless.

The next part of the article describes her work on a documentary about childless women. The reasons for remaining childless are similar to my patient's reasons.

Just as some women talk of a visceral urge that propels them to have children, others speak of an equally visceral urge that propels them not to. Laurie, a transplanted southerner who teaches history in New York, began to realize at an early age that she didn't want children, as she watched wealthy mothers in Richmond hire other women to care for their children. "These people compelled to have trophy babies in certain socioeconomic echelons don't want to face the realities of raising a child." She is now infuriated by what she calls "that Mother Right" -- the assumption that everyone will make way for a woman with a stroller or a child in tow. She goes on to challenge me: "If we believe that this is the hardest thing that anyone can do, then why should it be assumed we should all be doing it?"

This has been a more painful journey for my friend Lori from Tennessee, who, though quick to find humor in things, was devastated by a miscarriage. Her husband, who had two children from a previous marriage, was reluctant to try again. She's irritated by the signs in parking lots reserving spaces for parents with children: "I park in those spots sometimes just out of sheer defiance -- I'm a peri-menopausal woman under stress -- and I need a sign!" Lori argues that "if you don't have children you've . . . thrown a brick in your path that you're going to spend your entire life trying to crawl over. It would have been a lot easier having had children."

I realize that I'm putting a big target on myself and my blog for bringing an issue like this up. I have found that the "child people" Vs. "childless people" are very passionate about their respective points of view.

Me? I'm not passing judgement on this either way. I will be further exploring both sides of this issue, because I think it will help me better understand a patient's point of view.

Christmas Song Meme

Yes, that's right, boys and girls! It's not even December yet and I'm starting this meme. Can you believe it? Well, I figure that I actually still like Christmas songs right now. Ask me two weeks from now, and I'll be totally sick of them.

This meme is pretty simple: List (at least) five of your favorite Christmas tunes and tag (at least) five of your favorite blog friends to keep the meme going. Simple, huh?

My Fave Christmas Songs (in no particular order):
Christmas Time Is Here from A Charlie Brown Christmas
Christmas (Baby Please Come Home) by U2
Santa Claus is Coming To Town by Bruce Springsteen
Run Rudolph Run by Brian Adams
The Chanukah Song by Adam Sandler (I know, not a Christmas song)
Christmas Eve (Sarajevo 12/24) by Trans-Siberian Orchestra
Please Come Home For Christmas by The Eagles
The Christmas Song by Nat King Cole
(I'd better stop here, or I'll be here all day...)

The lucky people I'm tagging:
Mimi from Mimi Writes (The Meme Queen)
Julie from Flip This Body (It is meme Tuesday, isn't it?)
Kim from Emergiblog (Are there any Notre Dame Christmas songs?)
Fat Doctor (Check out her blog Thursday for the Change of Shift blog carnival!)
Morgen from the Blog Eat Blog World (Gimme the BIG MO song list!)
Skittles from Skittles Place (Just a quickie list would be fine. HA!)
Ipanema from Under the Canopy (Great wreath on your site!)
Irene from Pregnant Pauses (She has the best gift on her site for you!)

If anyone feels left out, then consider yourself tagged as well. Give me your top five Christmas songs and tag five other people for me. (Just place a link back to this post so I know who's in!) This will be fun! Go for it! Gimme your favorite five songs!

What to do with a MeMe: Copy the idea of the MeMe into a new post on your blog. Fill in the answers. Tag people! (Thanks Skittles. I forgot to add this sentence in case people didn't know what a meme was or what tagging people meant)

Grand Rounds

Grand Rounds 3.10 is up and running at Notes from Dr. RW. It is self-described this week as a "running commentary, stream-of-consciousness style, to provide some structure to this incredibly diverse collection of links and perhaps liven things up a bit. I’ll sneak a few opinions in here and there, but you’ll know them when you see them." Thanks to Dr. RW for including my submit this week:

Ectopia what??? Ectopia cordis---a rare developmental anomaly in which the heart is situated outside the chest. Dr. Anonymous writes about a recent case.

For those of you sitemeter watchers out there (I am definitely one of them), it'll be interesting to check out the Dr. RW sitemeter as it goes through the day today.

Next week, Grand Rounds moves to The Antidote: Counterspin for Health Care and Health News. That's funny. Does that mean that Grand Rounds is a poison? Tune in next week to find out. Enjoy Grand Rounds!

Hosting Grand Rounds 3.09 (pt2)

(Look below for part one of this post)

This post will be a little more free-flowing. I thought I would have some steps that you could follow, but it was hard for me to boil down my experience into some simple steps. I encouage you to check out Emergiblog and Tundra Medicine for some other feedback on GR hosting.

I was on call the weekend before my GR posting. So, my schedule was just crazy. As I've said before, my job gets in the way of my blogging. I tried to keep ahead of things by reading submissions as they came in. Sunday was kind of nuts because it was a busy day on call. And, Sunday night after the deadline, there were some people still submitting. That's when I came out with my submission closed posting on Monday which some people remarked as a little moody.

I spent the entire day Monday trying to stay awake and make my final edits on the GR post. I was switching posts from the bottom section to the middle section, from the middle section to the top section, and all combinations in between.

The GR post went live at 6:30am and I waited. To further punish myself, I put up two poll questions to seek feedback on the GR layout and on the quality of GR. I had no idea what the reaction would be to the "link dump" at the end of my post.

At 6:30am, my site meter read 100 total visitors for the day. For the first few hours, it was reading between 20-30 per hour. Then at 9am, it spiked up to 52 visits in an hour. The next few hours, it was between 40-50 visitors per hour. Then at 2pm, the number read 72 visitors the prior hour. A few more hours went by, and then at 5pm, here's what the sitemeter read:

Yes, that's right 183 people saw the GR post in the last hour. Plus, in seeing more data, there were 85 people on my site at the same time! Thinking about this is just incredible.

Then, I was wondering if I hit 1000 visitors in one day. This occurred just before 8pm. Yay! The final question I had on that Tuesday was how many total visitors? When all was said and done - just over 1,300 visitors!

I had no idea what Wednesday would bring. I thought things would cool off a bit, especially because it was the day before Thanksgiving in the US - usually a huge travel day - and not expecting too much blog traffic. Then, at 10am, I saw this from site meter:



Little did I know that at the end of that day, I would have just below 1,400 visitors - quite a shock to me. Then, reality set in and on Thanksgiving day (Thursday), I only had 600 visitors.

Looking back, this was a memorable experience for me. People have asked me how much time out of my day did it take to put everything together. Hmmmmm. That's a tough one. People have estimated about 20 hours total during GR week, I guess that sounds right. Knowing me, I probably spent more time than that. I hope I get the opportunity to host again - although maybe not very soon. HA!

Finally, here are the poll results:
What did you think of Grand Rounds 3.09?

• One of the best: 38%
• Great: 51%
• Ok: 8%
• Below Average: 0%
• Awful: 3%

Did you like the format/layout of Grand Rounds 3.09?

• Yes: 94%
• No: 6%

Hosting Grand Rounds 3.09 (pt1)

So, you're thinking about hosting Grand Rounds? I have to be honest by saying that I was totally intimidated by the entire notion. But, when the opportunity presented itself, I took it and then tried to figure out how to make it happen. If I did it, and so can you! Just follow these steps....

Step One: Prepare, prepare, prepare!

The first thing I did was go right to the source which is the Blogborygmi site. I did that because I wanted to see the origin of this idea and the original target audience. GR is not targeted toward the medical blog commmunity. It is targeted toward the general public. I think this is the right idea, because this is the only way that the medical blogosphere will grow. Read about my research in this GR background post.

Everyone has told me that the more work you do up front, the less crazy GR week will be for you. I cannot agree more. However, I did not have that much time to prepare, so my timeline was very much truncated.

About the Grand Rounds interview - Take my advice. Do NOT take this lightly. As of this writing, I've had about 2,500 referrals from the medscape interview site. Plus, I'm still getting referrals six days after the original posting.

The more memorable you make your interview, the more people that will check out your site. How do you make your interview interesting? Well, you have to think a little bit like a PR marketer. What do I mean by that? Well, if you can think of a witty soundbite or "one-liner" that people will remember, then that will make your interview more interesting. The only other thing I would say is just be honest and talk from the heart - people like that.

I did not have a theme, mainly because I'm not that creative with that type of thing. Plus, I put a poll on my site and the majority of people didn't want me to have a theme.

If you do opt for a theme, make sure you have a vision for this before you're awarded Grand Rounds. With all the craziness of GR week, I don't think there'll be a way for you to figure out a theme and read all the posts that week. The only other thing I would say is that it's possible to be TOO cute with the theme and not be able to convey to the reader what the link is about. Be careful of that.

Step Two: Promote, promote, promote!

Your first item of promotion will be asking people for submissions. Usually, the GR host before you will announce your site and get the ball rolling. Now, the ball is in your court. Figure out when your deadline is, because this will be the first question that you'll get as host. For me, I was really paranoid that I would not be done on time, so I made the deadline on Sunday night. Usually, the deadline is sometime on Monday.

Usually, the top section of the GR post is called "Editor's Picks." The next question people want to know after the deadline is how to get into that top section. For me, I know I wanted to highlight well written stories. Also, I knew that I wanted to keep some kind of order to the submissions as they came in. So, in my submissions guidlines, I put the deadline date/time, my vision for the editor's picks and directions on how I wanted the submissions (blogger name, blog name, blog URL, post name, post URL, one line description of post). I also preferred that submissions be sent to my e-mail, so I included that also.

As the posts came in, I put them in one of three sections: top 1/3, bottom 1/3, and the rest. You'll have your own instincts on what's good. Trust those instincts. There will be at least a couple of posts which won't feel right. Again, trust those instincts. The people that know you will send you their submissions first. But, like everyone says, the bulk of the posts come in on the weekend.

I kind of overdid the GR promotions on my blog during my week, but I was really trying to hype things up. In addition to posting your GR submission post a week prior, I would suggest at least one more GR post during that week to help your own promotion. Also, look to your own friends for postings, even if they have never posted to GR before. This can potentially grow the GR audience.

Step Three: Follow up, follow up, follow up!

With each submission, I would send an e-mail thank you back to the blogger. I knew I would be moving posts around on the priority list right up until the last minute. So, I would send a generic thank you to the person, not "promising" where I would put the post, only that I would "consider" their post - which was true.

Also, with each submission that would come in, if I had time, I would take a quick read of other posts on that person's blog. There was a couple of occasions where I thought another post would fit better with my vision of GR. Topher asked people for revisions, and I didn't feel comfortable with that (just my personal decision).

Be firm with your submission deadline. People will try to push you and give you every excuse in the book to try to get into GR. And, some people just ignore your deadline and then will expect to be included in GR. It's your choice how to deal with this. But, always remember, don't try to make everyone happy, because it's not going to happen.

Everyone has said this, but I think it's important. Double and triple check every link before you go live. Don't be too bent out of shape if one or two slip by. And, don't be too bent out of shape if one or two authors e-mail you to clarify their URL - this happens every week.

After you publish your GR post, there will be many people who will announce GR on their site. Make sure you place a comment of "Thank You." This will definitely go a long way. I added a bunch of links the past week also, because I had no idea how wide the reach was.

Oh no! This is running a lot longer than I thought. Re-reading it, it may not be as helpful as I intended it to be. I'm happy to answer any questions. I'll have to work on a part two post....

Interview

In case you didn't have the opportunity to check out my interview from last week, here it is. Also, just to let you know, Patient Anonymous did turn on her RSS feed, so feel free to put her in your bloglines, google reader, or whatever...

The "Anonymous Doctor" Finds a Voice on the Web
Posted 11/21/2006 -- Nicholas Genes, MD, PhD

After discovering political Web-logs a few years ago and medical blogs this year, a young primary care doctor was tempted to start his own site: Doctor Anonymous. Despite his unfamiliarity with the medium, Dr. A's humor, attentiveness, and genuine rapport with his readers quickly earned him a large, faithful audience. I'd guess those same traits would make him a good physician, but I suppose we'll never know for sure...

Corresponding with Dr. A this week, I had the chance to learn a little bit more about the man and what he thinks about his online endeavors.

Dr. Genes: Many blogs come and go, but few start off with -- and maintain -- the exuberant enthusiasm of yours. Is this your first foray onto the Web and having an online presence? Are you like your posts would suggest, or are you more reserved and bookish in person?

Dr. A: Probably like most other people, at first I was intimidated by starting my own blog. There are so many great blogs out there that I really didn't know what else I could contribute or what I could do to set myself apart. It was a good 5 or 6 months of me going back and forth on whether to become a blog writer and not just a blog reader. My first blog was in May (not many people out there know that), but it did not work out at all. I was using my real name at the time. I live in a small Midwestern town in the United States, and I didn't realize that people on the Internet can learn all kinds of information about you. I then became very paranoid about what I was writing, and the blog was just boring. So I scrapped that idea and didn't know if blogging was still for me.

The Doctor Anonymous blog launched on June 19, 2006, with a mere 5-line post. Being anonymous really has let me be free to not worry as much about what I'm going to type. Being a doc in a small town is tricky; I'm constantly worried that anything I say or do may end up in our local newspaper, so I'm constantly filtering what I'm going to say. With blogging, I feel a sense of freedom of expression that I haven't felt in a long time.

People ask me what I'm like in person. I guess that's hard for me to describe. I certainly didn't make up this phrase, but I would describe myself as an "extroverted introvert." For the most part, I'm a pretty laid-back guy, but sometimes when I get around people, I'm a lot more outgoing. I guess that's what happened when I started my blog.

I absolutely had zero experience at producing any kind of Internet content. I have a lot of experience at being an Internet consumer, but not a producer. So those first 2 weeks of blogging, I had no idea what I was doing. The one thing that really fascinated me was the interaction with people in the blogosphere. I talked about my first contact with other bloggers.

Dr. Genes: What are some of your favorite posts? Something that really resonated with readers, or captured something you worked hard to express?

Dr. A: One post that sticks out in my mind is called "Why". I wrote it during a bad night on call. It was definitely a change in the upbeat style I was doing for the previous 4 weeks. I hesitated on posting it, because I didn't quite know what kind of response I would get. But I did anyway, because I wanted my blog to be a reflection of me, and sometimes you have bad days. I was quite surprised by the response I got. For the next couple of days, my frequent readers did a type of reflective post of their own. And I really learned that people outside the United States were reading my blog. To think that my little blog is reaching people around the world blew my mind.

Dr. Genes: Some of your posts point to a soul-searching about what your blog should do for you, where it should go. Has writing frequently become too much of a chore? Will you be going more or less medical? What have you gotten from this community of readers and fellow bloggers?

Dr. A: I try to have a mix of medical and nonmedical topics. In my first posts, I had a lot of blogging questions. So I just put questions out there like, What does it mean to be tagged? Or, Do I have to respond to all the comments in my comment section? Or, What is Grand Rounds? Sometimes, I would ask questions I was just curious about, like, Do you prefer your doctor to wear a lab coat or not? I have very much appreciated the interaction that I've gotten from my readers.

There were times when I talked about blogging feeling like a chore. I have told myself that when I feel like blogging is like work, then that's the time for me to take a blog break, or even consider giving it up altogether. People have even told me that they sense that my energy level is not like it was that first month. But I guess that's normal, right? Whenever you first start a project you really like, there is a natural excitement. But as time goes on, that honeymoon period dissipates, and you ask yourself whether you want to keep blogging.

Even though it's only been 5 months since I've been doing this, I feel a significant change in my blog coming in the near future. My early posts talked a lot about patient encounters, and now I feel like I've shifted a little bit more toward news commentary. What the next change will be, I don't know.

I feel very lucky to have achieved what I have up to this point. And that's the advice I have for anyone considering blogging. Here's what I wrote on June 21, Day 3 of blogging, and I think it still holds true: "Blogging is like being at the podium, and to get people to listen to you, your thoughts have to be pretty well developed, or people will walk away. The good blogs that I've run into make me think a little bit and make me post a comment. The interaction with people (conversation like interactions) takes place in the comment area. The blog is kind of like the lecture and the comments are like the Q&A."

Dr. Genes: The shadowy but genial figure of Dr. Anonymous steps into the spotlight this week to host Grand Rounds, the collection of the best in online medical writing. Check out Dr. A's edition of Grand Rounds on November 21, 2006.

Medscape Med Students. 2006;8(2) ©2006 Medscape

Patient Anonymous

Yup, you read that right. This past Wednesday, I posted something called Opportunity in which I talk about being approached by an insurance company for statements I made in my blog. (BTW, I still haven't decided what I'm doing yet.)

I read this comment by someone calling herself Patient Anonymous...

I just found your blog courtesy of your Medscape interview. I should probably read more of it before just jumping right in and posting but I'm all about immediate gratification and lack of impulse control at the moment.

I would not respond to this. I used to co-moderate a support board/group of fora for mental illnesses, meds etc... and I won't go into the details but we received trolls like this.

Also, it just sort of screamed, "Let us pimp you out!"...and such a cheery (form) letter from an insurance company? Yeah.

If you wish to get published, go for something a little more reputable.

Oh, and I just picked this name in quick, rather unoriginal random fashion so if someone else already has it, apologies--I'll change it.

Thanks and I look forward to reading more here.

There are two thoughts that pop into my head. First, I absolutely do not want to make this person mad. LOL! And, second, this person, whomever she is, really needs to start a blog. So, I responded in my comment section (with the second part only - HA!).

Now, I never believed that this person would take me up on this. So, the very next day, here is the beginning of the first post for the Patient Anonymous blog...

Well, I blame Dr. A for all of this. I posted on his blog and he said I should start one of my own because he thought I'd make a good blogger. Huh. Well, I'm sure this will prove him wrong!...

...Well, if nothing more it will prove to be an interesting "experiment" and I love experiments! It will either be the most pathetic blog in the history of the internet or I may actually get someone (besides Dr. A) to read it.

So, if you could do me a favor, and show some love to the newest person in blogland. Please stop by and say hello. And, don't forget to tell her that Dr. A sent ya! HA!

Ectopia Cordis

This is the name of the congenital birth defect which caused Naseem Hasni's heart to be outside his chest. He was born on October 31, 2006 and has been at a Miami children's hospital ever since. (Miami Herald)

On Wednesday, the first of many corrective surgeries took place to try to correct the defect. Now, a thin film along with a thin membrane of his own skin cover his beating heart. Soon, he will be fitted with a plastic chest to protect the heart. It's optimistic, but Naseem may return home by the end of December in time for the holidays.

This defect is so rare that it occurs in only eight in one million babies. Most are stillborn or do not survive the corrective surgery. One can beat the odds, however. I found the story below about Christopher Wall who was born in 1975. Chris set the record for living the longest with the heart outside the chest. This is from a TV broadcast in 1998 and the piece is about 8 minutes long. Very inspiring story.

Happy Thanksgiving

Rocky and Bullwinkle love Thanksgiving, do you? It's the day to spend with family, eat too much, watch the parade, and watch football. How do you spend the day? All the best to you and your family.

Opportunity

I know I said I was taking a break, but I wanted to tell all of you about something that just happened. As I have been enjoying the accolades of a successful, Grand Rounds, I received the following e-mail below about an hour ago...

Hello-

I am contacting you as the editor of [insurance company program] Newsletter. We are an international provider of medical and managed care insurance. Our clients consist of health plans, managed care organizations and health insurance companies within the US and Canada. [Our company] is the nations foremost insurance based managed care consulting programs. We have been in operation since the 1980's.

[Our program] is designed to partner with our customers to control risk, reduce cost and more importantly support quality healthcare outcomes. Although, we offer a variety of services, one important component of our program is to provide research and educational opportunities. [Our newsletter] is one avenue in which we provide clients of [our company] with information on a wide variety of topics related to catastrophic medical case management. Case histories, facility highlights and similar articles are intended to serve general information not endorsements of facilities, programs or products of any kind.

In addition to submissions from each of our [company] physician consultants, I plan to include specialty clinical related articles from outside sources i.e. [our company's] consultant's or vendors that we may have a relationship with. It is my goal to rotate topics to meet the needs of our broad audience.

I am contacting you to request permission to include something from your blog entries. Something for variety for our clients. Although, I am not familiar with "blogging" after review of your blog entries, I am intrigued.

If this is something of interest to you, please let me know. In addition, if you have any specific topics or ideas for an article, I welcome your suggestions.

Thank you for your consideration. I look forward to hearing back from you and have a Terrific Thanksgiving!

Regards,
XYZ company

Now, I probably blew my whole deal with broadcasting this on my blog. But, I was curious to see what all of you thought. How does this letter read to you? Is this a potential venture that you personally would consider?

Personally, for me, I'm leaning no, at this point. Probably, they would want me to reveal all kinds of personal information (like my name, etc). How credible would their newsletter be if there was a quote from a "Doctor Anonymous" - probably not much. I'm not ready to come "from behind the curtain" yet (Wizard of Oz reference).

People have e-mailed me that they are curious about the relationship that I have with my readers. This is probably one of the reasons why. I'm curious what you think, no matter what it is....

Epilogue

If you're looking for Grand Rounds 3.09, scroll on below and enjoy!

In my sidebar, I moved up the top 5 most popular links from yesterday. It's always interesting seeing what people will click on and read further.

I'll have a more comprehensive Grand Rounds hosting wrap-up post soon (probably something similar to what TPA wrote). Just a few thoughts for now...

In the midst of the hoopla yesterday, you may have missed checking out my interview with Nick Genes. He told me that his medscape editors were going to release the GR host interviews the day of GR to try to increase traffic. I would agree that this was a great idea, because I got a lot of traffic from that link.

You're probably wondering about the numbers. On Monday, I was averaging just below 300 visitors a day - not too shabby, if I say so myself. My numbers were going up for the past week with all the GR hype I was trying to generate.

I'm giving all of you exclusive access to my numbers for the next few days (especially those of you thinking about being a GR host), just so you can see what happened. According to Site Meter, I had 1,300+ visitors yesterday! According to StatCounter, I had about 1,700+ visitors yesterday. (Here's more data). Now you can debate which is more accurate, but for me, I don't care! I'll never get close to 1,000 in one day again.

Well, that's all for now. My apologies to the NaBloPoMo people, as I may be taking a blog break the next few days and catch up on some other things. (Eek, there's other things besides blogging? I am a blogaholic, ya know...)

News Update: It just turned 12 noon where I'm at and I already have had 613 visitors today. Maybe it's another 1,000 visitor day. Yay! We'll see what happens...

Grand Rounds - Volume 3 number 9

Welcome to the most anticipated Grand Rounds in a long time! These are the 27 best posts that the medical blogosphere has to offer this week. In my editors picks, I wanted to highlight well-written stories. There's also a short excerpt to check out from the best of the week. I've tried to make this a potpourri of posts for your enjoyment. Let's go!

Best of the Best: Editors Picks of the Week!

The end of life is always difficult for healers to discuss. But, the death of a newborn is even more tragic. Carrie, a NICU nurse, writes this moving first hand account of Love's Labor Lost.
Everyone slowly filtered out of the room - except for one nurse. The nurse who had cared for the baby that morning was standing at his bedside in tears. I walked in and asked her if I could do anything to help and she turned to me and said, "What do we do now?" It was a good question... She was newer than I am even, and neither of us had ever done "post-mortem care." (I'm sorry - I cringe when writing that, too...)

Grunt Doc, a Texas ER physician, writes a powerful and moving post called My Grandfathers' Guns.
My paternal grandfather (step-grandfather, really, but functionally my grandfather, and role model, long story) I knew during my life: a slightly built but sturdy man, one who worked every day because that's what Men Do. He was not an elaborative fellow, and never one to brag or conflate so far as I know; his role seemed to me to be provider and pair for my grandmother. He had a good sense of humor and I will always remember his and hers bowling trophies they won in League Competition in Wink, TX, because that's where the bowling alley was. They lived modestly, which is more their upbringing than financial status. That's just who they were, as a couple. He loved my grandmother, completely, and she him. A good match.

Watching patients slowly get worse with their chronic debilitating medical conditions is very tough to watch. In her first contribution to GR (Yay!), Artemis, a physician, shares her thoughts on a patient when optimism and realism collide.
I don't want to imply that I am devoid of hope when talking with patients regarding various conditions. I'm the first to realize that in too many neurological conditions hope is the ONLY thing we have to offer our patients...but I'm all for a healthy dose of realism and planning for the future as well. When patients agree that physical therapy is a good option, and go to all of their therapy sessions and follow through with the home exercise program and actually see a benefit, we all can rejoice in the improvements made. But what is the next step when patients have exhausted therapy options because no improvements are identified and medications are no longer providing any discernable advantage?

Susan Palwick, a patient with depression, writes a heart-felt analysis of society's attitudes toward cancer patients compared to society's attitude to patients with depression.
Depression's not sexy. It's common as dirt and every bit as dull. Depression's boring, both for the patient and for everyone else in the vicinity. For one thing, there aren't visible battle lines. Depression isn't an invasion by foreign or mutated cells. If anybody's come up with a sexy metaphor for neurotransmitter imbalances, I haven't heard it yet.

Ever wonder what it is like to be a volunteer at your hospital? Difficult patient (Thanks for coming back to Grand Rounds) describes an evening in the newborn nursery.
One Friday night when I arrived, I was summoned by a tiny and apparently inconsolable little guy. Because the baby hadn’t been named, I decided to give him a “pet” name as they do in India--children in India sometimes go for years before being named officially. I held the baby close, using this “pet” name, whispering prayers of hope, health, blessings, and protection. His tiny body jerked periodically, and I snuggled him closer. I thought, what this little guy needs is love, crazy love. That is something that I am qualified to give.

Bad Doctor, a second year medical student, faces a death in his family and his first request for medical advice in An Unwilling Consultant.
You can imagine the turmoil that her imminent passing threw my wife's family into. Of course they all knew that sooner or later her body would fail at her age (or, as she liked to say, her body would go "kaput") but I'm not sure they could imagine a life without her, or their immense family without her as the matriarch. The family that I had joined only a year previous was on the cusp of great change, and I soon found myself thrust into the situation, honored and more than a little terrified, as I found those I love looking to me for medical knowledge for the first time.

Always Learning, a resident physician, elaborates that there is more than meets the eye when breaking down the true meaning of the patient-physician office visit.
We're taught to hone our skills continuously so that we can best detect and treat disease. We're taught and tested and mentored so that our physical exam is done well. There are classes that teach you how to ask your questions so that you get the answers you need to make a diagnosis. There are classes (can you imagine!) that teach the budding medical student that there are two agendas during each patient encounter. The first is the agenda that the patient has - why they are here. The second, most importantly, is the physician's agenda - to treat the high cholesterol, to talk about weight loss, to freeze a precancerous skin lesion. You do this because there may be medical issues that do not bother the patient, but treating these today may prevent health problems in the future.

On the lighter side, Mother Jones RN writes this amusing tale of classic books from her family collection. Ah, the golden days of medicine....
Nurse! Don’t you know it's unprofessional to parade around a doctor’s office dressed like a trollop? You certainly have the doctor’s attention. I also see you’re thinking about what happened last night after office hours instead of tending to your patients.

Kerri Morrone, a patient with diabetes, writes an "Open Letter to My Pancreas." (Great stuff!)
Dear Pancreas I’m not sure what the hell happened to you, but you’ve taken it upon yourself to stop working. You did have that job for about six years, where you got up early every day and produced my insulin, but apparently that was too much for you. You were laid off or fired or something. Don’t blame it on that virus again. I think you just slept through the alarm and were let go and you just don’t want to admit it.

Here are the best of the rest...

TSCD, a doctor, shares personal feelings and family frustrations in dealing with a patient's choice to refuse life-prolonging treatment.

Type1EMT presents a poem called Three Pairs of Shoes. Not only is it very creative, but also it relates to her diagnosis of diabetes which she's had since 1998.

Holiday time is quickly coming. Kim from Emergiblog remembers one of her first patients in this post called Merry Christmas, Katrina.

Dr. Trofatter shares a poignant story about young child, who is dying of leukemia, helping his mother who has just found out she has a baby with a birth defect.

Topher tells the story of the people and students of St. Vincent as they are drawn together in the death and autopsy of The Old Man.

There are times life moves fast. Inevitably, there is always something that occurs which makes you stop and think. The #1 Dinosaur share this story of being Blessed.

Ripped from the headlines, Dr. Deb links pathological narcissism and sociopathy in discussing OJ's new book. (OJ wrote a book? Me? I'd rather see that new Borat movie. HA!)

The Tundra PA describes the difficulties of large distances and lack of transportation in assessing sick patients in Distance Triage.

All of you know how I love talking about flu shots. The Fat Doctor rants on five stupid reasons people give for skipping the flu shot. You go girl! Also check out the 20+ comments which follow - sheesh!

Pain, especially a headache, is very difficult to deal with when it comes on. Drytears describes an experience and frustration with an occipital nerve block.

Dr. Wes describes the challenges of a new policy initiative to perform primary angioplasty within 90 minutes of arriving to the ER.

Rita Schwab expresses concerns about the validity of anonymous physician rating sites. I would have to agree that I'm also concerned about potential abuse of this system.

Why doesn't anyone allow you to have food or drink beginning at midnight prior to your surgery? Judy answers these questions in NPO after midnight.

Dr. Rob talks about the challenges of balancing patient autonomy with patient responsibility in improving the health of medicaid receipients.

I had no idea where Borneo was in the world until reading this blog. Borneo Breezes describes a training course for volunteers of the Healthy Child Uganda project (Great pictures here!)

Seeking medical care outside a patient's home country is becoming more common these days. In separate blogs, Doctor Emer and Louise discuss this topic.

I'm a tech geek like anyone else. In this piece, Dr. Palter from Docinthemachine predicts the future of surgical procedures as it is influenced by technology.

That's it! Sheesh! Thanks to Nick Genes for giving me this opportunity to host Grand Rounds. Glad to step in at the last minute to help out. I'll share my host experience in the near future. Look out! Next week, Grand Rounds goes to Notes from Dr. RW.

Addendum: My "Pre-Rounds" interview with Nick is right here.

For those of you in the USA (and around the world), Happy Thanksgiving!



I had many requests to at least mention the rest of the links submitted, as a kind of compromise to leaving all these out this week. So, if you're interested here is the list of the rest of the links:
Moreena reflects on what it means to live life to the fullest when it comes to her post-transplant daughter.
Volkmann's Ischemic Contracture from Unbounded Medicine.
Dr. Lisa Marucci interviews surgeon Dr. Carol Scott-Conner.
Henry Stern reports on an insurance company venture to try to address the uninsured.
Tara Smith reports a scarlet fever outbreak in North Korea.
Dr. Aleksandr Kavokin discusses hip fracture cost and complications.
UK Community Pharmacist discusses medicine use reviews.
Mona Johnson talks about an association between diabetes and dementia.
Nancy Brown talks about HPV and meningitis vaccination in teens.
Dr. Auerbach gives tips on how to avoid shark attacks.
Dr. Bob reflects on a patient and shares how ER physicians deal with death.
Cyndy King gives tips cancer patients & families can to to survive the holidays.
Dr. Choi gives tips to survive the in-flight medical emergency.
The Granola discusses silicon implants.
Mike Pechar reports on a study involving semen allergy.
Amy Tenderich interviews a health care executive about diabetes topics.
Marcus Newberry objects to being left out of last week's GR.
Gerald Pugliese writes a commercial post for a book.

Grand Rounds FYI

Ah, the calm before tomorrow...

As of this second (5:30am eastern time), submissions are closed! For those of you who e-mailed me in the last few hours past the deadline (you know who you are), whatever you wrote has to be pretty remarkable for me to consider it.

For the rest of you, don't even think about sending me something now. The deadline has been up on this site for six days for everyone to see. Almost every post of mine for the past week has been about Grand Rounds. Why did the entire blogosphere see it and not you?

I mean, the world is not going to end. Just submit it next week. Plus, the whining and excuses that people are sending are really getting to me. "Oh, Dr. A, I didn't know about the deadline, please, please, please.." C'mon. I guess I'm really making friends now, huh?

Just to let everyone know, Grand Rounds 3.09 will be up and running around 8am eastern time on Tuesday, November 21, 2006 (hopefully before that).

Thanks so much for those of you who participated in the Grand Rounds poll last week. The results are pretty similar to what was found during this post on Thursday. There wasn't too much interest past Thursday, and that's why I took it down.

The list of all previous interviews of Grand Rounds hosts can be found here. I'm hoping that my interview gets posted soon - because it's a good one. You won't want to miss that.

Right after my last post, work got tremendously more busy. Plus, I have an entire day in the office in front of me. I'm glad that I made the deadline early, because I'm going to need all the extra time.

Since I've never been a GR host before, I have to say that this has been an interesting process. I'll share a little bit more later this week. But, for now, I have to get through today and then finish my post for tomorrow...

Grand Rounds Deadline

If you haven't heard already, where the hell have you been all week? I'm hosting Grand Rounds in just two days (ek!). Grand Rounds is a blog carnival with the best that the medical blogosphere has to offer. It will make you laugh; it will make you cry; it will make you come back for more.

The deadline for submissions is less than 12 hours from now. So, if you haven't started writing your medical related post yet, you have a little time - sheesh! Submission guidelines are right here. The deadline is 11:59pm eastern time, November 19, 2006. Not one minute more. You have been warned!

We have had 500 submissions already! Well, not really. That would really drive me nuts, wouldn't it? Working this weekend has been ok. Being on call the weekend, is always crazy, but I think I've been able to keep up with things ok.

Thanks so much to my friend Mimi Lenox (of peace globe and meme collector fame!) over at Mimi Writes. She gave a Grand Rounds plug on her blog today (welcome to all of you who clicked on over from Mimi's place). Feel free to make an announcement on your blog. The more the merrier on Tuesday!

Well, back to work. Congrats Ohio State Buckeyes who have the Best Damn Team in the Land with the Best Damn Band in the Land. Onward to the National Championship game. Doesn't make sense to me that the game is 50 days from now. But, oh well...

Number One Reigns

THE Ohio State Buckeyes 42 - Michigan 39

Intro to Grand Rounds

For those of you who are new to my blog and who are not regular readers (yet), you're probably wondering what this whole Grand Rounds thing I've been talking about this week. Hey, a special shout out to those referred from NaBloPoMo and Bestest Blog. Welcome!

Every Tuesday, Grand Rounds is an accumulation of the best posts from the medical blogosphere. Its original intent was to be written with the non-medical blogger in mind (this means you). I mean, who isn't interested in medical topics?

And, what kind of stuff would you find? Just about anything! It can be stories about patient interactions. It can be commentary on the latest medical news and research. It can be explanations of clinical disease processes. (I know I'm leaving out a lot more possible topics.)

Grand Rounds has been around for about two years now, and has been growing by leaps and bounds. However, I've received some e-mails this week asking me if Grand Rounds was in trouble because of the discussions this week.

In my opinion, I think the discussions this week among the medical bloggers is merely just "growing pains." If I can use a medical analogy, as you're going along, sometmes you have to stop and re-evaluate the patient and modify your treatment plan. I think that's what happened this week. Undoubtedly in a few months, a similar Grand Rounds discussion will take place, and that's not a bad thing.

So, if you intend to submit for my Grand Rounds, what are you waiting for? Do it today! The deadline is Sunday at 11:59pm. Submission guidelines here.

For the rest of you out there in blogland, stay tuned here Tuesday. Because, you're going to see the BEST that the medical blogosphere has to offer - with me being your humble host.

You're not going to want to miss this! Either it's going to be the best Grand Rounds ever, or my last internet sighting for a long time - because I'll be hiding in a cave until the embarrassment is over. Either way, you'll have to see what happens...

Five Days until Grand Rounds

As you can see, this whole Grand Rounds thing has taken over my blog life, at least temporarily. The Doctor Anonymous blog has kind of become "the crash course on being a GR host" blog, at least until next week.

For anyone curious, here are the poll results as of this posting:

• Which do you prefer? (69 total votes)

• Grand Rounds with a theme: 42%

• Grand Rounds without a theme: 58%

• Ideal number of Grand Rounds links each week? (75 votes)

• Less than 25: 35%

• From 25-30: 47%

• From 31-35: 9%

• From 36-40: 4%

• More than 40: 5%

I got a few more submissions Wednesday. From what people have told me, this is par for the course (sorry for the golf lingo). I read a few more GR postings from the past few months, just to get a feel of how things have been done in the past.

And, in fact, a similar discussion on the number of GR links occurred about nine months ago (look here, here, here, and here). This was before I was even blogging. I don't know if it's good or bad that this discussion is coming up again. Because, the points that have been brought up this time were the same as back then.

Now, Nick is probably going to think that I'm stalking him, but in doing more background research on GR, I wondered how this entire thing got started - so I went back into the Blogborygmi archives.

Did you know that Grand Rounds was almost called things like "Carnival of the Caregivers," or, "Melee of the Medics," or, "Party of the Providers," or, "Hulabaloo of the Healers?" How different would things have turned out if one of those names were chosen?

Here are some other things I found:
August 6, 2004: Now, a certain fraction of medi-blog posts are too esoteric for the lay reader, but actually not that many. And that's part of the appeal: Each week authors would pick a post that general blog readers could understand and enjoy, and a rotating volunteer blogger would host the links. What gets linked would be at the host's discretion -- hopefully a nice mix of quality patient stories, science news, and policy points.

September 13, 2004: If you're a medical blogger (which so many of you are), and if you're interested in reaching more nonmedical readers, listen to this: I've received a lot of positive feedback about the idea for "Grand Rounds" (Carnival of the Caregivers) -- a series of "best-of-the-week" posts from around the medical blogosphere, with rotating hosts.

September 28, 2004 (The First Grand Rounds): Welcome to the debut of Grand Rounds, the weekly summary of the best of the medical blogosphere. It's our hope that this new feature will introduce a wider audience to the expanding array of talented doctors, nurses, techs and students writing online today. This week, we've got a roundup of new medical reports, opinions on current health topics, and a look into several medical specialties. Plus, some stories from caregivers to make you laugh, cry, or spur the contemplation of your mortality.

This is all great stuff. Definitely puts some things into perpective for me. As little as two years ago, it seems to me that the medical blogosphere was a little blip on the map. Now, we're having discussions that GR is getting too large? Hmmmm. Interesting....

Stay tuned: My Grand Rounds "Pre-Rounds" interview with "the man" Dr. Nick Genes should be coming to a Medscape site near you soon....

Countdown to Grand Rounds

Have you turned in your GR contribution yet? What are you waiting for?

Topher from The Rumors Were True (yesterday's GR host) commented here (comment #34) that there were over 1000 hits to the "Grail Rounds" site yesterday. Wow!

The GR polls are still open. Do you prefer a Grand Rounds theme, or not? What is the ideal number of links for a GR edition? The results up to this point have been quite surprising to me. Just when you think people feel one way, the votes come out differently. Please check out my sidebar and make your selections if you haven't yet.

On a personal note, I've got to say that this is becoming tough for me. It's great that I've already gotten some submissions -- thanks so much for that. As I read more and more from previous hosts, I find out that the concept usually is all figured out by now.

I've got to admit that I have all these concepts going through my mind on what I want to do. I haven't really figured out what my vision for this GR post is yet. Maybe like other things I've written, it will just come to me and everything will just fall in to place.

GR has to be informative, yet entertaining. It has to be inclusive but not too exclusive. Ah, the life of the Grand Rounds host! As I've said before, I wish this work thing didn't get in the way of blogging. Life would be so much simpler, right?

Grand Rounds

Grand Rounds 3.08 is now up and running at The Rumors Were True. Thanks Topher for hosting this week. Here's my contribution:

With all of the forward-looking, its important to remember why we’re doing any of this. This week, Doctor Anonymous writes a great story about counseling a difficult patient to undergo a stress test that may have saved his life.

Next week's host is Doctor Anonymous - ME! Yay! What the heck have I gotten myself into? We'll see. The deadline for submissions will be early - because I'm on call this weekend and will need more time to put things together.

The deadline will be Sunday, November 19th, 2006 at 11:59PM eastern time. E-mail submissions to doctoranonymousblog [at] gmail [dot] com. Please place "Grand Rounds" in the subject line. Also, please follow this format. It will definitely help me stay organized.

Blogger Name: Doctor Anonymous
Blog Name: Doctor Anonymous
Blog URL: http://doctoranonymous.blogspot.com/
Post Name: Are you an idiot?
Post URL: http://doctoranonymous.blogspot.com/2006/06/are-you-idiot.html
Description: [insert one line description of post here]

I went into the "way back machine" to see how Nick originially described what he was looking for in a GR post. You can read the full post here. But, I thought these words are still true today - even after two years since GR number one. I have always found it helpful to look back before looking forward.

Remember, the target audience here is NOT other medical bloggers, or people in the health care industry. It's the educated but nonmedical readers coming from general-interest blogs. So write for that audience, if only for this one post (even if your blog is about echocardiography). The idea is to introduce the wider world to the growing medical blogosphere -- the doctors, nurses, students, administrators, EMTs, techs, and patients who blog.

Two questions that are frequently asked:

1. Is Grand Rounds just limited to bloggers in the health care field? No -- I'll look at any medical-related post. There are some patient-perspective blogs in particular that I hope submit links. But like I said, the point of Grand Rounds is to promote the nascent medical blogosphere, and submissions from health-related blogs will take priority.

2. I'm a doctor / nurse / researcher / student / EMT / health care economist / patient who writes mostly about gardening / dating / reality television. Will you link to my post? Maybe. I'll certainly look at it, if it's medically related. And very few blogs are 100% medicine. But like I said, submissions from mostly health-focused blogs will take priority.

It's the host's discretion as to what gets included. This week, that's me. In addition to linking to your posts, I'll be providing the groan-inducing puns, and snarky comments, that readers have come to expect and dread. It's nothing personal.

So, I'm putting everyone on notice! 100 percent of submissions will NOT get in. I agree with those who say that there are just too many links, and that possibly drives people away. The number that will get in this week will depend on the quality of the submissions.

This may be my last time hosting Grand Rounds, and I may get a lot of flack (and all my future submissions may be rejected). But, hey, I'm the editor and I'm deciding what's in and what's out this week. Being included in Grand Rounds is not an entitlement; it's not a right; it's a privilege.

Whether you agree or disagree with me, my vision next week is to put the best medical STORIES (ie - first hand anedcotes) out there for people to read (I wouldn't call it a theme). When I talk to people about medical television shows, sure they talk about the technical jargon and the science. But, what really draws people to good medical shows are the stories that they tell. And, I agree that's something that first drew me to Grand Rounds, and has fallen off a bit in the last few months.

So, put your best medical STORY together and send it to me. Don't make me come after you! Early submissions are greatly, greatly, greatly appreciated (did I say they would be greatly appreciated?). Also, please feel free to hype up GR on your own blog. From what I've been reading, Grand Rounds may have lost a little luster in recent months. Maybe it's time to bring people back to Grand Rounds, and this is the week to do it!

Grand Rounds Poll

For you Grand Rounds readers out there, if you haven't checked out the discussion on Emergiblog yet, please do so. Here's a sample of the quotes from over there.

--
Here’s my thoughts on the matter of GR these days.
1) It’s too long. GR is supposed to be the BEST of medical blogging, not everything that every blogger wants to submit.

2) Don’t let your theme obscure the posts. Sometimes the host doesn’t tell you about the post itself, but rather, they come up with a “cute” blurb that may or may not be representative of the post’s content. Theme’s are great, but the posts are why we read.
--
I think you are right on, Kim. I am pretty new to the blogosphere and in my short experience with grand rounds I would have to say it is way too long. I don’t have hours and hours to sit in front of the computer so I pick and choose rather than taking it all in.
--
Kim- You’re on gal, right on the money and said it well to boot. Giving permission to those who host to edit what they want to include would be a big start. Maybe there should be a limit of 25 or 30 that is about my limit for reading and probably way over what most hosts want to provide. Thanks for this.
--
Having also hosted twice, I have to say that it was much tougher to get excited about the quality of the writing the second time around.

All of the posts I included (and it was nearly everything submitted) had merit, and most of them were well written.

What the majority lacked, and what I read Grand Rounds for, is heart. I want to develop greater understanding of the humanity of medicine.

I would support a maximum number of allowable posts - no more than 30. It gives the host a bit of leverage for picking and choosing. As it is everyone expects to be included, and as host, you do hate to disappoint anyone.
--
Things I would like to see more of on GR: More stories, more literary posts. I like the multidisciplinary approach - I enjoy the perspective of the MD, the patient, the pharmacist, the pastoral care representative - Reading these always brings a fresh approach to my own practice.

Things I would like to see less of: Themes (yes, some are clever but overall they are too cutesy - they take away from the posts, themselves). And less posts! I would skim it down to no more than 20. That would in theory ensure more quality.
--
Kim, first let me say that this post has all the elements…well written, brave, and something to say. Way to go! I feel grand rounds should be edited. And sure, it’s no fun to be left out but I don’t think a professional medical forum should hold ‘don’t want to hurt feelings’ as a criterium.

I thinks themes need to be handled delicately…some people get so wrapped up in their theme, that the content almost becomes secondary.
--
I, too, like the more anecdotal posts. The posts that are patient information and educational, I close immediately and don’t read. (in otherwords, they might have gotten my hit, they did not get my readership, and if it was a first time visit, didn’t even get enough of my recognition for me to return visit). I get enough patient information from my doctor’s, nurses, physical therapists and the like as it is. What I don’t get, I can look up … I don’t need it unsolicited. I have email support groups for my specific conditons.
--

Since I'm hosting next week, and since I'm curious, I've put two poll questions in my sidebar for your consideration when it comes to Grand Rounds themes (yes or no) and the ideal number of Grand Rounds links per week. Please vote. This information will really help guide me in what I'm going to do.

One of the things I love about the internet and the blogosphere is the interactivity with the reader. So, place your vote now and tell your friends about this poll because it's important. Thanks so much!

Press Conference

Thanks so much for attending today's much awaited press conference. I know that there has been a lot of rumors about me on the internet over the past week:
Is Doctor Anonymous ok?
Why has he not been posting as much lately?
What's the big announcement?

First of all, you've probably heard the latest news on people like Iowa Governor Tom Vilsack, Wisconsin Senator Russ Feingold, and Arizona Senator John McCain.

I would like to put the rumors to rest. I am definitely not going to seek either the republican nor the democratic nomination for President of the United States in 2008. I have decided to spend more time with my family and with my blog. I feel that I can better serve the country doing fake political announcements like this so that I can announce what I really wanted to say.... HA!

So, I got this e-mail last week that piqued my interest.

I've been meaning to contact you, to see if you were interested in
hosting Grand Rounds -- your blog is excellent, and you're a frequent
contributor to the weekly carnival.

We are booked into 2007 -- but the scheduled host for 11/21 has just
dropped out. Would you be interested in stepping in to fill this role?
I and some of the other hosts have prepared some tips and pointers to
guide you through it, if you're interested.

Please let me know, Nick Genes

Who is Dr. Nick Genes? He is the illustrious "grand pooba" of Grand Rounds - the wildly popular and most prestigious medical blog carnival out there. The self-described "best that the medical blogosphere has to offer."

I've been toying with the idea for weeks of contacting Nick myself, but I really didn't know if I could handle putting something like that together. I've even commented in the past that the work load in preparing Grand Rounds - especially to maintain its high quality, could maybe be too much for me. Plus, I'm on call next weekend. So, it was probably the worst time for me to try to put something together.

So, what did I do? I said yes. What am I nuts? Probably. Last week, after I accepted, I started doing a lot of research and reading a lot of past GR posts. I also read advice from previous hosts on how to make the experience not too crazy. I mean, hey, if someone as busy as Kim Emergiblog can do it, maybe even on call, I could make it happen.

So Tuesday, head on over to The Rumors Were True to check out GR 3.08. Then, get ready for me! My goal is simple - To make this the best Grand Rounds, ever! Not too much pressure on myself, huh?

I'll have the GR 3.09 posting rules and deadline up Tuesday. But, for now, I'm still figuring out how I'm going to do this and still remain sane. I'll have to stock up on Diet Coke. But, hey, I'm Doctor Anonymous, and I'm a blogaholic....

Addendum: I just ran across this interesting post from said Emergiblog. She listed some concerns and some suggestions on how to make Grand Rounds better. I invite you to make comments over there. I'm going to be watching that discussion very carefully.

Major Announcement

Sorry I haven't been around this weekend. No, I wasn't at THE Ohio State University Vs. Northwestern game yesterday - although I wish I was (sorry Dr. Wes). I've been working on a very exciting project that presented itself last week. I can't wait to tell all of you about it. But, not until tomorrow. How's that for a tease? Hope all of you are having a wonderful weekend. Til tomorrow....

Why I do this

Tuesday night was crazy on call - more busy than usual. Then, on Wednesday, I had a 7am hospital meeting, morning office hours, a noon hospital meeting, then afternoon office hours, then back to the hospital to finish my hospital rounds. Sheesh!

Don't get me wrong, I'm not complaining. It's just the fatigue was more than usual - kind of interesting now that I re-read my post on jetlag. Hmmmmmm...

Wednesday afternoon, I was just totally dragging and could not wait to go home and go to bed. I was not really in that great of a mood - kind of cranky. And, I did not have any tolerance for whining and excuses from my patients or my staff.

I walked into the exam room and saw Russell and his wife. I haven't seen Russell for about two months. Russell usually sees another doc in our practice. In fact, the last time we saw each other we had a spirited disagreement on why I thought tobacco use is unhealthy. So, my first thought was that I really did not want to go through that discussion again - especially today.

In addition to smoking, during our last visit, he reported symptoms of mild chest pain which he attributed to his "chronic bronchitis." After another heated discussion, he was agreeable to a stress test which occured the next week. I was quite surprised by the abnormal result. Russell was immediately referred to our local cardiologist and I kind of lost track of what happened after that.

His wife told me that Russell was seen by the local heart doctor and immediately referred to Huge Legendary University Medical Center where he underwent triple bypass heart surgery about a month ago. He just returned home following some cardiac rehabilitation at Huge Medical Center.

We talked some more. And before the visit ended, Russell's wife said, "You know, they said up there that Russell's heart was right on the edge of something bad happening. I know he can be difficult sometimes, but I'm glad you ordered that stress test. Doc, you probably saved his life and I wanted to thank you."

Russell looked right at me, didn't say anything, but noded his head. At that moment, all of my fatigue disappeared.

Catching up

Had a busy night on call. Took all day to catch up on my work.
Now, time to catch up on sleep. More soon.
Thanks as always for stopping by today.
(Photo Credit: Dave Martinidez)

Jetlag death

I admit this title is a little misleading, but now since you're reading...

So, I'm on call tonight. Typical disrupted night of sleep, and usually takes me a day or two to recover. I'm now learning that in animal experiments, those subjects who experienced changes consistent with jetlag or shift work changes had increased rates of mortality. (BBC News)

We all know that the body has a certain sleep/wake cycle called the circadian rhythm. And, those who cross more than one time zone traveling, or those who work different shifts, or those who may be up all night on call, or those who actually stay up to watch tv for the US election results (me), or those who call themselves bloggers, may have difficulty sleeping. Our bodies are used to a certain length of time with daylight and a certain length of time with darkness.

Researchers at the University of Virginia put mice to this test. They put some mice's clocks forward and other mice's clocks behind by altering their sleep/wake cycles.

Separate groups of young and old mice had normal [sleep] cycles. Younger animals appeared unaffected by alterations to their schedule. But only 47% of the older mice whose "nights" were shortened survived, compared with 68% of those whose nocturnal time was lengthened and 83% of those who remained on a normal schedule.

Yeesh! The only thing I can gather from this data is this -- Glad that I'm not an older mouse! I wonder if they have any data on lice or chickens, or the fly? (oh my!)

Fowl foam

Breaking news out of Washington, DC. Not to worry, if the United States happens to have a bird flu outbreak (I personally think it's not going to happen), now we have a way to limit it. (Chicago Tribune)

The US Agriculture Department approved a firefighting foam to kill chickens quickly if an outbreak happens in commercial poultry. This is an alternative to using carbon dioxide gas because gassing involves more workers and potentially more exposure to infected birds. Of course, peta prefers gassing verses foaming fowl because it's more humane (They're chickens, not humans - Sheesh!)

Why am I mentioning this story? Just another example of the priorities of the federal government. I'm glad they are concerned about bird flu, but why can't I still get human flu vaccine for all of my patients? Why can't they still fix the broken Medicare system? Why are they're still 45 million uninsured Americans (some of them going overseas for their health care)?

Sorry for the rant. For those in the US, don't forget to vote today!

Grand Rounds

Grand Rounds 3.7 is up and running at MSSP Nexus Blog. Here's my contribution:

Dr. Anonymous joins the Walmart Free Antibiotics discussion and reminds docs to have the courage to 'just say no' to unnecessary antibiotic prescriptions, and patients to hold back their wrath if you don't get the prescription you were hoping for.

Check it out! It is the best the medical blogsosphere has to offer. Next week, Grand Rounds will be hosted by The Rumors Were True. That is an interesting blog, if you haven't already had the chance to check it out.

Peace on Earth

Since it is November 7th in most parts of the world, I thought I would make my post a little early (at least in my time zone). Peace on Earth is more than just a day someone picked out and a graphic that you put on your blog. Yes, it's idealistic, but it's an idea of hope - In a world that needs all the hope that it can grasp. Thanks Mimi for your leadership in all of this - for having an idea and passionately making sure that it is followed through. I'm looking forward not only to seeing this graphic scattered all over the blogosphere, but also, hopefully, someday, seeing your dream come true of Dona Nobis Pacem -- Peace on Earth.

Got lice?

Are you sick and tired of meticulously combing out all the lice from your child's hair? Are you sick and tired of using those messy lice lotions and shampoos? Well, have I got the solution for you.

Dale Clayton from the University of Utah has found a unique way to get rid of nits without the muss and fuss. His solution? A hairdryer. Yes, a hairdryer. It is called the LouseBuster and it blows air heated to 140F/60C to kill the critters. A "rake-like attachment" is then used to comb out the lice. Here is the detailed explanation below -- picture and article from Times Online.



Now, when I saw this concept, it seemed vaguely familiar to me. Before I started blogging, I did a lot of television watching late at night - mainly infomercials. And, I vaguely remember the Flowbee Vacuum Haircut System. This is a vaccum cleaner thing that also cuts hair. Yes, I'm serious. This is so funny, I even remember seeing this talked about on an episode of Friends. Here's the promo picture (what would Chandler say about this?).



Conincidence? You be the judge! How about taking this concept to the next level? You know, I'm such the enterperneur -- in the spirit of The Apprentice (the first season is still my fave). Why not combine both of these products? What would you call it? Of course, the Flowbee LouseBuster! Remember, you heard it here first. Get rid of your kid's lice while giving him a trendy haircut. Call right now! Tell your friends and neighbors! Operators are standing by.... HA!

Addendum: Welcome to all of you from the WeKnow Parenting Forum! I heard I was linked there. If you liked this, then feel free to check out the rest of my blog. You might like it!

The Fly

Remember this annoying movie starring Jeff Goldblum in the mid-80s? Like many other of his movies, he plays an annoying scientist guy. But in this movie, his character's genetic makeup accidentally gets combined with that of a fly. Why am I telling you this? Because this is what I thought of when I read this next story.

Apparently, St. Georges Hospital in south London has become infested with flies. Yes, flies. (Guardian) Apparently, this has been going on for at least three months - and the hospital knew about it! Sheesh!

A hospital spokesman said: "We have had a problem with small flies in the unit recently and suspect it has to do with recent building work nearby. Our engineers and cleaners have been trying to identify the source of the problem and we hope to have eliminated it very soon. We would like to apologise to any patient who has been worried by it."

And, some people in this country would like the British model of medical care to come here? Can you imagine receiving dialysis three days a week for three months and knowing that you're going to see flies? What an odd situation.

Medical marijuana

Happy Birthday Prop 215! Don’t know what this is? This was the first medical marijuana law in the United States. It was passed in California a decade ago. (Mercury News)

Call me old fashioned, but I don’t think that marijuana should be used in the medical setting whatsoever. However, I have read and reviewed some of the medical studies which state that there could be a benefit in conditions such as cancer, anorexia, and AIDS.

The legal controversy is a little more interesting. The California law states that marijuana can be used not only for the above conditions but also "where medical use is deemed appropriate and has been recommended by a physician who has determined that the person's health would benefit."

What does that mean? Potentially, you could get a “prescription” for marijuana for just about any reason. For example, that bunion would feel so much better if you had some pot, wouldn’t it?

The California Medical Board has tried to set up guidelines, but these will undoubtedly make their way through the courts. It may be another ten years until all that is sorted out.

Finally, did you know that there is a state funded research center at the University of California, San Diego, doing clinical trials for marijuana use?

Igor Grant, director of the Center for Medicinal Cannabis Research, said the results have been promising, in reducing inflammation and muscle spasms and treating conditions such as high blood pressure and multiple sclerosis. By studying the brain receptors that stimulate appetite when exposed to the chemicals in marijuana, scientists even are looking into possible treatments for obesity.

I think I’m having second thoughts on this. At least in California, I can’t get sued for improper use of marijuana, right? Maybe I’ll move there. NAH!

Random

This post will wander, so bear with me today...

Shopping: My dress shoes are on their last legs. So, today, I went out to the local shoe warehouse to find a nice new pair of work shoes. OMG! I can't believe all the choices out there. One thing that is good about this store is that I could roam around and try things on. I never like those stores where the clerks, er, associates (that's the PC term, right?), stalk you around the store just to get their commission. I have kind of wide feet, so it's always tough for me to find a comfortable pair of shoes. But, finally, what felt like hours later, I found a nice pair of wingtips. At least it will be months until I have to do this again. Sheesh!

Voting: I finally filled out my absentee ballot and put it in the mailbox. I kind of like it a little better, because I could at least think about the issues and the candidates a little bit more than when I was in that voting booth. I still cannot take these political ads anymore - AHHH!

Welcome to my Blog: Thanks for stopping by today. Hope you return again! Welcome to those of you from NaBloPoMo! I'm starting to see some referrals from them now. As always, I appreciate the traffic from Bobby Griffin's site (even though he's having some computer problems today - Hope you're up and running again soon, Bobby).

Blogroll Maintenance: I'm always amazed and honored by those of you out there who place me on your blogroll. I’m adding some new people today. I’ve also started to receive some spam comments. I might have to moderate comments if this is increasing. Just wanted to give all of you a heads-up if this happens this week.