Monday, July 31, 2006

Landis update

The New York Times is reporting that carbon isotope testing (a more sophisticated test verses the initial) on the "urine sample A" shows the testosterone in the sample came from an external source.

The Floyd camp has been on a public relations frenzy for the past 3-4 days. They will now have to explain these latest results. Apparently, they finally officially requested testing on "urine sample B." The saga continues...

Supersize me

Late news out of LaJolla, California. Dinner is on me and you can order anything that you want because US scientists have found the solution to the obesity problem -- and instead of a pill -- it's a shot -- a shot they're calling the anti-obesity vaccine.

You see, they gave these rats this vaccine directed against a hormone that helps regulate energy. The results show less weight gain and less body fat than those fat rats that got no vaccine.
The finding, said the scientists, might be especially important to stop what is commonly called "yo-yo dieting," the cycle of repeated loss and regain of weight experienced by many dieters.
Wait a sec, I like my yo-yo dieting. What's up with that! One week I'm down three pounds, and the next week, I'm up five pounds. This is awful! This is horrible! Where's my potato chips and diet coke? Maybe this will be a good thing. We'll see.


While I was at one of my favorite fast food joints (I know, it really does along with my claim of laziness from my earlier posting today), I ordered a medium Diet Coke. What I got was this huge cup which I thought was a large or even extra large.

I know people have probably noticed this already, but are food and drink servings getting bigger, or is it just me? I thought that places like McDonalds did away with their "Super Sizes." Maybe they got rid of the name, but the portions are actually larger now. I might have to do some research on this -- I mean google search, not actually sample all the fast food places around here. HA!

Also, let me know if you're having any problems loading up my blog page. I've had some problems this morning. My browser was freezing up when loading. It seems to be solved now, but let me know.

Move to Denmark

My parents just got back from their trip to Russia & Scandanavia late last night. I was wondering whether I should call her during a lull in my morning schedule or at the end of my morning. Sometimes my mom is very talkative, and sometimes she's not.

So, I took my chances. I just got off the phone after a 30 minute conversation. Don't get me wrong, I'm not upset, my mom is just funny sometimes. She gets into this long story about how my dad couldn't find the right currency for that country (apparently that person did not accept Euros), but my mom really wanted this sovenier. They went with a big group of their friends. And, the airline stories....

Why am I telling this story? Well, I think mom's funny. And, I found this CNN article about a study with partial data from the United Nations (we know how reliable they are -- HA!) and conducted by a British scientist.

According to this study, Denmark is the "happiest" country. The United States came in at 23rd, Britain was in 41st place, Germany 35th and France 62nd. Other countries were not given (for my other international readers out there -- Sorry!).
"Smaller countries tend to be a little happier because there is a stronger sense of collectivism and then you also have the aesthetic qualities of a country," White [the researcher] said.
What does that quote even mean? I think that's research double-speak. I mean, only 5 million people live in the entire country. Maybe they make all the unhappy people move to Germany? Maybe it because of that whole viking heritage thing that they got going there? Who knows? Anyone been there (other than my parents)? What's the deal with Denmark?


I went to my first 5K race over the weekend. No, I did not run in the event. I was just in the cheering section. It was a night race, which I guess is an even more special event.

I never did track or cross country in school. So, this was an entirely new experience for me. It was at our high school football stadium. The place was full of energy. There was a DJ over where the band usually sits. This was where the prizes were to be given out later.

As I got to see the track, I saw a bunch of people walking and running on the track. I was thinking to myself, "Aren't these people going to get tired, especially on a humid night like this?" Maybe Runner Girl and others can give me insight on this.

"Hey Doc! Why aren't you running in the race?", many people asked me. I made up something like it was because of my old knee injury from chess club back in high school. *grin*

This is an entirely different topic, but I know I'm out of shape. And, I do admit, that I'm just as bad as some of my patients in that I make excuses for not working out. I know what you're going to say, "Practice what you preach." Thanks for calling me out on that one. Back to the story...

I always wondered who decides who is in the front of the starting pack. The starter lined up the runners by "speed," meaning those who have run faster times in front and those with slower times in back. I guess this makes sense, because you don't want people running over other people just at the start.

The race started, and then the waiting began. The entire group did a lap in the stadium, and then they ran the streets of the town, including in the park. The excitement grew minute after minute waiting for the first runner to arrive.

And then, the stadium erupted with cheering as the first people arrived. For the next 30 minutes you would hear occasional cheers as loved ones spotted friends/family as they entered the stadium for their final lap.

Overall, a fascinating experience. I thought people would be negatively competitive in asking what times you had and saying how they were better. It was very supportive. People told me it's not a race against other people as much as it is a race against yourself and the clock. Who knows? Maybe I'll pick up this running thing myself?

BTW, kudos to Cathy who survived her blogathon weekend and exceeded her goal of fundraising. Congratulations! Hope you got some well deserved rest.

Friday, July 28, 2006

Rush to judgement

I ranted about Floyd Landis yesterday. I have heard from a lot of people to wait and see how all of this plays out. Maybe the initial test was not definitive. Maybe the "sample b" will show something different.

We do know that he will "stand up" Jay Leno tonight and go on the hard-hitting (yeah right) and soft ball question throwing Larry King Live to start his PR campaign to save his personal and professional reputation. Good Luck Floyd.

There's also a new blog site (Free Floyd Landis) which may be part of his PR campaign. Maybe I was too harsh in my initial analysis. We'll have to see what happens.

BA on the North Coast

Pack your bags because we're heading to Ohio (yes, Ohio). What's there? The latest edition of the BA meeting hosted by Cathy. We're on Lake Erie (I think they still call it the "north coast" up there). The dinner menu sounds great and the tiramisu sounds even better. You'll have a great time. And, remember, what happens at Put-In-Bay -- Stays at Put-In-Bay. See you there!

Thursday, July 27, 2006

Done with cycling

What a difference eight days makes. Eight days ago, Floyd Landis rode himself out of this year's Tour de France. Everyone, even himself, was already looking toward next year. Landis announced earlier this month that he would have to go through hip replacement surgery because of his years of cycling.

Seven days ago, Landis had his best day as a professional cyclist. He won that day's race stage and set himself up to win the entire Tour -- which he did five days ago. Since then, he has been enjoying the spotlight. That is, until yesterday.

On Wednesday, the international cyclist union announced that one rider returned a positive test. The union president said, "The credibilty of the sport is at stake. The rider, his federation and his team have been informed of the situation.”

Speculation started that Landis may be the rider. Today, Phonak, Landis' team, made the confirmation that he had an "unusual level of testosterone" in the test following his stage win.

I'm so upset now, I can't even stand it! I didn't even know what the Tour de France was until Greg Lemond was the first American to win the race twenty years ago. Then, Lance Armstrong made me and a lot of other Americans fall in love with the sport of cycling. The year before Armstrong began his winning streak, the Tour was rocked by a drug scandal, which really put cycling in a negative light. Armstrong (who has his own drug allegations) helped to increase cycling's popularity.

The night before this year's Tour started, more than a few top riders were suspended and not allowed to start because of drug allegations. We should have known that this was a sign of things to come.

I've decided. I'm done with cycling. I just can't take it anymore! I stopped watching baseball because of Barry Bonds. I'm also done with football and basketball. Olympics - yeah right! Definitely not the summer games. Maybe my beloved golf is the last bastion of honor in all of sport. Unfortunately, I betcha that they'll start drug testing Tiger Woods and Annika Sorenstam in the near future.

Wednesday, July 26, 2006

The empire strikes back

Thanks to HealthPsych for this heads up. Petite Anglaise lives in Paris. This post has caused quite a stir. Apparently, this person was fired for blogging.
“I’m afraid I have called you here to tell you that I am obliged to terminate your employment with the firm.”

I sit.

My mouth forms a perfect “O” of astonishment.

“This is because of your internet site.”

Somehow he manages to make “internet” sound like an unspeakably filthy word.
It makes for an interesting read. It has definitely struck a nerve out there, because as of this writing, there are 241 comments, which will undoubtedly continue to rise. It definitely makes me reflect to past posts like this one or this one (oh yeah, I'm talking as if they were years ago -- but they were only within the past month). Is that darth vader I hear coming up behind me?

Swiss seek out blogaholics

CNN reports that Switzerland's Department for the Prevention of Addiction (no joke) launched a poster campaign for potential addicts.
"They are at risk of facing problems in their social surroundings or at the workplace," the department said. Internet addicts suffer from psychological withdrawal symptoms, it said.

I can't believe that they found out I live in Switzerland! I thought I successfully took steps to hide my identity and location. Sheesh!

I'm glad that the Swiss have recognized this problem and are taking action. Does anyone have friends in Switzerland? Maybe we can have a Blogaholics Anonymous meeting there to really help them through this difficult time.

Right to choose

Can the court force you to take medical treatments? This is the debate in Virginia right now. Starchild Abraham Cherrix is a 16 year old diagnosed with Hodgkin's disease. He has already went through one round of chemotherapy. He told his parents that he did not want to go through chemo again because of all the side effects. The family decided to pursue alternative therapy instead of another round of chemo.

In a shocking decision last week, the court ordered the teen to report to children's hospital to start chemo for his Hodgkin's disease. In addition, the court ruled the parents neglectful in allowing their son to make his own health decision -- Thereby, forcing the parents to share custody of their son with social services. I already have a problem with the legal system. But this story goes much deeper....

Government Intrusion: The government, through the court system, is going to tell patients what treatments to receive? It shouldn't matter what your political views are. This has got to bother you.

Alternative Therapy: The natural health bloggers are absolutely upset with this ruling and the possibility that seeking alternative therapy was a factor in the ruling. What if this family refused chemo in order to pursue a faith healer?

Parental Rights: How can parents be labelled neglectful after considering all treatment options and deciding to support their son? Some parents do not agree that immunizations are beneficial. If parents refuse their child to receive immunizations, are they neglectful? Can the court force immunizations on children? If a Jehovah's Witness refuses blood products for their child, are they neglectful? Can the court force blood transfusions? Who has final say in the care of children? The parent or the court?

Patient Rights: What's fascinating and troublesome at the same time is that if this patient were 18 years old, an adult, this would not be a news story at all. Adults have the right to refuse any and all treatment, even potentially life saving treatment. This is personified in the phrase Do Not Resuscitate. Hollywood glamorizes this decision making process in TV and movies. What's different about a 16 year old that the court has to step in? No matter what your political view, it is true that in some states 16 year old girls can consent to an abortion. Why can't a 16 year old guy refuse treatment?

Late Tuesday afternoon, the ruling was lifted and a trial date set for August 16th. The joint custody order was also lifted. What will happen next? I don't know, but this story may have huge medical and legal ramifications depending on how it plays out. Definitely a story to keep close watch on. What are your thoughts on this case?

Tuesday, July 25, 2006

Grand Rounds

This week, Grand Rounds 2.44 is being hosted by Medical Humanities.
Welcome to our garden. We’ve gathered together a multicoloured collection of species from all over the world. We’re interested here at Medical Humanities in artistic and literary metaphor which is why we’ve chosen gardening as our theme this week.
I must say, very creative. The pictures, the layout, and the text itself paints a picture that you're definitely in a garden. Me? I'm in "The Gazebo."
Doctor Anonymous no doubt would also appreciate a holiday. He poses some tough questions after a long night of being on call. He also gets some answers to the question, 'Why?', from his readers.
I know what you're going to say. The first link is incorrect and takes you to I e-mailed them to let them know, and hopefully by the time you read this, the problem will be corrected. Next week, Grand Rounds will be hosted by Inside Surgery.

MH e-mailed me back and corrected the link. Should be ok now.
Doctor Anonymous no doubt would also appreciate a holiday. He poses some tough questions after a long night of being on call. He also gets some answers to the question, 'Why?', from his readers.

Monday, July 24, 2006

Soccer doc

Just another manic Monday -- isn't that how the song goes? (all you 80s music fans know what I'm talking about) Why is it that after a weekend, you feel like you need another weekend? Just like you need a vacation after getting back from vacation.

It's not like I was really stressed out over the weekend. In fact, I had a really good weekend. I don't know if I told you before, but I'm the "Soccer Doc" for our boys high school soccer team. They had a pre-season tournament over the weekend.

I'll go into it in a little more detail as the season unfolds, but working with high school kids is really refreshing to me, mainly because my maturity level is about the same as theirs -- HA! It's a good time kidding around with the kids on the bench as they talk about their summer, school, and, girls.

Of course, I feel older and older every year I do this as they talk about music I've never heard of and movies that I've never seen. We joke around a lot. They call me old when I start quoting movies and music from my high school days. I call them young punks, because, well, they are!

The season starts in about a month and goes through October (I think -- have to double check that). Hope you're having a great day. Don't forget Grand Rounds tomorrow.

Sunday, July 23, 2006

And the winner is...

Thanks so much for your feedback on which post I should submit to Grand Rounds. In reviewing the comments, I'm going to be submitting Why. I knew that none of you would let me down. I may ask you to vote again in the future for my GR submission -- That was fun! Although,I have to admit, I did not expect the impact this post would have, because others made their interpretations on their meaning of why....

NeoNurseChic, in her post, Why: One of Life's Biggest Questions, talked about being in a neurology case study and started off her questions with "Why Did This Happen To Me?" She then posed a set of questions of the frustration in her job and with her life. I really appreciated her post in that it really tapped into the emotional state I was in for my writing. Carrie, you and I are on the same wavelength sometimes (feel sorry for you). Thanks for your poignant post.

kt asked some why questions on the lighter side of life in her post It Was A Good Idea At The Time. Funny stuff. I do admit that I'm one of those people who get up at the end of the night to karyoke. My song: "Roxanne" by The Police. Can you imagine this? You don't have to, there's probably video of me somewhere doing this song. Check YouTube.

For Those Times You Ask Me Why, is the title of a post on In My Humble Opinion (formerly the Fine Art Doctor -- I like the name change by the way). It is insightful poetry about being in medical school. His writing ends, "...And all I can say... is sadly, I don't know why."

Ripple of Hope turned the conversation around with the post Why Not? "Why not try to change things and why not get involved?" Interesting thoughts.

Dreaming again changed the conversation again in the post titled, "How, not why" "How do I begin to tear down the wall without putting up another one in it's place?"

I really appreciate all the discussion that has taken place. It has been very insightful to me. I'll finish with a couple of humorous posts asking "Why Ask Why?" One from Use Wisdom and the other from GJ. Enjoy!

Friday, July 21, 2006

Tie or no tie

Following up on yesterday, aside from the heat, we had great weather. I left my pager at home. I left my cell phone at home. I was pleasantly inaccessible to the world. Just me, and golf, and good friends. Just a great time to escape from real life for a little while....

Somewhere on the 18th hole, after many adult beverages (if you know what I mean), we had a knock-out-drag-out yelling discussion about doctor attire. Last Friday, we had a great discussion on whether docs should wear lab coats. And, that's initially how our discussion started yesterday. Then, someone in our group mentioned wearing a tie and a lab coat during office hours. Last week, here's what Dream Mom said about neck ties:
Also, I still like it when the docs wear a tie to work-doesn't matter if it's a bow tie or regular tie. Call me old fashioned, but I like it. As for the female docs, it wouldn't hurt to put a little make up on from time to time; some of the female docs look liked they just got out of bed.
As our discussion got more heated yesterday, someone in our group made reference to this study which stated that neckties carry germs. I think that's a cop-out. Personally, I like the neck tie - Maybe not every single day (like the lab coat). But, for me, most of the time, I wear a tie.
What do you think? Which do you prefer? Tie or no tie....

Update: Nurse Ratched's Place just posted an interesting commentary called "Do You Remember When" which also talks about nursing attire:
Do you remember when you HAD to wear a white dress, white nylons and nursing shoes, and a nurse's cap? The dress was hard to keep white (you know what I mean), the nylons were uncomfortable and would run, and the hat was always getting tangled up in IV tubing while you were counting those infernal drops. At the end of my shift, I looked more like a bag lady than an angel of mercy.

Thursday, July 20, 2006

Rock the vote

I know, I know, I know. I actually said I would not blog today. HA! Who am I kidding? I'm Dr. A and I'm a blogaholic.... (it's amazing what sleep does)

This is a history making post! Why? Because I'm asking you, the Doctor Anonymous reader, to vote on which post I will submit for next week's Grand Rounds. In the entire history of Grand Rounds, this is unprecedented (maybe not, but sounds good, huh?).

The only ones that you cannot vote for are this one and this one, because they have already been posted on GR. Any other post is fair game!

According to the blog meters, this is my best week ever! Thanks to all of you out there in blogland. I thought that this would be the perfect day to try this. Will it work? Stay tuned to find out.

After I post this, I'm going to take some "me" time today. Thanks for your advice on this. I'm golfing and I won't be back to my trusty little Mac until tonight. Don't worry, I won't go into withdrawl, I'm wearing the blog patch. *grin*

So, I'll leave the door unlocked. My blog is your blog! Feel free to come and go as you please. I am running low on Diet Coke, so if someone is going to the store, pick up some for me and I'll pay you back.

For all I know, you could have a BA meeting over here today, and I wouldn't even know. My neighbors are used to the noisy parties at my place (if you invite them, that smooths things over).

I'm off to my early morning tee time and I'll be back tonight (don't wait up). I'll close voting sometime on Saturday (or even Sunday) and I'll post the results here. Vote early and vote often. Tell your friends, they can vote, too. Have a great day at my place!

"Never doubt that a small, group of thoughtful, committed citizens [bloggers] can change the world." -- Margaret Mead

Update 7/21: Had a great day yesterday, but I got back late. I will start going through my comments today. Thanks so much for your votes and feedback. If you haven't voted yet, please do! Keep that feedback rolling in....

Wednesday, July 19, 2006

Why revisited

Welcome back to Dr. A Unplugged. Ever see this MTV show? It was at its peak in the early 1990s when Mariah Carey was still someone you said, "Who is Mariah Carey?" And, nirvana was just another grunge band from Seattle. The popularity of the show was, in my opinion, due to its raw nature. No electronic keyboard, no electric guitar, and no sound effects -- just a guitar, maybe a piano, and just the voice of the singer. Very refreshing when music was (and still is) littered with electronic manipulations.

I'm feeling in that kind of raw state right now. Most thoughts unfiltered -- not going through the politically correct washing machine before it comes out of my mouth or off my keyboard. Kind of a liberating way to blog, let me tell you. I guess that's why I put that out at 3am. I was really close to hitting the delete button. But, I wanted to get it out there, because, life is full of ups and downs. And, your blog should be a reflection of your life, right? I feel like I'm at a Blogaholics Anonymous meeting.

I'm apologize if I'm worrying people today with my posts. It was not my intention to do that -- just to give a little snapshot of my life first hand. Now, I just need to get through the afternoon, finish the work that absolutely needs finished, and then go home and sleep. It's amazing what a little sleep does. It's life's little pause button. Probably take a blogging break tomorrow and make a comeback Friday. We'll see. Thanks for all the well wishes!

The Forgetting

As I was totally feeling sorry for myself (oh, poor Dr. A), I was asked to see Isabel at the nursing home at the end of my morning. She has Alzheimer's which I would say is in the intermediate stages. She was having some arm pain and had a question about a cortisone shot for her shoulder.

I'm thinking to myself, "Oh great, just another thing that I have to fit in. How am I going to do that? I have to drive back and forth from there and make sure I'm not late for my afternoon office hours."

Following her exam, I thought she had a pulled muscle and prescribed some physical therapy and analgesics. She then asked me, "How long am I going to be here?" As I was frantically writing in the chart, "Well, we talked about this the last time I saw you. It is unsafe for you to go home because your husband has a lot of medical problems as well, and he cannot take care of the both of you."

"No, doctor," she looked right at me, "How long am I going to be here?" "Oh," I paused a long time before speaking again. "I don't have any idea on that. The Alzheimer's may slowly or rapidly progress. You're on the best medicines we have right now."

"What would happen if I wanted to stop all my medicines?" she asked. "Likely," I said, "this would probably progress rapidly for you." "I certainly don't want to live like this in a nursing home when I used to be independent, and yet I want to be around for as long as I can -- especially for my grandkids."

This is one of the tragedies of Alzheimer's -- when people are not mild, and yet not severe. They feel themselves slipping away as they forget more and more and, in addition, they start to lose their bodily functions.

If you know little about Alzheimer's, here is a link I want you to check out. It has a video clip that's about 3 minutes of a PBS program called, "The Forgetting." It really personifies what this tragic disease is all about.

Isabelle and I and a nice discussion and ultimately she made a decision that I went along with. Needless to say, after this humbling experience, I was brought back to reality and then went back to the office to continue my day....


Why do manipulative patients wait until 5 minutes before the office closes to call for a medication refill?

Why does poor planning on someone else's part constitute an emergency on my part?

Why would a clueless patient page me at 3 o'clock in the morning and ask me for a test result that happened 2 wks ago?

Why do I have to stay calm as people are yelling at me through the phone?

Why do arrogant specialists only want to talk about the car that they're driving?

Why do helpless primary care docs only bitch and moan and not be proactive to come up with a solution to the problem?

Why is it when I walk around the hospital that the only thing I hear staff concerned about is when they're going on break?

Why doesn't it bother me that radiologists sit in a dark room all day?

Why do hospital case managers bug me every day about discharging patients because they do not meet "criteria" for hospital admission?

Why does hospital administration only care about quality data and federal/state regulations?

Why does the hospital security guard always give me that look when I enter and leave the hospital?

Why do I even get up in the morning after a rough night of call?

Tuesday, July 18, 2006

BA at Waikiki beach

Aloha! T.J. from dogscatskidslife is graciously hosting the latest edition of the Blogaholics Anonymous meeting from Hawaii -- specifically Diamond Head and Waikiki Beach. There are great pics on the site already. I'm really jealous and wish I was actually there. T.J. says that dinner is prepaid, so get there right now before the tab is closed.

Grand Rounds

Grand Rounds 2.43 is hosted this week by Chronic Babe and she had a theme, "It's All About the Ladies." I can't believe I'm taking abuse over this.
Here's healthpsych: "So, an honorary girl after all? (Grand Rounds theme - It's all about the girls)" Ouch!

Anyway here's the snipet from today's Grand Rounds post:
Doctor Anonymous works with an elderly patient to decide her best course of care. "Whatever you decide is probably as good or better than anything I would say," he tells her. In the end, she decides to leave things be.

Thanks to Chronic Babe for hosting this week. I haven't seen anyone announced for the host for next week. Hmmm.....

Monday, July 17, 2006

Space spatula

Saw this story from an Australian website (good stories from Australia today). Apparently last week, an astronaut lost a "space spatula" that is now orbiting the earth...
The $2700 spatula drifted out of Sellers's tool kit while he was conducting repair tests outside the shuttle Discovery on Wednesday.

"My spatch has escaped ... it was tethered to me," he reported to ground controllers during his 7hr 11min spacewalk. "It's gone, gone, gone. Nobody's going to find it."
First of all, a $2700 spatch? Where's NASA shopping at these days? They can save a lot of money just by going to the dollar discount store (how much do things cost there anyway?).

In a related story, after Discovery landed at Kennedy Space Center in Florida this morning, Sellers was overheard saying, "Has anyone seen my car keys?"

Obesity & asthma

I just read this interesting article from WebMD. Here's a quote:
July 13, 2006 -- A lung-irritating protein made by fat cells may be the missing link between obesity and asthma, say Australian researchers.

Obesity makes it about three times more likely a person will have asthma. And when obese people with asthma lose weight, their asthma gets better, says Michael Rolph, PhD, one of the researchers on the study.
The article goes on to say that there's a protein made by fat cells that causes inflammation of the lungs which then worsens asthma. This is very interesting because if this protein can really be isolated, then more treatment options may be coming along for those with asthma.

I'm seeing more and more kids overweight and more and more kids having diseases like asthma and diabetes and others. There are many scattered theories on the origins of the obesity epidemic, but unfortunately, there is not united agreement on a solution to this problem.

(Don't forget, Grand Rounds is tomorrow. And, a little birdie told me that my submit made the cut. Hmmmm.... Stay tuned to find out.)

Sunday, July 16, 2006

I love the 70s

Ok, so I was innocently watching college championship frisbee football when a commercial break came. I decided to do some channel surfing and I ran into this show called I Love the 70s on VH1. For those of you who have never seen this, it's a bunch of has-been celebrities commenting on the pop culture moments of that decade.

I started at 1972 and got hypnotized into watching the rest of the decade. What's wrong with me? I just could not turn the channel. They just kept talking about the movies and music and TV that I remember from back then. I could not stop myself. Help!

But, I was thinking, 30 years from now, I could be on a show like that.....

Hey, Dr. A, what did you think of:
World Cup 2006: "You know all I could remember was that guy from France head-butting that guy in the chest in the final game. What was that guy thinking? 'Oh yeah, like no one is going to see me do that.'"

American Idol: "This was the hottest show on TV. This was the only time in my life where I wish I could actually sing. I only watched the show a couple of times, because I was totally intimidated by Simon. The guy totally scares me. In fact, I still have nightmares about him, 30 years later..."

iPod: "Oh yeah, I remember my first iPod, I put all of my CDs on it (you remember CDs don't you?) and I was amazed that I still had room on the thing to put other music. And, then the screen scratched and I cried the whole weekend and thought that my life was over."

Sign me up! I'd be great at this show. Or, maybe I just need to turn the channel back. There's got to be something on that's not so hypnotizing...

Lazy Sunday

You know, it's really refreshing to get some time off every now and again. Before this weekend, I was worked 12 days in a row with hospital and/or office responsibilities (sometimes 12-14 hour days). Don't get me wrong, I'm not looking for sympathy, just sleep. And, boy have I taken a break this weekend.

I was really thinking of not blogging today, because, hey, I've really got nothing going on -- and for me that's news. I'm used to the go,go,go schedule and no time to take a breath. Don't worry, I'll be returning to that tomorrow.

But for today, maybe I'll just hop around the blogosphere (and catch some blograys and work on my blog tan), or really start that diet/exercise program I've been meaning to do, or take more of a break today. Oh well, I guess it's my choice. What are you doing today?

Saturday, July 15, 2006

Hotel Coffee

I logged into bloglines this morning and saw an update of my favorite podcast called Hotel Coffee. Dan O'Leary is a pilot who works in the western United States. I don't know anything about aviation, and it's SO different than medicine. It's been very interesting listening to all the technical aspects of the show. And, I've enjoyed learning about the life of a pilot.

Podcasting is an entirely different medium than blogging. I have to be honest -- at first I was drawn more toward podcasting rather than blogging. I like listening to books on CD and hearing someone's voice telling a story (and also added music) definitely gives a lot more layers than reading a story on a page.

I finally e-mailed Dan this week and I got mentioned in his show. Very exciting -- my first podcast plug! I know this is going to sound really cheezy, but it was because of Hotel Coffee that I decided to start blogging. Earlier this year, I was really exploring podcasting and I found out that there was a lot of technical stuff that my patience probably couldn't handle.

I heard from a lot of different sources, including Hotel Coffee, to just start writing (meaning blogging) because it doesn't really matter what you say or if anyone reads it. And now, it's almost four weeks later of blogging and here's where I'm at!

Thanks to Dan for mentioning my fan mail on his podcast and putting my link up on his website. (BTW, Welcome to all the Hotel Coffee listeners!) I encourage you to check out his site and his podcast. I load up Hotel Coffee every week on my iPod and I know you will enjoy it, too.

Friday, July 14, 2006

BA at the nurse's place

We're having a lot of meetings this week, aren't we? May from about a nurse has graciously opened her blog doors to host the latest edition of the Blogaholics Anonymous meeting. As always, bring your food and beverage of choice, and I'll see you there! She's got pansit, do you know what that is? Head on over and find out...


I had a pen explode in my lab coat pocket yesterday -- a tragedy, I know. At the end of the day, as I was leaving the office carrying my lab coat home to be washed, one of the other docs said, "I don't know why you still wear that thing. None of us feel the need to wear lab coats anymore. Do you think you're still a resident?"

He was joking, of course, and then we had a short discussion on the the philosophy of a doctor wearing a lab coat while seeing patients in the office. From my perspective, I like my lab coat. Not only is it fashionable, it is practical. I'm able to carry my stethoscope, my prescription pad, a couple of pocket-sized reference books, and a pen (when it doesn't explode).

His points were that the lab coat can make a physical and emotional barrier between you and the patient which can hinder communication. And, it's difficult to continually keep a long white coat clean (I conceded that point).

I'm kind of curious, what do you think? What's your preference? Lab coat or no?

(Notice the new blog title? Why? Leave a comment to find out...)

Thursday, July 13, 2006

Leaving things be

Mrs. D came in yesterday for her four month checkup. She just saw her vascular surgeon within the last month and had some questions....

She was the full-time caregiver for her husband until his Alzheimer's disease got to much for her. She was 88 years old when she thought she "gave up" and moved her husband into the nursing home. "I don't think you gave up," I said to her back then. "You're not exactly a spring chicken anymore and he's more than twice your weight. I have no idea how you've been able to take care of him at home by yourself for such a long time."

The other reason she had to place him in a nursing home was that she required surgery to repair an abdominal aortic aneurysm. In addition to recuperating from the surgery, one important restriction she had was absolutely no heavy lifting -- like of her husband when he would fall on the floor at home.

Her husband died peacefully a few months later. A couple of Mrs. D's children moved back to the area to help sell the house and take care of the legal affairs. They all live in the same house here now.

Oh yeah, did I mention that this was the only surgery that she ever had and currently is on no prescription medicines. It's not because she refuses to take medicines, it's because she's THAT healthy and is still very independent.

...."My doctor told me I need an MRA. What's that?" Mrs. D's doctor initially ordered a carotid ultrasound to check for blockages. The findings were questionable, so an MRA was recommended to get more information. I explained what an MRA was and if there was significant blockages, then surgery could be done to repair it.

"Do you really think I need an MRA? I really don't want anymore surgery. If I was your grandmother, what would you say?" This is probably one of my least favorite questions in all of medicine. Usually, I put my lawyer hat on and give a laundry list of potential problems if a critical stenosis is not diagnosed or treated.

"If you were my grandmother, I'd say that you've been getting along for almost your entire life without the need for medications and doctors. Whatever you decide is probably as good or better than anything I would say. I mean, hey, you're healthier than I am. I should be taking health tips from you."

"Well, I think I'll leave things be. You don't think that nice young man," she meant her vascular surgeon, "would be mad at me if I cancelled the MRA." "No, not at all. I think that he'll understand." "Well, then it's settled." "I think it is."

Tuesday, July 11, 2006

In a mood

I don't know what's quite gotten into me today. I'm in this rapid fire blogging mood today. Anyway, I have a confession I'd like to make (other than I'm a blogaholic). I can't believe I did this, but I consumed about 1200 calories at lunch today. What was I thinking! It's just that Wendy's was calling my name and I couldn't stop myself. Yes, I'm an idiot. Whew! Now, I feel better.

Speaking of moods, I guess Blogger is in the mood for maintenance.
We will have an outage of 90 minutes from 4p to 5:30p (Pacific Time) as we perform some hardware upgrades. At the beginning of this outage (the first five minutes), will appear completely inaccessible. Following this, a status message will appear for the remainder of the 90 minute outage during which time users will be unable to update their blogs.

With all the stuff happening with Moof to FD to Cathy to anyone else, who knows what will happen with this scheduled Blogger outage. Maybe this will be my last blog ever. Thanks for the memories. HA!

BA at the beach

Put on your swimsuits and come on over to Carrie's beachhouse for today's meeting. As always, it's BYOB (bring your own BLOG). Don't forget your suntan lotion, and of course, your food and beverage of choice. See you there!

My first grand rounds

Grand rounds 2:42 is hosted by donor cycle and she did a fabulous job. I don't know how people can read all those posts in such a short a period.

Despite what I've been feeling and what I've been telling people, I got up the courage to submit something and it got included in this week's GR. Not only did I get in GR, I even made it into the Top 8 list. Yay me!

Here's the quote:
8. What do you do with a non-compliant patient? Go to their Doctor Anonymous.

Thanks DC for hosting and thanks for including my post in GR this week. Next week, GR will be hosted by Chronic Babe and she has a theme, "It's All About The Ladies." Hmmm... I don't know if I'll be able to get into that party. We'll see....

Monday, July 10, 2006

Blogger hopping

Some people call it blogger surfing and others call it blogger hopping. I like seeing what other people are blogging about. I found cathy_bythesea over the weekend (my first Frappr pin in the Philippines!) and she talked about the loss of her father in, "On Losing A Parent:"
I lost my dad when I was sixteen, in the summer before my senior year in high school, on the brink of womanhood. For many years I grieved his loss and looking back now, I realize that I was searching for my father in many of the relationships that I had. Dad, became the yardstick that men had to live up to. Those who knew him well, know that daddy was definitely a hard act to follow. Admittedly perhaps, this is the same reason why I married someone much older, whether fair or not, I was looking for my father when I finally decided to get married. This was something that took me many years to resolve, and when I finally did, through much introspection and by the grace of God, just as the quote above says, it certainly opened doors that I would not have dared walk into many years ago, altered my outlook and changed the dynamics of many of my major relationships.
Fine Art Doctor also talked about the loss of this father in, "Thoughts on July 4th and Memories of My Father:"
My father died when I was seven years old. He woke up one morning with a headache and went to work. While rounding at the hospital he collapsed. He was immediatley taken to the ER but it was too late. He had a ruptured Cerebral anneurysm and the neurosurgeons told my mom there was nothing they could do. As the years pass I find that my memory of my father has faded. I can no longer rememeber the way he smelled, the way he walked, the sound of his voice. If I concentrate I can still see his image in my mind but I often wonder if the recollection is from pictures.
These two selections have really made me reflect upon my own relationship with my father. Even Cathy (not by the sea) recently wrote a cute recollection of her father drinking and singing at her wedding (funny story). What kind of relationship do I have with my father? You always think that you're going to have more time to make great memories, but you never know when your last memory is going to be. I think I'll give my dad a call, maybe he wants to play golf tonight...

Sunday, July 09, 2006

Swingers nursing home

Yesterday was my monthly visit to the nursing home. It's probably the closest thing I have to making house calls. Walking up to the nurses station, I saw their big screen TV. Of course, in a nursing home, the volume is turned up. On TBS was the movie Swingers with Vince Vaughn and Jon Favreau. This is one of the best movies EVER! All I heard down the hall was, "Vegas, baby, Vegas!" More quotes here.

I visited some of my patients down the hall and then came back to the nurses station to fill out some paperwork. As I look up, it's the one "quasi" racy part of the movie with Vince Vaughn making out with this hottie. The funny part is that when I looked up from the desk, there are five wheelchairs huddled around the TV, but all the people in the wheelchairs are sleeping! This sight was SO money!

Then, I realized that I was watching a love scene on TV in a nursing home. I had these conflicting emotions -- part of me wanted to bust out laughing, and the other part was getting more and more nauseated. I quickly finished my rounds before my emotions overcame me.

Saturday, July 08, 2006

Blog conversations

I appreciate it very much when people include me in their blogroll. I'm even more honored when they mention me on their blog. When I do my "blog rounds," I try to leave witty and thoughtful comments. But, for the following two postings, I felt more than leaving comments, I'll talk about it here.

Dinah from Shrink Rap talked about her experience attending the social function of a patient. I really didn't get into my personal thought process when talking about Jen, so I'll talk about them here. (BTW, I forgot to add Shrink Rap to my blogroll, but I'll do it now).

Setting boundaries in your professional life (and personal life) is difficult. There is no magic recipe or book that you can read to find out how and when to do this. Our town measures 16 square miles and has about 16,000 people. This is significantly smaller than the city where I did my residency. So, I knew coming in that I would have to deal with being a small town doctor -- which for all purposes is a celebrity. People definitely know you, know where you live, and know what car you drive. This really disturbed me for the first months I was here, because I was used to riding underneath the radar all the way from high school, to college, to med school, to residency.

It's definitely been a learning process to me. If you met me, I'm a pretty introverted person. And, as you've seen in my blog, privacy and anonymity are important. When I first started working here, I tried to avoid going to big places like Walmart thinking that my patients may stop me, ask me about a medical problem, or ask me to refill their medication. But, a strange thing happened, I learned that for the most part, people in this town respect my privacy and when I'm not "on the clock" conversations have been social and actually pleasant. Of course, there are the few people out there who will take advantage of anyone at any time, but those are few and far between.

At this point, I've accepted the reality of being a doc in a small town and everything that comes with it. It's been a long road, but I've learned a lot about people and a lot about myself along the way.

The Tundra PA has a very delighful post from the "Way Back Machine" -- like from January of this year. The original post is from The Blog That Ate Manhattan and the title is simply "I Love My Blog." TTPA thought that those from Blogaholics Anonymous would enjoy this post, and I agree. Check it out, you'll like it!

Friday, July 07, 2006

Blogaholics Anonymous

Hello, I'm Dr. A, and I'm a blogaholic....

Before we get started, just a couple of announcements. If you haven't signed up for the map, yet, please do so before you leave today. Also, if anyone forgot their container from their covered dish from the last meeting, I have it in the back of the room.

For me, this week was going pretty good until last night. I was flying around reading and commenting on blogs when I got a message in my e-mail box. I go over there and all of a sudden, I had this feeling of anger and rage. It was a spam alert.

Now, don't get me wrong, this is not my first experience with spam. But, when I set up this blog less than a month ago, I set up a new e-mail account also. I couldn't believe that it only took a few weeks until the spam started flowing in. It took a few minutes of slow, deep breathing and meditation until I calmed down. After that, I continued on the blog patrol.

Does this happen to other people with spam? How do you deal with it?

Wednesday, July 05, 2006

Against medical advice

I was sitting in my office Monday afternoon after hours getting some paperwork done, when my cell phone goes off, "Doctor, this is the hospital switchboard, is your pager not working?" I quickly grabbed it. "There are no pages on it," I said. "Well, the ER has been looking for you for about an hour." Oh no, I was thinking to myself. I hope there wasn't anything urgent going on. So, I rushed over to the hospital which is only across the street.

"Sorry, I don't think my pager is working," I said. "I thought as much because you usually call back pretty quick," the ER doc said. "We've got a 54 year-old guy that passed out at home and brought in my his wife. I'm thinking that he probably needs to be admitted."

I go into room 10, "Hello, I'm Dr. A. What happened at home today?" "Well," the patient's wife said, "he was just at home watching TV when he stopped breathing and was out for about 30 seconds. I think his eyes may have rolled back, too, but I'm not really sure."

After a few more minutes talking, I said, "What's going to happen now is that I'm going to do some paperwork to get you admitted to the hospital." "Doc, I don't think I need to stay tonight." What! I thought to myself. "Sir, I don't think it's a good idea for you to go home." "Well, doc, I think I have it figured out. My blood sugar must have been low." As I'm looking at his 320 pound frame, I'm not thinking that LOW blood sugar was his problem.

"Here's the thing," I said, "I have no idea what happened to you today, so I recommend that you be admitted for further testing." I was hoping that I didn't have to go into 'bad cop' mode, but I felt the situation escalating quickly. More discussion back and forth occurred for the next 20 minutes.

"Ok sir," I was fed up at this point, "You certainly have the right to be discharged. All you have to do is sign a paper stating that you are leaving the hospital against medical advice, and you're free to go." "Whoa! What does that mean?" "It means that I, as your doctor, am free of all responsibilty for your medical condition. It also means that YOU are accepting of all the possible complications to your condition which include heart attack, stroke, seizure..." I listed a few more and ended with, "....and possible death." I really hate it when I sound like a lawyer.

"YOU are not going to bully me around like that," he barked at me, "All you doctors are the same, just want to scare us and run needless tests that will turn up nothing anyway." "Sir, it looks like you've made your decision. I've said what I need to say. Let me get the nurse. You can sign the paper, and you can be home in an hour."

I left the room really second guessing myself. Was I too hard on the guy? Could I have de-escalated the situation? What should I have done differently? Maybe I should go back in there and apologize for my tone.

The patient's wife then came to the nurses station to talk to me. She looked sullen with her shoulders dropped and soft voice. I finally got through to them and made them understand. I may have been a little forceful about it, but, in the long run, I think I did the right thing.

"Doc, we've got family coming in tonight. When is the nurse coming in so that we can be discharged and go home?"

Tuesday, July 04, 2006

Tag! I'm it?

Wolfbaby tagged me on "the four things." Of course, being clueless blogger that I am, I had to consult with my blog specialist on what "being tagged" was all about. (Thanks Moof!) So, here are my answers:

Four Jobs I have had:
America's Top Model (oops, wrong list)
golf caddy (would you like the 7 or 8 iron for this shot?)
k-mart inventory/stocker guy
domestic environmental specialist (cut laws for a few summers)

Four movies I would watch over and over:
Airplane: The Movie
Spies Like Us
Hunt For Red October

Four places I have lived:
Mars (aren't men from Mars?)

Four TV Shows I love to watch:
Big Love
MTV: The Real World (guilty pleasure)
Anything on the Golf Channel

Four places I have been on vacation:
Key West
Grand Canyon
San Francisco

Four sites I visit daily:
Bloglines (does that count as one site?)
PGA Tour.Com
The Unofficial Apple Weblog
The Weather Channel

People I will tag -- You're It!:
jumpinginpuddles (sorry, looks like they already got you)

Independence Day

Joke of the day from Late Night with Conan O'Brien:

"July 4th is the day where America celebrates it's Independence...
....from Star Jones." HA!

Have a happy and safe holiday....

Monday, July 03, 2006

Dirty little secret

As I begin this third week of blogging, I found out something a little disturbing -- maybe I'm not as anonymous as I once thought I was. In the midst of my sidebar overhaul over the weekend, I added a couple of new counters and a cool map.

When I'm further exploring this, I'm learning that when I'm logging into other people's blogs, they can figure out what city and state I'm in. They even know I'm viewing them on my trusty Mac and the resolution on my screen (hell, I don't even know the resolution on my computer screen).

The super-techo-geeks out there could also probably tell me the prescription of my contact lenses, the color of my shirt, and the cologne I'm wearing today. The evil super-techno-geeks out there probably know my mother's maiden name, my social security number, and the expiration date on my discover card -- Scarry!

So, as you're out there on the information superhighway, don't think you're out there in some kind of stealth car hopping from site to site. The reality is that you're driving out there in a mustang convertible with the top down. The least that you could do is wave hello...

Sunday, July 02, 2006

Tour De France

I'm not a cyclist myself, but like a lot of other Americans, I became hypnotized every July for the past few years because of the story of Lance Armstrong. In his book, "It's Not About The Bike," Armstrong talked about his bout with cancer and his road back to cycling, eventially to win the most prestigous race in his sport.

The start of this year's race was yesterday. But instead of the usual talk about who is going to win, the buzz was about the riders removed from the TDF because of an international doping scandal implicating many of the top riders in the world. Although he retired last year, Armstrong himself was accused of using banned substances.

The Spanish authorities say that other sports could be involved, like soccer and tennis. We already know about the controversies with steroids and baseball in this country. And, every olympics, there is always talk of someone who had a positive drug test and had to give up her/his medal.

When I was growing up, sports was about learning the fundamentals of the game, learning to listen to the coach, and learning to work as a team. It was a great way to learn some socialization skills as a kid and to learn some strategy skills also -- skills that you could apply as an adult. In school, we used to joke about the use of "roids" in body builders. But now, the term is "performance enhancing substances," and there's talk about it everywhere - even at the grade school and high school levels.

Kids these days have lost interest in sports. Some coaches and some parents put so much emphasis on winning, that it turns kids off. They're happier in front of the xbox. Decreased interest in physical activity has also contributed to the obesity problem. Granted, playing sports is not the end all and be all solution for a happy and healthy childhood. But, without sports, I think kids are missing out on a lot.

Saturday, July 01, 2006

Add-on addiction

Ok, so I went about 36 hours without blogging and I just cannot take it anymore. GEEZ! Glad I said it. Actually, I've been on blogger all day (confession), but did not post anything until now.

As you can see on my sidebar, I kind of went nuts today. I was reading this from the blogger help desk about stuff that can be added to the page. I said, "Hmmmm, this looks interesting." So, I checked out some of the links, and did some google searches on my own. And, I explored other blogs to see what they had on them. What I kept reading was that if you can figure out how to change your sidebar links, you'll have no problem with add-ons to your blog. So, I tried my first one, and it worked!

Before I knew it, six hours went by and I just kept adding, what I thought was cool stuff, to my blog. It was really hard, but I cut myself off from searching anymore. I trimmed down the amount of stuff over there (that was tough). And, ended up with what you see now as the "new and improved" sidebar.

Here are just two things I want to highlight:
Frappr Map: You can put a kind of thumb tack anywhere on this map. Can also post a comment and other stuff I haven't figured out yet. You'll see that I put myself in Key West. I have visited there a few times and would like to live there eventually (except during hurricane season).

Babel Fish translator: It's strange seeing this page translated in different languages. I tried and it works for most of the languages listed.

There is so much more stuff over there that I don't even know what they do yet. But, they look cool, don't you think? All I have to say for myself is this, "I'm Dr. A, and I'm an Add-On Addict." Please help me!