Germ zone

I finally figured out where I got this cold I've been dealing with for the past week. It started last weekend when I was in DC. According to this article from this morning's Boston Globe, my hotel room could have made me sick.

When sick hotel guests leave their rooms, they frequently leave something important behind: the virus that gave them their colds.

During an overnight hotel stay, people with colds left viruses on telephones, light switches, and television remotes, researchers said yesterday at an infectious disease conference in San Francisco.

We've all heard about not coughing on people and not sharing cups with people who have colds. Now, apparently, you're going to have to ask if the people who had the hotel room before was sick. Wouldn't that be interesting? When it comes down to it, I agree with Dr. Owen Hendley, University of Virginia Health System, who led the research.

"It's an interesting study," he said. "But they haven't shown infectivity. I'm not going to go around opening doors with my elbows."

Big apple fat

Usually when you mention the word "trans" in New York City, you mean something completely different. But, right now, NYC's hottest "trans" is trans fat. Why? Because earlier this week, the New York City Health Department proposed a near ban on trans fat in NYC restaurants. As you already know, trans fat is found in fast food, cookies, cakes, and basically anything I think is good to eat.

"Trans fat causes heart disease. Like lead in paint, artificial trans fat in food is invisible and dangerous, and it can be replaced," New York City Health Commissioner Thomas Frieden said in a statement. (quote from Scientific American)

In the following quote from SFGate.com, by proceeding with a ban of one substance seen to have health concerns, this sets the precedent and opens the door to a laundry list of possibilites of future food bans.

There's also the issue of what should be banned. What about high fructose corn syrup? Sodium? Cases have been made that they're just as harmful as trans fats. Should we put a cap on the number of calories that people are allowed to order in a restaurant?

I always love when the government tries to legislate behavior. By making trans fat, in a sense, illegal, doesn't it then make it more attractive? This may seem silly, but I see drug dealers turning into trans fat dealers. They would hang out outside of NYC's swankiest (is that a word?) restaurants with one side of the raincoat with cheap Rolexes and the other side with illegal donuts to bring into restaurants. Sales of crack, heroin, and meth will fall off dramatically in favor of french fries.

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

Resources

This story from the Hamilton Spectator kind of hits home for me. It talks about a small hospital and what hospital administration does to try to improve the hospital and the community.

Why wouldn't Hamilton Health Sciences (HHS) put more money into emergency rooms to attract and keep doctors? Why wouldn't HHS top up emergency physicians' salaries to ensure stability and appropriate levels of service? It makes good sense.

Especially for small hospitals and small communities like this one and like mine, there are limited resources and priorities have to be made on where and how resources are managed. I'm all for getting the best docs and building the best facilities, but there are consequences to that.

The problem with emergency staffing seems to be double-edged -- crummy working conditions and pay that's not great. HHS has chosen to address those issues to ensure adequate emergency services.

Don't get me wrong. I'm not trying to lead you down a path here - especially with my posting yesterday of paying docs more. Like I said above, my small community and my small hospital are going through this right now.

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

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

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

Family Docs Rock!

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

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

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

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

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

Grand Rounds

GR 3:1 is hosted this week by Enoch Choi, MD from Tech Medicine. I wasn't aware that GR has been going now for 2 years. Congrats to Nick Genes. Anyway, Dr. Choi is kind of having a "Medical BA meeting" over there with appetizers and everything else. I'm under the "Who's Hot and Bothered" section.

Dr. Anonymous considers the FDA a bureaucracy without merit and next week's Grand Rounds host thinks clinical trials are sometimes without merit as well.

Got back home late from DC last night. Can't believe I'm back at work today. Oh well. Checked the site meter and it was over 400 yesterday, thanks to all of you! That's the highest it's ever been, at least for me. I haven't had a chance to review all the comments and my e-mail yet. Hopefully, I'll be able to do that in the next couple of days. However, I'm on call tomorrow. Sheesh! Thanks for coming to the DC BA meeting yesterday.

BA in DC

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

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

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

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

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

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

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

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

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

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

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

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

Oxymoron

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

Here's the news story: The Institute of Medicine, the people who stated that between 50-98 thousand people die each year from hospital errors, released a report Friday criticizing the FDA about how it reviews drugs, according to this report. Don't get me wrong, the FDA itself ask for the review.

Newly approved drugs in the U.S. should carry a warning that their safety isn't guaranteed, the medications should be reviewed in five years, and they shouldn't be advertised for two years, according to a report released Friday.

The report, released by the U.S. Institute of Medicine, said the Food and Drug Administration hasn't done enough to oversee new drug safety. The institute said the medications should carry a symbol, such as a black triangle, indicating they might not be safe. It also suggests agency rules be enforceable with fines.

Ok, let me get this straight. They want to put a warning that the safety isn't guaranteed? Why not put the same statement here that's on all herbal medicines: "This medication is not intended to diagnose, treat, cure, or prevent any disease." In fact, I believe that this puts more regulations than on herbal medicines.

"This report should be a watershed moment for FDA reform," said [Iowa Senator Charles] Grassley. "Public safety is at stake, along with the credibility of our nation's drug-safety agency."

FDA reform? Gimme a break. This is government bureaucracy. No one in this town that I'm sitting in right now has the courage and the political clout to do anything about it. The FDA is a good punching bag and the status quo will remain after all the hype. It's kind of like saying United Nations reform. Yeah right...

On the road

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

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

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

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

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

Grand Rounds

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

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

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

Transplant

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

The Seattle Post-Intelligencer posted on their website the first successful penis transplant ever reported in a medical journal. This occurred in China and here's the quote from the article itself.

The Chinese doctors could not be reached for comment, and their report does not explain how the 44-year-old man lost his penis. It says only that "an unfortunate traumatic accident" left him with a small stump, unable to urinate or have sex normally.

Surgeons led by Dr. Hu Weilie at Guangzhou General Hospital performed the transplant in September 2005, a hospital spokesperson said Tuesday. The penis came from a 22-year-old brain-dead man whose parents agreed to donate his organ.

Update: MSNBC is now reporting that the transplant had to be removed because of "severe psychological problems experienced by the man and his wife." Oh well...

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

Hospice

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

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

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

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

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

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

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

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

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

Balance

Ran across this great post today from my new blog friend, The Curmudgeon, who is a lawyer. Imagine that, a lawyer and a doctor agreeing on something - call the papers. Anyway, he was wondering of striking a balance between blog life and real life.

Since I'm self-employed, there's no one except me to tell me to stop reading other people's blogs and get back to work. I have noticed that my productivity is not what I would hope it should be some days, especially when I read on too long, chasing link after link. (Of course, my productivity is never what I think it should be... and it's been like this for years, even before I ever heard about blogging... but, you see? I'm already digressing....)

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

I'll hang up now and wait for your answers.

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

Error

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

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

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

Don't get me wrong. I'm not defending the hospital nor am I excusing their behavior. But, in reading the article, in cases like this, there is some kind of system breakdown to cause this tragedy to happen. I'm not looking to assign blame, I'm looking for a way to prevent this from happening again in the future. From the article:

Odle [hospital president/CEO] said the preliminary investigation showed a staff member, likely with the pharmacy department, placed a vial of the wrong concentration of the anti-coagulant drug heparin in a drawer of a drug cabinet at the nurses' station of the neonatal unit.

Subsequently, at least one other staff member -- probably a nurse or several nurses -- removed the vial from the computer-controlled cabinet and did not double-check to make sure the vial matched the concentration listed on the cabinet drawer before withdrawing the liquid drug into a syringe. The babies then were given an overdose.

My sympathies go out to this family. Obviously, this is something that should not have occurred. According to the article, police have ended a criminal investigation ruling it an accidental death. However, the family and the community will demand some kind of accountability. We'll have to see how this story plays out.

Yearly drug

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

I really try to keep up on this stuff. Because even though this drug is still in clinical trials and not able to be prescribed yet, I guarantee I will get questions about this in my office. Even though it sounds promising, here's the rub...

The most common side-effects associated with intravenous injection of Aclasta included fever, muscle pain, flu-like symptoms and bone pain. Most occurred within three days of administration of the drug and were resolved within three days of onset, Novartis said.

Potential side effects is one of the major stumbling blocks for drugs succeeding. There's already a drug out now for osteoporosis which you only take once a month. "Does this mean that if I have side effects, they will last a month?" patients ask me. I then quote them the info from the company, but the perception is there. Yes, it's good that you only have to take it once a month. But, it's bad if you have a problem.

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

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

Play that funky music

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

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

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

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

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

Sunday

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

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

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

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

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

Crossed legs strike

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

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

But, NO! Forget that deal, Pedro. The women of the Columbian town called Pereria have taken things into their own hands, sort of. They have declared what they call the crossed legs strike, according to this story from CBS news. Apparently, when their men give up their guns, they will give them some lovin'.

One gang member's girlfriend said withholding sex was proving a powerful incentive. "The boys listen to us. When we close ourselves off a bit they listen to us. If they don't give up their weapons, then we won't be with them," Margarita told AP Television.

"They say that if we don't drop our weapons, they won't be with us anymore," said a local gang member, who called himself Caleno. "We need our women, and you'll change for your woman."

I've heard that the United Nations is really getting behind this initiative. Instead of the oil-for-food program, they're calling this, well, you can probably figure out the name yourself.

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

Spinach frenzy

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

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

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

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

Blog responsibility?

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

The response to these stories has begun. According to this item from CNews, the "online community," (don't you love how things are phrased) states that the actions of the shooter has nothing to do with the site.

Site owner Jethro Berelson, who goes by Jet online, insisted Thursday that Gill’s actions and comments had nothing to do with the site or goth culture.

“You know, I think people on the site are generally very friendly and nice, and don’t really do any crimes,” he said in a telephone interview from Brooklyn, N.Y.

Goth is a culture? I had no idea. But, here's the thing. What bothers me is the fact that this is not the first time this site has been linked with a murder.

[the site] came under the media spotlight in April after a triple murder in Medicine Hat, Alta. A 12-year-old girl and 23-year-old man accused of the killings were alleged to have profiles on the site.

Even though this Montreal story is new, it goes back to the same old debate: Does the media (movies, music, television, videogames, internet, blogs, etc) have a direct link to influencing a person's behavior? Does the media have a responsibility to society to prevent producing products that are deemed harmful?

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

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

Don't pass the spinach

The US Food and Drug Administration just announced an E. Coli outbreak in eight states. There has been one death and about 50 people who have been made sick by this infection. The outbreak has been linked to bagged spinach and the FDA is advising avoiding it.

There's a cheap spinach joke in there somewhere, but I'm not going to take it. Hardly anyone dies from the E. Coli O157:H7 bug. That's why this story is alarming to me.

The Centers for Disease Control has good information on O157:H7 here:

Escherichia coli O157:H7 is an emerging cause of foodborne illness. An estimated 73,000 cases of infection and 61 deaths occur in the United States each year. Infection often leads to bloody diarrhea, and occasionally to kidney failure. Most illness has been associated with eating undercooked, contaminated ground beef. Person-to-person contact in families and child care centers is also an important mode of transmission. Infection can also occur after drinking raw milk and after swimming in or drinking sewage-contaminated water...

Most persons recover without antibiotics or other specific treatment in 5-10 days. There is no evidence that antibiotics improve the course of disease, and it is thought that treatment with some antibiotics may precipitate kidney complications. Antidiarrheal agents, such as loperamide (Imodium), should also be avoided.

Personally, I've never taken care of anyone with this infection. But, in reading about it and in talking with some physicians, you definitely do not want this. Hopefully, this outbreak will be brought under control soon, and the amount of illness will be limited.

134340

If you don't know, this is the new name for the "Planet formerly known as Pluto." This will be a trivia question soon, so don't forget it. In other naming news, the rock in space that, in my opinion, got Pluto kicked out of the planet club, was also renamed. The "before" name was "2003 UB313" (by the International Astronomy Union). The "after" name is now Eris, after the Greek goddess of discord.

Here's the funny part. The nickname for "2003 UB313" was Xena, as in Xena: Warrior Princess, the TV show. I know this is not true, but to think that a television show had an impact on the universe, it makes me chuckle a little bit.

I think I have to let go of the "Pluto is a planet" thing. Time to move on.

Top page posts

This question is only for true blogaholics. This is not for the faint of heart. If you're only a casual blogger, then move on, because this is not for you.

So, I'm up late tonight, as usual, on call. And, I'm out in blog land seeing what's going on. One of my favorite things to do when I find a new blog is to read the very first few posts. Even though the topics are usually the same ("My first post," "Insomnia," "Will anyone read this," etc), I always enjoy reading them.

On my blog, all 103 posts are on one page only. So, it's easy to scroll down to post number one. BTW, in reviewing my own early posts, I totally forgot about this one. Some blogs have all posts on the top page. Others, only have a few. Still others only have one post on the top page. Hmmm. I found this really interesting.

So, blogaholics, here's my curious question: How did you figure out how many posts to place on the front page of your blog?

For me, I just wanted to put everything on one page. But, some people may find that annoying, saying, "Who's going to scroll through 103 posts? Just put the five most recent up there on the top page. Sheesh!"

While you're discussing that, I'll head to the kitchen to get some refreshments for everybody. I think I have some cider and seaweed in the back. Any takers? HA!

Weight loss

Fucoxanthin: This may sound like a character in the latest videogame, but this compound is the future of weight loss. Some of you may know this already but fucoxanthin is found in seaweed, yes, seaweed. According to this article from Irish Health, wakame is a brown seaweed commonly used in Asian soups and salads. Fucoxanthin is the compound in wakame that promotes weight loss and even has anti-diabetic effects.

Dr. Kazuo Miyashita from Hokkaido University told the American Chenical Society National meeting in San Francisco that significant reductions in fat tissue were reported in rats and obese mice fed the edible seaweed carotenoid fucoxanthin.

Fucoxanthin induces expression of the fat-burning protein UCP1 that accumulates in fat tissue around the internal organs. Mice fed fucoxanthin showed clear signs of the fat-burning protein in fat tissue, whereas mice fed a control diet showed little sign of this protein.

Translation? You watch, wakame cafes will take the country by storm (How do you pronounce that kind of cafe?). Soon, one will be near you. They will be serving the "Seaweed Soup and Salad Special." (Say that three times fast) Fucoxanthin will be shortened to "F-thin," and the marketing will be huge. "The F-thin Factor" will be a best selling book, etc. Remember, you heard it here first.

Or, this research will be proved wrong, and you can go back to eating donuts and drinking diet coke again. I'm not a big seaweed fan anyway. Calamari, maybe...

Groundhog Day

Has anyone seen this movie, because I feel like that's what I'm going through today - no whining here, just this weird feeling today. For those who have not seen it, the movie is about a guy who lives the same day over and over and over again.

I was on call last weekend and I'm on call today. For us, if you're on call the weekend, then usually no call until the next week. One of the docs here is on vacation this week (Did you really need to know all these details? I'm thinking no.) So, for today, some quick thoughts on some topics, because my blogger withdrawl is driving me crazy!

On Call: It was a rough weekend for one of my patients. He had to be transferred to the intensive care unit. I had some long conversations with his family. Overall, things do not look good. He's a very nice gentleman, too, and one of my favorite patients. Really hard to see someone suffering like that, even though we are doing everything that we can. This is a part of my job that I do not enjoy.

The Path to 9/11: For those who have not heard of this, it's a TV miniseries that was broadcast on ABC television the past two nights. I did not get a chance to watch it yet, but I do have it on videotape for me to watch later this week. Apparently, there was a lot of discussion last week about this tv show. I can't wait to watch it and judge for myself. Did anyone see this miniseries?

9/11/2001: It was really interesting to read as people were retracing their steps. I did a little reflection as well, because none of us will ever forget where we were at and what we were doing that fateful day. Maybe someday I'll try to recreate that day on my blog. I was just too busy yesterday (with work) to put together a detailed account of what I was doing and feeling on that day.

Bestest Blog of the Day: So, Sunday at around midnight, my pager went off and I answered the call. Before going back to bed, I checked my e-mail, as I usually do before drifting off to sleep again. I was pleasantly surprised to find an e-mail congratulating me on being the Bestest Blog of the Day for 9/11. My first thought was, hmmmm, that's interesting. I felt kind of awkward. It was a definite mix of emotions. I was happy for myself, naturally. But, those feelings were mixed with all of the emotions of 9/11 and my fatigue of being on call. Maybe I should have just blogged about it.

I've got my blogging fix for now. Back to work. Maybe more later...

National anthem

I was frantically running late trying to get to the stadium for the soccer game. (In case you don't know, I'm the team doc for our boys high school soccer team.) Trying to find a parking spot is usually crazy as game time gets closer. Fortunately, things weren't too hectic because the junior varsity game draws a smaller crowd. So, the parking lot was not that bad.

I got out of my car, put on my cap, grabbed my "doctor bag", and rushed into the stadium. Actually, it's not your stereotypical looking doctor bag (like my profile picture). It's just a gym bag with tape, ace wraps, and other items for injuries.

Fortunately, the junior varsity was still warming up. A couple of our players asked me to tape up their ankles prior to the game. I also talked with some players who were managing injuries, and they seemed fine.

You can definitely feel the electricity in the air before a game - particularly before a varsity game. We play at the (gridiron) football stadium. And, before the varsity warm up session, the stadium lights are turned on. This definitely adds to the excitement.

Before each game, the referrees bring both teams to the center of the field and review items of sportsmanship - for example, being careful of overly rough play, intolerance of profanity during the game, etc. Following this, the team captains remain with the referees to determine who will get the ball first. The rest of the team has a final pre-game conference with the coaches.

After the captains return from the center of the field, the drama and the excitement continue to build as each player is announced over the loud speakers. Now, the crowd really starts to get into it. No one can wait any longer for the game to get started. Just when things are about to reach a fever pitch, the loud speakers blare with this announcement: "And now please stand for the playing of our national anthem as we honor America...."

Time pauses at that point. I believe that this is the most beautiful moment in sport. Even if it's our arch-rival high school, who usually brings a loud crowd and a good team with them, at this moment, we are unified and we are one. The crowd goes from a roar to absolute silence as all of us look to at the farthest point of the stadium where the flag is seen in the night sky. For a moment, all of us forget about soccer, forget about sports, and focus on what's really important...

Oh, say can you see,
By the dawn's early light,
What so proudly we hailed
At the twilight's last gleaming,
Whose broad stripes and bright stars,
Thru the perilous fight,
O'er the ramparts we watched
Were so gallantly streaming?
And the rockets red glare,
The bombs bursting in air,
Gave proof through the night
That our flag was still there.
O, say, does that
Star-Spangled Banner yet wave
O'er the land of the free
And the home of the brave?

According to Blogger, this is my 100th post. I'm on call this weekend, so I'll see you next week, sometime. Remember Monday. God Bless America.

Update 1: Thanks to all of you who put tributes up on your blogs over the weekend. I've been reading a lot of them and they are so moving. None of us will ever forget.

Update 2: I was pleasantly surprised to learn that I've been named the Bestest Blog of the Day by Morgen from It's a Blog Eat Blog World. Morgen is of the newest members of Blogaholics Anonymous. Thanks Morgen for the selecting me today, and thanks to Bobby Griffin from Bestest Blog for the opportunity to be a member of your blog list.

Modesty gown

Interesting story from London today. Apparently, two English hospitals will be offering head-to-toe hospital gowns for Muslim women who request them. A picture of the gown is on the link for the article.

"I noticed a gap in the market and thought that it would be great if there was a gown that helped to preserve a patient's modesty," said Karen Jacob, linen services manager for the trust, who designed the product.

In looking at various media stories today, some call it a "Muslim gown" and others call it a "modesty gown." How things are phrased is so interesting to me.

Some people would call this action cultural sensitivity and others would call it cultural favoritism. Personally, I don't have a problem with the gown. But, it does set a cultural precedent of sorts. Does this mean now that African and Asian religious/cultural customs and values will be observed at this English hospital in addition to those from the Middle East? Something to watch for and something to think about...

Artificial heart

The New York Times is reporting that the US Food and Drug Administration approved the sale of the first fully implantable artificial heart. Apparently, this device allows the patient to move about freely for up to two hours at a time.

The approval was given even though the grapefruit-size device was implanted in just 14 patients at four hospitals from 2001 to 2004. All of the patients, who agreed to receive the heart as an experimental device, were men, and all have died.

Two died from the implant operation. A third never regained consciousness, and the rest survived an average of five months. The longest survivor lived 512 days, when the mechanical heart failed.

Did I read that right? Fourteen patients in a four year period? All who received the device eventually died? If this was a medication, then it would be laughed out of the room instead of being approved.

The company is approved to sell 4,000 a year. But, in all likelihood will only be about 25-50. The cost? A cool $250,000. The company is not even sure if it will receive insurance coverage for the device yet.

For me, this is under the category of "just because we can do something, doesn't mean we have to do something." Granted, I realize that there are thousands of people who die each year waiting for a donor heart. The article also states that in the last six months of live, the slowing dying heart patient incurs an average of $1 million in ICU expense alone.

But, 14 patients in a four year period? Fourteen months ago, according to the article, the FDA voted to deny this same device because of concerns of complications like bleeding, strokes, and infection. Like the FDA is not embroiled in enough controversy with Plan B, Vioxx, Bextra, and other medications in the news.

In my opinion, these are just lawsuits waiting to happen. And, there are attorneys salivating out there just waiting for something to go wrong so that they can swoop in to defend these "victims" against the evil entrepreneur doctor who is seeking fame and fortune at the expense of a patient with a failing heart.

Update: I didn't realize the New York Times site only has limited access. Here's the article from The Washington Post. Hopefully, there are no access problems with this.

Stingray tape

The initial postmortem examination confirms that a stingray's venomous barb pierced Steve Irwin's heart causing his death, according to this article from National Geographic News.

It's not surprising to imagine that this entire incident was caught on tape. But, this article does confirm that there was video footage of the attack. This footage will now be examined by the coroner.

Irwin's friend, director, and producer, John Stainton, who was on Irwin's boat Croc One when the attack happened, says it is too early to release the footage of his friend's fatal encounter to the public.

What? Does anyone actually want to see this footage? I know that I don't. But, you know what will happen. The tape will be leaked out in some way and eventually end up on the internet and probably YouTube.Com as well. His family, friends, and fans are suffering enough. I hope this video is never released.

Update: Health Psych made this comment, "And the Steve Irwin backlash kicks off..." This article from the Guardian clearly exhibits this.

As a Melbourne boy, Irwin should have had a healthy respect for stingrays, which are actually commoner, and bigger, in southern waters than they are near Port Douglas, where he was killed. The film-makers maintain that the ray that took Irwin out was a "bull ray", or Dasyatis brevicaudata, but this is not usually found as far north as Port Douglas. Marine biologist Dr Meredith Peach has been quoted as saying, "It's really quite unusual for divers to be stung unless they are grappling with the animal and, knowing Steve Irwin, perhaps that may have been the case." Not much sympathy there then.

Blaming the guy who got killed? What the hell is that about? It's worse than kicking a guy when he's down. It's kicking a guy when he's dead. This really gets me upset. Of course, the next paragraph of the article mentions the controversial episode where he had his one month old son in one hand when visiting a crocodile in an Australian Zoo. The press just get me fired up sometimes.

Here's what I predict is going to happen. Politicians both in Austraila and in the US will use the hype generated by the press to pass laws preventing less direct contact between animals and people. The politicans will get a hold of the videotape from the Irwin episode and will broadcast it to make their point. The consequence of this will be significantly less wildlife/nature shows for television. And, television networks like Animal Planet will eventually become extinct. To be honest, I don't even watch nature shows. Am I overreacting to all of this?

Blogaholics Anonymous

Hello, I'm Dr. A, and I'm a blogaholic... Here's a question: Is it possible to tag yourself? (Insert joke here.) Anyway, in catching up on my bloglines, I was over at The Granola Rules and she got tagged by the latest meme to circulate the blogosphere. Title of the meme: What does blogging mean to me?

With everything going on lately (at least in my circle of bloggers), I figured, why not have a BA meeting and go through these questions! Now, BA meetings are only for those addicted to blogging (see my sidebar for details). If you're not, then this post is not for you - except if you're in denial of your blogging addiction - HA! Since, I'm hosting the meeting, I'll answer the questions first.

1) Are you happy/satisfied with your blog's content and look?
Uh, since day one of my blog, I've been obsessed with my sidebar and I have kept adding things to it. If people have cool sidebar stuff, please let me know (am I allowed to say that at a BA meeting?) As far as the content, I've been asked if I know any receipes and I can affirmatively say NO! (I'm not a cook, I only play one on TV) HA!

2) Does your family know about your blog?
Are you kidding? No way. Even if they did know, they wouldn't find it interesting. I don't talk a lot about my family in my blog. Not that I have a problem with talking about your family, I just choose not to.

3) Do you feel embarrassed to let your friends know about your blog? Do you consider it a private thing?
I presume this means your non-blog friends. I've been struggling with this question since I started. I guess I'm still of the mind set that it is a private thing. I've had some of my blog friends try to get me out of my shell to reveal myself, and I've been hesitant. Still thinking about my "semi"-anonymous status.

4) Did blogging cause positive changes in your thoughts?
I have no idea what this question even means. I'm glad I started blogging and I'm glad that I'm continuing. There were times when I considered stopping. But blogging definitely fills a need I have to express myself and connect with other people.

5) Do you only open the blogs of those who comment on your blog or do you love to go and discover more by yourself?
When I first started, I loved discovering blogs on my own - mainly by hitting the "Next Blog" button to see where I have ended up. Now, that my blogroll and my bloglines have increased, I've had less time to randomly stroll around the blogsosphere. I miss that.

6) What does a visitor counter mean to you? Do you like having one on your blog?
Great question. Yes, I do have a counter. I'm very competitive, and I have to admit that I'm jealous of those of you out there who have hundreds and hundreds of hits a day. I'm resigned to the fact that I will probably always be a Slimy Mollusc and will always be around 100000 on Technorati. But, I come back to telling myself that I do not blog for rankings or popularity. I blog for myself. If I lose sight of that, then that's the time for me to stop.

7) Did you try to imagine your fellow bloggers and give them real pictures?
I know fellow bloggers imagine me *waving at wolfbaby*. But, seriously, I have not given a real picture out, yet (see question 3 above)

8) Admit it. Do you think there is any real benefit in blogging?
Of course there is, or else none of us would be doing it. I tell people blogging is like putting a podium in the public square and speaking your thoughts. People can choose to listen, or not. People can choose to interact with you, or not. But, in a way, you feel like you're heard by someone, and that's comforting.

9) Do you think that blogger's society is isolated from the real world or interaction with events?
I think bloggers are part of the world in general. Do some bloggers choose to isolate themselves from current events? Yes, but some non-bloggers isolate themselves as well.

10) Does criticism annoy you or do you feel it's a normal thing?
I think I criticise myself more than anyone else. I don't know why, but I've gotten that feedback my entire life, "Don't be so hard on yourself." Criticism is normal and necessary. It just has to be constructive and not destructive.

11) Do you fear some political blogs and avoid them?
I don't fear political blogs, but I do avoid them. Especially now, politics is not about ideas and vision and leadership. Politics now is about total obliteration of a person's character and reputation. That's why the people who should be in politics to change things for the better - they avoid politics, and that's very sad.

12) Were you shocked by the arrest of some bloggers?
Technically, I was not arrested, I was only questioned. Just kidding. Were bloggers arrested? I did not hear of that.

13) What do you think will happen to your blog after you die?
I think it will be at the Library of Congress for future generations to study and learn from. Yeah right. I don't know what will happen to me tomorrow, let alone about my blog after I die.

14) What song do you like to hear? What song would you like to link to on your blog?
My Way but sung by Elvis Presley

15) The next "victims"?
I'm not going to tag anyone. This is a good set of questions. Blog about it if you like, or just comment on my answers. Thanks for stopping by!

Labor Day

If you ask any American what Labor Day is, you will probably get a variation of answers. It's not like Independence Day or Thanksgiving where there is a story that gets repeated every year. How did Labor Day start? When was the first Labor Day? I have no idea.

For most school kids in the US, Labor Day means the last weekend of summer. Most schools begin classes the day after Labor Day. One distinct memory I have of this holiday weekend is going to our local fair. This is a huge annual event around here. I never lived on a farm, but I had a lot of friends who did. Their entire summer was centered around this fair. Some had prized animals that would be shown and judged every summer (horses, cows, etc). Others helped their parents in the garden and had prized vegetables that would be shown every year. We have a diverse community and there would be a showcase of different ethnic foods, arts, dancing, etc, during fair week. Lots of great memories from back then. There are times I wish I could go back to those innocent days. The days when my biggest worry was whether my friends and I would have the same teacher for school the next day. Ahhhh, those were the days.

Another memory I have is watching the US Open tennis tournament every year with my parents. I still do this, and I'm planning to go over there today. In high school, I was really into tennis (when I was more athletic than I am now). And my friends and I would follow the tournaments all through the summer with the pinnacle being the US Open. Yesterday, one of my childhood heros played his last professional tennis match: Andre Agassi. I have watched this guy for the past 20 years, at different stages in his career and in his life. I'm always inspired by a superstar athlete who admits when things are not going well. I learned a lot about tennis and a lot about life. Thanks Andre.

The final memory that I'll mention is the annual Jerry Lewis Labor Day Telethon for the Muscular Dystrophy Association. Pk has had some very informative posts this weekend about muscular dystrophy. I encourage you to check them out. I had no idea what a telethon was until I started watching this as a child. I would ask my parents, "If the show goes on all day and all night, when do people sleep?" This was also one of my first introduction into fundraising as a child - not a bad thing, just a new concept that I learned as a youngster - the concept of philanthropy. I kept asking myself, "Why would people help other people that they don't even know?" I soon learned the answer to that one. Finally, it was one of my first introductions into medicine, or, at least, learning about a disease process. As a child, and even now, it was/is hard for me to imagine a child suffering for any debilitating disease.

Finally, I'm glad just to get August behind me. That was a very turbulent month on a lot of different levels. Thanks to May for giving me some closure and the ability to move forward. I'm ready to satisfy my blogging addiction again.