SF Pics

Back in the saddle again -- Let me tell you, I could really get used to taking time off. I don't think I have felt this rested in a long time. Boy, did I need it because I think my entire patient pool called today.

Don't get me wrong, I did feel the love from my patients. It was just a little overwhelming. I couldn't help but crack a smile everytime a patient said, "I'm glad you took some time off, because you deserve it. But, I'm so glad you're back!" I was so relaxed that it didn't bother me, at the time, to explain that our office totally used up our flu shot supply while I was gone (no rant from me, yet, on this).

I'm on call Wednesday. I don't even think I remember what it is to be on call. LOL! I think I was last on call about two weeks ago - an eternity in my work life. We'll see how Wednesday goes.

Since I've gotten back, I haven't had the time to post the pics on my Flickr page -- until now. I definitely learned from last time with my DC pics. Who has the patience and time to look at 82 pictures? Certainly not me. I just wanted to test out my Flickr pro account.

So, this time, only 15 pictures for your to peruse. Before you ask, no, you will not find Dr. A in this set. The digital camera ran out of battery before I could take any pictures of me. Believe that? I didn't think so. I'll be a while before I go out of town again, so enjoy the pics!

Time travel

What a long day yesterday. We left our San Francisco hotel at around noon to make our way to the airport. We told our taxi driver that we were going to the airport. "San Francisco airport?" the driver asked. All of us looked at each other and kind of told ourselves, "Duh!"

Our driver then told us that Oakland airport was about the same distance from our hotel and one time he took a passenger all the way to SF airport only to find out that the person was flying out of Oakland airport. Interesting.

All of us thought that it would be a heavy travel day and there would be long lines at the airport. But, we checked in without incident and went through the security line with no problem.

Our first snag occurred when we were told that our departure from SF would be delayed for an hour. Unlike when we had a straight flight to SF, we had a connecting flight going home. So, we began to worry about missing our connecting flight in Chicago, and maybe losing our luggage.

Four hours later, we landed in Chicago. The flight attendant told the plane to allow those with connecting flights off the plane first. Of course, no one listened. So, we had to negotiate from our 50th row seat to other passengers that we had to rush to our connecting flight. Most people were reasonable, but there's always that one person whose life is always more important than yours.

Luckily, the airport has an outside shuttle bus which takes people from the "c" concourse to the "e" concourse, where our gate was. There would be no way that we could walk that entire way in the five minutes we had to change planes. But, we made it home, with all of our luggage, ok.

It was past midnight when we landed at home airport. Someone said, "It's really 11pm anyway with that time change thing." Oh yeah, I forgot that daylight savings time ends and we had to turn our clocks back.

What an interesting concept. Some bureaucrat determines what time it is and has the power to "time travel." In doing a quick search, I found an interesting article describing the history of daylight savings time. And, Congress passed a law last year that will extend daylight savings time in 2007. (NPR)

These last 10 days have been very relaxing. Not looking forward to going back to work tomorrow, but I know I have to. Thanks for the great feedback on my blogcasts. They were fun! Don't know when my next one will be. A different change of pace from the written blog.

Blogcast 3

I'm leaving San Francisco around midday for home. We have a connecting flight through Chicago tonight. And, everyone knows the risks of possibly missing your connecting flight home and/or your luggage not making it back to your home airport. So, this will be an interesting travel day.

But, before all that, I recorded blogcast 3 last night - and obviously posting it today. I don't know if these are getting better or worse as I do more of these. I guess you can be the judge of that. Enjoy DABC3.

Fashion Police

I've talked about professional dress before on my blog - whether it be to wear or not to wear a lab coat, or to wear or not to wear a tie.

Now, the board at the East Lancashire Hospitals NHS Trust have taken this to an entirely new level (high or low depending on your opinion). They are proposing a dress code banning things like novelty socks. The Daily Mail article states that employees could face disciplinary action if socks had "characters [such] as Homer Simpson, Mr Blobby and Wallace and Gromit."

Distractions of inappropriate dress should be limited, it added. Novelty socks fall foul of the new code along with see-through clothes, clothing that is too tight or too loose and plunging necklines.

Plain black or navy blue socks are deemed suitable but socks can be left off in hot weather. The board is recommended to accept the new uniform policy.

Is this the same hospital that is promoting the modesty gown? I'm curious. Doesn't the modesty gown promote cultural sensitivity and tolerance? Why can't tolerance extend to my Homer Simpson socks? Doh!

Blogs & Myspace

Two interesting articles I read this morning. I picked up the complementary USA Today outside my hotel room and read an article called, "Students, officials locking horns over blogs."

The article reported three school districts taking disciplinary action against students because of statements made on a blog -- this included one student being expelled from a school in the Indianapolis, Indiana area.

As you can imagine, this has re-sparked the free speech and first amendment debate. Can school districts discipline students for statements made on a blog? Can a student go over the line when making free speech statements? Who determines where that line is? Apparently, the courts are now getting involved and will contribute to the debate.

For me, in reading this article, I support what these school districts did. I agree that there is a fine line between the perceptions of venting frustrations and criticism and the perception of personal attacks. I also agree that school districts have the right to preserve the learning process the best that they can despite comments made by students. This attorney disagrees...

Says [Tom] Clarke, the San Francisco attorney: "Sometimes I'm very surprised how paranoid school districts are about what is said about teachers. That seems to be a focus of a lot of their concern, that nobody bad-mouth their fine, exemplary teaching."

What if the shoe was on the other foot? What if a teacher was perceived to be overly critical of a student? Does the teacher have free speech rights, even if a case could be made that it was constructive criticism?

You know the answer to that one. This teacher would be sued for student harassment, a demand would be made for the teacher to be fired, and maybe even to have the teaching license to be removed. You can’t have it both ways, and that’s how I see these cases going.

The second article I read this morning was from the hotel complementary Wall Street Journal. It describes people completely removing their listings from social sites like myspace and facebook in the article titled, “MySpace, Bye Space” (free article on wsj.com today only). There are two reasons people are starting to rebel: ads and spam.

There's no question, however, that MySpace's recent popularity has brought with it a proliferation of spam that has annoyed some users. Many advertisers take advantage of the "friend request" function and send out requests that are really just advertisements.

And programs have cropped up that can automatically send mass friend requests to MySpace users -- in short, a new generation of email spam. Sites with names like FriendBot.com and FriendAdder.com sell the programs starting at $19.95.

There was a time when I considered getting a myspace listing to try to further promote my blog. I think I’m comfortable passing on that idea now. It’ll be interesting to see if there is a trend over the next few months of myspace profile deletions because of ads and spam.

Blogcast 2

Good morning from the left coast! Back by popular demand (or maybe not), this is blogcast number two! It's a little different style and format verses episode one. It's about twelve minutes in length and about fifteen MB in size. Let me know what you think Enjoy! Download DABC2

On the road

This clue is probably too easy, but it's the best I could do.
Will be my last vacation for a while, so I'd better live it up :)

Fugue

I don't want to be intruding on Shrink Rap's territory, but I thought this story was interesting. (I'm not a psychiatrist, I only play one on this blog).

Jeff Ingram left Olympia, Washington, on September 6th to drive to Alberta, Canada to visit a friend (Washington Post). He never showed up there. Somehow, he ended up in Denver for a month, and didn't know who he was or where he was.

Ingram's identity came to light last weekend after he appeared on several news shows asking the public for help: "If anybody recognizes me, knows who I am, please let somebody know."

So, the guy's fiancee calls the television station to identify him and they were reunited Monday in Seattle. That's the end of the story, right? NOT - Apparently, this is not the first time this has happened.

Ingram had experienced an episode of amnesia in 1995 when he disappeared during a trip to a grocery store. Nine months later, he was found in a Seattle hospital, according to Thurston County, Wash., officials. His mother said he never fully regained his memory.

When I first heard this story, I totally thought that this guy was making this up -- for attention -- kind of like the whole runaway bride thing a year and a half ago. Apparently, his story is true. And, there is a clinical diagnosis for Jeff Ingram's condition called dissociative fugue.

Dissociative fugue, formerly called psychogenic fugue, is one of a group of conditions called dissociative disorders. The word fugue comes from the Latin word for "flight." People with dissociative fugue temporarily lose their sense of personal identity and impulsively wander or travel away from their homes or places of work. People with dissociative fugue often become confused about who they are and might even create new identities. Outwardly, people with this disorder show no signs of illness, such as a strange appearance or odd behavior.

Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, conscious awareness, identity and/or perception. When one or more of these functions is disrupted, symptoms can result. These symptoms can interfere with a person’s general functioning, including social and work activities, and relationships.

I admit I had to dust off the textbook to re-learn about fugue. Interesting story. In 10 years, I wonder if we're going to hear another story from this guy when his fugue strikes again.

Non Smoking

When I go to a restaurant, I usually get asked where I would like to sit, whether in the smoking section or non-smoking section. I usually say the latter. However, if you go to Omaha, Nebraska, the non-smoking section begins at the city limits. What am I talking about? (WorldNetDaily)

The ban to smoke in Omaha began October 2nd and applies to nearly all public places. How about this for violators: $100 for first offense, $200 for second offense, and $500 for third and subsequent offenses.

The Nebraska city's elected leaders and police department are urging residents who see violations to call the 9-1-1 emergency system for an immediate response.

Yes, that's right. Omaha residents are encouraged to report violations of the non-smoking ordinance to authorities just like any other crime.

Douglas County Emergency director Mark Conrey said people should not call 9-1-1 every time they see someone light up in a restricted area. He said the very idea threatens Douglas County's emergency system.

But, even after Conrey's concerns, Omaha police insisted residents should use 9-1-1 to report smoking law violators.

I agree that smoking is bad for your health, but potential use of tax dollars for literally the "smoking police" may be a bit much.

I can just see this --> (Cue announcer voice) Next on COPS: From Omaha, Nebraska -- Don't even think about lighting up a cigarette. Watch as our TV cameras follow Omaha's Finest bust chain smokers -- Saturday at 8pm. HA!

Christmas shopping

So, I'm checking my e-mail this morning. Sarah Mclaughlin, who is one of my favorite artists (and it doesn't hurt that she's easy on the eyes, if you know what I mean), just released a new album last week and it's currently number one on the barnes and noble popularity chart.

Anyway, her new album is called "Wintersong" and has the following song list: Happy Xmas, What Child Is This, River Wintersong, I'll Be Home for Christmas, O Little Town of Bethlehem, The First Noel/Mary Mary, Silent Night, Song for a Winter's Night, Have Yourself a Merry Little Christmas, In the Bleak Mid-Winter, Christmas Time Is Here.

I read this, and I'm like, c'mon! I know it's not her fault nor b&n; it's the distributor. But, a full two months before Christmas? It's not even November yet.

When I was a kid, I remember watching A Charlie Brown Christmas and how Charlie Brown was complaining about the commercialism of Christmas. That has stuck with me and is re-emphasized through the years. I'll have more to say about the holidays as they get closer. I just can't believe the shopping season is being pushed earlier and earlier every year.

Fog

Kind of feel like in a tail spin right now. Not really motivated to do anything. I had an entire free day to myself. What did I do? Slept most of the day, to be honest with you. You know when you finally have a vacation, you have this list of stuff that you have to do? I really did not want to do any of that.

There were five or six times today when I sat down and actually tried to blog about something -- anything. Not really motivated to do any of that either *gasp* Call it writers block. Call it feeling out of gas. Call it being in a fog and trying to find my way back.

I remember when I was back in school, summer break was the time when there was less stress. I actually had some time to get out and relax and play golf and other outside activities. I could also just let my mind wander, and just think about anything - not just business, meaning school. I miss those summer breaks.

I also used summer as a time to reflect. A kind of mark in the road to see where I've been and where I'm going. In a way, this week is kind of like that. I've been looking back to some of my first posts. This is Not a Medical Blog, I proclaimed on June 20, 2006. I knew it back then, why am I pretending that it's different now?

This blog is the observations of a doc out there just trying to make it in America today. Yes, from time to time there may be some medical commentary. From time to time there may be some ranting. From time to time, I may even say something funny.

That's the real reason I started blogging. I knew that there are a lot of blogs out there that do medicine all the time - there's nothing wrong with that. I think over the past few weeks, I was fooling myself in thinking I was doing the same thing.

Someone sent me this message, "Hey Doc. No offense, but your medical posts aren't all that 'hard core.'" That really kind of hit me. Don't get me wrong, it wasn't mean. But, it was true. My blog is not to report the latest medical stories. My blog is not to report the latest medical research. There are a lot of other blogs out there that already do this, and do this well.

I admit I was seduced by my numbers as they improved. For me, it became about keeping up the numbers. I felt this rush as my numbers passed 100 then 200 visits a day and higher than that. This is the point when blogging became feeling like a job. And, I never wanted blogging to be like that.

Sorry about all the rambling. I don't know if I'm looking for a new direction and/or a new freshness to my blog. Still kind of feel like I'm in a fog...

Triple Meme

Dona nobis pacem in the Blogosphere from Mimi Writes: The events of Thursday, October 12 inspired Mimi to come up with the idea of a global post on November 7, 2006. I invite you to check out her compelling post...

"If you'd like to help me get the word out, please email. Or simply link this post on your site, in your emails, mention it in your comments. Tell people to save the blank picture (right-click, save, open in a photo editing program to write or draw on) and simply post it on November 7, 2006."

-----------------

Irene from Pregnant Pauses tagged me for this extensive meme:

1. 5 things I would do if I were a millionaire
* Get more Easy Buttons from Staples!
* Have a huge Blogaholics Anonymous meeting!
* Actually take some golf lessons.
* Finally pay off my medical school loans.
* Two words: plastic surgery (yeah right)

2. 5 bad habits
* Take a while to do my memes. HA!
* Drink too much Diet Coke
* Waiting until the last minute to do things
* Work too much, sleep too little
* Stress eating - not a good idea

3. 5 things I hate doing
* Working out, although I know it need to.
* Going out in the cold. I don't mind 90 degrees, but 9 degrees, forget it.
* Confronting people
* Going to a party where I know no one - that's tough for me.
* (couldn't think of another one)

4. 5 things I would never do
* Wear khaki - ever
* Walk through a cemetary at night - too scary
* Curling - what's the point
* Run for political office
* Buy a PC. Hi, I'm a Mac. HA!

5. 5 things I regret doing
* Not appreciating what I have until it's gone.
* Focusing too much on myself and at times forgetting about friends/family
* When upset, I say/do things I regret
* Not taking an overseas experience when I was in high school or college
* (couldn't think of another one)

6. 5 favorite toys or things.
* My trusty Apple stuff: iMac, iBook, iPod (can I count that as three things?)
* Golf clubs - when I use them
* Food - maybe too much at times

---------------------------

Finally, Kirsten from All About Me - And Then Some tagged me for "Nine Weird Things/Habits about Myself":

1. I have this thing for wicker "furniture". I'm hypotized by it.
2. I'm anti-khaki pants. No khaki. Never. Don't even think about it.
3. Some people can't wake up without their first cup of coffee. Me? Diet Coke.
4. I'm a news junkie. I'm kind of embarrassed by it. I used to watch sit-com tv, dramas, and movies. At night, I'd rather watch news channels.
5. Golf. I can't play it, but I follow it closely. If I'm not watching news, then it's the golf channel.
6. Definitely not a fix-it guy. I hyperventilate if I have to go to the Home Depot.
7. Sometimes I'd rather send an e-mail rather than pick up the phone to contact someone.
8. My attention span is nanoseconds these days. I haven't read a fiction book all the way through in years. Sometimes, I don't even listen to an entire three minute song on my iPod.
9. Actually cooking is something that makes me anxious. If there is an option to go out to eat, I'll take that.

Freaked out yet? Whew! That took a lot out of me. Do you feel like this too much information? Me too. I think I'll take a nap. Oh yeah, I can because I'm off this week. Yay! Sorry, no tagging. Til next time, I'm Doctor Anonymous. HA!

Distracted

This is going to be an interesting week for me. I'm not in the office this entire week. And, this is the first time in quite a while that I've taken this much time off. Usually, it's a long weekend (meaning three days) here or there. But, not stepping foot in the office for an entire week is kind of foreign to me.

I'm going to a conference this week beginning on Wednesday and back on Sunday. I'll let all of you speculate where that's going to be. I may even leave a hint where I'm going. (maybe i'll try that blogcast thing again)

Anyway, ever since I got home yesterday, I've been helping a friend out with a project that has been a pleasant distraction from the day to day grind of medicine. This plays out perfectly because for the most part, I'm not going to think about my job for a week.

I'm a little concerned about this because it may impact my blog this week with less "hard core" medicine topics, or even less postings in general. We'll just have to see.

I've always been fascinated with the topic of leadership. The project I'm helping my friend with has to do with leadership and the conference I'm going to this week has to do with leadership.

Thanks to all of you who have just discovered my blog. This will definitely be an atypical week for my postings and my blog. If it seems like I'm distracted, it is because I am, and I'll admit that up front. (Don't worry, I didn't forget about my assigned memes.)

So, I appreciate everyone being patient with me as I kind of change gears for a week. Who knows? I may lose my entire audience and have to start from scratch again. (I've already seen that in the last five days) Or, I may even get some new readers. Time will tell.

Blogcast update

I just did get home safely. Thanks for all the feedback and positive comments about the blogcast. Also thanks for letting me know about the download problems. If there are still problems, let me know that also.

I've been tinkering with this idea for the past few weeks. And, yesterday, I just decided to do it. I have to tell you, it takes a different type of preparation for a podcast verses a blog. I really didn't know what kind of format that I wanted to take. I literally just made things up on the fly to try to make some sense.

Maybe I'll try again in the next week or so. There still seems like there's something missing, but I haven't quite figured it out yet. Working with the technology is a story in itself. I had no idea about track volumes, master volumes, how close or far to sit from the microphone, or any of that stuff. It's fun, and challenging.

I initially thought that podcasting would be my thing. But, I now know that podcasting for me will only be intermittent. Blogging will remain front and center as my way of expression - because, hey, I'm addicted. Thanks again for all your support.

Blogcast

I have a surprise for all of you! I've been working on this all day and all night. Yes, I've went off the deep end and tried to do a podcast, er, blogcast. What's a blogcast? What city am I in? What have I been doing? All your questions will be answered.

Just a warning: This is a 10MB file. So, if you don't have a high speed connection, then forget it. Yes, this is my actual voice. If there are any problems with the download and/or the playback, let me know. Also FYI, it's about 8 and a half minutes. Hopefully, I'll be back home safe and sound by Friday night.

Click here and download DABC1 (Doctor Anonymous Blogcast) -- Enjoy!

On the road

Here's the city I'm going to today. Who knows where this building lives?

You must really like me, because I got tagged by three people last night.
Thanks Kirsten, Mimi, and Irene. I'll start working on these soon...

Forget HRT

HRT, or hormone replacement therapy, has traditionally referred to estrogen replacement therapy in women going through menopause. As you have probably heard, estrogen has fallen out of favor for menopausal symptoms because of estrogen's association with blood clots, stroke, and breast cancer.

Now, testosterone is now taking a hit, according to a study from the Mayo Clinic (ABC). What were the important clinical questions that they wanted to answer: In 150 people over 60 years old, does testosterone replacement therapy slow the aging process and does testosterone replacement increase libido?

At the end of two years, the hormone-taking men and women did have increased levels of sex hormones in their blood compared with those who had received fake pills or fake patches. But these hormone increases didn't make the volunteers any younger, as the supplement industry often promises.

"We found no difference in quality of life, including sex drive," said Dr. Sree Nair, lead author and professor of medicine at the Mayo Clinic.

Uh, I'm thinking that this is really interesting to know, but maybe I don't want to know how they conducted this study. It's kind of like TMI, or too much information. I can kind of just see a bunch of Alfred Kinsey wannabes flying around the Mayo Clinic with clipboards and questionnaires. Kind of amusing to think about actually.

Side Effects

One of the most common questions I get is about side effects of medications. Don't get me wrong, this is a good question to ask, especially if you're not familiar with the medication that is being prescribed.

In today's Journal of the American Medical Association, there is a study which estimates approximately 700000 medication complications each year (Chicago Tribune). I know what you're thinking, "Yeah, it's that Food and Drug Administration again. They're working for the drug companies. They just push all medicines through and don't care about side effects."

It's true that, in the study, the most common classes of medicines that sent people to the ER for treatments were insulin for diabetes and blood thinners like coumadin. But, the problem was not with the prescription medicine itself, but with interactions with other medicines, specifically over the counter pills and herbal supplements.

Dr. David Soria, chairman of the emergency department at Florida's Wellington Regional Medical Center, said patients should tell their doctors about drugs they have been prescribed by others, as well as over-the-counter drugs they take, such as aspirin and herbal remedies.

Soria said older patients seem to be taking more herbals because they're easy to get and there is heavy marketing of products that patients think will help to keep their minds sharp or give them more energy.

"Patients don't typically tell us what herbal medications they're on because they don't consider it a drug. They think it's a vitamin," Soria said.

Some studies have found that herbal products, including ginseng and gingko, can cause bleeding, and that others, such as St. John's wort and kava, can react negatively with other medications. St. John's wort also can interact with Plavix, a blood thinner, and cause bleeding.

But monitoring them can be a problem because few studies have been done on the herbals, and because there can be inconsistencies in the batches coming from different manufacturers, Soria said.

I'm not placing blame here, just re-emphasizing the fact that good patient-physician communication is essential for good medical care. I realize, especially for older people, who may see a lot of doctors, to try to remember who prescribed what and why. (Just a plug for the job of a good primary care physician.)

Herbal supplements are marketed as "safe" because they're natural. And, this may be the case when used by themselves. In addition, over the counter medications are safe when used correctly. Problems occur when people take prescription medicines, OTC meds, and herbal supplements. Interactions among all these chemicals could be a problem - thus the 700k medication complications each year. So, be careful out there!

Pass the fish

One of the questions I got today during my talk had to do with seafood. I was mentioning omega-3 fatty acids and that they can have a beneficial effect on a person's cholesterol. "I thought that fish was bad for you," someone asked me, and they heard that there were a lot of contaminants in seafood. The Institute of Medicine, in a new report, tries to clarify the confusion (CNN).

"The benefits of cardiovascular health from eating seafood, including farm fish, far outweigh the risk of cancer from environmental contaminants," said Dr. William Hogarth of the National Oceanic and Atmospheric Administration, the group that commissioned the report.

The environmental contaminants they're talking about include mercury, dioxins, and PCBs. The study found that the levels of these substances were so low in seafood, that there is no danger in consuming it, even a potential cardiac benefit.

The committee members say they aren't sure why fish reduces the risk of heart disease. It could be a direct effect of the omega-3s, or it could simply be that it is lower in saturated fats than other meats, and by adding more fish to the diet, individuals are eating less of the fattier meats.

I do not live close to the ocean. So, one of the many things I look forward to is having fresh seafood when on vacation. Finally, a news story about food that has nothing to do with spinach, ecoli, carrot juice, botulism, recalls, or any of that bad stuff. Order up some broiled salmon and veggies for me tonight. Yum!

Grand Rounds

Grand Rounds 3.4 is up and rolling over at Emergiblog. Kim, the Queen of Carnivals, has what seems like a HUGE number of links over there today. Grab a BIG cup-o-joe and enjoy! Next week's host is listed as Health Care Law Blog.

Can't get enough of blog carnivals? I know Kim can't because she's hosting Change of Shift: A Nursing Blog Carnival in just two days. How does she do that? Sheesh!

--

I just got back from my talk about cholesterol at the hospital. Thanks to all of you who gave suggestions on what I should say. I definitely used your comments as I prepared this talk. The audience was the cardiac support group. We have a small cardiopulmonary rehab center at the hospital, and the support group makes up the patients in this program.

Tough crowd, let me tell you. Don't get me wrong, not mean or anything like that. They were very well informed and had a lot of good questions about diet, exercise, and medications. I've done these talks before and the most questions are usually about medications.

Before leaving, the staff gave me a bag of caramel corn as a thank you for speaking. Following my earlier post today, the first thought that came to my mind was, "Whom can I re-gift this to?" HA!

Re-gift

So, I walk in my office yesterday and I see an envelope. I open it and it's a card that says, "Happy Boss's Day!" I didn't even know it was boss's day (check out Michael C for more comments on this). Who made up this "holiday" anyway? Probably the same people that made up Sweetest Day. I have an entire rant on fabricated "holidays," but I'll leave that for another time.

Anyway, inside the greeting card I see a gift card to one of our local restaurants. "Gee, that's nice," I think to myself. Then on the back of the gift card I see a little mark in the corner. It looks vaguely familiar to me. I think for a few minutes, and I figure it out. I'm the one who made that mark a few months ago when I bought this gift card on behalf of the docs here. These gift cards were given to the staff for another fabricated holiday.

Actually, I thought it was kind of funny. I walked into the nurse station and one of the staff members say, "Do you like your card?" I snickered and said, "This is a re-gift isn't it?" I never saw staff members scatter out of the room so fast.

I first heard the term re-gift on an episode of Seinfeld. All of you have done this before, I'm sure. It's when you receive a gift that you particularly don't want. And, instead of returning it or throwing it away, you give it to someone else.

Re-gifting is more common than you think. Cnn.Com reports a study which polled about 1500 Americans. More than half of the people polled said that they re-gifted in the past. In addition, a whopping 78% of respondents said it was acceptable to re-gift.

Nancy Wong, a spokeswoman for Harris Interactive, said she was surprised by the number of people who admitted to re-gifting.

"It's not something I've thought about and when I saw that nearly half had done it -- 52 percent have re-gifted and or would re-gift -- it's quite a significant number," Wong told Reuters.

I'm going to come clean and say, yes, I've done this before. The problem is accidentally re-gifting back to the same person, and getting caught. This has happened to me before when I give a gift, and that person says, "Didn't I give this to you last year?" So, that's why I wasn't upset when I got the card yesterday. Any funny re-gifting stories out there?

Blog changes

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 2.5 License.

Did you know that someone is making money off of your blog without your permission? I've been doing my own research on this, and I'm really upset about it. I'll refer you to Moof's description of the situation (Part 1 - especially the comments, Part 2, Part 3), as she is the first I heard about this. Mimi also has a descrpition on her blog. I also refer you to Lorelle.

Bitacle.org is the villain here. They are stealing your posts (the full text, pictures, etc from your post), slapping ads at the top and collecting the cash. Want to see an example? Click here.

Are you on bitacle? Check for yourself. Make sure you search under the "aggregates" tab to try to find your own blog. What can you do? Read about it more at Stop Bitacle. They have a button to put on your blog.

As you can see, I've but a couple of buttons at the top of this post. Bitacle doesn't see the sidebar, so if you decide to get a button, make sure you place it in the post itself to be effective. I'm toying with the idea of putting the buttons at the top of each post for the time being. That would be a significant blog change for me.

I just found another way to possibly fight back. It's from Plain Jane Mom; it's creative, and it's funny. If it works out, then I won't have to put those buttons at the top of each post. Check it out the great tip here.

In other blog related news, I'm going to moderate comments now. (I've talked about comments before, click here to read more.) I never wanted to do this, but I'm starting to get a lot of spam comments - the price of fame, I guess *smile*. So, if you don't see your comments popping up right away, that's why. (Parlancheq, thanks for asking)

Finally, I've decided to cut down the number of posts on the front page. (I've also talked about this before, click here.) I'm right around the 150 total posts range, and I've seen people have blogger problems when the front page gets a high number of posts. Want to read my previous posts? I invite you to check out the archive section in my sidebar. I'm really tired. Long weekend working, ugh...

Update: The bitacle link for this post is here. None of my top graphics are there. I tried Plain Jane Mom's suggestion but unfortunately it didn't show up as on hers - bummer, that would have been funny. Just wanted to update all of you.

Alarm

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

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

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

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

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

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

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

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

Alzheimer news

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

An article from Times Online reports that their National Institute for Health and Clinical Excellence (Nice) is denying medications like Aricept and Exelon to early stage and late stage patients.

Neil Hunt, the chief executive of the Alzheimer’s Society, said: "This blatant cost-cutting will rob people of priceless time early in the disease and later clinicians will have no choice but to use dangerous sedatives that increase the risk of heart disease and stroke.

I've talked about government interference with health care delivery before, so I won't belabor the point here. Suffice to say that from a disease treatment standpoint, I hope that Nice reconsiders its decision.

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

An article from the LA Times reports a study conducted by the National Institute of Mental Health using two psychiatric meds commonly used to try to alleviate symptoms (Zyprexa, Seroquel).

Depending on the drug, 37% to 50% of patients discontinued their pills because they weren't working, and up to 24% stopped taking them because of side effects such as drowsiness, weight gain and confusion. All told, 82% of patients quit their drugs.

In my experience, I've found similar poor results in my assisted living and nursing home patients. I'm going to keep trying meds like Zyprexa and Seroquel, because there is very little else out on the market right now to treat advanced AD. Hopefully, there will be other treatment options in the future.

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

An article from The Age reports that the Scripps Research Institute in California performed a study which found that THC helps to decrease the formation of the protein plaques which cause AD.

THC is also more effective at blocking clumps of protein that can inhibit memory and cognition in Alzheimer's patients, the researchers reported in the journal Molecular Pharmaceutics.

I'm just imagining how they actually performed the study. "Dude, my memory is so much better." "Dude, I'm hungry, pass the potato chips." "Dude, pass the controller. It's my turn for the XBox." "No, it's my turn." "No, it's my turn."

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

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

Electronic records rant

It's no secret that I'm a news junkie. You can plainly see this from my blog. In addition to my patient rounds, I do my blog rounds and news rounds. I became really upset when I read this article from the Washington Post called, "Doctors Slow to Adopt E-Records for Patients."

About one in four doctors use some form of electronic health records, suggesting that a technology frequently billed as a way to improve the quality and efficiency of care has yet to win widespread acceptance, according to a study released yesterday.

As these type of articles in the media go, the following paragraphs build the case why an electronic record is a good idea -- it "collects patient information, displays test results, helps doctors make treatment decisions and allows health-care providers to document prescriptions and medical orders electronically." In addition, they "improve patient care, reduce errors, curb unnecessary tests and cut paperwork."

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

So, what's the hold up? Why isn't everyone using it now? There are two main hangups, in my opinion. The first one is covered later in the Post article, and it is who will have access to this electronic infomation? Also along these lines is who owns the information inside the computer?

"The big problem is that the vast majority of electronic medical-record systems do not give patients the right to decide who has access to the records," said Deborah C. Peel, a psychiatrist and founder of Patient Privacy Rights, an Austin-based nonprofit that wants greater safeguards. "They do not give patients the right to segment sensitive portions. . . . The electronic medical records in use now have been designed primarily for the convenience of physicians."

For example, if I'm talking with a patient and entering information into a laptop, and this information is stored on the hospital server three streets away from my office, who has access to this information - besides me? How comfortable would you be if I told you your medical data is on a hospital server and possibly backed up on an offsite server, while now, your information is in my paper chart under lock and key in my office? Just something to think about.

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

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

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

This cut will hugely effect docs across the country. Just as an example, here's an article from the Concord Monitor.

The New Hampshire Medical Society estimates that the cut will cost the typical family practice $20,000 next year, which could force some doctors to stop accepting new Medicare patients.

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

"Primary-care doctors are really mom-and-pop shops," said Dr. Gerard Hevern of Suncook Family Health Center. "Most of us do it because we love it . . . but we do it on a shoestring. When you begin to erode that margin, it really impacts in ways that are profound."

So, bottom line, I totally agree that the electronic health record is the wave of te future, and all docs will eventually get on board. What the press neglects to cover is the real story of why this is not happening now. I know I'll continue to read articles like the one today in the Post, and I'll continue to get upset. But, here is the real story of why so few use electronic records now.

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

Unadopt

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

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

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

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

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

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

Update - Like a Foster Mom: I was talking about this Virginia story earlier today with someone at the hospital and she mentioned that pop star Madonna is in the African nation of Malawi visiting that impoverished nation. According to Times Online, Madonna and her husband just today have taken custody of a 13-month old boy and are going to adopt.

Malawian law does not allow for inter-country adoptions, and generally requires people who want to adopt to spend 18 months being evaluated by Malawian child welfare workers. But it seems even this is no obstacle for the Material Girl after Malawian officials, who refused to elaborate, indicated that such restrictions would be waived for the couple.

Don't get me wrong. I don't think this is a bad idea. In light of what I've learned today about adoption (thanks to your comments), I wonder what this child will be like 5-10-15 years from now. A Material Guy for the Material Girl? We'll see.

Smarter sex

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

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

A recent study of 100,000 high school students showed that men have a 4-5 point IQ advantage over women. (This was reported by the Financial Express) Matt Katz from the Lansing State Journal is very happy about this in his article called Are Men Really The Smarter Sex?

Whoooh-hooo! We're No. 1!

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

Don't believe the British? In Canada, another study analyzing SAT scores found that males ages 17 and 18 are more intelligent than females.

Take that women! What do you think of that? Now, before I really started rubbing it in to everyone here at the office, I ran into an article from CNN.COM. Apparently, men are smarter, except then it comes to going to the emergency room during the big game.

A drop in the number of men going to the emergency room during sports broadcasts on TV is followed by a surge afterward, reports an ER doctor who reviewed case numbers over three years at the University of Maryland Medical Center in Baltimore.

Oh well. I'm so disappointed. I thought that I found the answer to this time old question of who's smarter. I guess the research and the debate will continue.

Surgery vs contacts

If I ask you which is safer: eye surgery or wearing contact lenses - you'd probably pick the latter, right? In an article from WebMD, researchers looked at the complications of the eye surgery called LASIK and compared them to complications of wearing contact lenses. The research will be published in this month's edition of the Archives of Ophthalmology. Gee, guess what the findings were? Bias? You be the judge.

Based on their review of several large studies, ophthalmologist William Mathers, MD, and colleagues concluded that daily contact lens wearers have about a one in 100 chance of developing a serious lens-related eye infection over 30 years of use, and a one in 2,000 chance of suffering significant vision loss as a result. The researchers calculated the risk of significant vision loss due to LASIK surgery to be closer to one in 10,000 cases.

The articles goes on to outline the bad habits of contact lens patients - whether it's not making sure your fingers are clean before inserting contacts (prevents infection) or sleeping with your contact lenses in. The big finish to the article is describing the advances in LASIK surgery over the past 15 years.

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

Grand Rounds

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

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

Poll question

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

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

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

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

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

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

News briefs

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

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

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

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

Cleveland doctor arrested in Cyprus: Yazeed Essa was arrested over the weekend as he attempted to clear customs is Cyprus. (CNN.Com)

Prosecutors have said they believe Essa, an emergency room doctor, was having an affair with a nurse and wanted to be free of his 38-year-old wife. Prosecutors characterized the killing as a "divorce substitute."

What's going on the world today? If you don't like your spouse, then just divorce her/him. What's up with murder (er, I have to say alleged murder)? If guilty, I hope this guy gets put away for a long time.

Happy world post day

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

Well, not really. This day is recognition of snail mail. Here are articles from the Universal Postal Union, South Africa, and Sri Lanka. The following quote is from the United Nations.

World Post Day is celebrated each year on 9 October, the anniversary of the establishment of the Universal Postal Union in 1874 in the Swiss Capital, Bern. UPU member countries across the world use the event to emphasize the important role of the postal sector in the daily lives of people and in the social and economic development of countries.

Oh well, maybe some day there will be real recognition for blogging and groups like Blogaholics Anonymous -- HA! Keep on blogging!

Blog chatter

I'm always flattered and humbled when I'm featured on another blog. And, this time is no exception. Mimi Lenox, one of the newest members of Blogaholics Anonymous, mentioned me in her Sunday Blog Chatter on her blog called Mimi Writes.

Now, if you'll excuse me, I'm going back over to Dr. A's and put my name on the BA map and make it unofficially official. It's time I admitted the truth. Which, of course, means that I have to tell my mother the sad saga of my secret addiction first. This could take a while since she doesn't even know what blogging is.

On second thought, this could wait a day or two. Couldn't it? Let's let her sleep in peace one more night.

Mimi has a second blog called Book Meme Central (where I'll also be featured *wink*). She describes this blog as the place where all Memes come to be immortalized. A comprehensive collection of book memes from across the globe. If you have a chance, check out these blogs. You won't be disappointed. Thanks Mimi!

Health care coach

Hey, this should be your primary care doctor, right? This article from Forbes.com describes what they call "health care transition coaches," who can help reduce patient's hospital bills and rate of re-hospitalization.

The "transition coach" works with patients on four main areas: medication self-management; the creation of a personal health record maintained by the patient; obtaining timely follow-up care; and developing a plan to seek care if certain symptoms appear.

The program was created to solve problems -- such as conflicting medical advice, medication errors and lack of follow-up -- that often affect patients during periods of transition between sites of care.

This article doesn't say who these coaches are, who pays them, and how they get paid. These are probably agents of the insurance companies, who already dictate how health care is delivered in this country.

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

Make it so

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

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

When I was done there, I went over to Bangkok, Thailand to see a guy set a world record. In this article from CTV.ca, it describes a "Thai snake charmer" attempting to set a world record by kissing, yes, that's kissing, 19 poisonous king cobras.

One by one, the cobras were released onto a stage set up in a Thai beach resort town, as snake charmer Khum Chaibuddee kissed each beast and then moved on to the next.

Four additional snake charmers flanked the stage at each corner and a medical team waited on the sidelines with serum in case one of the snakes snapped, said a statement from Thailand's Ripley's Believe It or Not Museum, which organized the event.

This sounds strangely familiar, but didn't Mark Foley do the same thing while he was in Congress? Thank you, thank you very much! *running out of the room*

Where's the beef

Who knew that spinach could be related to beef? Friday, a company in Iowa voluntarily recalled 5200 pounds of ground beef products from seven states because they could have been contaminated by the same E.Coli strain that tainted spinach - according to an article from the Houston Chronicle.

E. coli lives in the intestines of cattle and other animals and typically is linked to contamination by fecal material. It's believed responsible for about 60 deaths and 73,000 infections a year in the United States. The potentially deadly strain can cause bloody diarrhea and dehydration.

The Iowa recall is the first significant one involving ground beef since a Tennessee company recalled some 4,300 pounds in early August, also because of possible E. coli contamination.

This case is getting more and more interesting. Since there is a criminal investigation now taking place with the spinach California company, I wonder if that triggered this voluntary beef recall. I also wonder if other voluntary recalls will take place. Hmmmmm...

Can you hear me now

The Nobel Prize in physics was awarded this week to astrophysicist George Smoot of Lawrence Berkeley National Laboratory and his NASA colleague John Mather. When Mr. Smoot got the call notifing him of the award, he thought it was a joke, according to this article from MercuryNews.Com.

Smoot, 61, who has an unlisted cell phone number, suspected a hoax when a caller with a Swedish accent told him about 3 a.m. that he had won the most coveted award in science.

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

Just to be certain, he checked the Nobel Prize Web site. And there it was: Smoot and Mather were being honored ``for their discovery of the blackbody form and anisotropy of the cosmic microwave background radiation.''

Uh, yeah. I know someone with a blackberry and a microwave, does that count? What's the lesson here? If you get a call at 3AM from someone with a Swedish accent, it may not be that annoying telemarketer. It may be the Nobel Foundation!

Exercise

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

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

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

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

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

Perseveration

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

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

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

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

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

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

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

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

Follow-up

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

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

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

Halloween meme theme

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ten million dollars

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

What am I talking about? The X Prize Foundation, the people that brought you SpaceShipOne, is at it again. This time, the challenge is pretty simple. If you can map 100 different human genomes in 10 days, then $10 million is all yours. Here's a quote from msnbc.com.

“It’s like geeks are taking over the world,” [Craig] Venter [founder of Celera Genomics] said in an interview. “Who thought a scientists could get $10 million for coming up with a breakthrough technology?”

So, who's with me on this? I've got a computer and an old microscope (although it may need a new lightbulb). Of course, I don't know 100 people. So, we'd have to recruit them. Maybe I can get the Nobel Prize guys to help me. This is ten million dollars and medical history! What you do think? Deal or no deal?

Canadian drugs

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

Formerly, the federal government, through the Department of Homeland Security, halted shipments of imported (Canadian) prescription drugs. According to an article in today's Los Angeles Times, this practice will be abolished and instead random searches will occur.

Popular medications such as Lipitor and Fosamax can be 30% to 80% cheaper from Canada and other countries, surveys have shown. But the U.S. government was confiscating as much as 20% of the shipments this year.

But, sometimes the integrity of these imported drugs needs to be questioned. This topic was covered on a recent episode of the CBS Evening News with Katie Couric.

“It sounds so good, cheap prescription drugs just a click away on the Internet,” said anchor Katie Couric as she introduced the September 20 “Eye on Medicine” report, but, “it could be really dangerous because you may not be getting what you think you are.”

Correspondent Jim Stewart told viewers of a federal bust of “11 people and an Atlanta-based company with a scheme to sell the fake drugs over the Internet.” Stewart noted that the phony drugs were manufactured in “a rented house in Belize” and the Web site peddling them told customers it was a Canadian pharmacy selling re-imported drugs.

I realize I may start a firestorm here with people pointing fingers at other people and groups. But, what's the answer here? I don't know. I do worry about the authenticity of imported drugs. I also worry that prescription drugs are expensive and my patients are doing what they can to stay as healthy as they can, even if they have to get their drugs from Canada.

Botulism

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

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

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

Tagged

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

With Halloween coming at the end of the month, he calls his meme "dark and creepy." The idea is to pick five songs that you'd like played at your funeral. Quite odd, I thought, because I haven't really thought about that yet. But, hey, I'm game. Here are Blog, MD's top five.

The Top 5 Songs I Want Played (Over My Dead Body):
1. “When the Levee Breaks” by Led Zeppelin: Because “Stairway to Heaven” is so obvious.
2. “Dies irae” from Mozart’s Requiem: This piece speaks for itself. I’ve loved it for years.
3. “A Love Supreme” by John Coltrane: I consider this to be one of the greatest pieces of music ever composed. Coltrane’s “humble offering to God” in the “Acknowledgement” converted this tired agnostic.
4. “Steppin’ Out” by Joe Jackson: A fitting way to say adeiu.
5. “Non, je ne regrette rien” by Edith Piaf: No regrets. None.

Here are my Top 5 Songs I Want Played, well, you know...
1. Canon in D by Johann Pachelbel: In my past life as a med student, I played piano accompanyment along with two violinists during a memorial service. Very moving experience, have to blog about that sometime. (Only serious choice in this group)
2. Roxanne by The Police: My one and only karyoke song. That would get people talking!
3. Hit The Road Jack by Ray Charles
4. Good Riddance (Time of Your Life) by Green Day
5. 100 Years by Five For Fighting

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

Flu shot rant

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

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

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

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

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

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

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

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