Shout Outs

Updated 3/2017 -- photos/videos and all links removed (except to my own posts) as many no longer active.

David, Health Business Blog, is the host for this week’s Grand Rounds. You can read this week’s edition here.

Welcome to the latest edition of the Grand Rounds blog carnival, the weekly roundup of medical blog posts!

The Blog That Ate Manhattan kicks us off with the Meaningful Use Song, surely the most antic entry I’ve ever hosted. Can’t beat the zippy refrain “I am the model user of an EMR that’s meaningful.” ………….

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Have you discovered Joanna Cannon’s blog yet? Here’s a nice post: Abor Vitae

The oak tree was worn and tired and sat in a field, where it waited to die.

“I have lived my life,” said the oak tree, “I have felt the seasons turn beneath my roots and I have watched the years unfold and spill themselves through my branches. Now it is time for me to move on.”

The other trees were distressed and pleaded with the oak tree to stay. ……

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bongi, other things amanzi, has a new post after a hiatus: physician, heal thyself

even doctors get sick, but there is often a difference.

i was rotating through orthopaedics and was on call that night. …... once i had finished operating i rushed through the change rooms to get back to casualties. while i was changing i heard the unmistakable sounds of someone throwing up in the toilet cubicle. quite soon the door opened and out came the orthopaedic registrar who was on call that night with me. he did not look good……….

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My friend Elizabeth, Methodical Madness, has a nice post: Fan Mail

I've had a handful of readers over the past couple of years e-mail me to ask me questions about pathology and advice about medicine but no one, until last Thursday, has ever prefaced their question as "Fan Mail." I was tickled pink. A first year medical student from a far away institution asked this, and kindly allowed me to answer in a post:

"My question for you is, are there times when you wished non-pathologist physicians remembered more about histology? What would you like them to know?"

The short answer is this: NOTHING. ……….

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H/T to @hrana for the link to the Wall Street Journal article by Robert Johnson: Plastic surgery is on the rise among older Americans

Mary Lou Ray decided at age 65 that she had seen enough of the person in her mirror.

"My life led up to this. I had been divorced for 13 years, my children were grown, and with the death of my mother—not to be unkind—I was finally free of criticism about things like dyeing my hair," she says.

So last year she spent $13,000 on a face lift and other cosmetic procedures that proved rejuvenating.

"I'm absolutely thrilled," says Ms. Ray, a real-estate agent in Roanoke, Va. "I think a lot of friends in my age bracket would like to try this, but they're afraid of getting that unnatural, yanked-up look. I don't have that; I still look like me." ……..

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H/T to @DrVes for the link to the Lancet article: Haemorrhagic herpes zoster 

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Check out this NPR article by Adam Cole: Visualizing How A Population Grows To 7 Billion   

Herr – Designer of His Own Limbs

 Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active.

Yesterday, I was able to catch the interview on NPR’s Fresh Air of Hugh Herr by Terry Gross:  The Double-Amputee Who Designs Better Limbs  (photo credit)

It’s worth reading or listening to.  Here’s the beginning:

Hugh Herr's legs were amputated below his knees in 1982 after a climbing accident. From his knees down to the floor, he's completely artificial.

"I'm titanium, carbon, silicon, a bunch of nuts and bolts," he tells Fresh Air's Terry Gross. "My limbs that I wear have 12 computers, five sensors and muscle-like actuator systems that able me to move throughout my day."

But Herr doesn't just wear artificial legs. He designs them, too. As the director of the Biomechatronics Group at the MIT Media Lab, Herr and his team are responsible for creating prosthetic devices that feel and act like biological limbs. They are also one of the subjects in Frank Moss' new book, The Sorcerers and Their Apprentices: How the Digital Magicians of the MIT Media Lab are Creating the Innovative Technologies That Will Change Our Lives.

Moss, the former head of the MIT Media Lab, profiles several of the researchers who are working on inventions that could change the way we move, socialize and interact with computers.  ……….

Related posts:

Amputations, Prosthetics, and War (February 13, 2008)

Facial Prosthetics Restores Face (August 5, 2010)

Rejection  (December 1, 2010)

Facing Monday  (January 24, 2011)

Rebuilding the Face Injured by War (March 2, 2011)

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. 

Center for Advancing Health (CFAH), Prepared Patient Forum, is the host for this week’s Grand Rounds. You can read this week’s virtual tour edition here (photo credit).

Welcome to Better Health’s Grand Rounds Volume 7, Number 44!

This is our second time hosting Grand Rounds and we’re excited about sharing the posts we received.  The theme of this week’s collection came from a recent Health Affairs blog post by CFAH president, Jessie Gruman, Patient Advocates: Flies In The Ointment Of Evidence-Based Care, which addresses a few of the many challenges of basing health care practices, policies, and decisions on evidence of effectiveness. ……….

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Check out @globalsurgeon paper in July Bulletin of @AmCollSurgeons: Beyond Volunteerism – Augmenting Surgical Care in Resource Limited Settings (pdf file)

Surgical care was recently characterized as “the neglected stepchild of public health.” Critical storages of health care workers throughout the developing world have led to “calls to action” and have reinforced the need for safer surgery. …………..

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H/T to @angryorthopod who tweeted “I liked this reminder from @drpullen for physicians and patients "Don't Trust Dr. Google." http://ow.ly/5Mud6”

I jokingly tell my patients that I am consulting with Dr. Google when I go online in the exam room to find information, but in fact I rarely use the Google search engine to access health care information. …….

When my daughter was in an entrepreneurship program at the University of Portland (e-scholars) I told her of my frustrations with having easy one click access to the best free online medical information I use in the office every day. Together we put up a web site called Exam Room Favorites that is designed to be an easy to use home page for physicians. ………….

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Dr. Rob Lamberts (@doc_rob) was recently a presenter in the CDC Public Health Grand Rounds:   Electronic Health Records: What’s in it for Everyone? (text and video)

Electronic health records (EHRs) allow for the systematic collection and management of patient health information in a form that can be shared across multiple health care settings. …….

This session of Public Health Grand Rounds explored the issues of EHR implementation with particular attention to public and population health while addressing concerns of cost, patient confidentiality, and other challenges. .…….

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This is worth reading/listening to if you missed it on NPR yesterday:  'Twelve Breaths': Lessons From The End Of Life (photo credit)

When life draws to an end, family, caregivers and medical professionals face a flurry of often heartbreaking decisions. Are there any last treatments to try? How much longer can a patient hold on? When is it time to turn off the ventilator — and who gets to decide?  ………….

Lee Gutkin's essay collection, Twelve Breaths a Minute, captures the experiences of doctors, caregivers, family members, 911 dispatchers and others who have learned valuable lessons from witnessing life's final moments.  …………..

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H/T to @MtnMD who tweeted the link to this Huffington Post article: Humpback Whale Puts On Show For Men Who Saved Her (VIDEO)

When Michael Fishbach set out for his day of boating around the beautiful waters of the Sea of Cortez, he probably didn't think that it would be the day he and his friends would become wildlife heroes. As luck would have it, that's exactly what happened…….

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BYU exhibit features African-American quilts (photo credit) (Deseret News article by Carma Wadley):

Quilting has been part of American landscape for centuries, but each culture has taken the art form and made it its own.

The quilts you see in "From Heart to Hand: African American Quilts from the Montgomery Museum of Fine Arts" at the Brigham Young University Museum of Art are "very different from the quilts that many Utahns make," says Paul L. Anderson, MOA curator for the show. Yet, they have a folk-art quality, a homespun charm that makes them appealing, he says. …..

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. 

Doctor Fizzy is the host for this week’s Grand Rounds. You can read this week’s edition here (photo credit).

I attended my very first grand rounds as a third year med student. The talk was given by my former pathology professor to a large auditorium packed with students, residents, fellows, and attendings. I don't remember the topic of the lecture, but I do remember this:
Midway through the lecture, the professor called on me. In an hour-long lecture, he called on one person out of 200 in the audience, and somehow that person was me. I almost choked on my cinnamon-raisin bagel.   ……..

All in all, not my favorite grand rounds.

But this week's grand rounds are going to be awesome. I'm dedicating it to all the medical trainees that got humilated during lectures, pimped during rounds, or tried to answer three beeping pagers at once.  ……….

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H/T to @medrants who twitted  “Practicing Medicine Can Be Grimm Work - http://nyti.ms/kveFkD -  a beautiful op-ed from one of our med students”  

The NY Times Op-Ed piece is by Valerie Gribben:  Practicing Medicine Can Be Grimm Work

TODAY, after four arduous years of examinations, graduating medical doctors will report to their residency programs. Armed with stethoscopes and scalpels, they’re preparing to lead the charge against disease in its ravaging, chimerical forms. They carry with them the classic tomes: Harrison’s Principles of Internal Medicine and Gray’s Anatomy. But I have an unlikely addition for their mental rucksacks: “Grimm’s Fairy Tales.”………….

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Robin Young, Here and Now/NPR, interviewed Francesco Pia last Wednesday: What You Don’t Know About Drowning

……Lifeguarding consultant Francesco Pia has some advice for the summer about drowning. He worked as a lifeguard in New York’s Orchard Beach, and he made a documentary called “The Reasons People Drown,” that challenged a lot of misconceptions about drowning. He found that:

1.) Drowning is often silent: …..

2.) Drowning happens very quickly: ….

3.) Drowning often happens when people are around others: ….

Remember Drowning Doesn’t Look Like Drowning

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Check out this great advice from the Better Health post:  The Right And Wrong Ways To Strengthen Your Core Muscles

What do slouching, back pain, and a middling forehand or weak shot off the tee have in common? Often it’s a weak core—the girdle of muscles, bones, and joints that links your upper and lower body. Your core gives you stability and helps power the moves you make every day……..

Core Exercises: 6 workouts to tighten your abs, strengthen your back, and improve balance is available from Harvard Health Publications. You can read an excerpt here from the report with tips on checking and improving your posture. ……..

Core Exerise #1: Plank

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I’ve always been concerned about the number of drugs some patients have to take. The risk of side effects and bad interactions increases with each addition. H/T to Dr. Elaine Schattner (@medicallessons) to the link to this Scientic America article by Laura Newman: Overprescribing the Healthy Elderly: Why Funding Research and Drug Safety is Paramount

My frail, 92-year-old mother was prescribed 80 mgs of the cholesterol-lowering drug, or statin, simvastatin for years. She fell four times in the last four years of her life: the last fall was the least forgiving. Doctors diagnosed her with rhabdomyolysis, a life-threatening condition, and acute kidney failure; she was dead within 8 weeks. …..

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Dr. Sanjay Gupta speaks with Paul Stanley (KISS) about microtia and how he has dealt with it himself.

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Sarah McFarland, Threads Magazine, has a piece announcing: “Show Your Support" and Embellish a Bra (photo credit)

The 2011 American Sewing Expo is coming right up - September 23-25 at the Suburban Collection Showplace in Novi, Michigan…..

A staple exhibit at ASE is the annual entries in the "Show Your Support Bra Challenge." Sponsored by Coats & Clark and BurdaStyle, the contest showcases some amazing lingerie decorated by the skills of sewers across the country…..

You can find the Show Your Support Bra Challenge full rules and the entry form online at the ASE site. Good luck, and good for you if you enter!

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. 

Grand Rounds is  taking a break this week. If you would like to host a future edition of Grand Rounds send an email to Nick Genes (you can find his contact info at here).   The most recent edition can be found here at Medgadget.  Other editions can be found here on the Grand Rounds Facebook page.

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@movinmeat  wrote a post recently, A case study in applied ethics, which lead @inwhiteink to write an educational post on decisional capacity

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“Decisional capacity” refers to a person’s ability to make a decision for a specific clinical issue. This issue is usually related to treatment. After assessment, physicians can opine whether someone possesses or lacks decisional capacity for something specific: ……

Appelbaum and Grisso published an important paper that provides a four-point rubric to assess decisional capacity. (At only four pages, it is a short, high-yield article.) Most psychiatrists apply this rubric when assessing decisional capacity in medical settings. …….

Movin Meat’s followup post:  Ethics of refusing informed consent

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From twitter:   @Mtnmd The Twitter chat that killed Sermo http://bit.ly/ipw4au

Her link is to an article by Joe Hage which I encourage you to read:  The Twitter Chat that Killed Sermo | #MedDevice

I’m not a physician. I don’t play one on TV. And I’d never heard of Sermo, the largest online physician community in the US (boasting 120,000 members) until @HJLuks mentioned them the week before.

Mine was an innocent invitation to talk during last night’s #MedDevice chat (Thursdays, 8 pm EST).

Who knew it could unravel the company.  …….

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Yesterday NPR aired this story:  Army Nurse Helps Soldiers Heal From Burn Wounds

As part of NPR's ongoing series, 'The Impact of War,' guest host Allison Keyes explores one of the tragic consequences of combat - burn wounds. Such wounds can subject victims to a painful and unpredictable recovery. Army Lt. Col. Maria Serio Melvin shares her experiences at the military's largest burn center, the Brooke Army Medical Center in San Antonio, TX, where she treated service members injured in the Iraq and Afghanistan wars …………

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Some inspiring stories of healthcare workers during the Joplin tornado

H/T @Mtnmd -- 45 Seconds: Memoirs of an ER Doctor from May 22, 2011

H/T @SeaSpray – Operating Through the Tornado

James D. "Dusty" Smith, MD, and his surgical team were midway through a routine case, the draining of a patient's infected hip, when the tornado hit St. John's Regional Medical Center in Joplin, Mo., Sunday.  ……….

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From @scutmonkey, her piece on Psychology Today:  The Radical Notion that Doctors are People, Too

Though there are few subjects as immediate to my experience as that described in Gardiner Harris's article in The New York Times, "More Doctors Say No to Endless Workdays," (April 1st, 2011), perhaps the truest indication of my opinion on the matter may be the fact that, upon first glance at the headline, I didn't feel much need to read the rest of the article.  More doctors say no to endless workdays?  Well, of course we do.  Duh.  …..

Her tweet of the article led @DarrellWhite to tweet a link to his view on the same topic:  Residency Training and the Modern Physician

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H/T to @brainpicker and @ctsinclair for the link to this:  Anatomy made of LEGO (photo credit) 

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Last Tuesday (May 24, 2011) NPR celebrated Bob Dylan Turning 70.  Near the top of the story written by Linda Fahey is a button “Visit FolkAlley.com To Hear The Mix” which links you to a wonderful mix of Dylan music sung by Joan Baez, Tim O'Brien, Rosanne Cash, Jimmy Lafave, many others — and Dylan himself.  Thanks NPR.

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Threads has a nice article by Susan Khalje on Creating Perfect Bias Fabric Loops  (photo credit)

……..we decided that loops and buttons would be a cleaner alternative.
Here are a few samples to show you what we did:
We started with strips of bias-cut fabric, making a sample or two to determine just how narrow we wanted the finished loops to be. ……….

Shout Outs

Updated 3/2017-- photos/videos and all links (except to my own posts) removed as many no longer active. 

Prepared Patient Forum, What it Takes is the host for this week’s issue of Grand Rounds! You can read this week’s edition here. 

We received more than 40 contributions for this week’s collection of health care blogs and columns. Patients, clinicians, policy wonks and interesting folks with opinions submitted original posts that are sure to expand your thinking and perspectives. …..

On Calling the Shots, Beth Gainer takes issue with using terms such as “sexy” and “sassy” to describe the experience of having breast cancer.  As a breast cancer survivor, Beth understands the reality of the diagnosis, treatment and aftermath that left her feeling anything but sexy or sassy.

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Paul Levy, Not Running a hospital, on health care policy:  The Whac-A-Mole school of health care policy

Boy, if you ever needed a summary of how messed up our health care system is, check out this story by Robert Pear in the New York Times. Entitled, "Nursing Homes Seek Exemptions From Health Law," the essence is that nursing homes want to be exempt from the employer requirement to provide health care benefits to their staff because the payments nursing homes get from Medicare and Medicaid to deliver care to patients are too low to provide enough cash to those institutions to offer those benefits. …..

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A lovely post on humanity by Jordan, In My Humble Opinion:   I'm Coming Home

As the door opened the look on her face was undeniable. Grief. Pain. the tears rolled down her eyes. She let me into her small dorm room and hugged me. And then she told me that her grandmother was dead.

She was a mess. Her sadness was overwhelming. She sat on her bed in a stupor. And I sat with her. Holding her hand. Not saying a word. Just being…..

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Dr. Smak writes about what grief has taught her:  Reflections

………….Last week our moderator asked us to reflect on how we have changed, what we have learned, from our experience as a bereaved parent. There were several things mentioned, and much overlap as expected. These stood out for me:   …….

3. Finally, what I'm still struggling to learn: life goes on. Not his life, but everyone else's. …. As one father put it, "My other children are still growing up." …... I don't want to miss out twice. And I don't want her to miss out on having a present mom.
Being a bereaved parent hasn't made me a better person, but I'm different than I was.

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Shared on twitter (photo credit) by @dwescott1

RT @pbaniak: I must say, these photos are pretty cool: Rare albino robin spotted in Winchester: http://bit.ly/lqiLd5 cc: @GrrlScientist

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Brought to my attention via @MotherinMed and @enochchoi: Magic of the MD-patient relationship NYT: Our Health and the Luck of the Draw

Sometimes you hear stories from your patients that leave you staggered by the caprice of life. A young West African patient told me how his extended family had trudged through the forest on foot to escape rebels. He was 10 years old at the time. At one point in the journey, he had to urinate. He excused himself and retreated several feet into the bush. Moments later shots rang out. When he finally had the courage to crawl back out onto the path, he saw that his entire family had been killed in an ambush. …….

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I feel even more fortunate to have never been sued as I read the statistic “6 in 10 doctors are sued by the time they reach age 55, said a 2010 report by the American Medical Association.” This comes from the AmedNews article by Alicia Gallegos: Life after lawsuit: How doctors pick up the pieces

Before dawn, nearly every morning in the days leading to his trial, Stephen Lutz, MD, woke abruptly, his mind filled with thoughts of the looming witness stand.

He would spend the next few hours lying in the darkness, going over the case again and again.

"I awakened many mornings rehearsing what I would say to explain myself. It's almost as if I was giving testimony every morning at 4 a.m.," said Dr. Lutz, a radiation oncologist in Ohio who was sued in 2008.

Experts say such stress associated with a medical liability lawsuit manifests in different ways, often affecting all aspects of a physician's life. ……

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How cool would it be to go to a concert and be invited on stage?  Well, NPR tells the story of just that happening to Rayna at a Paul Simon concert:  Paul Simon And A Moment Of Pure Sobbing Joy

Paul Simon has brought joy to so many for so long, but on this night he made Rayna Ford's dream come true. During a show in Toronto on May 7, Rayna Ford, a fan from Newfoundland, called out for Simon to play "Duncan," and said something to the effect that she learned to play guitar on the song. In a moment of astonishment and disbelief, Paul Simon invited her on stage…...

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. 

Dispatches from Second Base is the host for this week’s issue of Grand Rounds! You can read this week’s edition here.

Welcome to Grand Rounds! First, a quick shout-out to Nick Genes, an emergency medicine physician who blogs at blogborygmi (possibly the best blog name ever) and is one of the founders of Grand Rounds. I had no plans to host GR a second time until I saw Nick’s APB for April hosts. I had forgotten how much fun this was until the posts started coming in. So thanks, Nick.

The theme this time is what gives your life or work meaning. One of the loveliest, most contemplative posts I’ve seen on this topic is Nourishing Healthy Seeds from Deb Thomas, who blogs at Debbie’s Cancer Blog. ………..

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Last night a tornado all but wiped out the small town of Vilonia, AR.  I went to school there from the 4th through 12th grades.  I played basketball.  The town and school are much larger than when I went to school there (didn’t live in the town limits or postal zip code).  I have learned of at least one friend who lost her home in the storm, but all the family members are okay.

I know this is nothing compared to Japan’s disaster, but it is my hometown.  KATV has made it easy to donate to the Arkansas Red Cross (as well as the Japan Tsunami relief) here.

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NPR reminds us the Sitting All Day: Worse For You Than You Might Think  (photo credit), so get up and move. 

Yes, exercise is good for you. This we know. Heaps of evidence point to the countless benefits of regular physical activity. Federal health officials recommend at least 30 minutes of moderate exercise, like brisk walking, every day. ….

But now, researchers are beginning to suspect that even if you engage in regular exercise daily, it may not be enough to counteract the effects of too much sitting during the rest of the day.  ……

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Another great interview by NPR.  This one by Terry Gross (Fresh Air) of Dr. Emery Brown on 'What Happens In Your Brain During Anesthesia' :

If you've gone in for surgery, it's likely that your anesthesiologist has told you to count backwards from 100 — and that you'll wake up after a nice deep sleep.

But that's not exactly true.

"Sleep is not the state you're going in, nor would it be the state in which someone could perform an operation on you," explains Emery Brown. "What we need to do in order to be able to operate on you — to perform a procedure which, is indeed, very invasive — is to put you in a state which is effectively a coma which we can readily reverse."  ……..

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NPR had a very interesting segment yesterday on interviewing Amy Stewart, the author of the book Wicked Bugs:  Where To Find The World's Most 'Wicked Bugs' (photo credit)

Japan is home to the world's largest — and most painful — hornet. With a wingspan of up to three inches, the Asian giant hornet can look more like a tiny flying bird.

And if you're a bird — or a bee — watch out.

The Asian giant hornet can inject "a deadly neurotoxin, [which] actually can be fatal," says science writer Amy Stewart. "In Asia, they call it a yak-killer because it has such a potent neurotoxin."  …..

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NPR’s Science Friday is a wonderful site. This past Friday they highlighted three space science videos. One uses candy corn to demonstrate how soap works and the last shows what happens to water balloons in space when you pop them (or how large would rain drops be with no gravity).  Here’s the one that answers the question of how a yo-yo works in space.

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Shout Outs

Updated 3/2017-- photos and all links removed as many are no longer active and it was easier than checking each one.


GruntDocs is the host for this week’s Grand Rounds! You can read this week’s edition here.

Welcome to this weeks’ Grand Rounds, a self-selected compendium of the best of the Medical Blogosphere!

This is my 7th time to Host (first Seven Timer), and it’s always an honor. I asked everyone who submitted to send the date of their first blog post. After graphing them it’s a waste of time, nothing to see, you’re spared/welcome. Thanks everyone, anyway.

28 submissions by 27 authors, thanks to all.

First, the only post recommended by someone other than themselves (Liaka’s MedLibLog offered this, and kudos) is Dr. Wes with Social Media and The Challenge of Overcoming the Challenge of Intellectual Complacency. Tests (really, information / teaching) via Twitter. This would be cool, were I not complacent. ………

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H/T to @mtnmd for the link to this amazing story!  Chase Britton, Boy Without a Cerebellum, Baffles Doctors (go watch the video)

Chase was also born prematurely, and he was legally blind. When he was 1 year old, doctors did an MRI, expecting to find he had a mild case of cerebral palsy. Instead, they discovered he was completely missing his cerebellum -- the part of the brain that controls motor skills, balance and emotions. …..

Chase is not a vegetable, leaving doctors bewildered and experts rethinking what they thought they knew about the human brain.

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Interesting interview on NPR by Fresh Air's Dave Davies:   V.S. Ramachandran's Tales Of The 'Tell-Tale Brain'

Dr. V.S. Ramachandran is a neurologist and professor at the University of California, San Diego,….

In his latest, The Tell-Tale Brain, Ramachandran describes several neurological case studies that illustrate how people see, speak, conceive beauty and perceive themselves and their bodies in 3-D space.

Take, for example, the clinical phenomenon known as the "phantom limb." In the majority of cases where people have lost limbs, they continue to vividly feel the presence of the missing limb. Chronic phantom pain — which strikes roughly two-thirds of patients who have had a limb removed — can become so severe that patients seriously contemplate suicide.  …..

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I love these heart coasters (photo credit) featured by Street Anatomy!

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Words, phrases, titles and their meanings/origins have been on my mind as can be seen in my posts the past two days (here and here).  This continues with Future Docs’ new post:  Student Doctor or Medical Student? & Other Confusing Names

….Complicating matters is the propagation of the term “student doctor” at some institutions which is especially problematic.  After all, how many patients will be quickly discern that ‘student doctor’ actually refers to ‘medical student’ and not a ‘doctor’?  Unfortunately, patients who hear the term ‘student doctor’ may not hear the term ‘student’ and just zero in on the ‘doctor’ part, as they often wait patiently for their doctors to see them in the hospital.   This brings us to the problems of how doctors are named in teaching hospitals.  The system could not be more confusing.  ……..

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It’s that time again, St. Baldrick’s, but this year it’s different for our friend Movin Meat:  The Cause of My LIfe

When my wife was diagnosed with breast cancer eight weeks ago, at the age of 36 and with four kids, the youngest of whom was 4 months old, it was what one might call a shock, the like of which you don't get too many times in a lifetime. It was a life-altering moment. As we walked out of the hospital, numb, one thing was clear, above all else:

This Changes Everything
There were so many decisions to be made. ……What was I going to do about St Baldrick's?  ……….

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The 2010 Medical Weblog Awards Update – the voting is closed.  The winners will be announced tomorrow.  Congratulations to all of them!  Well deserved.   (photo credit)

The 2010 Medical Weblog Awards nominees...

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H/T to  @MedicalNews for the link to this article:  Mummy remains show false toes helped ancient Egyptians walk (photo credit)

Two artificial big toes -- one found attached to the foot of an ancient Egyptian mummy -- may have been the world's earliest functional prosthetic body parts, says the scientist who tested replicas on volunteers. …….

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Check out Scanman’s recent post: A Parable Of Rigidity in which he tells of how the use of twitter allowed doctors in two different countries to help save a patient’s life.  He tend rants (justifiably) on the red tape medical journals place on writing up such a case report.

Note: This is a true incident.  ………

Some of my friends in the medical blogosphere and medical twitterverse know that I loathe the red tape associated with submitting articles / papers to big medical journals. The story above just reinforces my loathing.

I prefer posting case reports in my blog rather than go through this.  ……

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H/T to @precordialthump for the link to this very nice post over at Academic Life in Emergency Medicine:  Trick of the Trade: Conveying risk for postexposure prophylaxis

A health care worker hurried in to the ED after being poked with a needle.

'It was an old 18G needle with dried blood', she said. Her puncture had drawn blood. You discussed the very low risk of contacting HIV and the side effects of postexposure prophylaxis (PEP). She asked, 'What does very low risk mean?'

Is there another way to covery risk for patients?

From the Bottom of My Heart

Updated 3/2017-- all links removed as many are no longer active and it was easier than checking each one.

Listening to NPR Saturday morning, I caught part of Scott Simon interview of brothers Stephen Amidon and Thomas Amidon, M.D. discusses their book The Sublime Engine: A Biography of the Human Heart.    The interview touched on the story of the human heart in science/medicine, history, and culture.

It turns out that the classic red heart symbol we see almost everywhere around Valentine's Day doesn't look much like a real human heart at all.

"Of all the theories about where that symbol comes from, my favorite is that it is a representation of a sixth century B.C. aphrodisiac from northern Africa," says Stephen Amidon,….. "And I kind of like that history because it sort of suggests that early on, people sort of understood the connection between love and the heart."

Words and how we use them were the focus of Dr. Pauline Chen interview by WIHI host Madge Kaplan this past Thursday, February 10th (H/T Paul Levy):  A Legible Prescription for Health 

On this edition of WIHI, Dr. Chen wants to spend some time talking about language, especially the words doctors use with one another when describing patients; the unintended barriers created the more doctors and nurses don protective, infection-protecting garb; the mounting weight of patient satisfaction surveys; and more.

Back to the NPR interview on the sublime engine: the human heart.  The authors do not feel that as our advances in surgical techniques become commonplace, that the heart will lose any of its cultural and metaphorical significance.

"One of the things that surprised me during the course of writing this book was how durable the heart's metaphorical power has been — not just in the past 50 years in the great explosion of cardiology, but in the past 500 years since the great anatomists of the Renaissance began opening up bodies and began looking at the physical heart," he says.

Even as all this was happening, the heart has retained its metaphorical power.

"So perhaps there will be a day when we no longer touch our chest and kind of nod, and people understand we're talking about qualities that can't be explained by medicine — we're talking about courage or devotion or inspiration," he says. "You can have a situation where someone receives an artificial heart, and afterward goes to their surgeon and says, 'I thank you for this from the bottom of my heart.' This will make complete sense to us."

On this Valentine’s Day, I thank you from the bottom of my heart for spending part of your day with me. 

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

John Mandrola, M.D., Dr John M, is the host for this week’s Grand Rounds! You can read this week’s edition here.

Hey all.
Welcome to another edition of Grand Rounds, a collection of writings from medical bloggers, the world-wide.
Here are this week's posts, collated into four chapters, with just a little commentary and a few selected images. ……….

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A really nice piece at EP Monthly by Dr. Greg Henry:  The ED as Political Safe Zone 

………..Now if you believe that the ED is that bastion of neutrality, free of all political bias, I have a bridge in lower Manhattan that heads to Brooklyn that I’d like to sell you. The reality is that politics are everywhere. The question is, how do we rein them in so that we can give out reasonably competent care without letting our innate prejudices control us? ………….

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As Movin Meat said in his post: An Anticipated Relaunch

One of my favorite writers has returned to the blogosphere!  Intueri has relaunched as In White Ink -- The Unwritten Details!  The early posts are promising, as one would expect of a long-time medblogger, and the site design is lovely, as one would expect from the beautiful, minimalist design of the old site.

…….I've added it to my feed reader, and I'd recommend you do as well.

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Kim, Emergiblog, is the host of the latest edition of Change of Shift (Vol 5, No 12)! You can find the schedule and the COS archives at Emergiblog. (photo credit)

Welcome to Change of Shift!

…….Now, let’s get started!

Editors Pick of the Week and Dedicated to Raise Blood Pressure Post: A story of a frequent flyer who needs the flights, presented by NPs Save Lives at The Nurse Practitioner’s Place: He’s Gotta Ticket To Ride and The NP Says It’s Okay posted at The Nurse Practitioner’s Place.

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From twitter comes a link to a very nice article

@Mtnmd RT @apjonas Sedentary Physiology Part 1 – Not Just The Lack of Physical Activity http://bit.ly/hlZrxq VERY interesting

The article is written by Travis Saunders who is a PhD student researching the relationship between sedentary time and chronic disease risk in children and youth.  It begins:

Welcome to our 5-part series delving into the fascinating research being performed in the emerging field of sedentary physiology.  Today, we’ll start with an introduction.  For Part 2 in our series, click here.

……., I’d like to give a bit of background.

What is sedentary behaviour?
Sedentary behaviours are those characterized by very low energy expenditure – typically those requiring 1.5 METs or less.

Here are links to all 5 parts:
Sedentary Physiology Part 1 – Not Just The Lack of Physical Activity
Sedentary Physiology Part 2 – Can Sitting Too Much Kill You?
Sedentary Physiology Part 3 – The Importance of Interruptions in Sedentary Time
Sedentary Physiology Part 4 – How Does Sitting Increase Health Risk?
Sedentary Physiology Part 5 – Future Directions

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Medical advances can be amazing!  This NPR story by Richard Knox is exemplary of just such an advance in the field of congenital heart malformations:   Stitch In Time: Fixing A Heart Defect Before Birth

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About 17,000 U.S. babies are born every year with a serious heart defect. Nobody knows how many might benefit from the kind of fetal surgery Wells had. ……

The root cause of HLHS, much of the time, is a partially blocked valve that regulates blood flow from the heart's main pumping chamber, the left ventricle, to the aorta, which carries blood to the entire body. …

The goal of fetal heart surgery is "to open the aortic valve at a point when the left ventricle is not quite beyond irreparable damage," says Dr. Wayne Tworetzky, a cardiologist at Children's Hospital in Boston.  ….

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NPR story by Susan Stamberg: In Paris, A Display From Hockney's Pixelated Period.   All the drawings are done on either an iPhone or iPad.  Beautiful!  (photo source)

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Shout Outs

 Updated 3/2017-- videos/photos and all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

Notes from Spice Island is the host for this week’s Grand Rounds! You can read this week’s edition here.

Welcome to this Edition of Grand Rounds. I'm honored to be hosting for my first time. The topic is education and lessons learned. I hope you enjoy!  ……….
Don't forget to check out Grand Round next week with a special election themed edition, Dr. Wes is hosting. Enjoy your Tuesday!

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While this Better Health article by Barbara Ficarra, RN focuses on cancer prevention news article, the same tips can be of help with any medical news articles:  Cancer Prevention: How To Sift Through The Headlines

Most of us can’t keep up with all the new ways to avoid cancer. Thanks to the Internet, we now have an unlimited supply of cancer knowledge at our fingertips. But, how can we filter out the good, the bad and the questionable?

Below are steps to help you tease out the facts when reading that next big news story on preventing cancer.

Says who?

Don’t just take the writer’s word for it. Dig a little deeper to find out the source behind the hype. The American Cancer Society says you should ask yourself these questions when reading an article:  ………….

Knowing the answers to these questions can help you decide on where you need to go to seek more details about the study findings. Visit the source of the information to learn more about how this new substance or method was tested.  ………..

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From twitter: RT @doctorwes: Electronic era part of problem? RT @AbbieCitron RT @Lawcats RT @MatthewBrowning: Missed Nursing Care- http://bit.ly/b5fEj2

The article, Missed nursing care: View from the hospital bed (Part One), is by  Beatrice J. Kalisch

Health care providers often assume they know what inpatients are experiencing. How different the view is from the hospital bed. Suddenly, the paradigm is flipped. Insights gained about hospital care from that vantage point can be quite astounding and must be examined if inpatient care is to improve. It is toward this end that I share my experience as an inpatient for seven days in an acute-care U.S. hospital. I was out of town and a longtime friend took me to the emergency department (ED).   …………….

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Via twitter: @ milblogging Military Blogs

U.S. Navy releases Social Media Handbook (View Online) http://tinyurl.com/2v6w37o

Navy Command Social Media Handbook - Online VersionView more documents from US Navy Social Media.………………..

I like NPR, Elton John, and Leon Russell which made this segment NPR did last week very enjoyable for me:  Elton John And Leon Russell Reunite On 'The Union'

Elton John and Leon Russell's paths seemed fated to cross: Both grew up at the piano, learning to play as little boys. Both played piano in bars while in their teens, and both started their careers as piano players for hire. But, according to John, there's one important difference.

"He is a better piano player than I am," John says. "As far as gospel and stuff like that, that's why I wanted to make this album. He is my idol."   ……
And this one:  First Listen: Elton John And Leon Russell, 'The Union' which gives you the opportunity to listen to some of the songs on the album.

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Dr Anonymous’ show will be about FMEC Mtg. The show begins at 9 pm EST.

Shout Outs

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active. 

Bongi, other things amanzi, is the host for this week’s Grand Rounds.  You can read this week’s edition here.

it's not just the soccer world cup that is on south african shores but the great grand rounds, something that some would say is far more important than the world cup (ok only one guy would actually say that and he is in a psychiatric institution in outer mongolia) is also presently hosted in south africa!!! proudly south african!!!

but time to see what the bloggers have dished up for us this week.

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Kim, Emergiblog, is the host of the latest edition of Change of Shift (Vol 5, No 1) which marks the beginning of the 5th year!   You can find the schedule and the COS archives at Emergiblog. (photo credit)

Welcome to the Change of Shift anniversary edition!
Today marks the beginning of Change of Shift’s fifth year.
Thanks to everyone who responded with suggestions for our carnival! I’ll be compiling those thoughts into a future post (let’s just say link lists are out…).
Many thanks to those who contributed! This week, I’ve added a few new-to-me nursing blogs I’ve discovered along with favorite CoS regulars………

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NPR has a wonderful series called StoryCorps were family members interview one another.  In this one, two young children interview their father about his bionic hand:  For Kids, Dad's Bionic Hand Recalls 'Star Wars'

In 2007, Eric Jones survived a bout with cancer, but complications from his treatment led doctors to amputate his right hand. He then became one of the first Americans to receive a bionic hand. He recently spoke with his son Alex, 7, and daughter, Lanie, 10, about his recovery.
"How did you get your bionic hand, Dad?" Lanie asks.
"On the Internet," her father says.
"Did you just go to Google and look up, um ... 'bionic hand?' " she asks…..

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Interesting article on lack of remuneration to organ donations via a tweet by @txmed -- “The organ donor—alone among all the participants in the world of transplantation—receives no benefit http://bit.ly/cWImng”:  Our Deeply Unethical National Organ Policy (bold emphasis is mine)

………Everyone involved in the organ transplantation process benefits handsomely, except the donor. Organ transplantation provides a wonderful example of life-saving science and technology deployed in serving mankind. It is also a thriving industry. The entire transplant team, including the surgeons, nurses, technicians, pharmacists, nephrologists, and other specialists are well-paid for their respective roles in providing organ transplant service. The medical centers at which transplants are performed are also handsomely compensated. The procedure feeds revenue into virtually every facet of the hospital. It occupies rooms, keeps labs busy, requires numerous expensive tests, and staff at all levels benefit. The pharmaceutical industry certainly benefits, as transplant patients remain on various expensive drugs to protect their new organ for the rest of their lives. Then, of course, there is the recipient who is, perhaps, compensated best of all. He or she gets his or her life back. Only the donor, who gives the most and without whom the entire process would grind to an abrupt halt, is required to forego any material recompense for his or her service.………………..

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TBTAM has been interviewed by Womens Health.gov

I was privileged to be the featured interview this month at the Spotlight on Women's Health series at Womenshealth.gov, the website of the Office of Women's Health. Thanks to the editors for their thoughtful questions and  for the opportunity to speak to women about HPV, healthy living and, of course, cooking!

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The Alliance for American Quilts received 115 quilts for it’s “New from Old Quilt Contest Contest.”  You can see all the quilts here.  My entry was “Label Me.”  The winner was this lovely quilt called “Metal Measures” by Jamie Fingal of California.

Measuring tape fabric, wool felt, old zippers, embroidery thread. Fabric was Mistyfused onto zippers and handsewn into place. Zigzag on domestic machine to felt.

The quintessential American design made into a modern day log cabin that is heavy on the metal.

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Dr Anonymous’ BTR show will be on summer break until late August.

Upcoming shows (9pm ET)

Jul-Aug: Summer Break
8/26: Dr. A Show 3rd Anniversary

Shout Outs

Updated 3/2017--  all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

DrRich, The Covert Rationing Blog, is this week's host of Grand Rounds. You can read it here (photo credit).  It’s the “cost containment in healthcare” edition.

Critics of the Obama health (insurance) reform plan have been formally served notice that they are under observation, ……….. So, as he embarks on this week’s edition of Grand Rounds, DrRich would like to welcome any visitors who are here on behalf of such important surveillance efforts, and hasten to tell you that DrRich is on your side. Indeed, this version of Grand Rounds is dedicated to exploring the many ways in which the proposed health (insurance) reforms will succeed in all its goals, and most especially in achieving cost containment…….

The latest edition of Change of Shift (Vol 4, No 3) is hosted by Man-Nurse Diaries who used a video game theme!   What fun!You can find the schedule and the COS archives at Emergiblog.  (photo credit)

It's August and school is looming around the corner, so kids everywhere are scrambling to waste time and do as much nothing as possible. What better way to dampen your brain activity than with video games? So here it is, your video game themed Change of Shift Vol 4 No 3: The Revenge!

H/T to  @EvidenceMatters for the link to this article:  A new superbug found in Britain is major concern: Government scientists by Rebecca Smith, Medical Editor.  The article talks about an un-intended consequence of medical tourism – the global spread of antibiotic resistant bacteria.

A new superbug that is resistant to all antibiotics has been brought into Britain by patients having surgery abroad, Government scientists said.

Doctors are urged to be vigilent for a new bug that has arriving in Britain with patients who have travelled to India and Pakistan for cosmetic surgery or organ transplants and is now circulating here.

Great show on NPR yesterday on “End Of Live Decisions And The Health Care Bill.”  You can listen to it here.

A portion of one health care bill in congress states that the cost of consultations between patients and doctors over "end-of-life" issues would be covered. The proposal has sparked fears that the bill promotes euthanasia.

Dr Rob has made his local paper, “Doctor 's humor is a hit on iTunes!"  Check out his podcast,  “House Call Doctor.” You can find the list of his podcasts here.  Enjoy!

Did you know that approximately 200 people die each year in the U.S. after being struck by lightning?  H/T to @laikas  for the link to this article: ER Doc explains how to avoid or respond to lightning strike

Prevention begins by seeking cover at the start of a storm. “Lightning seems to be concentrated at the forefront of a storm,” according to Zinzuwadia, “so there tends to be a greater risk of being hit by lightning at the beginning of a storm.”

WhiteCoat raises an interesting question in his post Charity Care Tax Exemptions. 

If exemption from federal income and/or state property taxes for non-profit hospitals is based upon providing “charity care” to their surrounding communities, how will hospitals qualify for income tax and property tax exemptions if health care coverage becomes “universal” and there is no longer a need for “charity care”? ………….

Crazy for Quilts Contest Gallery is up!  The quilt I did is #4.  

All contest quilts will be auctioned via eBay. All proceeds will support AAQ.
All auctions begin and end at 9:00 PM Eastern

On eBay search keyword "Alliance for American Quilts." Never used eBay? No problem! View a great tutorial on the eBay website.

                            

This week Dr Anonymous guest will be  The Hollums Adoption.  Come joint us.  The show starts at 9 pm EST.

Upcoming Dr. A Shows 

8/20: Dr. Rob & House Call Doctor podcast
8/27: Dr. A Show 2nd Anniversary & BlogWorldExpo
9/3 : Dr. A Show (9:30pmET)

Shout Outs

Updated 3/2017-- all links removed as many no longer active and it was easier than checking each one.

 

Captain Atopic is this week's host of Grand Rounds. You can read it here.  He calls it the “Grand Rounds 5:45 - Le Tour de France Edition!”

Where Grand Rounds is the Grand Tour of Medical Blogging, the Grand tour of Cycling is undoubtedly Le Tour de France, which concluded on Sunday in Paris. After three weeks of cycling, nearly 3,500km at an average speed above 40km/h, the peleton will ride up Paris' Champs Elysee's to the finish. Throughout the race, certain riders and teams will have reached their goals, revealed their future potential and achieved great triumphs. This week's Grand Rounds features some sterling examples of writing, all capable of Stage Victories, and some, much more. Welcome to the Tour...

The latest edition of Change of Shift (Vol 4, No 2) is hosted by Ross at Nurse in Australia! You can find the schedule and the COS archives at Emergiblog. 

The beautiful sunshine coast in Queensland, Australia is where I call home, so I’ve themed this edition the Sunshine Coast Edition. So welcome, thanks again for visiting my corner of the world!

Close your eyes for a moment and take a deep breath of that coastal air, and get ready to invigorate yourselves with some great posts for this edition of change of shift

You can read Movin' Meat’s  interview of Dr. Nick Jouriles, President of ACEP, over at The Central Line.

• Interview with ACEP President Jouriles (Pt 1)
• Interview with ACEP President Dr Jouriles (Pt 2)

Several bloggers come to Dr Regina Benjamin’s defense.  I agree with them.  It is much more important to look at her impressive qualifications.

• Dr Rob – Stone Throwing
• KevinMD  -- We should not care about Regina Benjamin’s weight
• Emily Walke -- Critcism of Regina Benjamin's Weight Nothing But Sexism

I’d like to direct you to Buckeye Surgeon’s post “The Meaning of Life.”  Be sure you read the comments.

Our purpose, our meaning is driven by the concept of "life"--- making it better, richer, less intolerable. If we admit this, then we are obligated to define what we mean by "life", because that is the fulcrum upon which we operate. What is life? What is it exactly that we are trying to save, to alleviate, to improve?

H/T to @MedicalQuack who tweeted the following. 

Nice Mention of @GruntDoc in Houston Chronicle http://tinyurl.com/mvoymy

Interesting NPR interview of Michael Ruhlman on cooking and his new book, Ratio.

His new book, Ratio, is about learning basic ratios. For example: 3:2:1 — three parts flour, two parts fat (like butter) and one part water — makes a basic pie crust. Add a dash of salt, and it's a savory base for a quiche. Add some sugar, and you've got a shell for cherries, chocolate cream or fresh peaches.

Dr Rob is now doing podcast as the “House Call Doctor”  giving “quick and dirty tips” to help you take charge of your health.   You can find the list of his podcasts here.  Enjoy!     

Recent NPR Stories on Plastic Surgery

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

I want to say these two stories were well done (both aired on June 1, 2009).  I was actually interviewed, but not quoted, for the story on fat-grafting.  I pointed Allison Aubry to Dr Scott Spear as her expert.  He is involved in one of the U.S. studies on breast augmentation using fat grafting. 

Sculpting the Body with Recycled Fat by Allison Aubry.

Doctors Still Unsure Of Long-Term Risks

Surgeons like Dr. Scott Spear of Georgetown University Hospital want to know more about the techniques used to transfer fat for breast augmentation.

"We're at the beginning of the learning curve," he says. He has initiated a clinical trial to answer some questions about the best way to perform the procedure and whether there are any measurable risks. To date, there are no published studies in the United States, so doctors are relying on their own clinical experience.

Silicone Injections May Harm Some Patients by Patti Neighmond

When people get injected with silicone at pumping parties, Gorton says "there is no way to verify if they're using medical-grade silicone. You can go to hardware stores and buy a big tub of it," he says. "The element is the same, but it's just not the same safety or purity or quality."

My past related posts:
How Not to Do Buttocks Enhancement
Short Cuts to Beauty?
Fat Injections for Breast Augmentation
Complications After Autologous Fat Injections to the Breast – an Article Review