Between the Lines is a Must Read

I am one of the physicians Dr. Zilberberg  (@murzee) mentions repeatedly in her book “Between the Lines” who don’t understand statistics.  I know it is one of my weaknesses.  Her book has done much to aid my understanding.  I will re-read it and pass it on to my niece who has mentioned she might want to go to medical school.  I had already told her to make sure she took a statistics class.

The book is easy to read and @murzee makes the concepts easier to understand than anyone I have ever heard/read.  If you want to gain a better understandings of the different types of scientific studies, biases, and statistical analysis, then“Between the Lines” is a must read.  

Leadership and Goal Play

Paul Levy’s (@paulflevy) book “Goal Play” is out!  If you read his blog you will recognize many of the vignettes as I did.   He teaches us lessons of leadership (not management) he has learned from coaching soccer. 

Easy to read.  Engaging stories as examples.  You can read from the beginning to end or flip through and read at random.  Either way you will gain valuable insights.

The book is available both at Amazon and at Createspace. 

Shout Outs

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.


My thanks to @jordangrumet for this tweet.  It gave me the motivation I needed to sit down and write.  I have lacked it lately, unsure where my blog is headed with the job transition, not wanting to lose contact with my fellow bloggers.  So thanks, Jordan. 

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

Welcome to Grand Rounds, where writers, readers, and bloggers send in their best stuff on a weekly basis to share, cross-pollinate, and build new audiences.

Tip of the hat to Grand Rounds co-creator Nick Genes, MD, PhD, an ER doc in NYC who knows a thing or two about blogging, tweeting and now Tumblr.

a timeless and inspiring read...

The theme of this week’s Grand Rounds is “Finding Meaning in Medicine,” with full attribution to Dr. Rachel Naomi Remen, author of the masterful book Kitchen Table Wisdom: Stories that Heal.  …………..

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H/T to @medicallessons who tweeted about this very unusual medical case in the NEJM:  Disappearance of a Breast Prosthesis during Pilates (includes images)

A 59-year-old woman with a history of breast cancer who underwent bilateral mastectomy and placement of breast prostheses presented for evaluation, reporting that her “body swallowed one of the implants” during a Pilates stretching exercise ….

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Another plastic procedure gone awry documented in a NEJM case report (h/t to @Neil_Mehta):  Blindness after Fat Injections

A 32-year-old man presented with vision loss in the left eye. one week earlier, while under local anesthesia, he had had an autologous fat injection into his forehead for correction of glabellar frown lines. The patient reported that while he was receiving the injection, he felt a sudden, severe periocular pain and had complete vision loss in his left eye. …..

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I found out via a Christmas card I received last week that a classmate from medical school was diagnosed with early mild cognitive impairment(mci) amnestic type last December.  He began writing a blog to chronicle his journey as he progresses towards Alzheimer's disease:  organicgreendoctor. 

He was a Family Practice doc before he retired.  He was/is a super nice guy.

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TBTAM has finally (smile) gotten around to giving us a list recommended NYC Restaurants

Home cooking is what I do best. And yet, the most frequent e-mail request I get from readers, friends and family is – “Where should we eat when we come to New York?”  And so, after years of wracking my brain for recommendations, I decided to create a list here of the places I go to and like. Some I’ve reviewed here on the blog – Most I have not (even though I have dozens of pics  and the best of intentions). But let me be clear – I am not a restaurant connoisseur. I’m just an ordinary New Yorker who knows what she likes. …..

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I never get around to reading all the books recommended to me, but still…  Here’s a list from Seattle Times reviewers:  32 of the year's best books

………Here are the results — 32 books, 21 fiction (who says the novel is dead!?), 11 nonfiction. Top vote getters were three novels, "The Sense of an Ending" by Julian Barnes, "The Marriage Plot" by Jeffrey Eugenides and "Ed King" by David Guterson, and Erik Larson's work of nonfiction, "In the Garden of Beasts." ……..

Shout Outs

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


Amy Tenderich, Diabetes Mine blog, is the host for this week’s Grand Rounds. You can read this week’s edition here.

Welcome to Grand Rounds, Vol. 8, No. 9, the 2011 Thanksgiving edition of the weekly summary of the best health and medical blog posts on the web. Many thanks to the organizers at Get Better Health for inviting us to host!

In a world where major economies are imploding and a climate catastrophe seems impending, there is still much to be thankful for — especially in the arena of health and medicine, where technology is empowering a revolution of sorts in hospitals, clinics and doctors’ offices, and in patients’ everyday lives.

What We’re Collectively Thankful for, from all around the med-blogosphere:

Last week’s host, Alvaro Fernandez at Sharp Brains, is thankful that everyone contributing to and reading Grand Rounds has a human brain (no bots, we hope!), and thankful that the human brain is not fully pre-wired.  .….

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H/T to @gastromom  for the link to this Huffington Post article by Dr. Rebecca Palacios:  Learning to Cook and Cooking to Learn

The holidays offer wonderful opportunities to create learning experiences for children that center around cooking. These experiences are especially powerful because they involve all of the senses: smelling, tasting, touching, hearing, and seeing -- which is one reason that memories created in the kitchen can last a lifetime! With a little thought and preparation, you can use this time to build important understandings and skills in literacy, mathematics, science, health, and even art. ……….

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H/T to @doctorwes for alerting me to this WSJ article: Doctor Revolt Shakes Disability Program.  His link required a subscription for full access, but @MDBuyline sent me a tweet with a link to full article.  I’m still thinking about it (as this is the work I am now doing), but my initial reaction is that the article is selectively biased.  The graphics with the article are impress though – take this one for example (check out the interactive map here)

See how the percentage of residents ages 18 to 64 receiving disability benefits has changed in each state since 2001.

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H/T to @sandnsurf for this tweet with link:  “Cool... Free e-book: Oh Doctor, The Places You Will Go... Precious Bodily Fluids t.co/FomfzD2r” 

  …….a parody of Dr Seuss' classic Oh, the Places You'll Go! It is a candid look at the journey people make in order to become doctors. I found it charming. Go download it. .…….

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How about a book review by @medicallessons:  ‘Cutting For Stone,’ and Considering the Experience of Practicing Medicine

A short note on Cutting for Stone, a novel I’ve just read by Dr. Abraham Verghese. He’s an expert clin­ician and pro­fessor at Stanford. The author uses rich lan­guage to detail aspects of Ethiopian history, med­icine and quirks of human nature. The book’s a bit long but a page-​​turner, like some lives, taking a strange and some­times unex­pected course.

For today I thought I’d mention one passage that haunts me. …….…….

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The Alliance for American Quilts received 119 quilts for it’s 2011 "Alliances: People, Patterns, Passion" contest.   You can see all the quilts here. My entry was “Redwork Quilt” and is included in this week’s (Week Two --Mon, Nov. 21- Mon, Nov. 28) quilts being auctioned off on eBay.

All contest quilts will be auctioned via eBay starting on Monday, November 14, 2011 and ending December 12, 2011. All proceeds will support the AAQ and its projects. ….

Week TWO auction guide: Monday, November 21 - Monday, November 28 ……
New this year: "Alliances" contest artist's were offered the chance to record their artist's statements thanks to the generous services of AAQ Business member, VoiceQuilt, visit them at www.voicequilt.com.

Shout Outs

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

Kim, Emergiblog, is the host for this week’s Angry Birds issue of Grand Rounds! You can read this week’s edition here (photo credit).

Welcome to the Angry Birds edition of that weekly compendium of medical blogosphere goodness, Grand Rounds! I’ve chosen my addiction du jour, Angry Birds, as the theme for my 7th turn as host.

For those who are not familiar, Angry Birds is a game in which Green Pigs steal Bird eggs, causing the Birds to become angry, start screeching and begin catapulting themselves from sling shots in an attempt to destroy the Pigs, who house themselves in various structures and giggle at the Birds.

Got it?
Okay then! Let’s get started!  ………..

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Last Tuesday @EvidenceMatters alerted me via twitter to a panel discussion regarding Vitamin D “Vigorous panel talk: Boosting Vit D - Not enough or too much? Liveblog: http://bit.ly/gL9JuX Video: http://bit.ly”

The webcast of the panel discussion can be viewed here.

The consensus report:  Dietary Reference Intakes for Calcium and Vitamin D

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I caught part of this great  @radiorounds episode (#509) this past Sunday afternoon.  The episode kicked off “Donate Life” month and  focused on the topics of organ donation and the organ shortage crisis.  It aired live on April 3 and will be available on April 5 on their iTunes page!   

The featured guests included:

• Dr. William K. Rundell, Director of Transplant Surgery at Miami Valley Hospital in Dayton, Ohio and Clinical Professor of Surgery at the Wright State Univ. Boonshoft School of Medicine

• Dr. John Donnelly, Asst. Professor of Family Medicine at the Wright State Univ. Boonshoft School of Medicine… and a pancreas transplant recipient

• Dr. Alex Tabarrok, Professor of Economics at George Mason University and co-author of the economics blog Marginal Revolution

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Victoria (@vpmedical), Beyond the Bedside, wrote her own post in response to mine:    Hand Transplant vs. Prosthesis

…. As a life care planning expert in amputation injury and limb loss, I find hand transplantation somewhat disturbing.  I can appreciate the technology and biological advances that have allowed transplantation to occur. …….

One need only to review the case of Mr. Jeff Kepner, a bilateral hand transplant patient, to understand the concerns of such a procedure.  One year after his transplant he still regretted his life changing decision. In his words……….

Be sure to read the comment from Wolf on my post.  It is very insightful.

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Engadget had an article by Christopher Trout yesterday:  Bionic eye closer to human trials with invention of implantable microchip

We've had our eye -- so to speak -- on Bionic Vision Australia (BVA) for sometime, and with the invention of a new implantable microchip it's coming ever closer to getting the bionic eye working on real-deal humans. The tiny chip measures five square millimeters and packs 98 electrodes that stimulate retinal cells to restore vision. ……...

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A lovely essay on the origin of how human hair wigs are sourced, created and distributed by Julia Sherman:  She Goes Covered

Following the global hair trade, from the braid-laden Peruvian highlands to the sheitel machers of Borough Park.

I.     In the fall of 2009, Helene Rosen, her husband, Yoni, and eight of their eleven children moved from Baltimore to Cusco, Peru, to harvest human hair.1 Helene is a forty-four-year-old Orthodox Jew and self-proclaimed “master sheitel designer” who began making wigs fifteen years ago, for ten dollars an hour; her custom hairpieces now sell for up to two thousand. “You can bring me any wig,” she said this past winter, sitting at the table in her spare dining room in Cusco, “and I can tell you how old it is, how much it has been worn, and if it has ever been repaired. I can tell you everything about it.”   ……….

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Arkansas Literary Festival begins this Thursday (April 7-13).  One of the authors this year is the son of a long time friend (from college days, a fellow physics grad who now works for Lockheed Martin in laser research). 

Benjamin Hale is a graduate of the Iowa Writers Workshop, where he received a Provost's Fellowship to complete his novel, which went on to win a Michener-Copernicus Award. He has been a night shift baker, security guard, trompe l'oeil painter, pizza deliverer, cartoonist, illustrator, and technical writer. He grew up in Colorado and now lives in New York. The Evolution of Bruno Littlemore is his first novel.

To visit Benjamin Hale's website, click here

In Stitches: a book review

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

I was given the book In Stitches to review.  The book is a memoir written by fellow blogger and plastic surgeon Anthony Youn, MD.

Having lived through medical school and residency, I don’t tend to read memoirs of the experience, so it is not a book a would tend to gravitate towards.

Having said that, I enjoyed reading it.  Dr. Youn has an easy to read writing style.  He tells his story with a lot of humor throw in. 

His Korean father, an ObGyn in Michigan decided his son would be “A doctor. Surgeon.” when his son is only 2 days old.  Dr. Youn goes to medical school for his father, but along the way learns to love the discipline and maintain his humanity.

You can read excerpt from In Stitches  here.  If you love memoirs, if you enjoy reading about the effort it takes to become a physician, if you enjoy good books; then you will enjoy this one.

In addition to the book’s website, there is a Facebook page and a book trailer on youtube.

You can follow Dr. Youn on twitter:  @TonyYounMD

Repost: Focal Dystonia of the Hand

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.

Earlier this week I caught bits and pieced of Diane Rehms interview of pianist Leon Fleisher. She was interviewing him about his many musical careers and his memoir: My Nine Lives: A Memoir of Many Careers in Music.

So I thought I would repost my blog post from October 2007 on Focal Dystonia of the Hand.

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Earlier this week I read an article in Reader's Digest (November 2007 Issue) on Leon Fleisher and his focal dystonia of his right hand. The article is written by Oliver Sacks, MD and is a exert from his book "Musicophilia: Tales of Music and the Brain". I wanted to review what I knew about focal dystonia and ended up learning much. I would like to try to share this with you. Enjoy this "Ravel Piano Concerto for the Left Hand 1/2" played by Leon Fleisher.

The term dystonia collectively refers to a heterogeneous group of movement disorders characterized by sustained involuntary muscle contractions that result from co-contracting antagonistic muscles and overflow into extraneous muscles. Focal dystonias are adult-onset forms that affect a specific area of the body, ie hand, neck, vocal cords. Most focal dystonias are primary. By primary it is meant that the dystonia is the only neurological symptom.

Focal hand and limb dystonia usually begins as a painless loss of muscular control in highly practiced movements. A genetic predisposition is thought to occur in less than 5% of all cases of focal dystonia. There are many professions that require repeated and intricate hand movements. However, focal hand dystonia is more common in musicians than any other group of professionals, including dentists, surgeons, and writers. This disorder is often referred to in medical literature as occupational cramps (ie, “violinist’s cramp”, “pianist’s cramp”, "writer's cramp"). (photo credit)

Cause
There is no one isolated cause of hand and limb dystonia. A variety of pathological conditions may lead to similar symptoms. As a child develops, he/she learns many different movements (such as walking, writing, or playing an instrument) that are stored in the brain as motor programs. Instances of hand dystonia that are highly task-specific have been described as a “computer virus” or “hard drive crash” in the sensory motor programs that are essential for playing music. However, additional factors, such as a genetic predisposition, are likely to play a significant role in the development of such a sensory-motor dysfunction. Why this “computer virus” cannot be easily overcome by establishing a new and improved sensory-movement pattern remains an important question for researchers.

Symptoms
Most affected persons describe symptoms in terms of their occupation terms. A musician may notice

• Subtle loss of control in fast passages
• Lack of precision
• Curling of fingers
• Fingers “sticking” to keys
• Involuntary flexion of bowing thumb in strings

A writer may notice:

• Deterioration in neatness or speed of writing or just clumsiness
• A cramp or aching in the hand on writing
• May report that the hand freezes up on attempting to write
• Difficulty in moving the pen across the page

A tremor may or may not be associated with the spasms. In most cases, the dystonia is present only in the context of specific tasks (and may be very specific to one instrument--a clarinet but not a saxophone). The dystonia may appear extremely sensitive to sensory input: a pianist may experience symptoms while playing on ivory keys but not while playing on plastic keys. Sometimes the modification of posture and even facial expressions may affect dystonic spasms in the hand.

Physical Exam

Inspection

No special examinations are described for focal dystonia other than inspect the patient performing his task.

• The pen commonly is held very tightly, with an exaggeration of the normal semiflexed posture of thumb, index and other fingers, and with hyperextension of the distal interphalangeal joint of the index finger. Occasionally, the hand suddenly stops and the paper is perforated, or it might dart across the page with a sudden jerk. The script produced is usually abnormal. Tremor is a common finding in all forms of writer’s cramp but it is usually not severe. (photo credit)
• Examination of the musician while playing reveals non-physiologic posture and gestures in most of the patients. Sometimes it is possible to identify involuntary dysfunction such as flexion, curling in one or two fingers, or involuntary extension of the “sticking fingers”. These may be difficult to detect, even with slow motion video.

The remainder of physical examination is often normal, but subtle findings can be noted in some patients: dystonic postures of the affected limb when the patients sit or walk, or loss of arm swing of the affected side during the gait.

Palpation

There is minimal unilateral increase in muscle tone in some patients. There are no other abnormal findings.

Quantification

The Fahn-Marsden scale was designed to quantify generalized or focal dystonia and can be found here.

Electromyography

Electromyography studies show prolonged duration of muscle bursts with superimposed shorter, repeated bursts of activity. The pattern is of complete lack of selectivity for individual muscles with overflow of contraction to muscles not normally activated by the task being performed. Electromyography may also useful as a guide to botulinum toxin injections.

X-rays

Radiographs are not useful in the assessment of focal dystonia. Occasionally, in an appropriate setting, magnetic resonance image of the brain can be useful to rule out a cerebrovascular disease.

Treatment
There is no cure for dystonia at this time, and although treatment of the disorder may be challenging, there are several available options. The different causes of hand dystonia may warrant different treatments. Don't give up--see Leon Fleisher's story.

Oral medications: There are a number of therapeutic agents with clear beneficial effects to writer’s cramp, including anticholinergics, clonazepam and benzodiazepines. High dosage of anticholinergic drugs is firstly recommended for the treatment of dystonia.

• Doses recommended of biperiden are 2 mg per oral two or three times a day and titration to 16 mg a day.
• Diazepam is another choice. However, it is rarely adequate when used as sole agent. Doses are 10mg per oral two or three times a day.
• Clonazepam can be useful for improvement of phasic symptoms in cases with myoclonus and/or tremor. Doses are 0.25 mg per oral twice a day, increasing to 0.125 to 0.25 mg every three days up to a dose of 4 mg/day.

Botulinum toxin injections has been used for the treatment of writer’s cramp with good results. Its application requires careful and precise technique. The selection of the muscle should be based on careful physical examination while the patient writes or plays in order to trigger the dystonic movements. The injection should be carried out under EMG guidance with a hollow recording needle and the botulinum toxin is injected through the same needle. Small volume injections into multiple sites are preferred to a single large injection. Dose per muscle varies from 2.5-25 units. Initially, only few muscles are injected. The dose per muscle and number of muscles injected are optimized (based on response) for subsequent injections.

Splints

Some patients find that finger-splinting device made individually according to their symptoms help improve their ability to write or to play a musical instrument. Limb immobilization for four weeks and a half is a simple and sometimes effective treatment for this condition. (photo credit)

"Therapeutic approaches involving the practice of movements are likely to remain unsuccessful unless their design includes a framework that, in principle, aims at interrupting this vicious circle. Indeed, a recently developed behavioural therapy, termed sensory motor retuning, holds great promise (Candia et al., 2002). Musicians with focal hand dystonia performed repetitive movements with fingers of their dystonic hand while one or more fingers except the dystonic ones were immobilized. After therapy, movements of the dystonic fingers were substantially better controlled, with some musicians reaching near-normal performance levels. Along with improvement of motor behaviour, the topography of the somatosensory representation of the fingers became normalized." from Brain article (see references below).

For an interesting list of people who have struggled with this problem, check here.

References and Resources

Mark Hallett, MD

NIH clinical study "A Training Protocol for the use of Botulinum Toxin in the Treatment of Neurological Disorders", reference No. 85-N-0195

Focal Dystonia of the Hand by Marcos Sanmartin

Focal hand dystonia – a disorder of neuroplasticity?; Brain, Vol. 126, No. 12, 2571-2572, December 2003; Joseph Classen

Upper Limb Disorders in Musicians by Raoul Tubiana, MD

Tubiana R. Musician’s focal dystonia. Hand Clin 19: 303-308, 2003.

Dystonia Fact Sheet--National Institute of Neurological Disorders and Stroke

Dystonia--pianomap

Focal Dystonia from a Guitarist's Perspective by Jarrod Smerk

A Tale of Two Hands--Charlie Rose talks to pianist Leon Fleisher

Muscians with Dystonia Foundation

Genius on the Edge – book review

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

I received a free copy of the book, Genius on the Edge: The Bizarre Double Life of Dr. William Stewart Halsted by Gerald Imber, MD, a week ago.  I have enjoyed reading it.  The book is the biography of Dr Halsted, but also gives you a glimpse into the life of many other great medical figures:  William Osler, William Henry Welch, Harvey Cushing, etc.  (photo credit)

In many ways it is a history of medicine/surgery in America.  Halsted was very influential in bringing aseptic techniques to surgery and introduced the residency training system.  He used his knowledge of anatomy to improve surgical technique.  He performed the first successful hernia repair and radical mastectomy for breast cancer. 

Early in his career Halsted became addicted to cocaine while experimenting with the drug for use as a local anesthetic.  Treatment at the time, involved substituting morphine for cocaine.  Halsted spent 40 years of his life struggling with his addiction to both cocaine and morphine.

His career was almost ruined by his addiction, but with help from his friends who still believed in his brilliance he was able to resurrected his career at the new Johns Hopkins, where he became the first chief of surgery.  Here he took changed surgery to a lifesaving art rather than a horrific, dangerous practice.

You don’t need to be a surgeon to appreciate this book.  You only need to have a love of history.  Dr. Imber, a plastic surgeon in private practice in Manhattan, has written a fine book.

Shout Outs

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

Dr. Rob,  Musings of a Distractible Mind, is this week's host of Grand Rounds.   It is the Groundhog Day edition. You can read this week’s edition here (photo credit).

It happens every year.

I try to get a little shut-eye, but then these guys in hats come around and yank me out of bed.  They proceed to parade me around a huge throng of people (most of whom are not wearing hats), obsessing about the presence or absence of stratus clouds.

What a strange group of people.  I seem to be the center of attention for the day, though, and that’s not all bad.  It’s my day on February 2nd, and nobody has ever taken that from me.

Until this year.

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Have you seen the National Library of Medicine’s exhibit “Changing Faces of Medicine”?  One of the physician’s mentioned on the site as a “local legend” is Dr Betty Lowe (photo credit) who was head of the department of pediatrics at Arkansas Children’s Hospital when I was a medical student.

“I like science; the idea of doing something that isn't always the same. And life as a pediatrician is definitely unpredictable!”

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From Peter Lipson, White Coat Underground:   Why you should read The Immortal Life of Henrietta Lacks (photo credit)

This is a special shout out to the doctors and scientists out there. Everything we do in our fields has repercussions, often unexpected ones. Because of this, we strive to practice ethically to help prevent or minimize negative repercussions.

This discussion comes up specifically as an epiphenomenon of the release of The Immortal Life of Henrietta Lacks (my full review can be found here.) How one reacts to this book would, I suppose, depend on your perspective. A neighbor of the Lacks's might react quite differently than a 22 year old doctoral student. And that's really the point.

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Voting continues at MedGadget for the medical blog awards. Polls will close 12 midnight on Sunday, February 14, 2010 (EST).  Vote here. 

The categories for this year's awards are:

-- Best Medical Weblog
-- Best New Medical Weblog (established in 2009)
-- Best Literary Medical Weblog
-- Best Clinical Sciences Weblog
-- Best Health Policies/Ethics Weblog
-- Best Medical Technologies/Informatics Weblog
-- Best Patient's Blog

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The need for help to Haiti continues. Anyone wishing to donate or provide assistance in Haiti is asked to contact the Center for International Disaster Information. Here is a list of organizations who need your help in providing care to Haiti:

• Clinton Foundation -- Donate online or Text "HAITI" to 20222 and $10 will be donated to relief efforts, charged to your cell phone bill.
• American Red Cross International Response Fund – Donate
• Doctors Without Borders
• The International Rescue Committee
• International Medical Corps
• Mercy Corps Haiti Earthquake Fund (1-888-256-1900)
• Partners in Health
• UNICEF (1-800-4UNICEF)
• UN World Food Program
• National Disaster Search Dog Foundation (SDF)
• The International Fund for Animal Welfare (IFAW)

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If you are a physician and would like to do volunteer work in Haiti, then check this out:  Help Haiti: AMA registers physician volunteers

The registry -- launched Jan. 26 -- is open to all licensed doctors and requests information such as specialty, language skills, availability and previous disaster medicine experience.

The registry is available online (www.ama-assn.org/go/haiti-volunteer).

An in-depth Webinar on how medical responders can prepare for working in Haiti is available, along with other resources, at the AMA Web site (www.ama-assn.org/go/haiti-earthquake).

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H/T to @NHPCO_news  Noted researcher Joan Teno MD shares her family's hospice experience on public radio's "This I Believe" http://www.wrni.org/content/hospice.  It is an interesting listen.

Death.  It's not a pleasant subject, of course, yet all of us know of its inevitability, in our own lives and those of the people we love.  Sadly, for many the end of life is filled with a toxic mix of pain, suffering, and an agonizing loss of control.  But, as Dr. Joan Teno notes, life does not have to end this way.  Indeed, we know better.

Dr. Joan Teno is the daughter of Doris Teno, who died on October 15, 2008.  She is professor of community health at The Warren Alpert School of Medicine of Brown University and Associate Medical Director of Home and Hospice Care of Rhode Island.

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From Threads comes this article, Create Intricate Fabric With Pin Weaving, which gives clear instructions on the technique.  I’ll be adding it to my list of things to try someday, especially now that I have more leftover yarns as I am knitting more.

Pin weaving doesn’t require much equipment; you only need a padded board for a base that will act as your “loom.” The pin-woven fabric is formed over a piece of fusible interfacing. Once you are happy with your design, iron it to the fusible interfacing to hold everything together.  The result is a soft, pliable and beautifully textured fabric.
…….Pin weaving is the perfect on-the-go craft for sewers looking to use up scraps from their stashes.

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Dr Anonymous is back this week with Dean Brandon from Pediatric Dentistry blog.  Come join us.

Upcoming Dr. A Shows (9pm ET)
2/11 : Drew Griffin from Wound Care Education Institute
2/18 : Rhett and John from FireFighter Netcast

Book Review -- Critical Conditions

I enjoy reading novels by Stephen White. He is a clinical psychologist who lives in Colorado. This one, Critical Conditions, involves his main character, Dr Alan Gregory, in some twists and turns of human behavior dealing with a family deals with one of their own who needs care that their HMO won't approve. It's a good read, classified as a psychological thriller.

Some of it will make you think about the discussions ongoing in medical care/insurance coverage. His first page made me think of Dr Edwin Leap's request for last week's Grand Rounds -- "Why we do it".

Here's that first page:

I hold the hands of people I never touch.
I provide comfort to people I never embrace.

I watch people walk into brick walls, the same ones over and over again, and I coax them to turn around and try to walk in a different direction.

People rarely see me gladly. As a rule, I catch the residue of their despair. I see people who are broken, and people who only think they are broken. I see people who have had their faces rubbed in their failures. I see weak people wanting anesthesia and strong people who wonder what they have done to make such an enemy of fate. I am often the final pit stop people take before they crawl across the finish line that is marked: I give up.

Some people beg me to help.
Some people dare me to help.

Sometimes the beggars and dare-ers look the same. Absolutely the same. I'm suppose to know how to tell them apart.

Some people who visit me need scar tissue to cover their wounds. Some people who visit me need their wounds opened further, explored for signs of infection and contamination. I make those calls, too.

Some days I'm invigorated by it all. Some days I'm numbed.
Always, I'm humbled by the role of helper.
And, occasionally, I'm ambushed.

This first page also made me think about my post Suitability.

The Big Read

I saw this on Purplesque's blog (thanks Vijay for the introduction). It seems to be a meme going around the blogosphere rather than a list coming from the come from National Endowment for the Arts (NEA). The NEA does have a program called "The Big Read".

The Big Read is an initiative of the National Endowment for the Arts designed to restore reading to the center of American culture. The NEA presents The Big Read in partnership with the Institute of Museum and Library Services and in cooperation with Arts Midwest.

Still it is interesting to read the "meme list" and see which ones you have read. So here it is:

“The Big Read reckons that the average adult has only read 6 of the top 100 books they’ve printed.”

1) Bold: I have read.
2) Underline: Books I love.

3) Reprint this list in your own blog so we can try and track down these people who’ve read 6 and force books upon them ;-)

1. Pride and Prejudice - Jane Austen
2. The Lord of the Rings - JRR Tolkien
3. Jane Eyre - Charlotte Bronte
4. The Harry Potter Series - JK Rowling
5. To Kill a Mockingbird - Harper Lee
6. The Bible
7 . Wuthering Heights - Emily Bronte
8. Nineteen Eighty Four - George Orwell
9. His Dark Materials – Phillip Pullman
10. Great Expectations – Charles Dickens
11. Little Women - Louisa M Alcott
12. Tess of the D’Urbervilles - Thomas Hardy
13. Catch 22 - Joseph Heller
14 . The Complete works of Shakespeare (Like Purplesque I've tried, and failed. Have seen many of them performed.)
15. Rebecca - Daphne Du Maurier
16. The Hobbit --J.R.R. Tolkien
17. Birdsong – Sebastian Faulks
18. Catcher in the Rye - JD Salinger
19. The Time Traveler's Wife
20. Middlemarch - George Eliot
21. Gone With The Wind - Margaret Mitchell
22. The Great Gatsby - F Scott Fitzgerald
23. Bleak House - Charles Dickens
24. War and Peace - Leo Tolstoy
25. The Hitch Hiker’s Guide to the Galaxy - Douglas Adams
26. Brideshead Revisited – Evelyn Waugh
27. Crime and Punishment - Fyodor Dostoyevsky
28. Grapes of Wrath - John Steinbeck (one of the few Steinbeck's I haven't read)
29. Alice in Wonderland - Lewis Carroll
30 . The Wind in the Willows - Kenneth Grahame
31. Anna Karenina - Leo Tolstoy
32. David Copperfield – Charles Dickens
33. Chronicles of Narnia - CS Lewis
34 . Emma - Jane Austen
35. Persuasion - Jane Austen
36. The Lion, The Witch and The Wardrobe - CS Lewis
37. The Kite Runner - Khaled Hosseini
38. Captain Corelli’s Mandolin - Louis De Bernieres
39. Memoirs of a Geisha - Arthur Golden
40. Winnie the Pooh - AA Milne
41. Animal Farm - George Orwell
42. The Da Vinci Code - Dan Brown
43. One Hundred Years of Solitude - Gabriel Garcia Marquez
44. A Prayer for Owen Meaney - John Irving
45. The Woman in White - Wilkie Collins
46. Anne of Green Gables - LM Montgomery
47. Far From The Madding Crowd - Thomas Hardy
48. The Handmaid’s Tale - Margaret Atwood
49. Lord of the Flies – William Golding
50. Atonement - Ian McEwan
51. Life of Pi - Yann Martel
52. Dune- Frank Herbert
53. Cold Comfort Farm - Stella Gibbons
54. Sense and Sensibility - Jane Austen
55. A Suitable Boy - Vikram Seth
56. The Shadow of the Wind - Carlos Ruiz Zafon
57. A Tale Of Two Cities - Charles Dickens
59. The Curious Incident of the Dog in the Night-time - Mark Haddon
60. Love In The Time Of Cholera - Gabriel Garcia Marquez
61. Of Mice and Men - John Steinbeck
62. Lolita - Vladimir Nabokov
63. The Secret History - Donna Tartt
64. The Lovely Bones - Alice Sebold
65. Count of Monte Cristo - Alexandre Dumas
66. On The Road - Jack Kerouac
67. Jude the Obscure - Thomas Hardy
68. Bridget Jones’s Diary - Helen Fielding
69. Midnight’s Children - Salman Rushdie
70. Moby Dick – Herman Melville
71. Oliver Twist - Charles Dickens
72. Dracula - Bram Stoker
73. The Secret Garden - Frances Hodgson Burnett
74. Notes From A Small Island - Bill Bryson
75. Ulysses - James Joyce
76. The Bell Jar - Sylvia Plath
77. Swallows and Amazons
78. Germinal - Emile Zola
79. Vanity Fair - William Makepeace Thackeray
80. Possession - AS Byatt
81. A Christmas Carol - Charles Dickens
82 Cloud Atlas - David Mitchell
83. The Color Purple - Alice Walker
84. The Remains of the Day - Kazuo Ishiguro
85. Madame Bovary - Gustave Flaubert
86. A Fine Balance - Rohinton Mistry
87. Charlotte’s Web - EB White
88. The Five People You Meet In Heaven – Mitch Albom
89. Adventures of Sherlock Holmes - Sir Arthur Conan Doyle
90. The Faraway Tree Collection – Enid Blyton
91. Heart of Darkness - Joseph Conrad
92. The Little Prince – Antoine de St. Exupery
93. The Wasp Factory – Iain Banks
94. Watership Down - Richard Adams
95. A Confederacy of Dunces – John Kennedy Toole
96. A Town like Alice- Nevil Shute
97. The Three Musketeers - Alexandre Dumas
98. Hamlet- William Shakespeare
99. Charlie and the Chocolate Factory - Roald Dahl
100. Les Miserables – Victor Hugo
I would also suggest:
Angel of Repose by Wallace Stegner
You Can't Go Home Again by Thomas Wolfe
Out of Africa by Isak Dinesen
Midwives by Chris Bohjalian
Mountain Time by Ivan Doig
Ramona by Helen Hunt Jackson
Tony Hillerman's mysteries (featuring Chee and Leaphorn)
Linda Barnes mysteries (featuring Boston PI Carlotta Carlyle)
Stephen White's mysteries (featuring psychologist Dr Alan Gregory)
Susuan Wittig Albert's mysteries (featuring China Bayles, owner of a herbal shop)

Would welcome any suggestions for myself or to give to my nieces and nephews (ages 2 yo to mid-30's).

Some Shout Outs

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

Grand Rounds 4:39 comes to us from the South Pacific this week. It is hosted by David Khorram at his blog, Marianas Eye. David is an eye surgeon and author. You can check out the book here. Back to grand rounds, here's what David has to say:

I’ve always wanted to be a newspaper editor, not because I want to edit, but because I want to write headlines. And not for a respectable paper like the New York Times. Maybe for a newspaper, like the Enquirer -- you know, where an editor can have some creative freedom with the facts. So, finally, I get my chance with this week's Grand Rounds. Sometimes the headlines I’ve written relate to the post, sometimes, they are just a whacked out free associations. Like all headlines, their purpose is to get you to read the posts. I hope I can entice you. There are some really great writers out there. Great job everyone.

I say he did a great job! Hope you will check it out.

Dr David Loeb will be the guest this week on the Dr Anonymous Blog Talk Radio Show. Dr David is a pediatric oncologist at John Hopkins. It should be a very interesting interview. I hope you will join us in the chat room.

Tips for first time Blog Talk Radio listeners (from Dr A):

For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.
*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.
*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.
*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. There is also a "Click To Talk" feature where you do not need a phone to call into the show - only a microphone headset. Hope these tips are helpful!

And a reminder to get those posts in for the FINALE edition of the FIRST season of SurgeXperiences! The host will be anaesthesist Dr. T at her blog Notes of an Anesthesioboist on Sunday June 22, 2008. Deadline for submission is midnight Friday June 20th. T's request:

Tonight I was honored once again to be invited to host the SurgExperiences blog carnival for its final edition of the season, SurgExperiences 124, to be posted on June 22. I am considering the theme "Secrets and Surprises," but the last time I thought I might have a theme, the collected works morphed into something else - so again, the "theme" isn't written in stone!

Please submit your posts here or email her directly at anesthesioboist@gmail.com with a link to your post.
Here is the catalog of past surgXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.

Women in Medicine

Updated 3/2017-- photos and links removed as many are no longer active

Harriet Hall from the Science-Based Medicine blog wrote a piece on "Women in Medicine" recently. It is interesting reading, as I hope her book will be. I've ordered my copy.

Something very interesting is happening in medicine. It’s happening slowly, quietly, and steadily, with no help from affirmative action programs.

At the beginning of the 20th century about 5 percent of the doctors in the United States were women. In 1970, it was still only 7 percent. By 1998, 23 percent of all doctors were women, and today, women make up more than 50 percent of the medical student population. In 1968 only 1.2% of practicing dentists were women. By 2003, 17% of dentists were women, and 35% of dentists in new active private practice were female.

A Singular View

Updated 3/2017-- photos and all links removed as many no longer active.

Back in March after writing the post on prosthetics, I received a package that contained a copy of the book, A Singular View, and a copy of the Journal of Ophthalmic Prosthetics (JOPPro) along with a note. Michael O Hughes, ocularist and senior editor of the JOPPro asked me to submit an article for a "focus" edition on esthetics that they are putting together for next year.

My thought of an article (only four pages needed!!) would be expectations of the patient from the perspective of a plastic surgeon; which is very similar to the restorative work of an ocularist and a oculoplastic surgeon. Please keep in mind; ocular/facial prosthetics is very different from orthotics; which you may be more comfortable/familiar- due to your father.

Facial disfigurements can hit a patient at the core of their security. Then again; some patients are very flip id about the loss. Regardless; the world of ocular prosthetics is surrounded by myths and many misconceptions. Maybe plastic surgery; for the average consumer is also.

Michael Hughes

I have no experience, either in training or in practice with patients who have lost an eye. I do not feel qualified to write such an important article. If there is anyone out there who can (perhaps David Khorram, MD who writes the blog marianaseye), please do so. Thank you.

There is a lot of information at Mr Hughes website. The information covered includes ocular prostheses (photographs, the fabrication, and the history) and patient resources.

As for the book, it is a great source of information on adjusting to monocular vision. It contains practical suggestions such as:

• Lightly touch the pitcher of water/tea to the rim of the glass before pouring.
• When choosing a seat at the dinner table, try to sit with your unaffected (remaining eye) side to the person you will be conversing.
• Learn how to use perspective and relative movement to judge distance.
• Don't give up the activities you enjoyed prior to your eye loss. Relearn how to do them with monocular vision. The books author was a pilot both before and after his injury left him with one eye.

The book gives a nice explanation of how depth perception works and is changed by the loss of one eye. Depth perception involves 1) retinal disparity, 2) convergence, and 3) accommodation.

Retinal disparity depends on an object being viewed with two eyes separated by several inches so that each eye is looking at the same target from a slightly different location at the same moment.

Convergence has to do with the merging of these two images produced on the retinas. The effort by the eyes to bring the two images into exact correspondence produces a strain on each eye, and the experienced brain knows how to translate this into a measure of distance.

Accommodation is a term for the automatic adjustment each eye makes to bring an object into focus. It is only effective for judging distances up to about six feet; thus it's likely to be the least useful of the three mechanisms. When you've lost an eye, however, it's the only one available to you, and we will cultivate it to its limit.

There are many famous people who have had great careers and only monocular vision. Some examples are:

• Peter Falk -- an actor well known for the detective Columbo. Surgeons had removed his right eye, along with a malignant tumor, when he was three years
• Sandy Duncan -- an actress and dancer. In the 1970s, she was treated for a tumor behind her left eye, which damaged the optic nerve. She lost the sight in the eye.
• Theodore Roosevelt -- 26th president of the United States. He lost his left eye in a boxing match with a naval officer
• Sammy Davis Jr --singer/entertainer. He lost his left eye in an automobile accident prior to achieving stardom as an entertainer
• Wiley Post, pioneering aviator who made the first solo circumnavigation of the globe with vision in only his right eye
• Elizabeth Blackwell, the first woman to graduate from an American medical school lost an eye while in postgraduate school in France
• James Stuckey, MD--not as famous, but did practice Plastic Surgery in Little Rock, Arkansas. He was very well thought of by his patients, his peers, and the nurses. He retired in the early 1990's and died almost 10 years ago. (Couldn't find a link to his obituary)

Suture Self

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

Shortly after I began my blog, I got a message through mybloglog from Dr. Judy Paley (Denver Doc Online), "I thought of the greatest name for your blog: Suture Self."

I answered her back something like "I kind of like the play on words I had--similar to working for a living." I still like the name of my blog.

However, the other day in Barnes and Noble while perusing books this book caught my eye. The title, Suture Self, reminded me of FemaleDoc's comment back in June. So I had to buy the book and am reading it now. It's not heavy reading, but is entertaining.

The synopsis: A bum hip has bed-and-breakfast hostess Judith McMonigle Flynn limping off to Good Cheer Hospital -- a questionable "haven of healing" where two recent patients didn't make the cut after routine surgery. Judith's trepidation at undergoing the knife is eased only by sharing a room with cousin Renie, who's in for rotator cuff repair. Though the cousins survive their surgeries, the ex-pro quarterback next door is permanently sacked after minor knee surgery. With the scoreboard showing Grim Reaper 3, post-op patients 0, Judith decides that she and Renie are obliged to get to the bottom of Good Cheer's carnage. But in order to sew up the case, Judith and Renie must probe into the suspects' psyches. And suddenly it looks as if the cousins' own prognoses could take them out of the game...for good.

I wonder if I had changed my blog name to "Suture Self" if I would have been in violation of copyright.