"I Always Miss the Cool Stuff..."

Do you remember the time when you were a girl from Mars? I don’t know if you knew that.

I agree with Chris. The Pistons are hard to watch this season.

The Apples in Stereo’s new CD, New Magnetic Wonder, has the classic Apples in Stereo sound. Their previous album, The Velocity of Sound, kind of diverged from their style. I enjoy The Velocity of Sound, but I think New Magnetic Wonder is a better CD in all aspects from production to song writing. My favorite song is Skyway. Everyone should check out this CD.

I’m doing excellent with one of my New Year’s resolution, eliminating road rage. In the 2007 I have not once yelled or raised my voice while driving. I’m dropping the ball with the other one’s though.

Thanks Jacob for fixing my Internet. You are way better than Geek Squad and a lot cooler. Fuck Geek Squad.

Why does everyone think dating a doctor would be good? It could be just the opposite. Which I guess would be bad, or ungood.

On Tuesday the New York Times reviewed a book that discussed the racism that has occurred in medicine in the United States. Some of the topics discussed were the infamous Tuskegee experiments in which physicians did not treat syphilis in African American men from 1932-1972 to see the natural progression of the disease and James Marion Sims cruel surgical experiments. Harriet A. Washington’s book, The Dark History of Medical Experimentation on Black Americans From Colonial Times to the Present, also warns of new abuses occurring in the medical community, such as pharmaceutical companies testing medications in Africa in poor populations as well as experimental surgeries in countries with less medical-legal oversight. I have read similar books discussing the racism in psychiatry/psychology; Even the Rat was White by Robert V. Guthrie and Don’t Believe the Hype by Farai Chideya. Every profession I seem to study or in which I am involved has a dark history of racism. That’s no good.

“I always miss the cool stuff,” another medical student said to me on Tuesday as I was walking back from the radiology department where I left my white coat. Every medical student, intern and resident wants to see as much as possible as far as disease and illnesses are concerned. There were the maggot incidents while I was on infectious disease at Henry Ford and frequently medical students are asked to go see interesting cases even when he/she may not be part of the team managing the patient’s care. Tuesday in the Emergency Department, I was involved in a very intense case (I can’t go into details for all the confidentiality reasons) and the patient’s prognosis was/is very bleak. As I finally got a chance to sit down and catch my breath I thought about the comment from my medical student colleague. I have said that same thing a million times, but it was different today. I thought about how I gathered the clothes of this patient and gave them to the patient’s family as they were trying to come to terms with what had happened. Then I thought about how scary this has to be if you have no medical knowledge of what is happening. When I got home and decompressed I realized that saying that really shows the lack of empathy and the immunity individuals in the medical profession develop in a rather short period. It’s no one’s fault, it just happens after seeing sick people over and over again. However, I won’t say, “I always miss the cool stuff,” ever again. I want to be a part of life saving measures and do everything that can be done for a very sick patient, but it really isn’t “cool.” It is rarely a good thing to be an interesting case in medicine.

The State of the State of the Union Address

We are all well aware that President Bush is not an exceedingly intelligent man. After all he bragged about the C's he received at Yale.

In the 2007 State of the Union Address he did not mention the Iraqi War until page five of the transcript. (I won't watch him on TV.)

This was by far the most ridiculous statement in the midst of several obtusely idiotic assessments:
"We did not drive al Qaeda out of their safe haven in Afghanistan only to let them set up a new safe haven in a free Iraq."

The United States NEVER drove al Qaeda out of Afghanistan. US forces had Osama bin Laden pinned in the caves in late 2003 and somehow bin Laden escaped. Shortly after this the Taliban and al Qaeda began retaking parts of northern Afghanistan and he some areas are the controlling power.

Moreover, one could make a very strong argument the Iraqi War has led to more violence than it has prevented and al Qaeda was only able to establish power in Iraq because of the US invasion and the instability that ensued thereafter.

Only one more State of the Union address from Bush, right?

Here are some other absurd statements:

“Our country is pursuing a new strategy in Iraq - and I ask you to give it a chance to work.”
Aw, shucks. I guess. As long as you think it will work. You have a great track record so far.

“It would ease the burden on the Armed Forces by allowing us to hire civilians with critical skills to serve on missions abroad when America needs them. And it would give people across America who do not wear the uniform a chance to serve in the defining struggle of our time.”
Dude, are you hinting at a draft? And who is this “us” who will be doing the hiring?

“Dikembe Mutombo grew up in Africa, amid great poverty and disease. He came to Georgetown University on a scholarship to study medicine - but Coach John Thompson got a look at Dikembe and had a different idea. Dikembe became a star in the NBA, and a citizen of the United States. But he never forgot the land of his birth - or the duty to share his blessings with others. He has built a brand new hospital in his hometown. A friend has said of this good-hearted man: "Mutombo believes that God has given him this opportunity to do great things." And we are proud to call this son of the Congo our fellow American.”
What the fuck? This guy is a total jackass. Not Dikembe. I have always liked “this son of the Congo.”

Down with Blogging

Today was a crazy weird day. Besides the fact that our dryer broke last night in a crucial phase of the laundry process (the drying part), work was eerily weird. I had the most mundane task to do...for the majority of the day. I had to enter and correct code into our accounting software, to fix this other guy's mistake. Although it was boring, I made the best of it by communicating electronically on the world wide web for a period of time while doing it. Although it is not really risky, as I like to pretend that it is, (since I am new at work) I got scolded for a minute. My senior didn't have a problem with it, but just voiced his concern if an administrator or official for the County saw it. Apparently it looks unprofessional. Do you know what else looks unprofessional? My eyes being so dry from staring at a computer screen for hours on end and falling asleep at the table where I was sitting. Besides from that, I can't believe anyone would pay me this much to do this job. I am sure it will get harder and more complicated and possibly even more stressful, but for the time being, I am flabbergasted.

Everyday when I get home from work I do the same thing. I change my clothes into scrubs and a zip-up hoodie. Sometimes I work out. Not as often as I NEED to, but sometimes. I make dinner which more often times than not ends up being either my special egg concoction consisting of a piece of toast, two eggs with fat-free cheese mixed in and Tabasco sauce on top or cereal (unfortunately not Barbie cereal-it wasn't on sale in Lansing). Sometimes I eat a bean burrito. Sometimes I eat some delicious leftover lasagna. That is only when I actually take the time to make delicious lasagna.



Tonight was no different. I got home, put on scrubs and hoodie, and had some Honey Bunches of Oats. Then Kade told me she needed to go to the grocery store. I wanted to go, so I did. There was only one problem, OK, maybe two. I didn't want to change out of my scrubs. I also didn't want to go to Meijer, where she always goes. I have this thing against Meijer. I can't remember why. It is like when you are a kid and you are mad at something, you throw a fit until you can't even remember why you were mad in the first place. Or, it is like a silly fight in a relationship.

Although this last Sunday, I went to Meijer with Andy, Jacob, Brooke, and Emily. I started to like it a bit more then. After all, they sell delicious donuts, mini carrot cakes, floating danishes, DVD's, wireless routers, and various other useful items.

Tonight, I went into Meijer with a different attitude. It was an accepting attitude, with an anxiousness to burn my former silly bridge with my beef with Meijer.

I also went into Meijer with AZ in mind. I love Andy's stories about food wars and food domination. I ended up buying three times as much as I needed, so they could compete for superiority of my delicacies. For example, I wanted to make burritos, so I bought refried beans, pinto beans, and black beans. While they sit in my pantry, I wonder who will come out on top. Or, perhaps could we find bean harmony and make a burrito with all three? I doubt it.

So, the moral of the story is that I think I am over being biased against Meijer. I don't think that is a moral. But, just for occasions like this, I took a picture.

Oh yeah, I have another story from the weekend that involves speeds in excess of 100 mph, near-death, and intimidation. Someone remind me to write about it sometime.

An update of sorts.

First off, sorry if you don't like the JT video. I do.

Every town, has it's ups and downs. Sometimes ups, outnumber the downs......but not in Nottingham.

It seems like forever since I have posted anything. Life is kind of a blur right now. I am trying to catch on and excel in a new job. All together it is probably more hours than my old job, but at least I am in one spot for now. I am also fairly compensated for my time, and feel appreciated.

It has basically been two weeks and a weekend since I came back from California. I dearly miss it. I had so much fun with Dave and Mary and Rachel and Renee and our other encounters. Not seeing the sunshine, mountains, and ocean makes me sad. I love getting up in the morning and driving with my windows down. It is a little bit of a jaunt to get to Decker Canyon Rd, but it takes you through the mountains to the ocean in Malibu on a truly incredible road. It makes my soul feel warm and soothed. (Driving 282 miles in a now/sleet/ice storm is not my idea of soul soothing).

Since then, I have most recently seen Sloan. They are one of my favorite bands. It had been a long time since I went to a good show. I liked the opening band, Spiral Beach. I think I may have been the only one who did.


Back up to 2:30 when Brooke and I arrived at Andy's house. We were welcomed promptly with tasty beverages of the Miller Lite variety. Tecmo Super Bowl was played a dozen times.

Andy is superior to me at that game. (I would whoop his ass at Dr. Mario though). I can only rush the ball. Sometimes that works when you are playing as the Nigerian Nightmare. The dance party was phenomenal, as you can see.


We ran out of beer after I stole Andy's right off of his coaster. Circle K was visited, where I was warned that drinking beer out of cans gives you Alzheimer's and dementia. It was then when I looked in my hands to find a 40 and a six pack. Thank goodness I am safe.

I have never really drank at a concert. But 32oz. drafts are delicious.

Sometimes I pay $5 cover to stand in a bar that I don't necessarily want to be at, after I am quite finished drinking.

I am excited for the season premiere of Prison Break and the second installment of The Hills tonight.

Is it bad that I see on CNN that a Continental Airlines plane is being grounded and evacuated in Houston because of a bomb threat and I cynically think to myself, hmmpt (just a sound). The plane is a smaller commuter jet, so no one is going to take the time and risk to blow up a smaller plane. They would go big time. Or at least, if I were in the market for that sort of thing, I would.

I think the Super Bowl is ridiculously terrible this year, even in HD.

I wish the weekend consisted of four days.

I am really glad that Danish Floats.

I hope all is well out there in Blog reader land.

The Saga Continues...

I’m not good at darts. I’m even worse when I’m drunk. But still it is sure fun to play.

In other 16873 news, the bottles won. Hands down kicked the cans ass. Moreover, the bottles have started to multiply. Notice the Pacifico and the Rolling Rock.

As anonymous suggested, I invested in some other refrigerator products. I feel the mushrooms are a nice touch (shelf two, in the centre). As are the apples (bottom shelf, slightly left of centre).

But what the hell does skim milk think it’s doing (top shelf, surrounded by Pacifico and Rolling Rock)? Could skim milk start a revolution and take over the fridge? Stay tuned…

(No animals were harmed in the making of this post, basically Ozkar wasn’t hurt.)

Friday Observations

These are some things I thought of/observed today in the Emergency Department and Henry Ford Wyandotte Hospital.

1. Some people, who look like Dick Cheney, are not really Dick Cheney. Sometimes their name is John.

2. My adductors are very tight/sore.

3. I have no clue on how to talk to women.

4. It is inappropriate for a med tech during a trauma case to pull me aside and ask me if I remember treating his girlfriend back in April, why certain tests were done and if I thought all of it was necessary.

5. I don’t like it when I hear people say, “That’s ghetto.” Most people who say that have probably never been to the “ghetto” and it is almost more of a racist statement than anything else. I think Naughty by Nature said it best, “If you ain’t never been to the ghetto, don’t ever come to the ghetto, ‘cause you wouldn’t understand the ghetto, so stay the fuck out of the ghetto.” So true.

How lame is it to post a blog on a Friday night. I give it a six on a scale of one to ten. Oh my, now it’s a seven because Wilson Phillips is playing on my ITunes.

Slo-an! Slo-an! Slo-an! Slo-an! Slo-an! Slo-an! Slo-an! Slo-an! Slo-an! Slo-an! Slo-an!

Be My Emergency Valentine?

So I have an Emergency Department journal club meeting tonight. It is at one of the attending’s houses in Allen Park.

Apparently the entire residents/interns/medical student significants others were also invited for socializing after a brief discussion of the articles.

Does anyone want to be my significant other tonight so I’m not the only person there without a significant other?

The focus of tonight’s discussion will be directed toward sepsis and here are the articles:
1. The Association of Sepsis Syndrome and Organ Dysfunction with Mortality in Emergency Department Patients with Suspected Infection
2. Effect of Treatment with Low Doses of Hydrocortisone and Fludrocortisone on Mortality in Patients with Septic Shock
3. Efficacy and Safety of Recombinant Human Activated Protein C For Severe Sepsis

Sorry for the late notice. Call me if you want to go. Chances are if you are reading this blog you have my phone number.

Number 84? HPV, Sick Patients and Women

There’s a storm brewing, brewing all around. The snow is falling; it’s covering the ground.

I’m working on the SSRI post. I hope to have it done this weekend. Sorry about my basketball rant on Monday. And sorry about the picture of me in the previous post. That cannot be pleasant for the eyes.

Matt Sims, son of the NFL Hall-of-Fame quarterback Phil Sims, took an official visit to Michigan State this past weekend. The Spartans need quarterbacks after Keith Nichol sold out State. Sims was an Army All-American and would add to what is turning into a surprisingly solid first recruiting class for coach Mark Dantonio.

Some studies have been released showing circumcision may be as effective in preventing HIV in Africa as a vaccine. This is potentially another reason to have a baby circumcised.

Speaking of viruses, several patients in the ER have been asking about Gardasil, or the vaccine against cervical cancer. Human Papilloma Virus (HPV) causes cervical cancer, but it also can cause genital warts. However, different serotypes of the virus cause different disease. For instance, HPV 16, 18, 31 and 35 cause cervical cancer while other strains cause genital warts. The vaccine is only protective against two of the HPV serotypes that cause cervical cancer. If you already have HPV the vaccine will not eliminate it from your body; the virus will always be there. The vaccine will protect you from two of the HPV serotypes (16 and 18) that can cause cancer. Currently most insurances are covering the three series of Gardasil shots for females between 9-26 y/o.

Chris Webber is a Piston and he will wear the number 84 jersey. Odd.

Saying someone is sick to another doctor is different than hearing patients tell you they are sick sometimes. For instance, a woman with a perforated ulcer in severe sepsis is sick. A woman with breast cancer with mets to her brain and liver who currently has a blood clot in her lung is sick as well. A man who states his feet hurt or a woman who feels fine enough to sit in bed, laugh and text message and talk to her boyfriend about how slow the doctors are are not sick.

I’ve talked too much about medicine. Maybe I should ask for topics to discuss for these Wednesday ramblings.

There aren’t a whole lot of movies I’m interested in seeing right now.

Just because I like Kate Spade, enjoy matching ties with outfits, have credit cards to Macy’s and Nordstrom’s and have fun thinking about how to decorate my future apartment/home does not mean I don’t like women. I really like women. A lot.

Monday

The only way to kill a yellow beetle is to beat the shit out of it.

I am not a doctor. I leave those duties to people who are qualified, like AZ. My approach to health and medicine was to destroy my body, and hopefully the illness with it, by drowning it in liquor. Now, sensible Jon would have taken it easy and not went out this weekend. I knew this and thought it was a good idea not to do much. There is one rather large problem with sensible Jon though. He is easily influenced and overruled. Think of it as the devil on the other shoulder.

Friday was similar to other Fridays in the past. After work, a bottle of wine, champagne, and a nice vodka drink at home to warm up. Then we were warmed up enough to hit East Lansing. Immediately it was realized that East Lansing was busier than it should have been, so we went to find shelter in the Woody’s. It was definitely a good idea. Although, I still wasn’t feeling well, I had my medical game plan and I was sticking with it.

After a full night out, Caleb and I did the right thing and took a cab ride home. It took over 15 minutes of waiting in the light rain to find a cab. Then it took 45 more minutes to get us home. It is no wonder why so many people decide to drive impaired. I am glad that we didn’t.

Saturday, I walked back to EL to get my car. It was chilly, but not unbearable. It was off to Chris’ house where dress-up, euchre, NFL, and Mad Gab ensued. I did not overdo it, but had enough alcohol to keep up with my self-medicating program.

Then, the ice……. I went to bed after a sleeping spot was created for me at 6am. I feel bad, because I can’t imagine what I would think if I had been asleep for a few hours and all of a sudden the lights are thrown on and I am picked up and moved from my place on the bed. It must have been frightening and disorienting. Anyways, I fell asleep for about two hours. I got up and was going to make my signature exit, when I realized there was ice everywhere outside. I defrosted my car and listened to the freezing rain. I was just about to a) fall asleep in my car, since it was all nice and toasty, or b). take a test run around the block to check the roads, when Jacob came out to ensure I didn’t do anything dumb. (Thanks Jacob, I need that sometimes).

To round out the weekend, a quick trip to Jimmy’s Pub on Sunday evening after everyone and their brother finished watching the premiere of 24 (not me, I watched Tom Brady be a stud) was my dying attempt to make the illness leave my body completely. It was the last step of my medical approach to my wicked sickness. I think I am smart and it worked.

In other news, the MSU basketball team showed signs of heart on Sunday in their big win over Illinois at home. They faced adversity at halftime, made adjustments, and followed their game plan in the second half with energy and focus.

LaDainlian Tomlinson is a poor sport. After the Chargers lost to the Patriots, some Patriot players went up to LT to console him. LT was visibly upset (understandably so). He proceeded to push the players away from him and run away toward the locker room. He passed by many people who had words for him as he exited the field. He ignored all of them. Now, since I needed to finish my medication cycle at Jimmy’s I did not catch any post game of this. So, I am not sure if he explained himself or apologized. I thought that LT was a classy guy. He was never flashy or unsportsmanlike. He always had a business-like demeanor. I guess whatever frustration he feels gets bottled up and pushed deep within himself until yesterday happened. He temporarily exploded. I think the release was necessary, but still, as a professional man in the media spotlight, he should be able to get over it.

Here comes the rest of the week. Hopefully I can keep up.

Pick-up Basketball

I’m not a great basketball player. Good may even be stretching it. But I’m certainly not bad. Today I went to play ball with interns, residents and medical students from “the Garden” (Garden City Hospital.)

In the first game we were severely undersized as I was the tallest player. But we used quick hands and good defense to win 11-8.

Things got interesting in the second game. A first year surgery resident came in and was on the opposing team. He matched up with me and I knew right away he was trouble. He held my shirt so I couldn’t come off a screen and then on the offensive end he took a contested two (three) point shot. He looked at me as he shot the ball and said, “This is good.” The ball hit the rim, hit the top of the backboard, then the front of the rim, rolled to the back of the rim, stopped for a second and fell through the hoop.

I thought, “Don’t talk shit like that if that’s how you’re going to make your shots.” The next time down he tried the same thing. However, he was not aware of my abnormally lanky arms and I blocked his shot. The next time down I stole his pass. On the offensive end he still held me, but I managed 2/5 shooting and beat him down the court for an easy lay-up and then off a screen for a 15-foot jump shot. I had three assists and despite having a little more girth than me, I out-rebounded him 5-1. (I decided to keep track of the stats because I thought this guy was a prick.) My team won 11-5.

Then as I was getting a drink of water we crossed paths. Instead of saying good game like I did, he said, “You better be ready because I’m running at you harder. Try to keep up.”

When it came time to match up on defense he asked someone else to guard me. So much for a rematch I guess. It wasn’t much of a game, my team won again 11-4.

After his second game he said he had to leave and told me, “I still have to go play a soccer game at ten so I conserved my energy.”

Really jackass? Because I ran 5 miles at seven this morning and you couldn’t keep up with me in the first game and didn’t want to defend me in the second.

I’m not saying all of this because I’m a superstar. I’m not. I just don’t like guys who talk and talk and then don’t back it up. I said nothing as I blocked his shots and stole his passes. Or nothing as my team beat his two straight games. The rest of the guys who play are awesome. They like to have fun, but also play hard. The calls are fair and no one gets upset. It's generally an outstanding atmosphere.

Overall my team was 4-1, with our only loss coming in “OT” 14-12. I played well. I didn’t’ miss my lay-ups like Goran the Moron and I shot 10/20 for the night and had to defend in the post a lot. Sometimes basketball becomes too competitive and people take it too seriously. I think it is the most common sport where people completely over-estimate their skills.

Warning.......Grossness Ahead

Sometime this week I became ill. I started my new job on Monday at my office in East Lansing. I felt fine, other than a little anxiety and a poor night of sleep. I didn’t sleep on Monday, mostly from anxiety and related issues to starting my first day of field work down in Coldwater on Tuesday. The work day went well as a portion of it included making copies and petting puppies. Tuesday night I didn’t sleep because I wasn’t feeling well, the anxiety was probably gone completely, since I met and got along with everyone on my team. The actual medical issues began. My stomach had a general queasiness to it. I had a headache and my body hurt. Wednesday, I woke up and got ready for day 2 in Coldwater. The work day went well, except for my frequent restroom trips. The bug, or whatever it is, had taken full grips on my body. By the time I got home, I was freezing, clammy, light headed, tingly, gross stomach problemy, headachy, nauseous, and exhausted. Some people suggested (and I half – whole heartedly agree) that a contributing cause to my sleeplessness is my current addiction to text messaging. I got home at 6:30 and was asleep on the couch by 7. Apparently Andy and Jeni came over to my house to visit later on in the evening. I didn’t hear anyone at the door. I was out. I eventually woke up and retired to my bedroom (even remembering to take out my contact lenses) where I fell asleep immediately. I woke up on Wednesday to the same symptoms described above, but to a slightly lesser extent. I should have taken a sick day, but it is the first week of my new job. I would feel like a chump. I got through the work day with minor symptoms, besides the gross stomachy condition. That got worse. I got home, and skipped dinner, which is the norm throughout this whole week. Eventually Kade and Caleb went out to the bar. In an attempt to be social, I went with, despite my health. I only had a few beers, since I knew my stomach couldn’t handle them. I was right. All other conditions were normal, and my spirits were high, but the gross stomachy condition began to strengthen more and more. In the meantime, I did a small scale test to see if conclusive results could be measured on the text messaging front. (of course they couldn’t). It was then pointed out to me that all of my issues and symptoms may currently be due to withdrawal from my text messaging addiction. It is genius and probably true because the source seems very wise, and has proven to be right countless times in the past. Forward to Friday. I am just sitting in my office with nothing to do. Nobody else has anything that I can help them with. My disgusting stomachy issue is as bad as ever. I am sure that the few beers I had last night certainly didn’t help things. Other than that I am feeling physically fine. Afterall, I have gotten two great nights of sleep in a row.

I guess there are a few plausible solutions here. Finding a balance in my text messaging and other electronic communications is one. Another is to start to eat over the counter drugs like Pez candy and hope for the best.

I really don’t want to miss Chris’ Housewarming / MLK Day event on Saturday night!

The Battle of Sensitivity and Specificity: Treatment or Prevention?

“The larger threat posed by American medicine is that more and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses,” H. Gilbert Welch, Lisa Schwartz and Steven Woloshin wrote in the New York Times on January 2, 2007.

The authors continued, “This epidemic is a threat to your health. It has two distinct sources. One is the medicalization of everyday life. Most of us experience physical or emotional sensations we don’t like, and in the past, this was considered a part of life…The other source is the drive to find disease early. While diagnoses used to be reserved for serious illness, we now diagnose illness in people who have no symptoms at all, those with so-called predisease or those “at risk.””

The last statement raises an interesting question and debate. Is it more efficacious both to an individual’s health as well as more cost effective to identify high risk patients and attempt to prevent disease, or do such actions decrease the specificity of a diagnoses and increase the number of treated false positives; that is a patient who appears to be at risk is treated despite really not having an elevated risk?

Prevention has been touted as being less expensive than treatments. In the United States the majority of health care costs are spent in a patient’s last six months of their life. And with the United States population demographics changing (those over 65 years old will triple in the next 20 years) it would seem to be intuitive to increase early disease detection as well as preventive measures to deflect health care costs.

The definitions of prevention are important here. Primary prevention methods are those used to prevent a disease from ever occurring, such as exercise and eating healthy are preventive against heart disease. Secondary prevention methods are those used in individuals with known risk factors, such as treating blood pressure to reduce stroke risk by up to 40%. Tertiary prevention are essentially treatments, such as someone who has had a myocardial infarction (MI) or heart attack receives a defined series of medications.

Of those three prevention methods, which one sounds like it will decrease the morbidity of a disease and is the cheapest? Obviously primary prevention. However, the cost of primary prevention is a lower sensitivity and more false positives.

Specificity and sensitivity definitions are important as well. Specificity rules in a diagnosis, while sensitivity rules out diseases. For instance, a test called D-Dimer is often ordered to rule out a Pulmonary Embolism (PE), a blood clot in the lung. PE’s often have an elevated D-Dimer, but not all elevated D-Dimers indicate a PE. Therefore, the test is sensitive for PE, but does not diagnosis it. A CT or V/Q Scan confirms a PE diagnosis; they are specific tests.

The authors are concerned today’s medical efforts are leading to more incorrect diagnoses and possible un-needed treatments. The real issue the authors are hinting at is that of specificity v. sensitivity. Has medicine sacrificed specificity for sensitivity?

This over-treatment of which the authors are troubled seems to be most prevalent in psychiatric diseases. Bipolar has become all the rage and everyone under the sun with mood swings now receives this diagnosis as well as the cocktail of pills psychiatrists use to treat it. Restless Leg Syndrome (RLS) has been associated with Parkinson’s Diseases as well as possible malignancies in middle-aged men. Now anyone whose legs move has Restless Leg Syndrome and is treated. But there has not been enough time to see if these preventive methods have decreased the incidence of Parkinson’s Disease or reduced malignancies in middle-aged men.

However, it is certainly advantageous to use a secondary prevention method such as a baby aspirin to prevent stroke after a patient had a transient ischemic attack, TIA or mini-stroke. The authors certainly would not argue this point.

So is medicine correct now to reduce specificity and increase diagnoses in order to potentially avoid future complications of certain syndromes and diseases? It is a very good question. I do not like sacrificing specificity for sensitivity. I prefer to treat people who definitely have a disease, but I am also a big proponent of prevention. So the solution to this is to understand when sensitivity is more advantageous than specificity, such as in the secondary prevention of stroke but not in the treatment of an individual who may or may not have bipolar disorder.

Medicine is moving toward prevention and sensitivity is trumping specificity in diagnoses and treatment/prevention. The authors are correct in showing anxiety about these movements and the potentially unnecessary treatments that result. However, there clearly are advantages to some forms of prevention. The solution to this problem seems to be rather simple: understand when using sensitivities in order to prevent disease outweighs the risks of waiting for specific tests to confirm a diagnosis. It sounds simple, but in reality it really is not. Hopefully, with a better understanding of disease mechanisms and disease course more effective prevention methods will be employed with high sensitivities as well as specificities.

Gollum Eyes, BMI and Infant Mortality

A scrub is a guy that thinks he’s fly, and is also known as a busta.

Why is TLC playing on my ITunes? It’s the randomness. The better question is why is it in my library? For that I have no good answer.

TLC could stand for T-Boz, Left Eye and Chili. But it could also stand for Tender Loving Care. Or in medicine it stands for Therapeutic Lifestyle Changes. I think it’d be fun to come up with other TLC meanings. For instance, Total Lactation Count or Torture List Consortium or Touché Little Child.

Those were stupid.

Eli Lily settled with 18,000 olanzapine (Zyprexa) patients for 500 million dollars. That’s a lot of money. I guess you shouldn’t lie about your research and side effects of your medication. Jack-asses.

Do I have dyslexia? oN.

Make sure you wash your hands several times a day. I always do, but I still got a nasty case of viral gastroenteritis (stomach flu). Not fun. It’s spreading like wildfire right now, so be careful and wash your hands.

I’m sure Michigan State basketball fans are very concerned after another 0-2 start in the Big Ten. Why is it that 8/12 of Tom Izzo’s years as head coach at State he has had to open on the road in the Big Ten? And the last two years he has had to open with his first two games on the road. Anyhoo, there are several problems with this team, but a big problem is Goran, the Moron, Suton. He misses lay-ups, he is 6’9’’ and doesn’t go up strong to dunk (which probably leads to his missed lay-ups), his jump shot is inconsistent, he has a slow first step followed by an out of control second step and he CANNOT dribble a basketball yet continues to try to take it to the hoop from 25 feet out. All the blame cannot be placed on the Moron, but he is a huge problem. Also, remember that despite Raymar Morgan, this team does not have a lot of explosiveness, athleticism or talent. There is not one McDonald’s All-American and Tom Izzo has not had a team or gone to the Final Four without at least one All-American since 1996. I predicted the Spartans would be 7-9 in the Big Ten. That may be pretty close, but I think they could also be 9-7. They should win their next four games at least.

I have nicknamed Ozkar Gollum Eyes because when I come home from work (can I call it work even though it’s still school?) he will be lying on my chair, hear me come in and prop his head over the back of the chair so all I can see is his eyes. It looks like the Gollum scene in the Mines of Moria when Frodo tells Gandalf Bilbo should have slayed Gollum when he had the chance. Anyhoo, since I have been listening to Sloan a lot recently, when I come in from work I sing, “Gollum eyes, see right through me,” to the tune of Golden Eyes. I also sing, “Fading into Ozkarity.” You know like Fading into Obscurity. I’m lame…or crazy…or both.

So the New York Times reported schools are sending home BMI, Body Mass Index, report cards to students who are overweight or obese. How stupid and frustrating is this? BMI is a standardized measurement used in studies because it gives an objective determination of what is considered normal weight. However, it does not take into account several important factors, one of those being muscle mass and the other lifestyle. For instance, my BMI is 25.1, which categorizes me as overweight. However, I’m not overweight. I have fairly muscular legs and muscle weighs more than fat. Many athletes, especially in a sport like football, will encounter a similar issue. BMI is not helpful and without the proper education of what a BMI actually means, it can lead to a lot of misinformation and have some deleterious effects, such as promoting eating disorders like Anorexia Nervosa. Shame on any school or teacher who does this to fragile adolescents.

Moreover, if we really want to address a public health issue let’s look at infant mortality in the US. The mighty United States is ranked 28th in the world with an infant mortality rate of 6.43 deaths/1000 births. That is behind Canada, Germany, the United Kingdom, Taiwan and Cuba! Singapore has the lowest rate at 2.29 deaths/1000 births. And the city of Detroit actually is more like a developing country with its infant mortality rate at 14.7 deaths/1,000 births (in the year 2000). That’s just about equal to the United Arab Emirates.

Oddly, on Sunday the New York Times ran an article discussing the health issues current runway models face because of their unhealthy eating habits. The article stated models should eat more and eat healthier. But not too much because then you will have a high BMI and get a bad report card.

Okay, this was long enough and I’m going on a rant. Sorry.

Boundaries

Good old CNN was talking about a not so new internet scam that is resurfacing in Pittsburgh, PA. It involves an anonymous emailer sending out extorting emails to professionals (dentists, doctors, lawyers, and I assume accountants), explaining that a bounty has been placed on their head for $50,000. They go on to explain that a larger sum of money will allow them to live. FBI Officials have warned about this kind of email hoax in the past, and there appear to be no victims of either financial loss or murder. THE FBI believes that this scheme, which in similar fashion has surfaced before, originated in Russia.

As friends, near and dear, I am reaching out to you AZ and Magnus. Stop the madness. This is going too far.

(Is this the premise for the new JT movie - Alpha Dogs)?

Correction

Dave and Mary: I realize the err of my ways. Sorry for the confusion.

Thank Goodness!

Thank goodness that college football is over. The bowl season is just ridiculous nowadays. Pretty soon, it will begin on December 15th and the national championship will be on Valentine's Day. I am not just bitter that Michigan State was terrible this year. I am also not bitter that the Big Ten barely showed up for a single game in post-season play. I was just really bored with it at the end.



On to College Basketball. AZ said the Spartans were promising this year, with a lot of fresh new talent. Despite the injuries, they had an impressive non-conference record. Enter conference play. The Spartans are slated to go 0-fer in the Big Ten. (OK, maybe I exaggerate....just 0-fer on the road in the Big Ten). It is unbearable to watch. Enough about that. On to Cal Tech. They brought hope to the world that nothing is impossible this weekend. They snapped an 11 year NCAA D-III losing streak that spanned 207 games. They routed Bard College 81-52 on Saturday. Next goal for the Beavers: win a conference game. They have a 245 game losing streak in the Southern California Intercollegiate Athletic Conference. This streak is just about 22 years old. Go Beavers!

I am going to try to give up on sports for a while and pursue other interests. Hopefully, I will learn how to write an interesting blog in the process.

One Week In

We are one week into the great year of 2007. Already, it is better than I could have imagined. Although the last few weeks of 2006 were already pointing toward that direction and I could see that a change in mind and soul were imminent. There wasn't any specific events that occurred that changed me, but rather a series of changes that my mind recognized and is accepting as reality.

2007 seems like a clean slate for me. Now, although all of the pressure is on me, if I mess this year up, it is because of something I did, not because of external forces and people. I thought for a long time that an empty place would be forever in your heart when someone you love extracts themselves from your life. I thought that abandonment would stand guard outside of your heart to ensure that the vacant space would never be filled again. Boy, was I wrong. Although a small amount of that space fills itself in with memories, the rest of the space fills in with millions of other things, if you allow it. Anything from family to friends - new and old, to the undeniable happiness you feel when you are breathing the ocean air and driving through the mountains. Coupling those things with the fact that a new job takes out all of the lingering stresses and memories of the old job makes it even better. Although physically, I am in a place of lesser beauty for the time being, I can open my eyes and find the beauty around me. It is there.

Basically, to sum it up, my soul is cleansed. It feels good, like a monkey off of my back. Although I like monkeys, this one was not so nice.

On a lighter note, how in the world can the Cowboys screw that game up last night? Seattle had no business winning that game. It is ridiculous!

I have so many things that I want to do today, before work and reality rears its ugly head tomorrow. I should get most of them done but cant type bloggy blogs and do them at the same time.

AZ, I hope you are feeling better. Chris and Katherine, it was fun to see you guys last night. Irish Car Bombs are excellent!

Beverage Battle '07!

Which beverage group will win the ultimate dominance of my refrigerator?

Shouldn’t I be reading or doing something productive?

Probably.

Trustworthy Coach

When can we say Nick Saban is the college football version of Larry Brown?

And by that I mean pure evil.

Reality, Fickle Fans and Russian Muscle

Does anything I’m saying even kind of make sense?

As I look at my apartment, I realize I got a lot of work to do. Damn.

I called reality stupid and then Emily replied via text, “Reality is my least favorite thing ever.” That made me laugh.

So this is the first Wednesday post of 2007. Should one of my New Year’s resolutions be to have 52 of these posts? Maybe I’ll strive for 90% of 52. How much is that?

There were a lot of people calling into the sports talk radio world before the Rose Bowl stating Lloyd Carr was a classy coach and individual because he did not “politick” for the National Championship game like Urban Meyer at Florida. He was also such a classy coach that he didn’t make any halftime adjustments during USC’s dismantling of U of M in the Rose Bowl. Now fans are upset over Michigan’s offense and are calling for Lloyd Carr’s head. These fans are almost as annoying as those saying he is a classy coach. Oh wait; they’re the same fans…

Season Two of the Wire was very interesting and some of the characters re-appeared in Season Four. This is intriguing because the drug importers, known as the Greeks, had to flee because the FBI and Baltimore Police were very close to catching them. The Greeks were absent in Season Three and…what you don’t care? Shut up Emily. My Russian muscle will take you out.

The Ohio State beat Indiana in their Big Ten basketball opener. I’ll be honest Mike Connely surprised me. He looked good putting up nine points and ten assists. Greg Oden got in foul trouble, but Thad’s team still was the beneficiary of several calls and at one point was out-shooting the Hoosiers from the line 7/7 v. 15/21. I will be on the officials all season, because the home court advantage in the Big Ten is out of control. The Buckeyes are good and are playing arguably the toughest schedule in the country. But National Championship contenders? I don’t know.

Those were long paragraphs.

There was an interesting essay in the New York Times yesterday concerning a dangerous epidemic: over diagnosing individuals. I may devote an entire blog to this, because it cuts at an interesting argument: prevention v. treatment.

That may bore the hell out of everyone else, just like my Wire obsession, but what else would I write about?

Maybe proper grammar.