Archive for the ‘Random Thoughts’ Category
Thursday, January 17th, 2013
On the way into my shift, I walked by a room and noticed that there was iodoform gauze packing hanging on the sign outside the room.
Why was it there?
Someone found it on the floor and put it there so no one would trip?
Ancient Shaman ritual to ward off evil spirits?
Secret code showing the surgeon where his patient had been waiting for the past 6 hours?
Turns out that the patient had a gangrenous foot that strongly smelled like rotting flesh. The iodine from the gauze almost acted as a barrier to the smell spreading. When the patient first arrived, the odor reportedly wafted through the entire ED. By the time I arrived for my shift I only noticed the faint odor of iodine.
Of course curiosity got the best of me and I had to open the door to see how well the iodine gauze was working.
Gauze … great idea.
Opening the door … not so much.
Sunday, January 13th, 2013
Just a couple recent pictures of our dogs that made me smile (post title from the late great William the Coroner – he’s been gone for more than a year now)
Saturday, January 5th, 2013
Dammit Shadowfax. You had to re-tweet the whole “taking pictures of your larynx with an iPhone” meme, didn’t you? Started with tweet by @traumagasdoc. Then @Shadowfax retweeted it. Then @maggiemay419 got involved.
I don’t have an iPhone. I upgraded to a Samsung Galaxy which is larger, so it’s a little more of a chore to jam the thing in the back of your mouth. The first time I tried it, my 6-year-old daughter looked at me and yelled “Mom! Dad’s eating his phooone!”
After a few dozen tries and several episodes of making myself retch, the best that I could do was a picture of my epiglottis. I angled the phone. I extended my neck. I pulled on my tongue, I used a spoon to push my tongue out of the way. No luck. Best picture is to the right. Tongue is at the bottom of the picture, epiglottis is in middle, trachea is dark area just out of view, back of my throat is at top of picture.
@traumagasdoc had a perfect picture. I’m convinced he is a Muppet.
Potential idea for an entrepreneur – create a detachable periscope-like mechanism that hooks onto the iPhone camera lens and can re-direct the iPhone’s LED light to use for video laryngoscopy using a smart phone. How cool would that be?
Thursday, January 3rd, 2013
I was going to post this yesterday but I got all fired up over the whole Press Ganey thing. Sorry about that.
What has happened in the past year?
My humble little blog has quite a few visitors over the past year. Depending on the source, last year I had between 700,000 and 780,000 unique visits and nearly 1.4 million page views. I just shake my head and say “dang.” That’s a lot of eyeballs. Hopefully that means we’ve been doing something right.
The most popular posts over the past year paralleled the top search terms leading people to this blog.
Ten times as many people linked directly to the home page of my blog than who linked to any specific article. Below are the next most popular posts in order of popularity.
Antibiotics More Harm Than Good For Strep Throat?
FDA: Zofran May Be DEADLY
**MEDICAL BLOG LINKS**
Doctor’s Work Notes and Medical Ethics
Treating Asthma on the Cheap
A Death Knell for Press Ganey?
Birdstrike also had several posts in the top 20. Not bad for a noob. . Thanks for the contributions, brother.
Saturday, December 29th, 2012
The holidays have been eventful so far.
In the “I wish I had my camera ready” department: Driving down the main drag in town where all the stores are located. A man in Clifford the Big Red Dog outfit is walking up and down the street with a sign saying that puppies in the pet store on the corner are $100 off up until Christmas. At the stop light someone sticks his head out the passenger window and starts yelling at Clifford. Clifford keeps walking. Rolled down the window to hear what the guy in the car was saying and heard him yell “don’t buy there – they sell puppies from puppy mills!” Clifford drops the sign, spins around, and gives the motorist two front middle toes.
Went to a holiday party and was discussing the economy with a friend. Said that he was having problems with home life. His parents moved out of their house and are living with him in their spare bedroom. His adult son and his son’s fiancée are living in his basement. Another adult son dropped out of school and is living in his attic with a girlfriend. His quote was “I don’t have a home any more … I have a commune.”
One of our family members went to the big goldfish bowl in the sky on Christmas Day. The kids won a bunch of goldfish at an amusement park 5 years ago and the goldfish have been part of our family ever since. Flash started swimming upside down a few days before he died. The causes of upside down swimming are apparently related to a swimbladder problem in fish. We treated him with antibiotics for possible infection and gave him peas to combat possible “bloat” since peas are a laxative for fish. Despite antibiotics and peas, Flash died. He had a good life, though.
There are sooooo many people showing up in the emergency department over the holidays. Our hospital is packed. Of 26 beds in the emergency department, 19 were being used to board inpatients at one point during my last shift. Makes seeing patients a little more difficult when there’s nowhere to put them. Everyone in the waiting room is wearing masks because most patients are suffering from influenza-like illness. My informal survey of patients is that <10% of patients I treat for influenza symptoms have been immunized for influenza. Both the immunized patients on my last shift were elderly and had mild symptoms compared with their non-immunized counterparts.
Thursday, November 29th, 2012
Some things just don’t make sense to me.
Why do dogs just like to eat random objects? Lately, it’s been a case of “guess what the dog ate today” around our house. Eraser. Hairbrush. Tube of toothpaste (she loves toothpaste). Martial arts training knife. Our other dog just walks around with his tail between his legs when he sees something chewed up on the floor because he thinks the other dog will blame him for it.
Then we get the great idea to lock spazzy boxer pup in the bathroom so she won’t have to sit in her cage for 12 hours while the family drives to a football game and back this past weekend. No, that was Ms. WhiteCoat’s idea. I had nothing to do with it. We returned to find the door broken, the stripping ripped up from the door jamb, and a bathroom that looked like it was being renovated. Our vet calls it separation anxiety. I call it something else. Then the dog gives us the big googly eyes when we get home as if to say if only we had provided her with a doggie counsellor to help control her impulses, none of this would have happened.
Where do all the damn headphones in the world go? I have this pet peeve. I hate it when people take my things and don’t put them back. With six people in the house, no one will own up to losing whatever it is that’s missing. So if things go missing more than a couple of times, I buy 10 of them. Kids kept stealing my combs out of the bathroom, I bought a 20-pack and threw a few in each kid’s room. Kids were taking all of my pens, I got a 100 pack of the pens I like from Staples for like $20 and bring up handfuls from the storage room when they go missing. Tennis balls to play with the dog go missing – I bought 50 used ones off of eBay. Of course, half the missing balls were in the gutter, but now we have extras. Also have a half dozen nail clippers laying all over the house. But mine are left alone. One thing that just doesn’t reach the saturation point of missingness is headphones. I had a couple of good pairs of ear buds that went missing. So I went online and bought 10 pairs of them for $4 apiece. Within a week, they had all vanished. Not a trace. I bought 10 more. Gone within another couple of weeks. WTF? So I said to hell with it and I jog listening to music from the speaker on my phone now. I checked on eBay and no one from this house is selling them. And I looked through the doggie doo and didn’t see any wires, so it isn’t spazzy boxer pup, either. Maybe we got ourselves a gremlin.
What is it with our family and insects? First, it’s the ants. Then I leave for work last week for an overnight shift. I get an urgent call from home telling the secretary to pull me out of a room with a patient. Mrs. WhiteCoat is on the other end of the line and is freaking out because our basement has turned into the set for some horror flick. She says there are like 200 flies on the ceiling of the basement buzzing all around. I made the mistake of telling her that maybe there was a mouse dead in the ceiling or something. She calls around to every exterminator in town and no one will come out at night. I tell her to get the can of Raid from the garage and spray it around the basement. Nope. Too many chemicals will land on the carpet and will get on the dog’s paws. Fine. Wait until the morning and I’ll come home and take care of it. Nope. Exterminator at the house before I get home, sprays “safe” can of Raid all over basement and leaves. Then he tells us to ventilate the room and wash the carpets after a day or so – which is the same thing I would have done for $80 less with the deadly generic Raid.
Ended up that one of the kids left part of a ham sandwich in the garbage. Flies like rotting ham.
Kind of amusing to listen to Mrs. WhiteCoat describe how she stuffed towels under the door and put tape around the door cracks so that the flies didn’t find their way into the house. The whole next day, I just kept looking up into the air as if a fly was flying around and watching Mrs. WhiteCoat grab her hair and duck for cover.
Why don’t kids listen? Oldest daughter has a boyfriend … or so she thinks. They’ve been dating for a month and he still hasn’t taken her out on a date during a weekend. We keep telling her that something is wrong with the picture. It was her birthday this weekend and she wanted him to come to the football game with us. He said that he was going there with his parents the night before and staying in a hotel, but that he would meet her at the game. So for her birthday, we drive the whole family to the game. She’s texting him the whole time and he doesn’t answer. Drive down there, watch the game, drive all the way back home. Nothing. Following day, he texts her and says that his phone wasn’t working and that he didn’t get any of her text messages until just then and he’s sorry that he missed her at the game. Then some girl posts a picture on Facebook of a guy hugging her and saying that she had the “best weekend of her life.” The guy looked awful familiar to my daughter, that’s for sure. Oh, and he never traveled to the football game at all. His parents ended up being “too tired.”
She won’t dump this kid. I just keep telling her what a “two-timer” is. Then I tried using the “fool me once” quote and pulled a George Bush.
Gotta let her learn for herself, I guess. Then we’ll be there to pick up the pieces.
Kind of made me smile how Jr. WhiteCoat was so upset about this guy making his sister cry. Shaking his head and punching his fist into the air once he found out what happened. Good kid, he is. Wrestling started up again this week and he has gained 5 pounds from last year. Another decade or two and he’ll be big enough to pound the stuffing out of this two-timer.
Mrs. WhiteCoat’s thyroid patient finally relented and came to the office. Funny thing. For someone who was “doing great,” she didn’t seem so during her appointment. Losing weight. Losing hair. Palpitations. Yeah. Her TSH was undetectable. Turns out the ENT doc started her on 0.025 mg of thyroxine after her thyroidectomy, then on the next appointment increased her dose to 0.1 mg without checking labs. So thanks to everyone for their advice on that one.
Had planned to write more today, but got to have an unexpected date day with Mrs. WhiteCoat. We went to lunch, had a glass of wine, then went to seek Breaking Dawn Part 2. Not really into the whole Twilight series, but the movie wasn’t bad.
Did anyone else notice that at the end of the movie the vampires weren’t glittering when they were sitting in the sunlight? Mrs. WhiteCoat got mad at me for mentioning it instead of just enjoying the movie.
Well, diary, there’s an early shift tomorrow. Time for bed.
Until next time …
Thursday, November 22nd, 2012
Just finished dinner and going to play a few games of Pictionary with the family, then have a few glasses of wine while watching a movie.
To get you in the Thanksgiving spirit, here’s a special Thanksgiving video from the great WKRP in Cincinnati:
And, for some discussion around the dinner table, did you ever wonder why they don’t sell turkey eggs in supermarket? Here’s one plausible explanation:
Hat tip to Instapundit for both ideas.
Special thanks and prayers to all our troops overseas. We all appreciate the sacrifices you are making for us and hope that you are home with your families soon. Your bravery and dedication means a lot to every one of us.
Hope everyone has a Happy Thanksgiving.
Wednesday, November 7th, 2012
Mrs. WhiteCoat had a patient issue and doesn’t know how to proceed, so she asked me to post the case for other people to comment upon.
A patient came to her practice 2 years ago with thyroid problems. She had been seeing an endocrinologist for several years before seeing Mrs. WhiteCoat and even the endocrinologist was having problems controlling the patient’s thyroid using medications. On the first appointment, Mrs. WhiteCoat performed an exam and found a thyroid mass which ultimately turned out to be cancerous. She referred the patient to an ENT surgeon for thyroid removal. The patient never followed up with Mrs. WhiteCoat after that.
A few days ago, the patient sends Mrs. WhiteCoat an e-mail saying that she is doing well and asking Mrs. WhiteCoat to call in a refill of the patient’s thyroid medications. Mrs. WhiteCoat wrote her back and said that she had not evaluated the patient since having her thyroid out almost 2 years ago, that she has no idea what the patient’s latest thyroid labs showed, and she doesn’t even know the patient’s medication dose. She stated that she wouldn’t call in a refill without seeing the patient in the office, examining her, and going over the patient’s labs with her.
The patient wrote back that she had “normal” thyroid labs in February and has been on the same dose of thyroid medications for the past year. She couldn’t afford to miss work any further, doesn’t want her thyroid to get out of control again, and appreciated Mrs. WhiteCoat’s understanding in calling in the prescription.
There are two ways of looking at this.
One one hand, the patient is probably stable after having her thyroidectomy and most likely will be continued on the same dose of medication if she does come in for evaluation, so an office visit would likely be low yield. That being said, when things go wrong, nobody thanks you for cutting corners to save them money. If the thyroid cancer returns, or if there are signs of metastasis somewhere and they are missed, then what happens?
On the other hand, some people may think that requiring patients to come to the office under circumstances like this is just being “greedy.” Mrs. WhiteCoat has student loans, office workers, office lease, malpractice insurance, and a dozen other expenses that she has to pay in order to keep the office running. If she provides free telephone services to all patients, then soon there may no longer be an office for patients to call for their refills.
I suggested that if another doctor is ordering lab tests on her, that doctor should be refilling her medications.
We kind of touched on this issue in a previous Open Mic Weekend, but now it’s a real situation.
What should she do?
Thursday, November 1st, 2012
The Hurricane Sandy coverage has me absolutely captivated. Hard to believe how much destruction occurred. Reading about all the hardships that people on the East Coast are going through right now makes me wish I could help somehow.
My brother lives in Hoboken and we weren’t able to get in touch with him until today. You always assume the worst when that happens. He still has 8 feet of water in his basement and wasn’t able to get out of the house until today. Still only spotty power in his area. He reports that much of lower Manhattan is still dark, tunnels are still flooded, and he spoke to police who said that lines of people trying to get into the city are “the worst they’ve ever seen.”
Seeing what they’re going through makes all of our problems seem so minor. Prayers to everyone going through this disaster. Keep strong and keep the faith.
Halloween is officially over. Son dressed up as a ghoul all in black and sat up in a tree scaring the kids who came to the house for candy. Said that he was taking after me, whatever that means. Little kids would come up and take candy from the bowl and he would shake a tree limb and stare at them. Some ran away without candy. While he was doing that, some guy in a clown suit with a chain saw (no chain) was walking up and down the street stopping and looking at people and freaking out all the parents. Funny, yet creepy.
Only went through 12 bags of candy this year, but we got smart and bought those giant bags of Dum Dums to mix in with the candy, so giving a few lollipops and a candy bar to kids at least made it look like they were getting more.
It was difficult getting our kids down to sleep. They all had a sugar buzz and a half eating all the candy they weren’t supposed to be eating. Son was up playing AC/DC at 10:30 on a school night. Oldest daughter didn’t have school today and she slept until noon.
The day after Halloween has also permitted me to discover that candy wrappers and lollipop sticks do not mix well with canine digestive systems. When sitting in the living room this morning wondering “what’s that smell?”, we eventually found two piles of doggie puke consisting of a mixture of Science Diet, candy bars, Laffy Taffy, candy wrappers, and lollipop sticks. Cleaning that up was enough to get me to skip breakfast. Mmmmmmm mmmmmm good.
Middle daughter just got word that her pictures were up for American Girl. She’s so excited and we’re so excited for her. I’d link to the page at American Girl web site, but don’t want them getting ticked at me. If you want to see her, go to AmericanGirl.com and go to the “Gift Guide”. She’s opening a present at the top of the page.
Oldest daughter just got her first IMDB movie credit, hopefully the first of many. She also found out that she made the basketball cheerleading squad. Good work, kiddo. Now that means I’m going to have to go to the basketball home games when I’m just not a basketball kinda guy, but that’s OK. I’ll be cheering loud for everyone.
Every year, our house becomes infested with fruit flies. I can’t figure it out. We keep fresh fruit in a fruit bowl and we give Master Oogway fruit in a dish a couple of times a week.
Side note: I never did tell everyone that the science teacher from middle school thought that we did such a good job taking care of Master Oogway during the winter that he gave Master Oogway to us at the end of the school year. “He doesn’t have long to live and I don’t want him to die in class” was the selling point. Mrs. WhiteCoat fell for that one hook, line, and meal worm. Here it is almost three years later and Mistress Oogway (we found out that she was a female) is still going strong.
Anyway, from the middle of October to the middle of November, we get infested with and dive-bombed by kamikaze insects. They’re particularly persistent and noticeable when I’m typing at the computer because they contrast well against the white background. I’m getting good at grabbing them out of mid-air with my hands, but it seems like just as soon as I get one of them, another one starts flying at my head in retaliation.
A neighbor mentioned putting out a glass of apple cider vinegar. Apparently, fruit flies are drawn to the aroma. He said to put a few drops of soap to break the surface tension so that the fruit flies go into the glass to sip the vinegar then they couldn’t float on the top and fly away. Hoooley smoley. Within 6 hours, there were like 40 of the things at the bottom of the glass. We put the glass in the microwave for 15 seconds to get more aroma out of the vinegar and after that, no more dive bombing. A couple of olfactory-challenged stragglers met with my swift hand of death, but what a difference. We’re buying bottles of apple cider vinegar for next year. Supposedly wine works just as well, but I’m not putting some brave vintner’s efforts to waste.
I saw a patient that made me sad the other day. She came in with a UTI. Burning with urination. Pretty uncomfortable. Initially she thought she had a yeast infection and she used some over the counter cream. That caused an allergic reaction and more burning to her sensitive areas. Her urine was normal and the allergic reaction was really her first herpes outbreak. This mope who told her he loved her and then dumped her a couple of weeks later gave her something that will last with her a lot longer. She was sixteen. I sat in the room and cried with the patient and her mom after telling them the bad news.
And then I think about how much we still have to teach our oldest daughter who is texting how much she loves her new boyfriend of less than a month. Nice kid and he’s making her happy so far, but you just never know.
Last but not least is another sappy dog picture. They’re waiting for me as I’m coming out of the pet store.
Treeeats? For us?
Wednesday, October 24th, 2012
The criminalization of society continues.
Regular readers know that I strongly disagree with state efforts to criminalize the practice of medicine. See previous posts here, here, and here for a few. Two days ago I posted an article about a doctor who was criminally charged with providing excessive pain medications to patients who died (as I expressed concern about back in 2009). Now federal agents are arresting physicians for providing fraudulent or “unnecessary” care.
This isn’t concerning to anyone?
I have no problem with taking professional action against any medical practitioner who is a danger to the public. Well, I have a little problem. Some of the assertions of “dangerous” activities I have seen made by state licensing boards make me wonder whether the board members should be charged with a crime for incompetency. In one instance, a board was prepared to file a letter of reprimand against a physician because he didn’t order a CT scan on a patient with a headache. The reason? “This patient came to the hospital by AMBULANCE and you didn’t do enough.” Action taken against license because a patient dialed 911.
I also don’t have a problem filing criminal charges against medical practitioners that break laws. Intentionally engage in fraud? You deserve what’s coming to you. Steal from patients? Go to jail.
However, throwing someone in jail for doing their job – even if they do their jobs poorly – just sends the wrong message and will lead to unintended consequences.
I’m not going to go on a long rant about this, but I wanted to illustrate how more and more professions are coming under a government attack because they allegedly don’t do their jobs appropriately.
Tarl commented about the case of the Italian scientists who were charged with manslaughter and sentenced to six years in jail because they failed to predict an earthquake that killed more than 300 Italian citizens. Prosecutors argued that the scientists offered “incomplete, imprecise and contradictory information” to the Italian citizens. As Tarl noted, scientists from around the world denounced the trial, noting that predicting earthquakes is impossible.
Think about the implications for Italian scientists in the future. Doing everything in their power to avoid a six year prison term in the future, the seismologists will now be encouraged to report to the media that an earthquake may occur and that things may not be safe every time that a truck without a muffler drives past the seismologists’ offices and shakes their equipment. Chicken Little, baby. If someone drops a cup of coffee, the sky must be falling. Run for the hills. In a few years, the population will be so sick of the false alarms that when the real earthquake does hit, they will have ignored the warning anyway.
But by criminalizing an inexact science, the buffoon Italian prosecutors have made Italy a safer place, right?
Then consider the case of attorneys for GlaxoSmithKline who were indicted for making false statements to the FDA when Glaxo was being investigated for promoting Wellbutrin for an off-label use. The in-house counsel hired a national law firm to help Glaxo respond to the FDA’s allegations. A year later, the government came after the attorney for obstruction of justice … for representing her client … alleging that the attorney had assisted Glaxo in furthering a cover-up or a crime. Even documents that are protected from discovery by the attorney-client privilege were forced to be turned over to the government.
How will the threat of criminal charges affect an attorney’s practice of criminal law? Go to jail if you defend your client too zealously? Be concerned about this, people. With the threat of criminal charges looming over attorneys who defend criminal clients, will clients really get the zealous representation to which they are entitled?
Finally, although not about employment, there is this Wall Street Journal story about how the North Carolina legislature has now made it a Class 2 misdemeanor (.pdf file) for a student to, “with the intent to intimidate or torment a school employee,” do such things as encourage others to post private, personal, or sexual information pertaining to the school employee; post an image of the school employee on the internet; repeatedly engage in e-mail or other transmissions to the school employee; or sign the school employee up for electronic mailing lists.
Take a picture of the teacher in public who is fondling a sixth-grader’s breasts? Even though the teacher is breaking the law and has no expectation of privacy, students may go to jail if they post the picture online or if they encourage others to do so. If the paparazzi hounds the same teacher for doing the same thing … that’s OK … I think.
Anyone every wonder why criminalization isn’t applied to the government officials when they allegedly don’t do their jobs appropriately? I was going to write someone in the North Carolina legislature an e-mail asking them about it, but I didn’t want to be breaking some other inane law they created.
What is happening to this country?