Guatemala Glucola Gana
As found in a comedrona’s (midwife’s) clinic, glucose challenges for diabetes in pregnant woman use coconut flavored water, instead of the orange-flavored stuff in the US. Score one point for Central American medicine.
or
As found in a comedrona’s (midwife’s) clinic, glucose challenges for diabetes in pregnant woman use coconut flavored water, instead of the orange-flavored stuff in the US. Score one point for Central American medicine.
Oh, to be alive in the ’70s. Apparently this video is from 1971 by Robert Alan Weiss for the Department of Chemistry of Stanford University, and shows some totally free loving hippies acting out protein synthesis as interpretive dance. I personally like the synth organ / bongo drums theme of mRNA binding to the 30s subunit about about 4:36 into the video. Hilarious.
[via kitsune noir]
Investigating a bit further into the Stewart Medical School craziness, there’s a Youtube account for someone claiming to be a med student there, and the videos the person favorited are craaaaazy lectures by this naturopath. (Medblogging gold, GOLD I say!) Like, seriously, seriously crazy, and you feel bad and worry for the students in the audience, ’cause there’s no way anyone could answer the questions in lecture, ’cause they make no sense:
“Tongues shaped like a hammer are the tongues of nymphomaniacs, as well as kidney problems.”
“If you get a patient who gets the flu, and a week later gets the flu again, what do you do? You have them throw away their toothbrush.” Also, if you have a high change in your morning cortisol levels, it’s “some kind of parasitic infection, some type of growth, some type of infection in the intestines.” A student asks him to explain these changes, and he says, “Oh, 15 years of gastroenterologists running correlations.”
A woman’s testosterone level is high because she is scared:
Pretty typical scenario for this real-life, accurate Flash game called Amateur Surgeon: Pizza delivery guy hits a homeless guy with his car, performs surgery on him using his Pizza Delivery Guy Tools, and homeless guy then teaches him how to perform other surgeries, as it turns out he used to be a doctor.
(If only closing wounds was as easy as stapling them and then burning them closed with a lighter! Especially lung lacerations.)
Okay so my idea for a daily randomness of linkage didn’t really pan out. But some random health care and non-health care goodies:
labnormality, n. lab•nor•MAL•it•ee. A patient’s laboratory testing value that falls outside the normal range. (plural labnormalities) Ex: “Man, this guy has a ton of labnormalities… hyponatremia, hyperkalemia, and he’s hypotensive… crap, adrenal crisis!”
Maria’s got a great post that is funny, true, and speaks volumes. Questions.
I for one am spending it with my significant other, my boards review book.
But it’s not all bad. There’s a new Indiana Jones trailer out.
And rejected Shoebox Greeting Cards:
Oh, and by the way? Paget’s Disease? I hate you and all the damn questions about you.
As I am counting down the days until I can get Step 2 over with (T-minus 10!), I’m going insane memorizing diseases I will never see in my lifetime. I need some laughs. So I’m asking everyone to please post their favorite medical joke. (And plus, it’d be a great chance to see people’s faces and comedic timing.) Oh, fine, if you’re anonymous, I guess you just can post the text, but come on, video is sooo 2008. (If you use YouTube, tag your video as “medicaljoke” so they’ll be easier to find.)
Either comment or email me the Youtube link or your blog posting, and I’ll start a running list here on this blog post. And if you don’t have a blog, just leave a comment! Please! I’m begging you! Help a guy escape from the hells of Boards reviewing. I’ll start:
Sorry for the dearth of posting lately; I’ve been busily hitting city after city on the interview trail–and the residencies, unfortunately, continue to be great (making my ranking decision next to impossible).
Two quick bits: Thanks to the LA Times for the mention about the placebo study (and very cool that the reporter found me via my blog).
And thank you to Chicago, where I’ve been interviewing as of late. After 11 years driving without a single parking ticket, thank you, Chicago, for welcoming your forgotten son (I went to undergrad in the area) back with open arms. Two tickets and my car towed today for a tow away zone sign that was crumpled and gnarled away. I missed you too.
(I’m really not that happy about it. I swear.)
Totally stealing this from JoshMD by way of KevinMD, because it’s just too funny:
For the guy or gal who has everything comes the “eTime Home Endoscope.” Nope, not kidding. The BoingBoing review: “Disgustingly Effective.”
As I’ve said before, I love McSweeney’s for all its literary humor and fun. And thus I present:
AN OPEN LETTER TO MY ACROSS-THE-STREET NEIGHBOR WHO ALWAYS DOES HIS YARD WORK IN HIS SCRUBS.
I have a friend at another school whose attending specifically wears scrubs for no reason to Starbucks, hoping women will hit on him, and there are plenty of people who have no reason to be wearing scrubs to the campus gym.
My policy is such: if I’m going to/from work and need to quickly do something in public (like pick up a gallon of milk from the store post-call), I’m not going to make an extra trip home or bring extra clothes for something simple. Otherwise, I want to get the nasty hospital-y stuff off me and slip on some jeans or something.
See? Exact opposite. (Click for the full size.)
With a baby, you pull down, THEN up. No, really!
(via a bathroom)
Indexed is a fun little blog I read with entries being simple graphs on index cards. Today’s entry with a healthcare feel:
Here’s all the entries tagged as ‘sickness.’ Pretty funny stuff.
November 1st, 2007We just had a 5.6er here, felt by everyone in the hospital. Lacking any semblance of survival instincts, I randomly just start walking down the hall. Let’s hope there’s no aftershocks.
What’s better than dancing condoms singing about safer sex? Dancing condoms singing about safer sex with a Bhangra Bollywood theme!:
Hats off to the Nrityanjali Academy who created this video to educate Indians about safer sex, birth control, and preventing the spread of HIV and AIDS in both men and women. (via Best Week Ever)
I had been planning to write on how amazing it is to deliver babies and such, but I’ve been sick with some nasty virus or something and feel just awful. Fevers, chills, sweats, enteritis, the works. It’s just fantastic, really. In lieu of anything medical related: JK Rowling says Dumbledore’s a bit light in the loafers.
October 20th, 2007Margaret Cho has this great bit about her experience with hematuria, and finally it is somewhat relevant enough to post! (I have no idea who she saw that employs a “vagina washer,” but maybe that’s how it works in the private OB-Gyn world. Who knows.)
I love Best of Craigslist. Some recent goodies:
Happy Friday.
October 5th, 2007I’ve heard arguments about creationism and intelligent design before, but the Creationists really shouldn’t have this guy arguing for them (unless he’s secretly trying to take down Creationism from within–if so, nice work!). Laughable video:
You’re at a wedding, wearing dress pants, and you’re so used to wearing a pager with dress pants that you constantly pat your hip, making sure the pager is still there.
(Feel free to add your own.)
A watched troponin never comes back.
While reading this interesting piece on body type and body motion correlating with sexual orientation, I found this hilarious website as an ad: IsMyBabyGay.com. Just make your baby lick a piece of paper you print out on your own printer, send it in the mail, and for just $20.00 you can find out if your baby is gay or not! What a steal!
(And there’s a 150% money-back guarantee if they’re wrong!)
Similar to Kotassium, my attending reminded me of another medical play-on-words: high-NR, an elevated INR.
Coatastrraphe: coh • tah • stroh • fee: noun. See also white coatastrophe. The act of moving too quickly, sitting down in a chair, or bending over, causing the multitude of notes, journal articles, reference books, pens, stethescopes, cell phones, PDAs, and other assorted items to fall from the pocket of one’s white coat onto the floor.
Can we just call the damn electrolyte Kotassium from now on? It’s potassium, it’s “K,” it’s the perfect combination, no?
Grahamazon Theatre Presents! (Don’t worry, I’m equally offensive to all specialties.) If you’re viewing this through a feed reader or email, you’ll need to visit the site to see.
(I’ve opened up comments due to several requests.)
Wanna be a rich man or woman? Work on wireless monitoring of EKG leads and heart rate, pulse oximetry, blood pressure, and temperature. The cords and wires in the OR are always a ridiculous mess, but the anesthesiologists are great at untangling them. (I’d love to see their Christmas lights and computer desks.)
Me? I’m working on an even more revolutionary invention: the wireless IV.
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Anonymous doctors talk about practicing medicine and The 50 Doctor Poll. Favorite bit:
Do doctors have God complexes?
Yes…. 28
No…. 22Do you have a God complex?
Yes….2
No…. 48
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I love a good pun:
Digital rectal exam, FINGER study, ha!
(I was searching for something totally unrelated, I swear.)
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Filed under “Bitter, Bitter Irony, You Taste So Very Sweet”: Protesters march to let their children walk in graduation if they didn’t pass the Texas high school exam, and of course, they march with this sign:
Homage to the guilty pleasure Overheard in New York:
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The disease-ifying of normal just took one leap forward today with this question from Ask Metafilter:
I get very moody if I don’t eat in the morning. If I don’t eat until 3-4pm I get headaches, drowsiness and feel nauseous.. I think I’ve always had this. Since I usually eat enough it doesn’t really bother me. I’m 21, male, and a vegetarian. What do I have?
I love the answers:
You have a condition known as hunger.
The good news: it is easily treatable
The bad news: there is no permanant cure
This condition can be treated at a specialized clinic, the one you want is known as a restaurant. This condition can also be treated at home, but you will need specialized supplies from a grocery store. Most sufferers find that several treatments per day are necessary.
Two Pomona drug suspects were arrested this morning after mistakenly dialing 911 when they were actually trying to reach their drug dealer, police said.
“No one said criminals are smart,” said Pomona Police Sgt. Michael Olivieri.
Love this stuff.
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In the old middle school joke style, set to the tune of “Yes, Oh Yes, This Happened To Me Yesterday”:
I’m an optimist. At least it didn’t hit my mouth.
Inspired by my 72 hours of hell (aka, all of my weekend):
Oh I hate you flu
Aches, fevers, chills and coughing
Tylenol won’t help
Cytokines do suck
Interferon is the worst
Man I feel shitty
Couldn’t even sleep
Nyquil barely worked, lasted
only an hour
I got a flu shot
So maybe it was para-
influenza. Hmm.
Took so much Advil
Hope my kidneys are not shot
(I’m a worrier)
Felt better today
Could stand up without weakness
Happy ambulation!
My roommate, a first year med student, tells the story about learning about fecal-oral transmission of HepA. A classmate leaned over to him and whispered, “I got the Hep A vaccine…so I can eat all the poop I want!”
Oh to be a first year again.
I think the Product(RED) stuff is kind of lame, and it seems like more has been spent on its advertising than it’s actually going to generate for HIV and AIDS treatment in Africa. Maybe I’m wrong.
But I’m still one to do my part. Introducing the newest Product(RED) line, Product(MEDRED):
And for my Spanish-speaking colleagues:
While reviewing infections of the neck and complications of strep throat, I read about PANDAS, which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections.
I hereby decree that all new Pediatric Syndromes must have similarly-cutesy acronyms. Like BUBBLEGUM or DUCKY or KITE or BINKY or BUNNY. Alternative spellings, like ELEFUNT, are acceptable.
(Not trying to offend anyone here, the name of the disease is cutesy, obviously the disease itself nor the patients it affects are being joked at.)
Curse ye, Lords of HIPAA! We had a patient with the funniest name ever, but I obviously cannot mention it. Le suck.
Takes place during a PBL session. Pretty funny. (via my roommate)
February 5th, 2007But Happy Christmas. A cute/funny holiday card from a hospital’s NICU.
December 10th, 2006The cutest/saddest animation ever. Happy Thanksgiving!
November 23rd, 2006Just moved up to San Francisco, and already beginning to call it home.
I swear this is not Photoshopped–I saw it driving by me last week:
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Now I could go for this. Playing video games before surgery reduced a laparoscopic procedure time by 11 seconds. 11 seconds is a long time if you’ve got a bad bleed.
How long do you scrub in? Longer than your attending. How long do you play Mario Brothers? Longer than your attending.
I humbly present, for your approval, evidence that most spammers are really, really schizophrenic and need to get back on their meds. We’ve got some serious derailments, thought blocking, and loose associations going on. Some recent messages:
with lower spurs of the Mountain. Two of these here thrust forward west
from the main mass in long steep-sided ridges that fell ever downwards
towards the plain. On this western side there were fewer signs of the
dragons marauding feet, and there was some grass for their ponies. From
this western camp, shadowed all day by cliff and wall until the sun
began to sink towards the forest, day by day they toiled in parties
if they saw him stoop; and even grownup he had still spent a deal of his
time at quoits, dart-throwing, shooting at the wand, bowls, ninepins and
other quiet games of the aiming and throwing sort-indeed he could do
lots of things, besides blowing smoke-rings, asking riddles and cooking,
that I havent had time to tell you about. There is no time now. While
he was picking up stones, the spider had reached Bombur, and soon he
mommy porterhouse kulak remorse attrition chimeric callahan drophead studio pigtail
permitted salaried cityscape whelan daphne concession secretary bella liturgic
impregnate antagonist bandit coed cognitive nude trudy afterglow cordite lens stoichiometry
angling thetis polecat birthday mattson coachmen mackerel serendipity
booky obeisant spartan carfare percent elect amplitude adagio
phlox ferocious kite plight sandpile leper typesetter ciliate
You see, when some schizophrenics are really sick, their speech gets all garbled up. People start speaking circumstantially–you ask a question and they’ll eventually answer it, but only at a very roundabout way. If they’re speaking tangentially, they go off on a tangent, and never actually answer your question. Even worse, they might start to have a flight of ideas–they start saying phrases that are somewhat related to each other, perhaps the last word of one sentence starts the next sentence: “All around the mulberry bush, the monkey chases the weasel… Weasels are great pets!” (Sometimes if it’s all rhyming words together, that’s clanging.) The most confusing are phrases using loose associations–the sentences don’t even relate to each other anymore. Thought blocking occurs when patients stop talking mid-sentence, and report having their train of thought totally disrupted.
I’d say the spammers need some Haldol, stat.
It appears there’s no physician consultant to the show Desperate Housewives (yes, I watch it religiously, so what?). Taken from this week’s episode, not only is the chest x-ray totally whitened out, it’s also upside-down and backwards. For shame!
A BBC news program(me) accidentally confuses a Internet marketing expert with the Internet marketing expert’s cab driver, and interviews the cabbie. Read the story and then watch the video, the expression on the man’s face is absolutely, absolutely priceless.
May 15th, 2006I don’t think this will come off as funny as my attending tells it in person, but she once had a medical student who thought that the abbreviations “BID” and “TID” were just doctor speak for “I agree” or “Yes, that’s all.” (BID actually stands for “twice a day” and TID stands for “three times a day.” As in, take this pill, three times a day.)
My attending found this out the hard way; she’d always ask the medical student about a patient’s medication doses. The medical student would say “The patient is on Haldol 5mg.” And my attending would ask, “BID?” And immediately the student would nod back with a smile, “BID!”
I really wasn’t expecting Michael to email me back. But he did. He had some pretty good answers, which I couldn’t find him plagiarizing anywhere from Google, so I sent back some replies to help him with his paper. Never assume!
Every so often I get an email like this, essentially asking me to find references and/or answer essay questions for some high schooler. This kid at least pulled off the enthusiasm bit:
Hello, my name is Michael XXX. I am a student at Troy High School who is doing a research project on universal healthcare / single payer system. Would it be possible for me to ask you a few questions regarding this interesting topic??
Please tell me your full name.
1. Tell me what you think universal healthcare means and how it will work.
2. Explain three ways how will it benefit society.
3. Some are concerned that the costs will overwhelm society with heavy taxes. How will healthcare be paid, and is it a viable solution?
4. Does society need universal healthcare? Why? What evidence is there of it?
5. What are at least three reasons against universal healthcare? Please explain.
6. How can you refute these arguments?
Could you also direct me to any more sources that you may know that could prove helpful for my project? I would greatly appreciate it.
Thank you!
Sincerely,
Michael XXX
My reply (I’m cruel):
Michael,
Which Troy high school?
Those are fantastic questions, and I would love to participate in an email discussion of these topics! I’m very busy taking care of children on my Pediatrics rotation, but I will definitely find time for this!
If you could provide me with your thoughts to these questions first, I think it will help me to respond more appropriately. I would hate to waste your time telling you information you already know.
Thanks, looking forward to it!
Sincerely,
Graham
The bf’s interpretation of me, with scrubs, white coat, and stubble after coming home post-call.
Set to the tune “Ho” by Ludacris (which I totally loathe, but hey, I’m on call tonight).
Who’s full code?
Who’s full code?
Who’s full code?
I said that you’re full code.
Rinse and repeat.
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Email was down, so if you emailed or commented, I didn’t get it. Sorry for that. I ask for your forgiveness. (I also ask for you to vote for me for best medical blog–I’m in the second half of the page.)
And just to know how my day went: One patient was hallucinating so much he thought he was eating a burrito; the other patient just started dialysis, had really bad abdominal gas cramps, and then looked at me and said, “Dude, I just pooped myself.” Ahh, medicine.
A hilarious graphic about how to choose your medicine specialty from a new blog I just found. Love it.
January 1st, 2006I’m allowed because I’m a blonde. (And because I know the real answer is 5.)
Saw a really kind patient today that is a Harley rider, complete with the leather vest and boots and all. He’s a big guy, obese, and has obstructive sleep apnea (he stops breathing when he sleeps because there’s lots of fat around his airway). The usual treatment for sleep apnea is a CPAP machine (continue positive airway pressure. You wear this mask at night that’s hooked up to a machine that blows air into you so your airway stays open).
He hated the mask–felt claustrophobic with it on–so now he just goes out and rides his Harley down the highway, and tilts his head up a bit so his nostrils hit the air stream. Similar effect, and works well for him, he reports.
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In a little more good-spirited fun, someone has knitted a digestive system. The liver’s a little small, and the common bile duct is emptying into the stomach, instead of the pancreas/duodenum, but hey. Not bad.
I’ve always thought that one way to tell if you’re truly fluent in another language is if you can make a joke in the language–humor requires not just meaning and proper grammar, but a level of comfort with the language and a good sense of comic timing. It’s totally true for the medical languages, too.
Case in point: at the beginning of this month’s rotation, I attended a weekly neuroradiology conference where the attendings kept making these only-funny-to-neurologist jokes about patient’s MRI scans, and I didn’t get a single one. They all went right over my head, but everyone else in the room was just cracking up.
Yesterday in clinic, I found myself making an only-funny-to-neurologist joke while evaluating a teenager with chronic daily headaches. As I sat down to present to the attending, I said, “Looks like a pretty classic case of giant cell arteritis,” and I got a good laugh from her.
Giant cell arteritis is a headache disease, but only presents in people over the age of 55. Ha! Err… ha. Sigh. Soooo lame.
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I’m pretty convinced a big plus of going into the surgical or emergency medicine fields is the stories that you get out of it. Blatantly stolen from an attending:
“You wouldn’t believe the kind of lies people make up when they present to the ER with something stuck up their butt. My favorite? A man comes to the ER with a zucchini up there, and proceeds to tell me, ‘Yeah, I was gardening naked tonight at home when I fell backwards and it got stuck up there.’”
Another hint from the attending–”If you ever get a votive candle stuck, don’t just pull on the wick. It’ll come right out, because your body has warmed up the candle wax, and you just won’t get anywhere.”
I’m tellin’ ya. It’s all about the stories.
What’s better than The Beatles’ song about a budding medical student who serially kills people with a metal mallet? When it’s put to animation.
I just laughed out loud in the library reading this piece from the NEJM:
Words never seem more needless to a busy resident than those elicited from a somatizing patient during a complete review of systems. All the compulsiveness nurtured in medical school evaporates before the onslaught of bewildering trivial complaints that have presumably found, finally, a sympathetic ear. How to shut off the torrent of words?
The conventional strategy is to ask questions that have simple yes-or-no answers, but this rarely hinders the determined somatizer from expanding a yes response into an intricate account of the details of his or her belly pain or dizziness. Long ago, a creative fellow resident invented the only effective method I know of for dealing with a patient with an all-positive review of systems, though I hesitate to recommend it. We called it the “Corning couplets” in his honor. Typical couplets might be “Have you ever had constipation or syphilis?” and “Do you have headaches or lice?”
[via kevinmd]
except student loans and coffee.
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I’m reviewing cardiovascular and respiratory physiology for the Boards right now, and a little self-experimentation goes a long way. I have a little burst capillary in my cornea right now, and I’m pretty sure it’s from doing a Valsalva maneuver to refresh my blood pressure and heart rate physiology. And whenever I start reading about tidal volumes and functional residual capacities and dead space, I have this uncontrolled need to breathe really deeply.
Heard today in class, which seems like it’ll be a really interesting month of classes. (Oh, the ESR is the “erythrocyte sedimentation rate,” a lab test that’s known for being very non-specific.)
Q: What’s the best reason to get an ESR?
A: To tell if the lab’s open or not.
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Fever of Unknown Origin (FUO) is when a patient has a fever (that’s >99.7F oral, or >101 rectal) on three occasions or three days in the hospital, and nobody can figure out why the heck he or she has it. It’s usually due to an infection, cancer, or autoimmune disease, but I’ve recently recalled from my childhood one major cause that no one at Smartypants Stanford thought of:
Child faking a fever.
I was no expert at this, and having a nurse and physician as parents didn’t help, but on at least one occasion I took the thermometer my mom gave me and stuck it up next to the lightbulb of the lamp next to my bed. Voila, temperature of 106. Unfortunately, lacking the knowledge that I’d probably be dead, or at least look close to it, at 106 degrees, I was forced to go to school.
Also fun to say in the “Eff You” category: 5-FU, a chemotherapy / cancer drug.
Herpes virus infections (oral, genital herpes, EBV – the virus that causes mono, VZV – the virus that causes chickenpox, and others) can never be cleared; they live in your cells until you die.
So, of course, the associated joke:
Q: What’s the difference between love and herpes?
A: Herpes is forever.
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I almost forgot. I’m the opening line in the latest Stanford Medicine magazine. Always happy to serve as the big, fat Commie Pinko.
5-10% of alcohol is removed from the body through the breath. This fact, of course, lead a classmate to ask if you can sober-up by hyperventilating. “Theoretically, yes,” said the lecturer.
Seeing as though this’ll be Valentine’s Day #2 without a significant other, I may just have to try it.
Speaking of V-Day, there’s a really nice piece at the end of this week’s This American Life about Johnny Cash, his wife, and the song Ring of Fire. Told by Sarah Jewell, one of my favorite contributors. It starts at about 47 minutes in, and it’s so sweet and romantic that it even made me feel a little less jaded and bitter about the whole thing.
Aldehyde dehydrogenase is the enzyme in your liver that helps you get rid of alcohol (actually, it’s the second step in the process, but I digress). Some people of Asian decent have less of this enzyme, so when they drink alcohol, they can turn red; in most texts, this is a mutation that decreases alcohol metabolism.
Turns out that everyone else is the mutation. If you look at animals’ versions of aldehyde dehydrogenase, they’re more similar to the Asian version of the enzyme; so somewhere along the way (Germany? Russia? England?), I evolved the ability to drink more. (Disulfram, a drug that can help alcoholics stop drinking, blocks this enzyme, making you flush, and not enjoy the alcohol as much.)
So no, I can’t control the weather, shoot force beams out of my eyes, or read minds… but I can drink more alcohol. Better than nothing, I guess.
IM conversation taken out of context:
On that lovely note, I’ve gotta shower and study my STD’s.
The STD’s. Not mine. I’ve got to stop saying that.
A number of totally random thoughts, after two days of class (we’re halfway through a week of derm):
My favorite gift wasn’t the dress shirt or slacks so I can look spiffy in clinics; it wasn’t What’s The Matter With Kansas, or the sour watermelon gummies, or even the underwear. Not the sweaters or calendar of Paris, either.
My favorite gift this holiday was the knowledge that I’m not going bald, as I had been previously thinking for the past couple months, and frantically ranting to my classmate Yana about. No, no, dear readers. I get to keep this lucious mane of hair. My mom has the same hairline forehead V that I have.
Yes, Virginia, there is a Santa Claus.
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From a former babysitter with her own GI stories:
Two doctors opened an office in a small town, and put up a sign reading “Dr. Smith and Dr. Jones, Psychiatry and Proctology.”
The town council was not too happy with the sign, so the doctors changed it to “Hysterias and Posteriors.”
This was not acceptable either, so in an effort to satisfy the council, they changed the sign to “Schizoids and Hemorrhoids.”
No go. Next, they tried “Catatonics and High Colonics.” Thumbs down again.
Then came “Manic Depressives and Anal Retentives.” Still not good.
How about “Minds and Behinds?” Unacceptable again.
So they tried “Lost Souls and A**Holes.” Still no go.
Nor did “Analysis and Anal Cysts,” “Nuts and Butts,” “Freaks and Cheeks,” or “Loons and Moons” work either.
Almost at their wit’s end, the doctors finally came up with a business slogan they thought might be acceptable to the council: “Dr. Smith and Dr. Jones, Odds and Ends.”
Problem: Inflammatory Bowel Disease is on the rise. It’s a set of GI syndromes-most notably, Crohn’s and Ulcerative Colitis-which are quite nasty: bloody diarrhea, fever, malabsorption of nutrients, indigestion, increased risk of colon cancer, many times requires surgery or lots of immunosuppression.
Solution: Give patients pig whipworms to eat. In a small study, 23 out of 24 people became symptom free by the end–quite a miraculous change. Note, these are not the type of whipworms that give you a prolapsed rectum. That would be human whipworms. Just in case you were wondering.
In other news, I’ll be ingesting a couple tapeworms (Steve and Lou are their names) to help me lose a few pounds before Hawaii. It’s a Paris Hilton secret.
I pray to the gods and the power of Grayskull, please help my neurons to dig up the lost memories of pharmacology from the depths of my mind. Specifically, the antibiotics, antivirals, antifungals, and anti-cancer drugs, as I’m thinking those are the ones that will be the focus of my exam on Friday. If I could get the toxicities back, as well as mechanisms, and all the mnemonics I made up for them, that’d be great.
Also, if it’s not too much trouble, all of microbiology would be awesome. If not, I’d like the major bacteria and viruses, specifically upper respiratory tract infections, pneumonias, diarrhea bugs, and urinary tract infections.
I’m really willing to make it worth your while, God.
Michael Paulus’s gallery of cartoon character skeletons is not to be missed.
In the spirit of conservation, recycling, and urine fetishes comes Repronex, a drug that comes from the concentrated urine of post-menopausal women. It’s used to stimulate the release of FSH and LH, two pituitary hormones important for sex hormone release and maintenance of most things sexual in the body.
Apparently it’s been around for quite some time, but, like my used car, it’s new to me.
Also in the “abusing nature for all it’s worth category”: Miacalcin, a salmon version of our body’s natural hormone, calcitonin. (The salmon version is much more potent than the human version. Go figger.)
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Now that we’re in endocrine, we’ve been talking about prolactin and other hormones that cause milk release, or, as the professor calls it, “milk letdown.”
My classmate Peter loved the phrase, just with a different definition: Milk letdown. When you have milk, you expect it to be really good, and it’s just okay.
Another interesting fact: the name galaxy (ex: our Milky Way) comes from the root galac-, which means milk. See picture below.
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I was just randomly listening to some Ella Fitzgerald, and realized that she says “dyspeptic” in her song, Bewitched.
Ella, you are even cooler than I thought you were already.
Note: do not read this whilst eating, thinking about eating, or just having eaten.
This was, by far, the most disgusting week of medical school, and Monday may just be the most disgusting day of my life. I’m not ready to proclaim this until I’ve been through the hell that is residency, but it’s gotta be top 5 at least.
Monday we started off with our intestinal tapeworms and nematodes (roundworms/helminths) GI lecture. This included whipworm, which causes, OHMYFREAKINGGOD, rectal prolapse (don’t click that!). We also learned about all the other fun ones, including ascaris (I wouldn’t click that one either), which can lay 200,000 eggs every day inside your stomach.
So that’s always a pleasant talk, I’m sure. Next, since I’m an anatomy TA, and we’re starting the pelvis, we have to pre-dissect the bodies for the students. This involves separating the abdomen from the pelvis and legs, and then hemi-section–separating each egg, by cutting down the middle. Along with vessels and nerves and muscles, you have to tie off the large intestine and cut it, so you can separate the top from the bottom. When you die, unfortunately your poop doesn’t magically disappear. It says right in the body. And, say, if you’ve never done this whole “hemi-secting” thing before, and you and your friend are sawing through a hip bone, you might just accidentally saw through a bit of bowel.
Yes, Monday not only did I see prolapsed rectums, but I got to clean a ton of shit out of a dead person’s rectum. This was, by far, the most traumatizing thing in medical school. We hit the bowel in two places, so we had to basically remove all the feces from the body and throw it away. No, they do not pay us enough.
And then, to wrap things up, for our GI test on Monday, I was studying Hirschsprung’s disease. This keeps you from pooping, because some of your nerve cells don’t make it down all the way to the end of your intestines, so feces can build up. I also learned, according to a review book, that the poop can build up so much… that you poop out your mouth. There’s a South Park episode where this happens, but it’s just that much grosser that it actually does.
And yes, I’m paying $50,000 a year for this wonderful life.
Diarrhea Quote of the Day, from a microbiology/infectious disease doc at Kaiser:
“Diarrhea can be hard to define. One good definition: stool that conforms to the shape of the container in which it’s placed… as long as the container’s not a big long cylinder.”
Farting-I mean, flatulence-is due to poor absorption of carbohydrates.
Beans contain raffinose and stachyose, tri- and quadrupe saccharides, and cannot be digested by humans. They get passed along through your large intestine, where your normal flora (bacteria living in your colon) feast on them. (They do this anaerobically, fermenting the carbs, so that’s where the gas comes from.)
This is clearly why I went to med school.
We’re in GI right now, and I couldn’t be happier to learn today in lecture that “dumping” is a medical term.
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I was going to be sarcastic and snarky and critical in an attempt to be funny, but I don’t think it’d work.
These elementary school drawings of human anatomy are surprisingly good. You’ve got muscles attached to bones, a simplified arterial and venous circulation (the renal veins are in front of the arteries, Sarah, and I hope that’s not blood in the ureters), and a nice little kidney (renal pelvis is a bit off).
Okay, so I was still critical. I’m sure they’re better than I could’ve done at their age.
Not much worse than the first year medical students!
Been wanting to post this for weeks, but as I’m feeling just crappy enough to justify not studying, now’s the perfect time.
I use Lippincott’s Illustratred Pharmacology for a study tool-it’s an excellent book, and really well organized. I was flipping through the pages a couple weeks ago and came across sildenafil-ie: Viagra-and found what is, quite possibly, the best illustration of a drug mechanism ever:
Okay, so a bunch of bloggers are posting about how funny the CDC Disease Cards are, but I have to admit, I think they’re kinda cool. I was really pulling for a coccidiodes (Valley fever!) or histoplasmosis (mimics TB). I am so lame.
Maybe it’s just the homosexual in me, but any time I read or say “toxic,” as in “Doxorubicin is cardiotoxic” or “Tetracyclines are phototoxic,” that damn song starts playing in my head.
Ever since my friend Ann told me about This American Life, an hourly show on NPR, I can’t get enough. Especially of David Sedaris’s readings. I present, for your listening pleasure, a few short pieces (only about 5 minutes long, and very funny). It starts at 37:20 (RealAudio file); the first is about the Orthopedic Surgeons Convention, and the other is, of course, about the largest turd in the world.
Besides the fact that they really just don’t seem that fun, part of my lack of interest in sports is my overall lack of coordination. On multiple occasions playing basketball on a team through my middle school years, I’d find myself shooting a basket under the backboard, only to have it hit the underside of the rim and come right back at my nose. As more evidence, I present my almost uncanny ability to choke on water daily. It somehow always manages to slip back into the wrong pipe, and make me cough violently. I, of course, am not to blame. My cerebellum is.
The cerebellum is, in a nutshell, your anti-klutz center. It helps coordinate and automate movements, and does error checking, too: if I reach for a glass and knock it over, the cerebellum gets a signal to adjust its coordination in the future. Mine, however, seems to mess up in spurts. I’ve have a month or two without a problem, and then out of nowhere, a whole slew of goofs, leading to large messes and stained clothes. (I have, for this reason, become something of a stain-removing expert.)
Today was one of those days. I’m surprised I didn’t end up wrecking my car. Then again, the day isn’t over yet. I ended up dropping a big yogurt container, splattering it everywhere, followed by staining my jeans with some Indian paneer sauce and splattering it all over the kitchen. Then I almost spilled the curry *again*. Oh, and this morning, I knocked my deodorant into the toilet. And just now I dropped my keys and almost lost them over a ledge. Please pray for my safety. On days like this, I need it.
From new kid on the block Shephali comes some decent medical cartoons. Kind of hit or miss, but definitely worth the click.
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Like my previous Rock Bands, I present, for your literary pleasure, medical terminology that could be confused with Harry Potter spells:
* Status Asthmaticus
* Medial Lemniscus
* Olecranon
* Staph Aureus
* Eosinophilia
* Rhabdomyolysis
* Ipratropium
* Amiodarone
As always, feel free to add your own. If some of them don’t sound like it, try saying it with a teen British accent. You’ll see what I mean.
My old boss gave me the ultimate in compliments last year. And I quote, “Graham, you’d make a good argument for human cloning.” Nothing has really come close, until I found Vivian’s note about me on her blog:
bq. 23 year old graham blogs about med school. my question for you: would you marry him? like, right now. would you? like i would marry jon stewart and ed helmes right now if either asked me (i put in some serious thought just then when i was thinking of who i’d marry). and you should know that i take questions seriously, my mec interviews take forever because i think hard.
I’m seriously flattered. But I’m sorry, long-distance just won’t work for me. What a tangled web we weave.
Blogborygmi’s latest just made my day.
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An oldie but a goodie, The Cyborg Name Generator now has its own domain. I’m, of course, Graham, the General Robotic Android Hardwired for Assassination and Mathematics. I’m a pacifist and hate calculus, but it’ll have to do. 
And I almost forgot, again from Neuro lecture: Mike the Headless Chicken! (He’s running for President in 2004.)
As the beautiful story goes…
bq(quote).. September 10th, 1945 finds a strapping (but tender) five and a half month old Wyandotte rooster pecking through the dust of Fruita, Colorado. The unsuspecting bird had never looked so delicious as he did that, now famous, day. Clara Olsen was planning on featuring the plump chicken in the evening meal. Husband Lloyd Olsen was sent out, on a very routine mission, to prepare the designated fryer for the pan… A skillful blow was executed and the chicken staggered around like most freshly terminated poultry.
When Olsen found Mike the next morning, sleeping with his “head” under his wing, he decided that if Mike had that much will to live, he would figure out a way to feed and water him. With an eyedropper Mike was given grain and water. It was becoming obvious that Mike was special… It was determined that ax blade had missed the jugular vein and a clot had prevented Mike from bleeding to death. Although most of his head was in a jar, most of his brain stem and one ear was left on his body. Since most of a chicken’s reflex actions are controlled by the brainstem Mike was able to remain quite healthy.
In the 18 MONTHS that Mike lived as “The Headless Wonder Chicken” he grew from a mere 2 1/2 lbs. to nearly 8 lbs. In a Gayle Meyer interview Olsen said Mike was a “robust chicken – a fine specimen of a chicken except for not having a head.” Some longtime Fruita residents, gathered at the Monument Cafe for coffee, also remember Mike – “he was a big fat chicken who didn’t know he didn’t have a head” – “he seemed as happy as any other chicken.”
p. Which just goes to show you: chickens don’t need a brain to live (their brainstem does most of the work), and chickens have no problem getting their heads chopped off. (Sorry, PETA. Don’t hurt me.)
Completely stolen from today’s lecture on the auditory (hearing) system, I’ve got two little multimedia pieces for readers today:
* First, a little cochlear damage. The cochlea is a spiral-shaped structure in your inner ear (past your eardrum) that lets people hear. It’s got tiny hair cells that move in response to vibrations (sound waves), and, well, to make a long story short, they’re how you hear. But you can lose these hair cells–from old age, from over-exposure to loud sounds, and depending on the pitch of the sounds, you lose hair cells in a certain area of your cochlea. A great picture to illustrate it: 
* And for my favorite–like I mentioned above, the hair cells respond to certain frequencies of vibrations. And one type of these hair cells actually contract when they detect a certain frequency. Even faster than our muscles contract. Anyway, a scientist in the UK isolated one of these contractile hair cells (an outer hair cell), and attached a small voltage sensor and speaker to the cell. Ladies and gentlemen, I present, for your viewing and auditory pleasure, please turn up those speakers and give a warm welcome to… THE DANCING HAIR CELL OF LONDON! (5.2 MB mpeg file).
I guess it’s fitting that at the same time a Congressman introduces a bill to punish anyone who uses George Carlin’s 7 dirty words, the Canadian Medical Journal has research to examine Words used by children and their primary caregivers for private body parts and functions.
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Damn. 62, and I’ve only been here 4 months.
The following scale has been developed in close cooperation with the UVA psychiatry services. It is designed to test if you have spent too much time in medical school and whether you are having adverse side effects due to prolonged exposure. Score one point for each statement that applies to you.
1 You have ever said “Netter is god”.
2 You can discuss autopsy/ anatomy over a meal
3 You own a 4 color pen
4 -it just isn’t enough colors for you
5 You use more than one color to take notes
6 You have use up more than 6 highlighters in the past 6 months
7 you have ever highlighted something YOU wrote
8 you retype handouts given in class
9 you haven’t had a date in 3 months
10 you haven’t had a date since entering med school
11 you have not been able to remember the normal term for something because you were thinking of the medical term (ie reflux for heartburn)
12 You get more sleep in lecture than at home
13 You know the correct spelling for pruritus
14 -you also know what it means
15 You have ever asked a question in class
16 -The prof. didn’t understand the question
17 -you didn’t believe the answer the prof. gave
18 -you went to look it up to see if they were right
19 You can’t hold a conversation on anything other than med school
20 You skip class to study
21 You’ve said you didn’t do well on a test on which you beat the mean
22 You spend more than 15 hrs a week on e-mail
23 You have a callous on you finger from writing
24 More than one professor knows you by name
25 When you ask a question, a new professor has said “Oh, I’ve heard of you”
26 You can name more amino acids than past presidents
27 You use more than 5 acronyms an hour when talking
28 you actually know what PERRLA stands for
29 You know all the steps of the TCA cycle
30 You do not read PTA as parent teachers association
31 You can remember the muscles in the forearm
32 You know the strucures in the urea cycle
33 You know the dermatome distribution
34 You can’t remember what you had for breakfast
35 You can’t spell world, much less backwards
36 You’ve ever been sexually aroused by the breast shadow on an X-ray
37 You equate “morning stiffness” with Rhematoid Artheritis
38 You actually know normal values for plasma Na
39 -K
40 Missing class causes you extreme stress
41 You have seriously asked someone “So how does that make you feel?”
42 You have asked will this be on the exam
43 -Just after the prof. said it wouldn’t
44 You identify with Deb on E.R.
45 You have made a medical joke
46 -no one laughed
47 -You figure they just weren’t that far in their studying
48 You wear your stethescope around your neck on the bus
49 -you don’t even know which way the thing goes in your ears
50 “SOB” means short of breath to you
51 You have gone to student health with suspicion of a disease you have studied
52 -within 3 days of the lecture
53 You have answered a question in class
54 -asked by the professor
55 -it was a rhetorical question
56 You can quote lines from the movie “Malice”
57 -you believe them
58 You can flip your pen over your thumb
59 -with both hands
60 -you do so throughout class
61 You have corrected a professor in class
62 -the rest of the class didn’t understand the lecture to begin with
63 You know how to claculate specificity
64 -positive predictive value
65 -anion gap
66 -you can’t balance your checkbook
67 You don’t know what the weather was like for the past week
68 You don’t know what the weather is like right now
69 You actually talk in open ended questions
70 DIC isn’t a slang term for the penis in your book
71 You think B-is a bad grade
72 you have stressed about a pass/fail class
73 You study during most of your meals
74 You saw nothing abnormal about the Obsessive-Compulsive Disorder
75 You draw all of the slides not already provided in the handouts
76 -including the cartoons (humourous type)
77 Anatomy makes you hungry
78 You would even consider saying “Ease back on my finger at your own pace”
79 You know the size of a RBC
80 -you don’t know the size of a football field
81 Your eyesight has worsened by 10 pts or more in the last year
82 You have the library hours memorized
83 Hou have your own seat in the library
84 You score more than 95 on the Epidemiology final
85 You own more than one white coat
86 You have debated between giving up sleep or eating in order to find more time to study
87 You started studying for boards more than 2 months in advance
88 You have never received a personal invitation to discuss your grades with the dean
89 A tie is the only addition necessary to what you normally wear when you go to see patients
90 You wear scrubs to tests
91 You have made plans to study on a beach during vacation
92 -you actually did
93 You have a designated seat in lecture
94 -You have ever asked someone to move from “your seat”
95 You sleep less than 4 hrs a night
96 -you think that is plenty
97-you have thought about cutting back
98 You study more than 35 hrs outsid of class
99 -you think you are a slackard
100 You think everyone answers yes to most of these questions
Scale
<20 You’re not in Med school.Go back to your party and leave us alone.We have work to do.
20-35 Either Med school is a breeze or you like the sound of “Senor doctor”
35-45 Gotta love that Primary Care
45-60 Well, I never really thought about MD/Phd, but now that you mention it…
60-75 Your social life is shot, might as well try to earn lots of money
75-90 Which surgery subspecialty did you say you liked?
90+ All hail, great Med School Nerd master.
I need a kid around me constantly to do cute stuff like this all the time. Helps remind me why I’m going through all this to begin with. Story from Thomas’s dad, I think, over at Rondayview, and more about Thomas’s condition. (I have also clearly lost the innocence that was my youth, as I instantly interpreted the “do not get any ideas” comment as something sexual. Oh well. It had to go sometime.)
I posit that It’s completely normal, in the span of one night, to have a dream that a) your 19-year-old brother has spina bifida that you somehow just detected, and that you’re arguing with a classmate on whether it’s “iliosquamous” or “iliopsoas” (and you, of course, are right). And if it’s not normal, then, I was, uh, just wondering. Hypothetically. Yeah.
I’m usually not one for painting with broad strokes, and in no way do I think that all lawyers are evil (just most), but Rangel’s got some pretty damn funny law-versus-medicine snippets.
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Been too busy and concurrently lazy to post lately, but I figured I’d give a couple updates and lessons I’ve learned:
* If you think it’s a cervix, it’s probably an ejaculatory duct. We had an anatomy walkabout (where they pin different things and we have to ID them) on the abdomen and the pelvis, and, yet again, I made a stupid mistake. Maybe it was from the lack of sleep. Maybe I’m just an idiot. Now maybe this is me setting my standards too high, but I think if they pin the ejaculatory duct, I should reasonably be able to tell that the answer “cervix” probably ain’t right. Especially when there’s a penis right there on the body. Urology, proctology, and ob/gyn have just been ruled out.
* The medical community is not telling you the truth about your amniotic fluid. When you take health class, or ever talk about pregnancy in class, the amniotic fluid is just this vague fluid that somehow develops to cushion the infant. It’s just kind of there, and you don’t generally ask what it is, or how it got there. And now I know why. Y’see, the amniotic fluid is basically, uh, fetal pee. It’s quite a beautiful cycle. You drink your pee, pee it out, bathe in it, and drink it again. No, really. If you’re really all that curious, there’s much more information about it, but really, ignorance is, without a doubt, bliss.
* It’s all about who you know. I just got a job working with the Virtual Labs Project, and I’m pretty excited about it. I’ll be doing some Flash animations and slowly learning how everything works, but I ended up finding out about the position from an older med student who saw my website and thought I had potential. Sniff. I’ll try not to get too emotional. Thanks, Phil.
* Damn. The body is amazing. Glad to report that my sense of wonder continues to develop. Just going over heart sounds on Friday, I was reminded at how mind-boggling it is that all these complicated things are happening, every beat, in the body. Muscles squeeze, valves fly open or snap shut, pressures rise and fall… and it all happens so naturally and quickly that to begin to understand it, you have to really slow down the process in your head. But then, you realize that the dynamics change so quickly that it’s almost impossible to follow the process real-time in your mind. Although your heart has no problem pumping, without stopping, for 76 years. I won’t even being to talk about its development, save for a quote from a Embryology professor: “It’s as if you had to make a cruise-liner engine from a tiny speedboat motor, in the course of 9 months, the only other stipulation being that you’re never allowed to stop the engine from running.”
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I figure at least first year you’re allowed to completely embrace your new found medical edification and knowledge, even on Halloween. Or maybe especially on Halloween.
I wasn’t alone. At our med school party, we had: the greater and lesser sacs, a megakaryocyte (complete with plates all over her), an ectopic pregnancy, and, of course, I went as Dermatome Man (what’s a dermatome?). Warning: image may frighten and traumatize small children. And yes, we followed Netter to get it right.
Seeing as though two out of three of my anatomy lecturers are British, I swear I’m going to run into pronunciation problems. It’s not capillary, it’s caPILLary; it’s not trachea, it’s traCHEA. UmbilICUS, not umbilicus, too.
I’m kind of scared I’m going to break into a British accent every time I try discussing anatomy with someone.
I would just like to state for the record that medical school provides an insane number of terms that would make great names for bands. Dave Barry would be proud. I find it works best if you imagine a British punk singer on stage, shouting out, “Hello Chicago, we are [insert band name here]!” A partial list:
* Infundibulum
* Zona Pellucida
* The Acromions
* Aponeurosis
* Secondary Granules
* Phrenic
* Dynein
* Neural Crest
Feel free to add your own.
As a grad student, you’re really in a worse position financially than you were even as an undergrad. At least you’re still considered a fledgling. Your parents support you, nurture you, even send the occasional care package every now and then. But then you start some sort of graduate work, and, even though your financial aid claims that you’re a dependent, you’re not. You’re pretty much on your own, digging yourself deeper and deeper into debt every day. Sure, I could ask my parents for support if I needed to, but I’m getting the feeling that I’m old enough to be completely responsible for myself.
I’m basically just alluding to the fact that you could, theoretically, get me to do almost anything (I emphacize the word almost) for anything free. Free food, free office supplies, highlighters. You name it, I’ll probably do it. I’m the king of the psych study. The master of the free lunch. And, it’s in this vein that I note the fusion of the best of both worlds. Free alcohol. From the med school. Since the occasion comes along only twice a year, I tend to embibe. A little too much. And thus, I present my official “2003 Stanford Medical School Stethescope Ceremony” picture featuring yours truly and the Dean, Dr. Phil Pizzo. I normally don’t smile that wide.
From the third of the Molecular Bio Professor Triumvirate, Mark Krasnow:
A patient comes in to see his doctor, and presents with a frog coming out of his forehead. He sits down and, astonished, the doctor asks, “How’d that happen?” The guy shrugs and says, “I don’t know doc, but it all started with a wart on my ass!”
Moral of the story: don’t assume anything about patients or their problems, you can’t always look at problems from one perspective, and, uh, get those warts checked out by a dermatologist.
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This is a medical weblog--a collection of thoughts about medicine, medical training, and health policy--written by a fifth-year medical student.
I recently stopped blogging, as I graduated from medical school and I'm now a physician in my residency training in New York City. But feel free to read and enjoy!
(To get rid of this thing, just wave your mouse over it. Ta da!
