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Tuesday, January 31, 2006

Grand Rounds

Vol 2, No 19 is up from Down Under at Barbados Butterfly.

Australia is a beautiful country. Not that that has anything to do with how good this week's set of the best of the medical blogosphere.

On a final note: Physiology, Biochemistry, and Human Behavior tests are done. Anatomy, Histology, and the Physiology Shelf Exam final remain for the week.

Saturday, January 28, 2006

Remembering Challenger


On this day in 1986 America suffered a shock when seven men and women lost their lives on the Challenger shuttle. It was not the first lives lost in pushing the boundaries of space exploration. It would not be the last.

"Don't we all learn as we go?" said Grace Corrigan, who lost her daughter, teacher Christa McAuliffe, in the Challenger accident. "Everybody learns from their mistakes."

I Can Learn

That is an amazing statement. I read these syllabi and I will remember what is in them (the degree to which I do so we'll see after I get my grades from the next round of tests).

As tests approach fast it comes to points at times where it'd be better to pound my head into a wall than continue staring blankly at the description of G-Coupled Protein Receptors or the anatomy of the pelvis.

But, it is amazing I can look at these descriptions and comprehend them. We are blessed, at such a fundamental level, with this gift. It is kind've hard to let that go to waste.

How do we learn? Well, that is kind've hard to say.

Monday, January 23, 2006

I'm Afraid

Don't ask me for figures but plenty of medical students become little miniature "hypochondriacs;" especially in the early years. Actually, hypochondria is a serious condition that I shouldn't make light of.

But really there are a lot of frightening things, not just diseases, mixed amongst the pages of our biochem and microbiology books.

Take what I'm looking at in biochemistry right now. I recently had a lecture on prostaglandins and thromboxanes.

That's not important in and of itself. The important thing is that cyclooxygenase is an enzyme used in the production of these molecules. Efforts to inhibit a form of cyclooxygenase, COX-2, has led to Merck opening up its wallet.

These COX-2 inhibitors, such as Vioxx, were suppose to be the safer anti-inflammatory painkillers, developed to target COX-2, and spare another enzyme COX-1. They were to be our bodies' friends, if you will, even going to far as inhibiting the development of some cancers.

Back to the story at hand. A few of your typical medicine cabinet painkillers (aspirin and ibuprofen) inhibit COX-2 and the inflammation it causes (good for reliving pain) but also its brother enzyme COX-1, which has to do with blood coagulation and gastric acid secretion.

Being the rational future physician I am I was sitting in class wondering if the next time I got a headache and then cut myself with a cheese grater (it could happen) if I was going to bleed out. And this is while I develop an ulcer from the increased acid secretion.

It turns out Tylenol (acetaminophen) is preferential for another form of cyclooxygenase, COX-3, which has nothing to do with bleeding or inflammation. Great news. No risk.

I went and bought some the next day.

Literally, twenty pages further in my biochemistry book (and several days later) I learn that this stuff is worse. Our bodies are so smart acetaminophen is metabolized, especially in the presence of alcohol, into something pretty nasty for our liver. More people make calls to poison centers involving acetaminophen than any other substance.

I think I'll try incense from now on to help relieve minor aches and pains. I don't know what I'm going to do however when we get to bacteriology later in the year in microbiology. All I have to say is that if Adriana Lima wants to make out with me, she better let me know before I learn what's in her mouth.


+


I better go lay down...I think I feel a touch of a Hantavirus (studied last Thursday) coming on.

Saturday, January 21, 2006

Off Topic USC 2006 Wallpaper


The Rose Bowl is January 1st and the national championship game is January 8, 2007 in Phoenix, AZ at the site of the Fiesta Bowl (after all the BCS Bowls have been played).

Fear Us



Wednesday, January 18, 2006

Great News from W. Virginia

The lone survivor of the Sago mine accident is being slowly brought out of his coma and with incredibly promising results so far. The quotes from his neurosurgeon include:
Now if you call his name, he will [open his eyes]. He will track family members and they believe that he has some level of connectivity with them.

If you put a piece of ice in his mouth he will take it and move it around with his tongue and swallow it and chew it and swallow it.
Still it must be remembered that,
Many people with severe carbon monoxide poisoning end up with severe cognitive, personality, memory, visual, motor response deficits.

HIV Passive Immunity

Researcher's at Brown Univ. have modified the gut dwelling L. Lactis to produce cyanovirin, a drug which some studies from the NCI show blocks human cell infection by HIV and Herpes viruses.

Tuesday, January 17, 2006

Stagery Fakery


I won't call this photo fake. Instead, let's give the benefit of the doubt, and imagine that the original caption to this photo was an overzealous mistaken on the part of the NY Times; looking to put a human touch on the perhaps dozen deaths (or more depending on who you want to believe) involved in the strike on a terrorist gathering in Pakistan. And there is strong evidence, that the strike killed foreign terrorists who were indeed at the location.

This is the original caption of the photo:
Pakistani men with the remains of a missile fired at a house in the Bajur tribal zone near the Afghan border.
However the photo was obviously staged because that is a decades old artillery shell they're standing next to. Lots of news photos are staged, and I find nothing wrong witht that. As well the photographer knew this wasn't a missile or American ordinance he was lining these villagers up next to (or he is an idiot).

The question is on the intention of the NY Times photographer to have this photo used as a representation of the consequences of American action in Pakistan. Or was this just a mistake by the editors back in New York confusing the photo for something else?

We may never know. However, what is troubling is when liberally leaning publications continue to print the picture, even after the NY Times correction, with the intention of portraying it as a photo of American intervention and the trouble it causes in other countries.

Oregon Assisted Suicide Upheld

I'm pleased with this. I'm just not sure it was decided right.

On an sad note, the three most conservative judges - the ones I would hope would uphold the idea of federalism - were the ones who voted against Oregon.

The case was one of definition. The ruling actually centered on the U.S. Controlled Substance Act and the meaning of the act's term, "legitimate medical purpose". Ashcroft, in the suit, basically claimed the executive branch's authority to provide depth to this ill defined term. It's probably the judicial branch's role to do so, and now they have spoken, under the CSA assisted suicide is a "legitimate medical purpose".

Certainly it is impossible to know for certain what congress intended by this term, if it was to protect the practice of physician assisted suicide. But it is likely they didn't intend it to do so.

In matters of definition only, shouldn't that be the basis on which courts interpret laws? On what the legislature intended?

As Scalia said,
The court's decision today is perhaps driven by a feeling that the subject of assisted suicide is none of the federal government's business. It is easy to sympathize with that position
The court did not have the courage to say that assisting those who wish to die is a protected act, and instead only limited law enforcement's ability to prosecute under current legislation. Don't be surprised if Congress acts to specifically outlaw assisted suicide as a criminal act with new more definitive laws. Maybe that will force the court's hand; but probably only make them shy away.

Infection Weapon

A robber took $1000 from a liquor store by threatening the owner with a needle he said had HIV infected blood on it.

Relying On The Super Rich

I don't like the idea that the super rich owe something more than others. I don't even understand how the proposition is defensible.

But off my ideological thought block for a moment, there are other reasons why taxing the super rich too much is a bad idea.

Here however is a novel pragmatic argument being made that relying on the rich for too much of your tax revenue provides inadequate diversity and opens yourself up for disaster. Just take the state of California where the top 5% of earners represented almost 60% of tax revenues.
The personal income tax represented $33.7B of the $73.6B in revenues in the 03 budget, high income filers represented 58.8% of 45.8% of the budget, or 26.9% of the annual budget.

Since this represents 680,000 returns of the 13.6 million filed, it's fair to say that half a million households provide about a quarter of the revenue to the state.

I think this is an amazingly bad idea. I don't think that this is a bad idea because it's unfair to the half-million rich households. I think it's a bad idea because it builds insane levels of volatility into the state revenue stream.

There's numbers on the site to prove it.

On the federal level the top 5% account for 38.4% of all federal tax revenue (not just income tax). Personal taxes account for almost exactly 80% of all federal revenue! 80%!

The United States government borrows and overspends obviously. But of the revenue they do bring in, around 2.2 trillion dollars, personal payments from the top 5% account for about 31%. This doesn't even include corporate taxes, many of which the top 5% of earners are likely to have vested interests in.

Nearly a third of revenue comes directly from the earnings of the super wealthy. The question is, do recessions, in terms of percentage change in income, not absolute dollars, hurt these individuals more than other classes?

Are the income sources of these individuals diverse enough for this reliance on them by the federal government not to be an unnecessary risk?

Monday, January 16, 2006

Anatomy

I went in and scrubbed in for a cardiac surgery today. Apparently the left ventricle is not the most anterior chamber of the heart, as I claimed. Thank the Lord it was after the surgery and to another doctor, not the surgeon(s), but it's not like it was a slip of the tongue. I was watching them cut into the left side of the patient's heart and thinking, during the surgery, 'this is really weird,' they're cutting into the LV. Why would you go in to close a VSD through the more muscular ventricle?

This despite the fact that I just went through this in anatomy lab a little over two months ago. It's not like I misidentified a CA branch...I thought I was looking at the LV because it was on the left side of the patient.

Good job me.

Sunday, January 15, 2006

Academic Medicine = Depression

This study involved a set of self reporting surveys that got less than 55% response. It found a number of complaints amongst academic physicians and that a significant percentage of them were clinically depressed.

While you have to have respect for the authors who are all notable academians, obviously those who feel there is something that needs to be reported, basically those who are depressed or are likely to report negatives about academic medicine are more likely to complete the survey.

Not to go into my history but I probably have as good a perspective about the condition of academic medicine as any undergraduate medical student. It has certainly been a part of my life since early childhood.

Is life as a physician really just as atrocious as this survey makes it out to be?
The term "crisis" has been used to describe the state of American medical care for a number of years.
There is stress everywhere in medicine and it goes beyond the financial situation and threat of litigation (although these are concerning) to the nature of the job. Certainly, such stress is unavoidable in academic medicine as well along with concerns that attractors for joining academic medicine - research and teaching - are being diminished. But there's a "crisis" going on?

My perspective is limited to specific academic institutions but...these numbers seem bloated. Still, it's not like depression manifests itself on the faces of those you pass in the hallway and it is hard to judge the situation without living it. This study could just as well be an accurate representation of the state of academic medicine.

H/T to HCRenewal.

Is America's Health Growing?

The United Health Foundation, American Public Health Association, and Partnership for Prevention have released their annual report on how fast America's health is improving. Apparently compared to the past 5 years the growth of America's health has slowed down and this is an issue of grave concern. I took this from NewsRX.

Of specific concern in the report and if you visit UHF's website is the fact that America is getting fatter. This despite the fact that plenty of reports document the fact that the health risks, in terms of absolute life expectancy, associated with being obese have been greatly overstated. Being mildly overweight appears to have no effect on life expectancy in this country. Read my previous post on this issue of reworking the numbers on obesity.

It should be noted that I'm nearly underweight, so I'm not defending myself here, I just think that America's prevention efforts are probably misplaced in spending so much time in slowing down America's "growth".

America does finish 27th in life expectancy, which is of note, and apparently how quickly our life expectancy is rising compared to other leading countries is concerning. Here is a list of world life expectancies.

The argument has long been, by those I typically disagree with, that America leads the world in health spending, both on services and research, and yet if we lag behind other countries in health then there is something wrong with the model. This report certainly adds to their argument.

Saturday, January 14, 2006

How Competitive Are You?

Would you step in front of Shaq to take a charge?

Just kidding. This program tries to tell you which medical schools you're most competitive at based on your state of residence, GPA, and MCAT score.

I don't know what the cutoff is but it arranges schools by extremely competitive, competitive, and less competitive (read: not competitive). I'm not going to post where I was "extremely competitive" and I wouldn't put TOO MUCH weight in this thing, but if you're applying to medical school, not too squemish or if you have a 4.0 and a 40 MCAT then it is kind of fun and maybe a guide.

Caribbean Medical Education

The Medical Board of California has documented 20 new for profit Caribbean medical schools, which cater to U.S. college graduates, since 2000.

Is there a reason for concern? I don't know. One one hand as this article from the AMA's site (password required) points out, these kids do much worse on the USMLE board steps.

But then there is some questionable logic from a member of the Federation of State Medical Boards,

"Boards are increasingly concerned about IMGs from these schools, their caliber and the rigor of their basic medical education," Austin said. "We have no good means of assessing that."

Why am I taking the Step 1 and 2 then?


"This is becoming a huge issue on a national level and in California," said Joyce Hadnot, chief of licensing at the Medical Board of California. "You may find someone ... sharp enough to pass a test [USMLE Steps 1 and 2] but not have the skills to practice medicine independently."

You have to put a lot of weight on their ability to complete these tests. Especially those that can do it on the first try. In that category there is some concern. 70% of graduates of Foriegn Medical School graduates who are not citizens of the U.S. but come here for residency training pass the USMLE Step 1 on their first try. Only, 53% of U.S. citizens who go to medical school outside the United States and then try to return for residency training pass the USMLE Step 1 on the first try. These are largely Caribbean school graduates.

That probably says more about the quality of the students at these out of country schools geared for Americans, than about the curriculum and quality of education. 99% of the Americans there failed to get into a stateside school despite the effort.

From The Lecture Halls To The Front Page

H5? N1?

Its semantic but thanks to actually opening my microbiology syllabus and going to lecture I now know what they're describing when they talk of Avian Flu as H5N1.

Orthomyxoviruses have two really important surface proteins involved with the viruses ability to enter and exit the cell: Hemagglutinin (H) and Neuraminidase (N).

The 5 and the 1 describe the specific proteins that appear on the Avian Flu. But these protein types are not specific to a strain, for instance the flu vaccine put out every year inoculates for three flu strains but, even though the specific viruses you're vaccinated against change year to year, it remains constant that one of the strains in the vaccine is always H1N1 and one is always H3N2.

Tamiflu is actually a neuraminidase inhibitor
. There are other antivirals that target influenza proteins, including hemagglutinin, and another protein which helps the virus exit the endosome once it is inside the cell. I'm not in pharmacology, and even if I was I might not be able to say, so I'm unsure why the neuraminidase inhibitor is the only one that seems to have any legitimate effect on H5N1.

Thursday, January 12, 2006

Real ID

After 9/11 the federal government set down guidelines for state driver's licenses. Like all "requirements" of states by Washington the federal government prohibited from "dictating" what the states should do. That would violate the entire principle of federalism.

But, Washington holds the purse strings and so states' rights is a farce. Those who don't adopt standardized requirements for issuing a license and link their driver history databases and driver's license application databases to a national collection will be prone to decreasing federal highway funds and,
State licenses that fail to meet Real ID's standards will not be able to be used to board an airplane or enter a federal building.
The law requiring airlines to require ID (and of a certain kind) is bogus. I remember my horror at the images of September 11th so well but is my "pre-emptive" security worth so much? I really, really believe that people underestimate what they're giving up with this sort of law.

I mean, who cares if I have to show an ID to get on a plane, right? It is one thing for this to be a dictated policy of the airline. Let market values drive security and if they don't then it isn't important. I understand it gets dangerous when I start shouting down all pre-emptive protection measures. Should I really be allowed to buy a rocket launcher? When does community safety outweight my freedom? When can I not shout "fire"?

Unlike a lot of people, I just think if you're going to err it shouldn't be on the side of safety. You start making that argument and it can be used to excuse all protective acts. You have to err on the side of liberty, although if I was a 9/11 victim's family I'd probably be thinking differently.

Kind of Stupid

These are physicians and scientists. Yet, they've basically made up a grading system of emergency healthcare. There is no apparent baseline and it certainly is not comparative with other systems.

I mean, there's really a difference between the model in California and Arkansas? Why didn't they compare the United States with other countries before giving the U.S. a grade? All we can take from this study is that you're better off being a victim of trauma in California than Arkansas.

Emergency care in the United States is comparatively fine (and that is all it is worth judging it on). There I've said it.

Wednesday, January 11, 2006

A Fetus is Not a Person...

...for the purposes of using a carpool lane. Check out the pretty funny story.

Woo Suk Hwang's Betrayal

The title makes it sound like he owed me something, and maybe he did in a sense owe something to all of humanity in his falsely promising work.

Here's a timeline of the events that led to the uncovering of the fraudulent stem cell lines by way of In the Pipeline.

At least the cloned dog is real...or maybe not...

Bird Flu Bad?

Even as certainly more than fifteen people have become infected in Turkey there's new research that H5N1 may have a lower mortality than expected.

Two brothers in Ankara, who both tested positive for H5N1, have shown no symptoms. The brothers have doctors questioning whether H5N1 infection may at times take a subclinical form...

This development follows a study by investigators at the Karolinska Institute in Stockholm, published Monday in the Archives of Internal Medicine, which found that H5N1 transmission may be more common than once believed, but with a lower mortality rate. A population-based study suggested that people who come into contact with infected or deceased birds may become mildly sick, but the sickness doesn't always progress to more advanced stages.
Time Magazine asks,

Is it just that physicians are getting better at finding all folks with bird flu infections, including those that don’t normally wind up in the hospital?
I predicted this. I know almost nothing about modeling public health crisises, but you have to believe, that the numbers they use to try to estimate the mortality generally downplay those who contract the virus and don't report it, and thus overstate the mortality figures. I know the estimates they create are very sophisticated, but trying to model the number of people who get the disease but display only mild symptoms and so are never diagnosed, must be very difficult.

How many bacterial diseases are there where there isn't at least a small set of the population who contract it and have only subclinical signs of the infection? You had to assume such a population of H5N1 patients existed as well, and at least question how accurate the estimates of the numbers of such (in trying to determine the mortality of the avian flu) were, when the media started hitting the panic button.

I understand this data showing that some H5N1 victims do not show clinical symptoms, and maybe a good number of them, is in and of itself uncoaborrated and preliminary data. Certainly avian flu, even with a mortality rate projected downward could still be a major health threat.

Tuesday, January 10, 2006

Customs Opening Letters

It's hard to remember those feelings of horror and outrage on September 11th. I never thought I'd say that but I am. Even so, what exactly did we trade in on 9/11 for security?

The news just seems to be getting more bizarre. After the NSA admits snooping on telephone calls to US citizens we get Customs opening up personal letters from overseas.

I don't want to draw too many conclusions from this dinky little news story but it doesn't look like these are packages that bomb sniffing dogs are picking out or suspected terrorist funds or weapons. And certainly I understand that before terrorism became a fear of every American, the Customs Bureau was charged with inspecting packages from overseas. Still, it looks like they're just opening plain personal letters and for what? To make sure it wasn't communication to a terrorist cell?

"Check it and make sure it's not in code, Johnson!"

This is a far cry from 1984, but I truly believe in the slippery slope argument. The line continues to be pushed back until, potentially, twenty years from now we're back at internment camps.

Monday, January 09, 2006

Human Behavior

It seems kind've obvious but really I could not put my finger on it. Why do I dislike my Human Behavior class so very much?

I really have a distaste for Human Behavior and someone please slap me if I ever consider psychiatry. That being said, it feels like it sometimes goes beyond trying to explain why people act the way they do, to predicting those actions. I guess that's a good chunk of psychiatry. Especially if you watch Profiler...

That rubs me so wrong. I really do want to believe in free will. 'Without bounds' free will. The 'I have the ability to drop out of medical school tomorrow and travel to Ghana to do missionary work' free will.

How am I ever going to buy into 'defense mechanisms' as anything more than lousy constructs, probably no more valid than what some bum off the street can make up. Even in PRACTICAL use. Man, I sound like I'm 16 and about to slam the door in my parent's face.

The challenge is to not let ideology blind me to what is presented to me in the classroom. You'd think so far into my education I would've reached that point.

Cuts In Medicare, Cuts In Docs?

A new study says that the percentage of physicians seeing Medicare patients has actually increased over the past four years. This despite cries from physicians that drops in reimbursements by Medicare would cut the number of physicians seeing those patients.

There are less dramatic ways, I figure, that most doctors are using to limit the hit they take from poor Medicare payments: limiting the number of Medicare patients, performing MORE tests per patient, and especially limiting the types of Medicare patients and the types of procedures you'll do for patients covered by Medicare.

Very time consuming, chronically ill Medicare patients are probably not worth cost and labor associated with them. They can be referred to other physicians or to academic and community care opportunities. The same goes for now 'simple' specialist procedures. Say an ophthalmologist performing cataract surgery may want to limit the number he's does per year on Medicare patients and refer the rest...or all of them.

Improvement

The lone survivor of that mine accident is improving according to physicians in Pittsburgh,
"when doctors lighten up on the medically induced coma in which McCloy is being kept to allow his brain to heal, he 'does move spontaneously, he does flicker his eyelashes,' Shannon said. 'All his brainstem functions appear to be intact.'"
This is a far way from seeing him make a significant cognitive recovery, which would be incredible considering his injuries, but it is hopeful.

Apparently they're also sending the miner back to West Virginia to continue his care.

*EDIT*
Here's more on the current condition, he's responding to pain stimuli when the sedation is removed and his liver's function is imporving.

Saturday, January 07, 2006

More on Sharon

More On Sharon's Condition:

'I am pretty optimistic about it. We are praying there won't be complications, like catching an infection,' [Dr.] Cohen was quoted as saying. But he stressed that Sharon would not be unscathed: 'To say that after a severe impact like this one there would not be cognitive problems is just not acknowledging reality.'


Friday, January 06, 2006

Go, Go Gadget Immune System

Researchers at BCM are looking at a kind of supplemental vaccine which increases immune response as a way to perhaps make future HIV vaccines more potent and successful. They claim that by inhibiting the production of a molecule in dendritic cells they increased their ability to activate the rest of the immune system.
Most immunization attempts to stimulate an immune response to HIV in the past have been disappointing, but Chen says his laboratory results hold promise to make current HIV vaccines work better. SOCS1 was found to be part of a pathway that not only controls the production of compounds (cytokines) that stimulate inflammation but also plays a critical role in regulating the potency of anti-HIV immune response. Dendritic cells in which SOSC1 was switched off were able to induce an effective long-term memory immune response to HIV.

Lone Survivor

Updates on the lone survivor of that terrible mining accident in West Virginia. He's in a medically induced coma and undergoing hyperbaric oxygen treatments.

Carbon monoxide has a much higher affinity for hemoglobin than oxygen and so displaces it in the blood, lowering the body's oxygen carrying capacity, and depriving vital organs of oxygen.

An NEJM study found hyperbaric oxygen treatments within 24 hours reduces the chance of cognitive disability after carbon monoxide poisoning. Obviously, this miner is outside that time frame.

Back Into The OR With Sharon

More bleeding in Sharon's brain caused him to be taken back to the OR.

Medical experts said that even if Sharon pulled through, his faculties could be seriously impaired, making a return to work impossible. His deputy Ehud Olmert was named acting prime minister on Wednesday after Sharon fell ill.

Here's some predictors of disability after strokes.

There is hope however that Sharon's drive for peace, for which I've always given him much credit, can survive him.

A poll Friday by the Market Watch Institute showed two-thirds of Israelis favor a continuation of Sharon's policies regarding the Palestinian territories.

Meanwhile, the crackpot Pat Robertson called Sharon's stroke a strike from God,
Sharon was personally a very likable person, and I am sad to see him in this condition, but I think we need to look at the Bible and the Book of Joel. The prophet Joel makes it very clear that God has enmity against those who 'divide my land'...[He] was dividing God's land, and I would say: Woe unto any prime minister of Israel who takes a similar course...
I support Israel and its right to exist but I always thought that they were never to make peace solely by arms; they would have to make some concessions and Sharon was willing to do that. It was a very noble step and if it was to fail because of continued Palestinian violence then I'd wish nothing but for every Palestinian 'freedom fighter' to be wiped out but at least he made a giant effort.

More On Pain

From Kevin, MD once again here's an article on an interesting alternative chronic pain treatment.

Medicare Cuts

This is old news but Congress is battling over whether to pass legislation (password required) that would halt an automatic kick in 4.4% reimbursement cut on Medicare payments to physicians. The passed House and Senate versions differ enough that they have to be 'fixed' in joint committee.
While the reimbursement proposal falls short of the minimum two years of positive updates for which the AMA fought, the bill also abandons a pay-for-performance plan disliked by many doctors.

I'm not quite sure what measures Medicare's pay-for-performance plan might have used to judge doctors but apparently it wasn't to the AMA's liking.

In any case, it is no wonder so many medical school graduates compete to enter residencies that offer the opportunity to do cosmetic, cash only procedures.

Thursday, January 05, 2006

Pain

I already have a very, very good sense I don't want to be part of a practice that has a large role in treating chronic pain and here comes another reason why. Drug seekers and psychosomatic problems are just too difficult to handle or figure out. The patient population I saw working in an ortho surgeon's office was, granted, probably heavily skewed towards those seeking drugs and seeking excuses, through pain complaints, to collect disability.

But it is terrible to see patients come in, and maybe they have some weakness and other symptoms but their chief complaint is pain, and so they have one fusion and then another surgery and then rehab and on and on and they're no better. Or to get calls every week in the office looking for pain med refills before the prescription is up.

"My dog ate them."

"I dropped them all down the sink."

"They were stolen from my car."

For those truly suffering it sometimes seems to me that diagnosing and then treating the underlying cause can be frustrating for both the patient and their physicians. The treatment of pain is a very important role for the physician, one that I think has grown since I've been alive, and so those doctors that do treat a lot of chronic pain deserve a lot of respect. I just can't imagine myself one of them.

H/T to Kevin, MD

Perspective





I came out here and had the privilige to attend the most hyped and anticipated college football game perhaps ever with good friends. Amongst my dissappointment let me not forget it could be far far worse. That's an understatement.

*EDIT*
Pictures added after my return home...apparently that 'Mess With Texas' shirt can only be used once. Man I HAVE to stop posting on college football.

Wednesday, January 04, 2006

Tailgating

We took an H2 limo to the game. An hour and a half to kickoff for the greatest game ever.

Rose Bowl

The greatest second half team in my lifetime goes in at halftime down by 6.

Tuesday, January 03, 2006

To The NFL

From USC's campus: Everyone knows Bush is gone after this season despite his insistece that he hasn't made up his mind yet but I have credible reports Darnell Bing is gone as well after the Rose Bowl.

On The Plane

I'm in the Phoenix airport for a couple hours. On my 'regional' flight (read: dinky almost Lear jet like plane and me fearing for my life) here probably 2/3rds of the plane were Longhorn fans flying to Pasadena.

It was pretty lonely as the only Trojan. The point is the return flight is likely to be the same. God forbid we lose. I'd probably wear my SC gear proudly anyway.

Monday, January 02, 2006

Test

This is a test of posting by email during the Rose Bowl.

Photography







If you disclude my time spent in the funnel cake hut at a local amusement park then my only real jobs have been in doctor's offices including a summer in a large ophthalmology practice.

I really wish I knew what I was doing. But I do like the one right above.

Sunday, January 01, 2006

To The Rose Bowl

I'm going to the Rose Bowl game to cheer on my Trojans. This media hype, especially this bizarre USC v. The World thing set up by ESPN, is frustrating me and the karma gods. Let's hope the gods are asleep at the wheel.

I wanted to set down my prediction, just for my own sake, just so it is there and I can't retract it (with ease at least).

I'm certainly more than a casual fan in this situation. I love USC football but being from Texas I grew up rooting for the Longhorns and as such I've seen every USC game in their entirety and probably 2/3rds of the Longhorn's games. Not that I necessarily always know what I'm looking for.

I'm scared of Texas, and as Heismanpundit points out, there's reason to be:

The 2004 Oklahoma Sooner line was believed (falsely) by the media to be the best line in the country...As it turns out, [they] couldn't knock anyone back 10 inches in the Orange Bowl. The reason? Their style of play. Despite having pretty good talent, the Oklahoma line was made up primarily of what some scouts call 'time buyers'. They spent much of their time backpedaling to protect Jason White and, when they ran, they utilized a zone blocking scheme that wasn't downhill and aggressive, but lateral and passive...The Texas line is different. It is no more physically talented than that OU group, but it has a different mentality. The Longhorn line is more smashmouth, more run-you-over.
Even I could see during the Orange Bowl that the way our front seven played was the key to the game. Forcing pressure and turnovers and just absolutely dominating AP. I know a lot of people figured OU's defense would have good success against our offense and that would be the key to the game, but for me, it was always a fear, despite being #1 in rushing defense, that that OU line would open up holes for Peterson.

It is the same fear this year. I may be buying into the hype and I may be wrong, but I don't think this Texas defense can stop USC, but as Heismanpundit points out their offense might gain a lot of yards on the ground against our defense. No one seems to have much faith in this defense. But there is hope,

The much-maligned Trojan defense is actually perfectly suited to take on Texas. The teams that have come the closest to beating the Trojans in the last 34 games have been successful at nickel-and-diming their way down the field with a short and intermediate range passing attack. USC's defense is actually designed to prevent the big play--it hasn't given up a pass completion of longer than 45 yards in the last 21 games, for instance. The Trojans focus on stopping the run, while giving up the underneath stuff in the passing game, gambling that they'll tackle their opponents well and force turnovers or that teams will make mistakes or lose their patience (once they fall behind). It's the kind of defensive strategy that has been able to keep things together despite numerous injuries and personnel losses. Unfortunately for the Longhorns, they do not have the kind of short and intermediate passing game at their disposal that they need. Texas is a big-play offense--just the kind of offense for which the Trojan defense is designed to stop. What's more, while Young is an improved passer, the Texas passing attack will probably be one of the more rudimentary the Trojans have faced all season--it certainly will be more so than Oklahoma's last year.

I read an op/ed in a Las Vegas paper by a college football oddsmaker up there who pointed out that the Big 12 (outside of Texas Tech) runs the simplest, least complex offenses in the nation, while the Pacific 10 conference teams run the most balanced, complex, and NFL like.

If USC can overcome the karma factor, can ignore and handle all the attention being lavished upon them, then even if that attention fires up Vince Young to have the game of his life, I think USC will win.

Predicted Stats
Vince Young - 15/28, 195 Yds, 1 TD, 2 Int / 9 Rushes, 65 Yds, 1 TD

Jamaal Charles - 17 Rushes, 115 Yds, 2 TD

David Thomas - 4 Catches, 32 Yds, 1 Fumble Lost

Limas Sweed - 3 Catches, 44 Yds, 1 TD

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Matt Leinart - 26/35, 324 Yds, 3 TD, 1 Int

Reggie Bush - 13 Rushes, 71 Yds, 1 TD / 3 Catches, 61 Yds, 1 TD

Lendale White - 17 Rushes, 102 Yds, 1 TD

Dwayne Jarrett - 7 Catches, 142 Yds, 2 TD

Predicted Score
USC 45 -- Texas 28

I guess I don't fear Texas' ability to run too much if I'm picking against them by three scores. Oh well.

My prediction is a little different than my NCAA 06 Simulation. And a little more than what the What If Sports sim predicts.

Vocabulary and Intelligence

I'm going to give myself a little credit. I was a prolific reader as a kid.

It has dropped off considerably to some dissappointment. It got me to thinking the other day how much of what we value as intelligence is related to one's ability to communicate what they're thinking. Not all of it, there are true idiots...but a lot of it.

For instance, a HUGE chunk of medical school is vocab. You're learning the concepts of course, but it is possible for me to understand, say the anatomy of the heart but without the common use names of the features and anatomical descriptors of position, I would have a hard time teaching anyone else it or showing I know it...or instilling faith in a patient once that time rolls around.

As much emphasis as there is in a student's progress towards being able to translate their newly learned medical vocabulary into everyday language for patients there is also some security for me as a patient when a doctor sounds intelligent, even if I don't understand all that he says.

The same is true in everyday life to an extent and nothing improves your communication skills more than reading.

Hope Is a Power

The new year is a wonderful time of renewal. Even being so blessed throughout the previous year, I find something wonderful in looking forward to what is to come next year. I pray everyone feels the same, and that as 2006 begins, even those facing great struggles are not in despair. Because, hope is a great thing.

Appreciate life and health if you're fortunate to have it.