Doc In The Box

Small Bowel Obstruction

2011-09-30T07:25:00.000-05:00

Excess Costs and Medical Services for Non-Breastfed Infants

2011-09-27T06:35:00.001-05:00

Table 22-3 -- Excess Medical Cost Among 1,000 Never Breast-Fed Vs 1,000 Exclusive (>3 Months) Breast-Fed Infants

	EXCESS SERVICES PER YEAR/1,000 NEVER BREAST-FED	TOTAL EXCESS COST
Office visits	1,693	$111,315
Follow-up visits	340	$22,355
Medications^[*]	609	$7,669
Chest radiography	51	$1,836
Days of hospitalization^[†]	212	$187,866
Total excess cost per year		$331,031

Adapted from Ball TM, Wright AL: Health care costs of formula-feeding in the first year of life. Pediatrics 103:870, 1999.

^*	Lower respiratory infection, otitis media.

^†	Lower respiratory infection, gastroenteritis.

Gunshot wound to the shoulder

2011-09-26T05:45:00.001-05:00

18 year old male with a gunshot wound to the Right shoulder.
He was casted and released without any severe sequela.

The Sky is Falling

2011-09-24T01:13:00.001-05:00

Art at 3am

2011-09-23T07:34:00.002-05:00

I was finishing rounds this morning when I came across this patient I had admitted earlier in the night for seizures. He drew this with a simple Bic pen that the hospital gives out for free.

A simple, cheap pen.
He gave me permission to take his picture with his artwork.
It was an honor to have him share it with me.

Drug deaths now outnumber traffic fatalities in U.S., data show

2011-09-18T06:43:00.001-05:00

Fueling the surge are prescription pain and anxiety drugs that are potent, highly addictive and especially dangerous when combined with one another or with other drugs or alcohol.

http://www.latimes.com/news/local/la-me-drugs-epidemic-20110918,0,5517691.story

Pneumonia

2011-09-14T05:26:00.002-05:00

Severe pneumonia in an 88 year old ICU patient.

Note the diffuse haziness in all lung fields. This is easily one of the worst cases of pneumonia I've seen on x-ray.
Unfortunately, the pt died 12 hours later. He had chosen a few years ago not to be placed on a ventillator if he was seriously ill, so we followed his wishes and provided comfort-care with all of his family at the bedside.

Have you ever thought about making an advanced directive to let others know about how you wish to be treated if something catastrophic were to happen?

http://www.caringinfo.org/stateaddownload/

Pilots vs Physicians

2011-09-14T05:25:00.003-05:00

2011-09-10T12:06:00.001-05:00

"I really dont believe in doctors. I dont get flu shots. I believe in Jesus, and that He will keep everything of harm away."
-My new patient who came to see me for management of his blood pressure medicine. She has a blood pressure of 187/98. (healthy goal blood pressure for an adult=130/80). I guess Jesus doesn't protect against hypertension? I didn't bother to ask.

Collapsed lung

2011-09-06T02:07:00.000-05:00

I was called by the ICU nurse and told that this patient's oxygen had dropped suddenly. I ordered a STAT Chest X-Ray and it came back with a collapsed Left lung (actual X-ray below. Notice the arrows that are pointing to the outline of the lung. It's shriveled up and much smaller than it should be.)

Infant walkers

2010-09-09T06:58:00.000-05:00

From the American Academy of Pediatrics:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/790

" In 1999, an estimated 8800 children younger than 15 months were treated in hospital emergency departments in the United States for injuries associated with infant walkers. Thirty-four infant walker-related deaths were reported from 1973 through 1998.

The vast majority of injuries occur from falls down stairs, and head injuries are common. Walkers do not help a child learn to walk; indeed, they can delay normal motor and mental development."

HIV

2010-09-08T10:23:00.002-05:00

HIV infecting a cell. The small blue dots are the HIV viruses attaching to the receptors on the cell (the cell is not really orange, but is colored that way for the picture).

Looking for things to do this summer?

2010-06-03T21:09:00.004-05:00

The state of Alabama is promoting its small towns this year.
This website has clickable towns and their festivities (almost all of which are free) for people to discover.
(Another pretty cool aspect of the website is that it has copies of every historical marker in Alabama).
Try looking up your hometown! - The Great Alabama Homecoming

This could help you live longer... quick, try it out below

2010-05-21T20:48:00.008-05:00

Healthfinder.gov is a great website. Bookmark it so you can always have a trust-worthy source of medical information. I recommend this site to my patients. It's non-profit and isn't bogged down with tacky looking ads or popups.
It also has free interactive tools to check your health, get personalized advice, and keep track of your progress.

Guinea Pig

2010-01-05T17:21:00.009-06:00

Death is a hard thing to cope with. Realizing that someone you love has only a limited time left to live is equally as hard.
People try to deal with it in many different ways, and Julie Staub chose to express her feelings through poetry.
I heard Garrison Keillor read this on the radio today. I've pasted the words below, but I suggest you listen to him read it. Come on-- do it. It won't take long.

Just click play below and scroll to the 3minute 57second mark.

On second thought, that might be a lot of work so I guess I'll let you get away with reading it on your own if you want...

Guinea Pig
by Julie Cadwallader-Staub

As if your cancer weren't enough,
the guinea pig is dying.
The kids brought him to me
wrapped in a bath towel
‘Do something, Mom.
Save his life. '

I'm a good mom.
I took time from work,
drove him to the vet,
paid $77.00 for his antibiotics.

Now, after the kids rush off to school,
you and I sit on the bed.
I hold the guinea pig, since he bites.
You fill the syringe.
We administer the foul smelling medicine,
hoping the little fellow will live.

admitting to each other:
if he doesn't,
it'll be good practice.

"Guinea Pig" by Julie Cadwallader-Staub. Reprinted with permission of the poet.

Crashing Jets and Birthing Babies

2010-01-04T15:58:00.003-06:00

I started OB today, and since the day was mostly spent filling out and receiving paperwork about the rotation, I haven't done much in the way of actual medicine. However, I did come across this really interesting nugget of wisdom from the OB textbook, page 1:

Maternal mortality has been an under-recognized issue worldwide despite an estimated 600,000 maternal deaths per year from pregnancy-related causes. Put in numeric perspective, this is equivalent to six jumbo jet crashes per day with the deaths of all 250 passengers on board, all of them women in the reproductive years of life.

The Forecast

2009-12-19T13:09:00.003-06:00

By Clay Bennett

Choose Your Own Adventure!

2009-12-09T13:59:00.001-06:00

Click Below to see the image full size.
Which path best describes your situation.......?!

Promotional Spending for Prescription Drugs

2009-12-05T19:21:00.002-06:00

Yesterday the Congressional Budget Office released a brief highlighting trends in promotional spending for prescription drugs and market characteristics that influence promotional strategies.

    The way that pharmaceutical manufacturers promote prescription drugs has changed significantly in the past decade. Up until the late 1990s, pharmaceutical manufacturers confined their marketing efforts largely to just doctors and other health care providers.
    In the late 1990s, the Food and Drug Administration changed its advertising guidelines and drugmakers then began marketing directly to consumers—a practice known as direct-to-consumer (DTC) advertising.
     Since then, the manufacturers of many prescription drugs have increased their purchases of air time on television and of advertising space in newspapers and magazines.
     This year, drug companies are no longer allowed to give out pens, notepads, refrigerator magnets (just kidding about the magnets...kinda...), or any other kind of product that promotes their drug.
    Many studies prove that that kind of "subliminal advertising" actually does persuade doctors to prescribe more of that particular drug, but I still say I wouldn't feel "guilted into" prescribing a drug just because I was given a free ink pen with that drug's name on it.
    So basically I've waited all these years to be a doctor and get free pens, and now they've outlawed it!

Today in History: The Iron Lung

2009-10-12T12:34:00.016-05:00

On this day in 1928, an iron lung medical ventilator, designed by Philip Drinker and colleagues at Children's Hospital, Boston, was used for the first time in the treatment of polio victims.

The 2 min. video below talks about a woman who has had to rely on an iron lung for over 50 years, after catching polio as a little girl.

So, Mark, just what is an Iron Lung?
An iron lung is a machine that enables a person to breathe when normal muscle control has been lost or the work of breathing is too much for the person to handle.

OK. Well, what is Polio?
Polio, caused by the RNA virus named Poliovirus, first enters the body through the mouth, infects a person's bloodstream, and then sneaks into the central nervous system by getting into the spinal cord.
[Read more about Poliovirus pathophysiology]
When the virus enters the nervous system, it damages the nerves that control your body's muscles, and thus it causes rapid paralysis.
Overall, 5–10% of patients with paralytic polio die due to the paralysis of muscles used for breathing.

How did the iron lung help polio patients?
Now it all starts coming together! As you now know, polio can cause your breathing muscles to be paralyzed, which would quickly lead to death.
With the iron lung, the patient lies within a sealed chamber and provides an effective oscillating atmospheric pressure. The pressure inside the machine goes up and down, just like the muscles in your chest cause the pressure in your lungs to go up and down, causing you to breathe.

Poliovirus
Electron micrograph of poliovirus virions.

An Iron Lung Ward filled with Polio patients, Rancho Los Amigos Hospital, California (1953)

Much respect.

2009-09-28T10:50:00.007-05:00

An AL deputy has his hand reattached at UAB Hospital after an arrest this past weekend....

http://bit.ly/Ml0vw

I can run into burning buildings, but there's no way I could be a cop.
I've got so much respect for those who serve and protect us.

“American Values” — A Smoke Screen in the Debate on Health Care Reform | Health Care Reform 2009

2009-09-24T04:48:00.001-05:00

“American Values” — A Smoke Screen in the Debate on Health Care Reform | Health Care Reform 2009

Posted using ShareThis

Protect Our Insurance Companies

2009-09-22T10:23:00.001-05:00

Insurance company CEOs have a right to THEIR American Dreams!

Protect Insurance Companies PSA from Will Ferrell

Featuring: Will Ferrell, Linda Cardellini, Jon Hamm, Olivia Wilde, Thomas Lennon, Robert Ben Garant, Masi Oka, Jordana Spiro, Donald Faison

Race

2009-09-21T13:18:00.001-05:00

A frustrating article from the Miami Herald newspaper:

In the pre-dawn hours of last Nov. 5, while much of the nation celebrated Barack Obama's election as the nation's first black president, three white men in Springfield, Mass., doused the partially completed Macedonia Church of God in Christ with gasoline and burned it to the ground.

After their arrest, the men told police they had torched the black church because they were angry about Obama's election and feared minorities would be given more rights.

At about the same time, newspaper Web sites were filled with millions of hateful messages about Obama, and the computer servers of two large white supremacist groups, the Council of Conservative Citizens and Stormfront.org, crashed because they got so much traffic.

This is why we're fat

2009-09-08T15:37:00.005-05:00

This is perhaps man's greatest achievement, or evidence of our civilization's impending doom. Maybe it's both.
Meet the KFC "double down."

That's correct-- It's a bacon sandwich that uses fried chicken as "bread."
(Which, from a guy's point of view, sounds INCREDIBLE!)
As a future physician, however, I would have to say it's probably not a good idea to eat this very often.
Has anyone tried it yet?
Pictures below...

Seven Falsehoods About Health Care

2009-08-14T16:02:00.002-05:00

From Newsweek.com

Power

2009-08-13T22:17:00.009-05:00

    Wow. I knew it before, but this is the first time I've seen it with my own eyes. Insurance companies have so much power.
     A few weeks ago I went to the doctor for my yearly physical/checkup. They routinely drew some blood (standard practice to make sure everything is normal) and had it sent off to the hospital's lab to be processed.
     The cost for the lab technicians and/or the laboratory doctor to examine the blood smear and run other tests on it came out to be $55.
     Fifty five dollars. That's a very reasonable price to have multiple sets of eyes (and computers) look at my cells and perform other tests on my blood to make sure I'm in good health!
Blue Cross Blue Shield apparently disagrees.
     Check out the "Processed Insurance Claim Report" I received in the mail today from Blue Cross. It's simple, but suprising.
Right next to the hospital's requested $55 fee for the blood work (circled in blue below) is how much money Blue Cross told the hospital it would get paid instead: $12.10

Twelve dollars and ten cents!
So this gigantic corporation is able to smugly tell doctors/hospitals/lab technicians (aka "Providers") "Welllll, we think we'll just pay you twelve dollars for doing that work-- take it or leave it."

I'm pretty sure if I tried that at the Wal-Mart checkout the cashier would laugh at me. If I tried it at Zale's Diamonds I'd probably get arrested.
If I was an insurance company, I could get away with it.
     That's quite some power.

Make Something Cool Every Day

2009-08-03T10:59:00.003-05:00

I found these daily entries by Olly Moss, who decided at the beginning of 2009 she would start the Make Something Cool Every Day (MSCED) project where she attempts to, well, make or do something cool .....you guessed it- every day.

2/28/09: the simpsons

3/01/09: burt and ernie making out while cookie monster watches

3/2/09: the blue man group carving a pumpkin

3/3/09: kermit the frog about to walk across hot coals

3/4/09: papa smurf gets angry, turns into the hulk

Birthmarks and Skin markings

2009-07-20T06:31:00.017-05:00

From an article on "Vascular Anomalies" (skin markings) that are usually present at birth:

Most vascular anomalies involve the skin, the largest organ of the body, and, therefore, are notable at birth. For centuries, vascular birthmarks (nevi) were referred to by colorful names derived from false traditional beliefs that a mother’s emotions or types of food she ate could "mark" the skin of her unborn fetus. Old medicals texts are dotted with references to brightly colored foods that best described the appearance of an unusual cutaneous lesion ("lesion"= any abnormal change in the body).Depending on the culture, the mother was blamed for eating too much or too little red fruit during her pregnancy. The modern use of such terms as ‘‘cherry,’’ ‘‘port wine stain,’’ and ‘‘strawberry’’ to describe various skin findings in a newborn can be referenced to that old belief.

From: Christison-Lagay ER -Surgical Clinics of North America - 01-APR-006

Week in Images

2009-07-11T14:11:00.008-05:00

Rounding on patients in the pediatrics ward.

On Call

2009-07-09T17:22:00.002-05:00

Tonight is my first "real" on-call night of my medical school career. I'm on the Pediatrics rotation for the next two months, and I have call every 5 days or so at the hospital.
I thought I'd let you follow me around...
(The next few posts might all be seperate ones until I can sit down another day this week and condense them all into one long "First On Call" post).

3 pm, Tuesday: Call officially begins.

4:34 pm: I'm told to head down to the Emergency Department to check on an 18 month old girl having asthma complications. When I get down there, she's already been given a breathing treatment and is looking much better! I interview the father (...by the way...I'm noticing a trend in Pediatrics that fathers often know FAR LESS about their babies than the mothers do!) who says he doesn't know how bad the girl was before the treatments because he just got to the ED to sit with the kid.
She seems to have improved a lot, but just to be cautious the Attending decides to admit the girl to our Pediatrics floor for overnight observation.

5:10 pm: Two hours into this and I'm already missing Heather, so I con her into meeting me for a quick dinner at Chipotle (cool website by the way).

5:40 pm: Back in the medical student lounge.

7 pm: A patient who has been in the hospital for 2 days because of Diabetic Ketoacidosis (due to lack of insulin production, which makes these kids have really, really high blood sugar) supposedly just ate dinner and now has a blood glucose of 430 mg/dL
That's really, really high.
[Normal should be anywhere from 80 to 120].
I go check on him and make sure he's not having any problems, and I explain to Mom that the high sugar is probably because he just ate dinner.
"I'll come back in a few hours to check on him again," I say, as I leave the room and head back upstairs.

9:08 pm: Headed to the newborn nursery to see if there are any new babies to examine and writeup.
Edit- no new babies.

10:33 pm: The OB/GYN resident informs me that they just delivered a baby. I'm headed down to the nursery to look over the chart and begin writing a Newborn Hospital Admission Note. Guidelines say that you should wait 4 hours to perform an exam on the baby, because their breathing, pulse, etc are still a bit crazy from the birthing process itself. If you wait about 4 hours, you'll be able to decide if the breathing, pulse, etc are normal or not.

12:30 am: Back in the student room. The new baby definitely has a working set of lungs. I wrote as much of the Admission Note as I could without examining the baby, and will go back down after 2am to do the physical exam and use the information gained from it to finish the Admission Note.
I guess it's time for a quick nap until then....

8am, Wednesday: Went to bed at 3am. Another baby was born at 3:05am. What luck. Now it's time to present my patients from last night to the Pediatric team at "Morning Rounds"

2009-07-08T08:14:00.001-05:00

Went to bed at 3am. Another baby was born at 3:05am. What luck. Now it's time to present my patients from last night to the Pediatric team at "Morning Rounds"

2009-07-08T01:15:00.002-05:00

12:30 am Back in the student room. The new baby definitely has a working set of lungs. I wrote as much of the Admission Note as I could without examining the baby, and will go back down after 2am to do the physical exam and use the information gained from it to finish the Admission Note.
I guess it's time for a quick nap until then....

2009-07-07T21:09:00.004-05:00

9:08 pm Headed to the newborn nursery to see if there are any new babies to examine and writeup.
Edit- no new babies.

10:33 pm The OB/GYN resident informs me that they just delivered a baby. I'm headed down to the nursery to look over the chart and begin writing a Newborn Hospital Admission Note. Guidelines say that you should wait 4 hours to perform an exam on the baby, because their breathing, pulse, etc are still a bit crazy from the birthing process itself. If you wait about 4 hours, you'll be able to decide if the breathing, pulse, etc are normal or not.

On-Call

2009-07-07T20:23:00.006-05:00

New Design

2009-04-28T04:12:00.014-05:00

So with my last day of absolute freedom before I start a 2 month grueling rotation in Surgery, I decided to re-design things around here in preparation for posting all of the interesting cases and people I'll come across in the next few years.

On the right is a YouTube feed of whatever topic I set up. Right now it's showing the most relevant videos about "swine flu."
(Question: Video Bar- Keep it or Toss it?)

I've also added a calendar so you can follow along with what rotation (also called a "clerkship") I'm currently on.

What do you think about the new design? What would you change?

What would make you want to read a blog like this regularly? What would make this blog better? (Be honest. I really am looking for constructive criticism here.)

Here's Something You May Not Have Known...

2009-04-08T10:34:00.006-05:00

A baby born in the United States is more likely to die before its first birthday than a child born in almost any other developed country. Among developed nations, only Latvia has a higher death rate for newborns than the United States.

Find out more @ the National Public Health Week official website.

Learn about Public Health

www.thisispublichealth.org

National Public Health Week 2009

The best license plate on the road

2009-03-31T08:40:00.005-05:00

Standing in line yesterday to renew my car registration (or "renew the tags" as I've always heard growing up) I spotted this gem of a license plate casually displayed with 30-or-so other specialty plates available for purchase.

I then decided that this is HANDS DOWN, *THE* MOST AMAZING LICENSE PLATE IN THE ENTIRE UNITED STATES.

After further research, The Wall Street Journal wrote a story in 2001 [note to self- why did it take you 8 years to find out about such a cool tag?!] about license plates across the US and briefly mentioned the "nuked veteran" tag:

"Alabama offers what has to be the single most bizarre plate on the road today, a tag that reads "Atomic Nuked Veteran." Those who would like to advertise this particular fact of their personal history must get a letter of verification from the Defense Nuclear Agency proving that they "were exposed to dangerous levels of radiation due to atomic bomb and weapons tested from 1946 to 1962."

Of note: Even though I think you should never, ever be given a traffic ticket if you are one of the few surviving people in this world with this plate, apparently you still have to follow all the rules. On top of that, you also have to pay a "...commemorative tag annual fee of $3.00 plus the normal tag and issuance fee and ad valorem taxes."

Couldn't someone have gotten that waived for these guys?!!?......

Unfortunately, The Answer Is "Yes..."

2009-03-26T13:15:00.003-05:00

Let's Learn about Hemochromatosis!

2009-03-25T15:18:00.010-05:00

I came across this fact while studying a few minutes ago and thought it was pretty cool. I knew about the disease already, but never knew about the airports!

"Hemochromatosis is a disease caused by the buildup of hemosiderin (iron) in the body.
In these patients, the Total Body Iron content may reach 50 grams.....enough to set off metal detectors at airports."

Here is a really good link to the CDC's page about Hemochromatosis. It's not too technical, and it has some good information about getting tested for the disease (it runs in families) and how it's treated (treatment is phlebotomy-- the same procedure as when you donate blood).

Figure to the Right: Some crazy sketch I found on Google Images that made me laugh a little..

Figure Below: The main events in the causation of Hemochromatosis

Studying Begins...

2009-03-15T09:48:00.007-05:00

Today marks the beginning of my official studying for USMLE Step 1.
I thought I would kick things off for everyone with just one simple concept to memorize for the test. This will get you one....maybe two...answers on the entire 8-hour-long exam.
Click on the image to view it in all its glory so you can see every wonderful enzyme.
Study hard--there will be a pop quiz tomorrow!

Clowns Eating Lunch

2009-03-03T13:13:00.003-06:00

I ate lunch at Children's Hospital today and had to snap a quick camera pic of two bright-pink clowns that sat nearby.

Eye movements in Autism

2008-12-14T15:47:00.005-06:00

Autism is a neurodevelopmental disorder that becomes appearant early in life. These children (and adults) struggle daily with this disorder's effects on social functioning, including language and communication, learning, and unusual behavioral patterns.
An interesting study focused on understanding some of the ways that autism affects a person's view of the world, and how that in turn can make social situations so dreadfully complicated for them.

Interpretation of social situations often requires your eyes to "scan" or search another person's face for clues to what that other person is thinking, saying, or feeling.

The figure below, taken from this study, shows the importance of understanding the manner in which the speakers are conversing, rather than just what the speakers are saying.
This is crucial to understanding social scenerios, and is the reason why people with autism have such a hard time in public.
Figure: Visual Focus of an Autistic Man (Red tracing) and a Normal Comparison Subject (Yellow tracing) when shown a film clip portraying a flirtatious exchange

From the Article: "The figure shows the visual
scanning paths of the two participants during this 7-
second shot. The data are shown collapsed onto one still
image. From the scanning pattern in this figure, the viewer
with autism (red path) seemed not to understand the inviting,
flirtatious nature of the interaction—or the impact
of these behaviors on Martha’s husband in the back, since
he did not once glance at the action in the background. In
contrast, the normal comparison viewer’s visual scanning
does track the important social clues."

Defining and Quantifying the Social Phenotype in Autism
Am J Psychiatry 159:6, June 2002

The Historical Perspective of the Spleen

2008-11-20T09:10:00.002-06:00

The spleen was felt by the ancient Greeks and Romans to play a significant role in human physiology. Aristotle thought that the spleen was on the left side of the body as a counterweight to the right-sided liver.^¹ He believed that the spleen was important in drawing off "residual humors" from the stomach. The spleen was also felt to "hinder a man's running," and Pliny reportedly claimed that "professed runners in the race that bee troubled with the splene, have a devise to burne and waste it with a hot yron [AKA they burned it away by jabbing themselves in their left flank with a hot iron] ."^²
The exceptional speed of giraffes was felt to be related to the erroneous belief that giraffes were asplenic [without a spleen]. Early references to removal of the spleen to increase speed make it apparent that it has
long been known that the spleen is not absolutely necessary to sustain life.

[PS- A study in 1992 in rats confirmed that after their spleens were removed they could indeed run faster]

The Amazing Phone Ride

2008-11-10T09:52:00.004-06:00

So I got to school this morning and realized that my new (AKA expensive) cell phone was no longer on my hip.
I had a feeling that it fell off this morning as I wiped Heather's windshield with a towel to remove the frost/dew so that she could see well on her drive to work (which is about an hour trip each way).
I left school and drove back home as fast as I could to try and find my phone before someone else would find it and become the proud new owner.

No luck. I searched everywhere in the parking lot. Multiple times.

I just knew it was gone for good. I caught Heather on Google Chat to tell her that I lost my phone.
After talking to me, she went out to the Faculty parking lot, looked at her car, and found my phone on her windshield wiper!

It survived an hour-long drive on the interstate without falling off.
Amazing.

Sharing the Wealth....

2008-10-20T09:56:00.002-05:00

Of Knowledge.

I've decided to return to the basics with this blog: to document my experiences in life AND in medicine. The majority of pre-clinical medical education revolves around memorizing and understanding hundreds of thousands of minutia about biochemistry, physiology, and histology/pathology of disease. As you can understand, I decided long ago that you, my few but dedicated readers, wouldn't want to be bored to death reading a blog about that stuff. You want something interesting, something that can be read relatively quickly, and something memorable. You don't want to feel like you're studying for a test the next day.

HERE'S the good news! Every now and then there are some really interesting medical topics and mechanisms of disease, and I decided this weekend that I should be sharing this cool stuff with you!

Let me know what you think, and also let me know if there are any medical diseases or random questions you would like me to investigate or answer (for example: Heather asked me the other night if I could explain why a baby's eyes are blue during the first few weeks of life. We both knew that it happens in babies, but we didn't know the biological reasons behind it. So, I looked in 3 of my textbooks to finally come across the answer. It will be one of my next few posts.....)

Best-Selling Nerd Shirts

2008-09-30T22:38:00.002-05:00

These 5 shirts crack me up (well, not so much the Pluto one, but the other 4 do!)....They are the top 5 sellers on a website I stumbled across today. If you want to check out some of the other "Nerd shirts," click on any of the shirts below.

America Is Better Than That

2008-09-11T14:10:00.002-05:00

"That guy making $40,000 a year will get a tax cut under my plan. I will provide a tax cut to 95% of Americans. That guy who makes a million dollars a year, his taxes ARE going to go up,..because he makes more than $250,000 a year.....
The notion that those of us who have been extraordinarily lucky can't pay a little bit more so the waitress down the street, or the guy making $40,000 or even the guy making $70,000 can get a little bit extra so that he can put away a little savings and watch his child walk off that stage with a college diploma in her hand-- I think America is better than that. I think we want to make sure everyone's got a fair shot in this society."
-Barack Obama, Sept 9, 2008

New Ride

2008-08-17T12:08:00.006-05:00

So after checking GovDeals daily for almost a year, I finally had enough money and enough buyer-beware experience to pick out a nice, used Police Impala.

Why would I buy a used police car?
The price. You can get these for about half of what the civilian versions cost.
The features. Automakers like Ford (who make the Crown Victoria police cruisers) and Chevrolet (makers of the Impala) add a lot of heavy duty features to these service fleets. From "Surveillance Mode" which kills all of the vehicle's lights for doing radar, to Heavy Duty suspension, engine, and cooling system, these cars are ready for whatever you can throw at them.

So, now we have a larger car for some road trips, and I have a new toy for responding to Fire and Medical calls with the Toney Fire Department. Check it out.

Growing up, Managing money

2008-05-06T08:28:00.001-05:00

Growing up has its perks....but the mundane tasks that go with growing up can be time-consuming at best. Take, for example, managing your money. I've been using Mint.com for the past 6 months, and can now say it's the best solution I've found for keeping tabs on...well...my tabs.

It lets you see all of your accounts in one place, which is nice because logging into 4 different financial websites to check balances is a lot of work and often results in me just not going to any of the websites at all....

It gives spending habits, budgeting ideas, and all sorts of cool graphs and charts.

My favorite part is that it does everything for you automatically.

It imports every purchase and categorizes it intuitively. You can also "train" it to remember certain stores, etc.

The difference between this and programs like Microsoft Money is that it does everything for you, ultimately making your life just a little bit easier.

Try it out for yourself......

Primary Care Crisis

2008-04-06T12:19:00.000-05:00

As you may or may not know, America's healthcare system consistently ranks lower than 40th in the World Health Organization's rankings of health statistics. Many Americans believe that we, the most powerful country in the world, also have the best doctors, best treatments, and best health-outcomes. Sadly, that statement is far from the truth.

One of the reasons behind our poor ranking is the lack of primary care that Americans receive . Fewer medical students are going into a career as a family physician either in big cities or in small, rural American towns. Because of this, illnesses go un-treated and diseases such as high blood pressure and diabetes go un-diagnosed. Early detection and treatment of high blood pressure can add 5 more years to a person's lifespan.

To me, it's no wonder that fewer of us medical students go into primary care after graduation. We're getting not-so-stable cues from those already on the front line.

A survey conducted by Physicians Practice magazine last year asked primary care physicians nationwide how they felt about their initial decision to practice family medicine:

"Only 39.5 percent said they would follow the same career track; 38.7 percent said they would have chosen to become surgical or diagnostic specialists; and 21.8 percent replied that they wouldn't have gone into medicine at all. "

The New "MacBook Air" Makes Fatty Laptops Disgusted With Themselves, Anorexic

2008-01-16T10:17:00.001-06:00

Aw, PC, don't get that look on your face. You're not fat, you're just well-built. Just because the MacBook Air is incredibly thin and sexy doesn't mean I love you any less. I mean, you've got so much more personality! You've got things like a built-in ethernet, optical drive, removeable battery AND user-upgradeable RAM and hard drive. That slinky little b*#*% doesn't have any of that.

The Martha in Me

2007-12-09T22:00:00.001-06:00

For all you ladies out there who are crafty and stuff..... here are some cool tips on making the gift-wrapping eco friendly and eye catching.

Gift Ribbon Storage
Homemade Ribbon Organizer
Take any shoebox and, using a regular hole puncher or a box cutter, make an opening for each ribbon to slide through. Behind the spools, there's room for scissors, tape, and gift tags....

Link: Ribbon Organizer

How to Wrap Anything
Tips to perfectly tie up any present, including:
The Right Gift-Wrapping Materials
Easy Gift Bag Ideas
Creative Wrapping Ideas
Creative Wrapping for Books
Tips for Tricky Wrapping Jobs

A Christmas Gift for the musically inclined

2007-12-07T09:29:00.000-06:00

My first gift to all is that of a great artist, Sufjan Stevens, and a nice 4 volume collection of holliday music. His record album Asthmatic Kitty is streaming it for free, and he's pretty talented. Kind of a folk/electronica genre if you're into that, and if not....well he's got a nice voice for opening your Christmas Presents to.

PS- if you like how he sounds, try and find a copy of "Chicago" by him. It's what got me interested.

Amazing, But Sad

2007-11-19T10:06:00.001-06:00

The amazing Lyre Bird with is superb sounds imitations. There has been no video editing--it is very real, and truly amazing. Sadly, this bird is singing of its own looming death: it lives in a forest that is being cut down, and has thus learned how to imitate/mimic the sounds of a camera, a car alarm, and even chainsaws.

Alabama Prescription Laws

2007-11-17T20:48:00.001-06:00

Good to know:

According to a lecture we recently had,

"In Alabama, you do not have to have a printed prescription pad. You can write a legal prescription on a paper sack as long as you draw 2 signature lines on it (which makes it perfectly legal)."

The Breakfast Photo Project: You Are What You Eat

2007-11-17T20:20:00.001-06:00

How bizarre. Jon Huck's Breakfast series focuses on one of the most important meals of the day, and his compositions match people to what they are for breakfast.

This guy with the bean burritto cracked me up. Give the gallery a quick 1 minute glance.....

Jon Huck’s Breakfast Portraits

Yabba Dabba Doo!

2007-11-03T14:51:00.001-05:00

Screw Big Wheels. If I were a toddler, I'd wanna be yabba dabba dooin' my way around the 'hood in these awesome Flinstones wheels.
I want to make stuff like this!

Pumpkins 2007

2007-10-31T10:35:00.000-05:00

Free 411: Help "On The Go"

2007-10-24T21:24:00.001-05:00

Google and Microsoft both launched their free directory assistance services this week. Google's GOOG-411 (1-800/466-4411; or 1-800-GOOG-411) came out of beta on Sunday. The next day Microsoft announced its own free directory assistance service, Live Search 411 (800/225-5411; that's 1-800-CALL-411). Each offers an attractive alternative to paying the nearly $2 that most mobile carries charge for the service.

Both services use voice recognition and menu prompts to guide you to the state, city, business, and the phone number you're looking for. (GOOG-411 also repeats what you say, which is why it took longer than Live Search 411.) They also both give you the option to have a text message of the street address and phone number sent to your cell phone; if you're using a smart phone equipped with a compatible Web browser, you can click a link to a map that helps you pinpoint the business's location.

What My Dogs Have Taught Me

2007-10-18T19:45:00.000-05:00

I love my dogs.

I love the way they live their lives, and I try to emulate them. I admire their happiness in the simplest of things. Like the way they approach each meal with endless appreciation and joy. While I struggle to decide what to eat from full cupboards and complain about what we don't have, they sit at the kitchen entrance, excitedly anticipating the very same meal (a pile of dry food combined with one can of gooey dogfood) over and over again. That's not even to mention how excited they get when offered just a small sample of my "Human Food."

I love how they live in the present. As my day fills with stress, looming tests, and upcoming deadlines, I try to be relaxed (or "chill") like Ceazer.

I love how they treat everyone the same, despite race, creed or appearance. They never pre-judge (well, Jinx does if she sees someone at night, but that's a lesson everyone should learn). Before Jinx and Ceazer, I didn't attempt to know anyone in the apartment complex or talk to people passing by. Now that we have our dogs, I say Hello to more people and enjoy meeting them, even if they are just stopping to see the dogs. Often, us humans are invisible behind their great personalities.

I love their loyalty and enthusiasm. Every time I come home I'm showered with Ceazer hugs and Jinx kisses. Those moments make it feel so good to be home and to be loved.

Because of the puppies, whenever Heather comes home I jump up and run over to greet her too, just like I learned from my dogs.

Blog Action Day - Replace your thermostat

2007-10-15T19:32:00.000-05:00

As a proud participant in today's mass blogging event, Blog Action Day, here's a special post about Blog Action Day's topic: the environment.

Last March I went to Wal-Mart and bought a $20 electronic thermostat. The old one in our apartment was typical of most houses and worked just fine- but I just knew there had to be a better version of a thermostat by now. Turns out there is! After a quick 20 minute install (I still have the old thermostat stored in a closet to install before we move out to avoid a damage charge), the new thermostat was up and running. Being electronic (runs off of two AA batteries- use Rechargable batteries and you'll help the environment even more!), it's very accurate when recording the room's temperature. An impressive feature is that it allows you to set different temperatures for whatever times during the day that you want.

Going to work? You don't need it to be a perfect 72 degress inside while you're gone all day!
Like to sleep with it chilly so you can cuddle up next to someone special? Set the thermostat to cool down to 71 degrees from 9pm-7:17am.

What's the benefit here besides protecting the environment?
Well if my calculations from power bills are correct, in the 7 months that we've had the new thermostat, we have saved about $60 a month.
That's a savings of $420 from just a twenty dollar investment.

Go out tomorrow, buy an electronic thermostat, install it, and enjoy the fact that you're helping both the environment AND your wallet!

"Ceazer's In Trouble?"

2007-09-12T08:36:00.000-05:00

So there are two little kids in the apartment neighborhood who are really nice (there are also two little kids above us who are quite the opposite of that, but I'll talk about them in another post I'm sure).
The two kids are brother and sister, and their family is from Mexico. The older sister is pretty good at speaking English, but her 5 year old brother still struggles sometimes.

Yesterday I was out walking the dogs and Ceazer decided he would run away into the hills to cause trouble. After 10 minutes of yelling for him to come down (an all-too-common sound for the neighbors to hear these days, I'm afraid) I caught his collar and quickly hooked his leash on. He knew he was in trouble and we started walking back as he held his head low and his tail tucked between his legs.

As we were crossing the parking lot, the two kids came running over to play with the puppies (one of their favorite things to do each day!).
"Sorry guys," I said. "Ceazer's in trouble. We're going home," I said as I pulled my reluctant furry friend home.

The little boy looked up at me, wide-eyed and with complete seriousness, as he asked in worried disbelief:

"Are you going to KILL him???"

His older sister laughed, popped him in the head for even thinking such a thing, and I reassured him that Ceazer was only losing his play time. Not his life.

I laughed the rest of the walk home.

Ceazer, Almost MD

2007-08-16T07:55:00.001-05:00

We decided to have an impromptu White Coat Ceremony for Ceazer the other day.
He's growing up so fast!

Happy 24th Birthday, Heather!

2007-08-14T20:04:00.000-05:00

I love birthdays. What a great thing to celebrate- someone's entrance into the world. I like all the bright colors that come to mind when I think "birthday," and all of the traditions that I'm so glad my family passed down. I'm having fun introducing Heather to some of those traditions, as well as putting our own twist or style on something in order to make it more "our own."
I've never been big into buying lots of stuff, but this year Heather needed some things that she's been so patiently doing without.

She's had a bright blue office chair since her Freshman year at Auburn. What little padding that thing might have once had is long gone, and you might as well be sitting on a swiveling wooden board with wheels.

So now she has a fancy-pants leather chair that will cushion her butt for hours while she writes paper after never-ending paper.

Also, back in May her digital camera decided to drink some water while we were at the beach, thus leaving her cameraless to take pictures of the puppies and the fat husband! I got her opinion on lots of different cameras, letting her think I was just curious about a possible camera for Christmas. I really threw her off when I went to Toys R Us and told her that her presents were all in the really big bag (I didn't lie, because the small BestBuy bag was inside the gigantic Toys R Us bag).

So, now she can point and shoot to her heart's content!

We're winding down now, but the party decorations are still up & the balloons are shouting "Happy Birthday" with all of their Mylar magnificance.

24's a nice number. See you there in six months!

Drug Particles Found in Air

2007-08-11T09:32:00.001-05:00

From August 1,2007 "American Family Physician" journal:

Is it love that's in the air? No, it's cocaine, marijuana, caffeine, and nicotine. Researchers sampled the air in areas of Rome and Taranto, Italy, and Algeria, and found particles of caffeine and nicotine suspended in the air of each city, as well as cocaine and marijuana in Rome. The highest concentration of cocaine (i.e., 0.1ng per m3) was found in Rome during the winter. The reseachers note that these results indicate how widespread the consumption of these substances is and how they remain in the atmosphere. Although the amount of drugs found in the air was minimal, even small concentrations of pollutants in the air can cause serious health problems.

Japanese Fun

2007-08-10T06:52:00.001-05:00

Japanese One-Click Award!

You're in for a treat.....

Blazers in for quite a season

2007-08-07T18:47:00.000-05:00

"The Blazers start out with an extremely difficult back-to-back at Michigan State and Florida State, and then play three straight conference games against Houston, Southern Miss., and East Carolina. It could result in an 0-5 start, which would doom the Blazers.

UAB, from their coach to their players, simply do not appear to have enough experience to compete in the C-USA this season."

Photo Roundup

2007-04-28T19:48:00.000-05:00

This week in pictures....

March of Dimes

2007-04-28T19:39:00.000-05:00

This time I came along with Heather on her Charitable Walk to support March of Dimes (named because America was told to "mail your dimes to the White House" to support finding a cure for Polio back in 1938) which now supports prenatal care.

It was a daunting 5 miles, but was actually a nice walk through 5 Points South and through some scenic parks and 100-year old houses.

Maybe next year we'll bring the puppies.

Smokin’ Study Break

2007-02-16T20:44:00.001-06:00

Another week of tests done with, and another reason to keep studying.

Tonight, though, I'm taking a break to watch some TV and a movie [Smokin' Aces] with Heather.

What are you doing this weekend?

R.I.P. Clippy

2007-02-10T15:44:00.001-06:00

I was sitting here studying Renal Physiology, just wishing someone could give me all the answers, when I realized that our friend Clippy might help! I rushed to the new Microsoft Word in hopes that Clippy would pop up and ask me how he could be of service. "It appears you would like the answers to Monday's Test…is this correct?"

Now, granted I usually hate that animated piece of metal and can only think of maybe 2 times I've ever used him ever on a computer. (those two times he poped up unwanted…) But now that I need him, Clippy isn't there.

Microsoft axed our bouncy nusance of a friend, along with the others in the gang of Animated Helpers. (Maybe you were fond of the dog? Perhaps Einstein?)

Microsoft said that they have been slowly killing the characters (a few years ago they began releasing Office with the Assistants turned off; you had to actively turn on the characters yourself) and now they have delivered the final blow.

So, goodbye Clippy. Here's to memories of you popping up when I never needed you, and to you leaving me hanging without the answers to Monday's test.

New Office, Same Blog

2007-02-08T09:36:00.001-06:00

So this new version of Microsoft Office is pretty swanky. It's got a lot of nice features, and for the first time it seems that Microsoft is actually caring about making their products look good as well. Macs always look really nice and sleek, but they are outrageously expensive. The new Word has a feature for publishing directly to your blog, and since I'm always trying to update more frequently, maybe this will give me the boost I need.

School: We're covering the physiology of the Kidney this week, and had the physiology of the Respiratory system last week. Could they have crammed two more dense/difficult topics into one test? Probably so. And it will probably happen next semester during the dreaded 2^nd year that is famous infamous for being the toughest course load during all of medical school. I'm staying home today from school to hang out with Jinx and get caught up on how the complicated Kidney does its magical job of filtering everything in the body.

Life: Heather keeps me going, as always. She is really busy with school and is always going somewhere and doing something to help out. She has a magical maternal instinct with Jinx it seems, in that she can almost always tell what it is that Jinx is thinking or needing. I try to interpret, but it usually just ends up with poop on the floor (Jinx's….not mine). Mom is still having a hard time finding a job, but we all have confidence in her. She's a great people-person and will undoubtedly land a job after a few interviews. It's kind of scary thinking about how competitive the job market is—many people I know are having a hard time finding a decent job.

Catching up

2007-01-19T08:18:00.000-06:00

Pseudostratified columnar cells look a lot like carrots.
New classes this block:
Medical Physiology
Medical Cell and Tissue Biology (a combination of Cell Bio and Histology)

Physiology is great, because the material actually seems relevant and medical. Trying to distinguish fibroblasts in the microscope for Histology, however, does seem annoying right now.

Heather was recently elected Vice President of another organization in the school of Public Health. Between school and our new puppy Jinx, things are busy (but fun). Hopefully after my next test block we can take another trip to Oak Mountain State Park so Jinx and parents can run around outside without interstates and traffic to worry about.

Splashing

2006-11-15T22:37:00.000-06:00

So it occured to me today that school has become like a nightmare swimming lesson. Picture yourself in the 12 ft. deep section of an olympic-size swimming pool. Now add the fact that the only preparation for this swim was that you recently aquired Floaties (but still haven't quite figured out the exact way to inflate and use them). At this point, you're either a sad 3 year old who has the remarkable ability to read blogs but is about to drown, or you are in medical school.

Being the later, I'll go on. So, you're in the middle lane and you are trying to make it down to the 3ft. section of the pool. Seems easy, right? Until your swim instructors start running along the side of the pool (where are the uptight, "No Running!"-lifeguards when you need them?) and throwing buckets of water at you. Yes, that's right, splashes out on you stealing what little breath of air you had; and, oh why not, the bucket itself hits you in the head too.

One after another, after another! They never stop! The next thing you know, the swim instructor is flying overhead in a National Forest Service Fire Helicopter and releases 500,000 gallons of water, knocking you 11ft back underwater again.

OK, so maybe it's not that bad. I know I'm complaining about something that I *willingly* pursued. But there really is no such thing as even being "caught up" these days. Every test hinges on the fact that if you just happen to miss one question too many..*just one question* more than the person next to you, there is a good chance that you're goin' home. The stakes are high, and the financial debt you're already in is higher.

I'm thinking medical school must be something like NAVY SEALs "for the rest of us."

Clap Hands

2006-11-06T15:27:00.000-06:00

Simply amazing. They're doing all of this with forks, spoons, and a turkey.
Beck was on SNL last weekend and rocked. This song, "Clap Hands", was my favorite.
They've got a new CD out this fall called "The Information."

Anyone wanna try this with me during Thanksgiving dinner? We've still got some time to practice...

Demand Answers. Vote for Change.

2006-10-15T16:48:00.000-05:00

Race For The Cure

2006-10-14T11:05:00.000-05:00

Heather is a much better person than I am. And I guess she looks better in pink than I do.

Out of bed at 6am, she put on her white Race for the Cure long-sleeved shirt, speckled with lots of company sponsor logos as almost all race shirts are. The night before, she had already picked out her pink "athletic-running-jogging-type" pants to complete the look (and, I think, to make sure her sister would be proud of her wearing clothes that match during exercise), and she headed to downtown Birmingham's Linn Park.

I rolled back over and went to sleep.

She was at the downtown park by 7:30 and ready to run. Her school of public health raised thousands of dollars through this race and through bake sales for the national Susan Komen Foundation's Breast Cancer Awareness Campaign.

Our entire medical school raised around $35 total.

I made it to downtown and found the park. The were pink balloons everywhere, and the energy was high. After wandering aimlessly through the festivities for a good 10 minutes, I found the finish line. The Official Race Clock said that 42 minutes had elapsed. Little did I know that I had just missed Heather's triumphant crossing in an impressive time of only 40 minutes (compared to another guy I know who runs every day, and it took him 37 minutes to complete the Race for the Cure today).

I don't think I would have ever taken an interest in the cause or the race if Heather hadn't taken the initiative to do it this year.
But I encourage you to find a Race for the Cure in your area. There is something really great about seeing the ladies with special Pink Survivor Shirts cross the finish line. I imagine it feels even better to know that you ran with them and donated your entry fee to fund research that will help others.

Good job, Heather. I think you've earned a nap.

Leaving Grandpappy Netter

2006-08-22T06:49:00.000-05:00

Leaving people is often hard. It suprised me that leaving a dead person is, in a way, hard too. After each round of tests in anatomy (one lecture exam and one lab exam based on the cadavers and identifying muscles, nerves, arteries, etc), one's lab group must rotate from its current cadaver to another cadaver. A stranger. Someone with a different body, a different feel, and a different story.

Our first cadaver was a 92 year old man who was quite healthy. He died in 2005 because of a random hemorrhage, or bleeding, into his brain and spinal cord.
His muscles rivaled those of a 20 year old. He had taken great
care of himself in life and could easily have lived another 8 years
if not for the fluke incident of cerebral hemorrhaging.

Our Grandpappy Netter (named after the late artist and physician Frank Netter who authored our anatomy atlas) was good to us too: when
a structure on his body was pinned with a miniature flag like those on your steak signifying medium rare or well done, the structure was easily identified as the ligamentum flavum. Believe it or not, that was probably the easiest question on the lab test.

So, now we have moved to the table on our left in the downstairs dungeon that is the anatomy lab. We might as well have moved across the state, as this new woman is completely different. She was in her late 80s, and she died of myeloma.
Her body is neither strong nor powerful. Hers is a weak body that tells of the long struggle she must have had with this bone-stealing cancer.

We dissected her chest wall, snipping the ribs along the way, and reflecting the chest
back almost like removing a shining knight's armored chest plate.
Inside rested her two lungs, finally at peace from 87 years of everyday breathing.

The dissection also called for us to remove those lungs. At this point, the professor who rotates around the lab visiting tables happened to stop at our body. He leaned in, took out his personal scalpel, and carefully made an incision where her lung was attached to the trachea.
"Watch very closely," he said. As he cut, bubbles began to rise out from the inside bronchiole tubes of her lung.
"Those air bubbles are from the last breath she ever took"

Our anatomy group stood there in silent awe for a moment, trying to take it all in; the fugaciousness of life.

Birthday!

2006-08-14T06:18:00.000-05:00

Happy Birthday Heather!
You are much loved today and every day.
I can't wait to see you after school!

Back in the saddle

2006-08-12T18:48:00.000-05:00

During orientation for med school last week, they told us that we would benefit tremendously by writing down our thoughts and stories from school. I really don't think people want to read stories about me cutting on dead people during Anatomy or listening to crazy stories about gunshot wounds from patients in the hospital....

Wait a minute. Tons of people will be interested in that stuff!
So, with Heather's motivation I'll begin writing more often. Hang around and read my blog, and I'll try to get UASOM to mail you a diploma in 4 years too.
Off to study the Extensor muscles of the arm.

Go here.

2006-03-29T17:01:00.000-06:00

My non-blog now contains photos.

doctamark.textamerica.com

Check it.