Mania

During my residency a few years back, I had a patient I will never forget. She had about 400 complaints, but when pressed she said mostly she was there to get her blood pressure checked.

She was the most manic a person can be and still function, though she denied any history of mania. “I’m always like this” was her response to questioning about her pressured speech. She was very knowledgable about health care, and may have been a nurse, but I cannot recall.

I left her for a moment, promising to return, after about 15 minutes of non-stop, stream of consciousness speech. When I came back, reassurring her she was going to be OK (her BP was fine), she was effusive in her praise, and gave me one of the several pictures she’d been drawing during her visit.

A picture is now worth a thousand thoughts, as well. It’s probably not work safe, in that you won’t get fired, but you will be remembered.

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Rock, Paper, Saddam

Funny stuff, if you need a laugh.

Woohoo!

I finally talked to someone who wants my business, installing wireless internet from my home to their connection to the innernut.

Why am I jazzed about this? Because I currently have a Satellite connection to the internet, and it works, but it’s weird and very slow for surfing and uploads. On big downloads it’s as fast as DSL, but big downloads are fairly rare (and will get you penalized on the satellite, so I avoid them).

For a couple of prior posts about my satellite:
speed
pings

Anyway, I stopped trying to interest the retail level people in my business (apparently they work on a business model in which they don’t need customers), and went to a company thet does wireless for apartment buildings and bigger commercial setups. Yes, it’s going to be more expensive, but they sound like a very professional group. Yea!

I’ll keep you posted. They come next week for a site survey.

Fourth person dies from organ transplant with rabies

from the Houston Chronicle

DALLAS — A fourth person has died from rabies after receiving a transplant from an Arkansas man who didn’t know he had the disease, officials said today.

The first three fatalities, which the government said were the first from rabies after an organ transplant, died following the procedures at Baylor University Medical Center in May.

The fourth victim died from an infected artery, but the hospital didn’t know it came from the infected donor until Thursday because Baylor only tracks organs and tissues, not arteries.

Umm, arteries are tissue. Really.

The donor’s lungs, liver and kidneys were donated to four patients in Dallas and Alabama after he died in Texarkana, Texas. Three of the transplant recipients, including two Texans who received his kidneys and an Oklahoman who received his liver, died of rabies. The patient in Alabama died from complications during surgery.

Officials did not release the name or dates of surgery or death of the fourth victim. They’re still conducting tests but said there’s no chance of more infections because tissue and organs are destroyed after seven days.

“All the tissue from this donor has been either used or destroyed,” said William Sutker, chief of the department of infectious diseases at Baylor.

They fervently hope, but they have to wonder what other non-tissue tissues are out there.

Baylor officials said they are planning to review their tracking system for arteries.

Good idea.

But officials said they were uncertain if they would start testing for rabies because that could delay transplants by up to 24 hours.

As opposed to doing the transplant and then having the patients die an awful death by an incurable disease?

Pam Silvestri, spokeswoman for the Southwest Transplant Alliance, which tracks organ donations, said they would have to “look at the risk versus getting organs to patients in a timely manner.”

OK, I’ve been a little harsh here, and it IS a rare event, but it should be looked into.

We had a rabies exposure here in the Fort Worth area last month (well, in Arlington), and at that time we had a heck of a time coming up with enough vaccine for the 17 exposed people. I cannot imagine how many people are getting vaccinated at Baylor right now, and I hope they’re all getting all the shots they need.

also posted at The Lingual Nerve

DVI splitters and me

I got a nice, new computer to replace the 4 year old box I currently use. I upgraded the old box about 2 years ago, with a new(er) digital video card, and use it to drive two LCD monitors (which is very neat, lots of open pages, etc).

Of course, in the time from then to now, the video card digital outputs have changed format, so the new card will connect to one of the monitors, but not to both (has to do with the male end of the splitter being a different shape).

I haven’t yet been able to find a DVI-I splitter. I can find powered DVI splitters for AV systems, I can find splitters for Matrox-type cards (mine’s an NVidia), but so far, no splitter for me. I called Dell, and “we don’t distribute those, you might try a dedicated computer store”. CompUSA says they know they exist, but they don’t stock them; the costomer-service challenged fellow I was speaking to didn’t engender a lot of confidence.

I ordered one from PCcables, and it’s the Matrox style (though their site says it’s for a NVidia card), so that goes back. Maybe they have a replacement that will work.

I know this is trivial, and it’s a nice problem to have, but it’s bugging me. If you have an answer, email me.

Happy July 4th

Here’s a photo of fireworks from our Disneyland trip, taken from near the Big Thunder Mountain ride.
Happy 4th of July!
Notably, Disney has a new way of launching their fireworks, and they’re giving the patents away. Makes for interesting reading.

Semper Fi from the NEJM

NEJM — Semper Fi

An account of a few of the challenges of being a doctor for the USMC.

I was lucky, in that I didn’t work with recruits, just really green boots when they came to the Battallion. As an Intern I saw a few on my ED rotation, who had stated suicidality as a way to get out of basic training. (They got out).

I never had to do anything near this hard, and now don’t think I’d survive.
via Marine Corps Moms

Rabies-infected organs kill 3 patients

CNN.com – Rabies-infected organs kill 3 patients

Rabies spread by organs taken from an infected donor has killed three transplant recipients, the Centers for Disease Control and Prevention said Thursday.

A fourth recipient died during the actual transplant operation, before there was time to develop the disease, officials said.

Rabies was also determined to be responsible for the death of the organ donor.

The unprecedented case began nearly two months ago, shortly after an Arkansas man suffered a brain hemorrhage and died at Christus Saint Michael Healthcare Center in Texarkana, Texas.

The man’s lungs, kidneys and liver were transplanted May 4.

The impact of the virus began to emerge within weeks.

The liver recipient died June 7; one kidney recipient died June 8 and the other kidney recipient died June 21. The patient who died was undergoing lung transplant surgery.

This is truly tragic, and will unfortunately be legal bait for a long time.

I suppose it’s not impossible for a person to have contracted rabies and have a stroke; rabies isn’t protective against other diseases. I wouldn’t even have considered testing potential donors for it, as it’d be an automatically exclusionary diagnosis, and I’m not certain if there even are any acute-phase rabies serologic tests (hard to develop and market tests for a disease that’s 100% fatal and has no effective treatment or cure).

Even if the transplant recipients had normal immune systems this would have overtaken them, and with their immune systems suppressed it’s possible nobody even knew what killed them (how did they make the diagnosis? It’s not stated here).

Just when you think you’ve heard it all.

cross posted at The Lingual Nerve

update: CDC on Rabies