Archives for November 2005

November is National Alzheimers’ Month

I’d forgotten, but was reminded by Dr. Serani: November is National Alzheimer’s Disease Month.

For more information: Alzheimer’s Association | Home

F.D.A.: Condoms Reduce Risks of Pregnancy, Disease – Medgadget –

The best medical graphic of the day comes from F.D.A.: Condoms Reduce Risks of Pregnancy, Disease – Medgadget – ”

From the New York Times:

Used correctly, latex condoms greatly reduce the risks of pregnancy and disease, the Food and Drug Administration said Thursday in a 63-page report.
Prepared in response to a five-year-old law, the report is to form the basis for labels for condom packaging and provide more up-to-date information about effectiveness.

But the graphic is the best:

best condom graphic

The Mother of all Subungual Hematomas

Patient fell and didn’t wake up for about a day, presents with several injuries. This, however, was the most visually impressive:


Information about subungual hematomas and their management.

Happy Birthday, Marines!

original poster from:

Gonorrhea Rate Falls and Syphilis Rises

Via CNN: CDC: Gonorrhea rate down; syphilis up – Nov 8, 2005

ATLANTA, Georgia (AP) — Gonorrhea (GC – ed.) has fallen to the lowest level on record in the United States, while the rates of other sexually transmitted diseases — syphilis and chlamydia — are on the rise, federal health officials said Tuesday.

The seemingly paradoxical findings can be explained by the cyclical nature of syphilis outbreaks and a rise in risky sexual behavior among gay men, researchers said.

The nation’s gonorrhea rate fell to 113.5 cases per 100,000 people last year, the lowest level since the government started tracking cases in 1941, according to the Centers for Disease Control and Prevention.

At the same time, health official saw increases in syphilis, which is far more rare but has been increasing since 2000. The rate of reported early-stage syphilis was 2.7 cases per 100,000 in 2004, up 29 percent since 2000.

Let’s not forget that syphilis as an infection is remarkably sensitive to antibiotics, and that it’s dogma that if you have one STD you’ve got more than one. Here’s how I think this happens: GC will make a patient get help, as it is painful and the copious amount of pus generated by GC isn’t something that can be rationalized or ignored. People with syphilis, on the other hand, have symptoms that are much easier to ignore (for the first 5-10 years), and so it’s easier not to get treatment.

Just remember:

original poster from

Syphilis, too.

original poster from:

AMA announces Ethical Requirements for Doctors to be Immunized

Via MedScape comes AMA Spells out Ethics of Quarantine

Nov 08 – Frontline doctors are ethically bound to receive the first vaccinations against impending public health disease outbreaks, according to a new report by the American Medical Association’s Council on Ethics and Judicial Affairs (CEJA).

The report on the ethical considerations surrounding decisions to quarantine or isolate individuals exposed to illness was approved without objection on Monday by the AMA’s House of Delegates.

The article title doesn’t pay off on the title, as it doesn’t discuss the ethics of quarantine. But, as a “Frontline” doc I know I need the immunizations.

Activity Log Oddities

To the person who repeatedly searches this blog for the word “oblation” and/or “oblation surgery”, I’d like to share the following:

  • The only occurrence of the word ‘oblation’ on my blog is in the comments section of this post.
  • ‘Oblation’ in that case is a misspelling of the word ablation, meaning 1. Surgical excision or amputation of a body part or tissue.
  • ‘Oblation’ actually does have a meaning, but it’s not medical: 1. The act of offering something, such as worship or thanks, to a deity.

I’ll leave it to you whether this means you should worship your surgeon.

(Also know as Uterine Oblation).

Blogroll additions

I’ve added a couple of new-to-me blogs to the sidebar under “Medical”, GeekNurse by a pediatric nurse (who has a much better camera than I do) and Doc Around the Clock by an Emergency physician.

The medical blog community continues to grow!

MedBlogs Grand Rounds 2:7

MSSPNexus Blog: Grand Rounds 2.07

It started out as a typical day in the Medical Staff Office. I leaned back against my leather executive chair and surveyed the top of my gleaming rosewood mahogany desk. The view out the large window was lovely, a sail boat skimming across the sparkling blue water of Lake Erie. (Hey, it’s my story; I can have whatever kind of office I want!)

Suddenly I sensed someone standing behind me. Turning, I see none other than Leonard McCoy, M.D., “Bones” from the original 1960’s Star Trek. “Dr. McCoy” I presume?

He looked instantly suspicious. “How do you know my name?”

“Easy, I had a big crush on you when I was 12.”

And so begins the latest of the Grand Rounds. Enjoy!

Commenters Welcomed. Really.

Crud. Outsmarted myself, again.

Several commenters yesterday got a “your comment has been moderated” message because of a stupid error on my part. The good news is that it’s now fixed.

The bad news is that your comments weren’t moderated, they were junked. I sincerely apologise. Please feel free to re-comment, or not, but that won’t happen again.

And feel free to comment. – Guidant Files Suit Against J&J To Force Completion of Merger – Guidant Files Suit Against J&J To Force Completion of Merger

From todays WSJ:

Guidant Corp. filed a federal lawsuit Monday seeking to force health-care conglomerate Johnson & Johnson to close its $25.4 billion acquisition of Guidant, a deal J&J has soured on due to safety problems with Guidant’s heart devices.

But even as Guidant escalated the dispute, it became apparent that Guidant’s own legal woes had worsened, as Guidant disclosed Monday the Securities and Exchange Commission had begun a formal inquiry into its product disclosures and trading in Guidant shares. Also, Guidant reported a substantial decline in third-quarter earnings and sales, citing the product recalls. …

Some legal experts say Guidant’s mounting legal issues could provide ammunition to J&J in arguing that Guidant’s prospects have gotten materially worse since J&J agreed to the acquisition in December 2004.

I don’t have a dog in this hunt, but think it takes some nerve to sue for the deal you had when things are getting so bad the SEC wants to look at your dealings.

Tearing Up

Tonight I teared up.

Not a pro reaction, but EM docs have emotions, too. Sometimes they show up, uninvited. The trick is not to let anybody know about it.

I was asked to assist a colleague with a wound closure (suturing) with his patient. (This is a completely normal request, and one of the reasons my job is wonderful: I ask my colleagues to help me with time-intensive procedures when I’m busy, and they reciprocate. The patients get more timely care, and we don’t have delays over procedures).

On entering the trauma room I noticed the patient had a severe problem: the vent was a clue, and the bolt sealed the impression: Very Sick Individual.

The laceration was ready to go, and I introduced myself to the family at the bedside. They were an elderly couple, completely devistated at the injury their child, one day past the 16th birthday, had just sustained. A closed head injury, from falling off a 4 wheeler, one of those gadgets seemingly designed to throw people off at high speeds. The patient is in a coma, and the parents are trying to cope with their acute reality. A severely brain injured child. Lives changed in an instant.

It’s hard to suture while your eyes are teary listening to “come back to us, sweetie, come back…” We EM docs, as a group, like to put up a brave front, but we’re human.

The wound closure was perfect. My eyes dried quickly.

The patient won’t ever be the same. Me either.

BBC NEWS | Wales | E.coli school testing under way

Since their E. coli “virus” gaffe, I’ve been watching BBC Health news to see what was next. The answer: studious avoidance of actually coming out and either admitting a mistake, or calling it a bacteria (bacterium for the stickler in the audience).

As an example, here’s today’s story about E. coli:

BBC NEWS | Wales | E.coli school testing under way: “….So far 159 people, most of them children, have been affected by the spread of the E.coli 0157 bug which first emerged in September.”

So, there you have it. It’s a bug (I do call them bugs when discussing infections with patients, but I’m not a News Organization).

And I’m never going to get tired of that petri dish photo.

With phishers like this, what do they catch?

I’ve written before about the very common phenomenon of phishing, and today I got a beauty of the species:

…Please verify your information simply by signing your account go to
If the account is not Sign out within 5 days then, your access to bid or buy on eBay will be restricted also ignoring this message can will cause the Suspension of your account.

Wow, who in their right mind would pass that one up? Dorks.

Stupid ebay phishers

Harmony in the ED

via Blogborygmi:

From the November 2005 issue of Annals of Emergency Medicine, by Goyal, Hollander and Gaieski at Penn:

The Figure displays an underrecognized clinical phenomenon for which we are proposing the term ‘synypnea.’ Synypnea is seen across the country and is defined as when emergency department waiting room patients have the same respiratory rate. We think it is pathophysiologically linked to menstrual synchrony. There is little scientific exploration on this topic, however, which represents fertile grounds for original research.

He’s pointing out one of the well-known oddities of medicine, that everyones’ respiratory rate is the same. This phenomenon is a precursor to the current trend that everyone has “10/10 pain”. A good chuckle for Saturday.