Archives for December 2005

Words to Auld Lang Syne

Auld Lang Syne lyrics |


Words adapated from a traditional song
by Rabbie Burns (1759-96)

Should auld acquaintance be forgot,
And never brought to mind?
Should auld acquaintance be forgot,
And auld lang syne?

For auld lang syne, my dear,
For auld lang syne,
We’ll tak a cup of kindness yet,
For auld lang syne!

And surely ye’ll be your pint-stowp,
And surely I’ll be mine,
And we’ll tak a cup o kindness yet,
For auld lang syne!

We twa hae run about the braes,
And pou’d the gowans fine,
But we’ve wander’d monie a weary fit,
Sin auld lang syne.

We twa hae paidl’d in the burn
Frae morning sun till dine,
But seas between us braid hae roar’d
Sin auld lang syne.

And there’s a hand my trusty fiere,
And gie’s a hand o thine,
And we’ll tak a right guid-willie waught,
For auld lang syne


auld lang syne – times gone by
be – pay for
braes – hills
braid – broad
burn – stream
dine – dinner time
fiere – friend
fit – foot
gowans – daisies
guid-willie waught – goodwill drink
monie – many
morning sun – noon
paidl’t – paddled
pint-stowp – pint tankard
pou’d – pulled
twa – two

Happy New Year!

The Year In Military Heroism

Riehl World View: 2005: The Year In Military Heroism

A review of those awarded decorations, many posthumously, in the service of their country.

Enjoying the Holiday

Nothing to say here, so I won’t.

We’ve had a series of just terrific visits with family and friends, and frankly I’m looking forward to going back to work to get some rest.

Maybe I’m getting old, but I’m counting my blessings this week, and not blogging.

MedBlogs Grand Rounds 2:14

The Health Care Blog: BLOGS: Grand Rounds

Welcome to Grand Rounds on THCB, the weekly round-up of all that is good and great in medical and health care blogging. This is a special edition as it’s the last of 2005 and so I’ve asked my fellow bloggers for their best posts of 2005. For some of them, like any great soccer player whose best goal is their last, their best post is their most recent. But for many we’ve gone back into the archives. There’s some great stuff, and some great series of posts too. So let me act like the consultant I am and put it into sections, and act like the blogger that I also am, and give you some not so unbiased commentary. Oh, and it’s pretty long with some nearly 60 posts mentioned. But you weren’t doing anything else this week, were you? So settle in and enjoy.

A very nice year-end ‘best-of’ for the medical blogosphere. Excellent reading.

Thanks for coming here, by the way. I have no idea why you do, but I appreciate it.

Merry Christmas!

If you’re so bored you’re trolling blogs on Christmas Day, here’s a few links to keep you occupied:

A Christmas Poem for the Marine

Jib Jab’s Santas’ Lament

And, a fun stumper for everyone:

Name All Ten Reindeer! (it’s harder than you think).

Again, a Merry Christmas!

Physician, know thyself:

Physician, know thyself — BMJ

how to choose a residency

As a resident physician working in a large academic medical centre, I am in frequent contact with medical students, many of whom feel apprehensive about choosing their future medical specialty. Students complain that they need balanced career guidance extending beyond “my specialty is the best” expressed by many doctors. Inspired by my interactions with residents training in all major specialties, I have created an algorithm to guide students’ choice of specialty on the basis of their personality characteristics. The algorithm has been well received at my institution by students and residents alike, many of whom exclaim: “That is so true.”

Boris Veysman, resident, Yale School of Medicine

There’s more than a grain of truth to this.

via Clinical Cases and Images and Dr. RW

12 STI’s Of Christmas

I have seen several searches of this blog for the British National Health Services’ “12 STI’s of Christmas“, and wondered why. The answer: the NHS site no longer carries the wonderful show, for reasons unknown to me. As for the searches, I guess the Christmas season has people thinking about sexually transmitted infections (diseases on this side of the Pond) set to Christmas tunes.

I had a hard time finding it, but here it is, for your seasonal enjoyment (not work safe!):


(Many many thanks to the Internet Wayback Machine for making a copy when I wasn’t smart enough to do so).

iBOT Mobility System: World’s Coolest Wheelchair

About The iBOT Mobility System

Expand your horizons with the iBOT Mobility System

Enjoy new opportunities with the revolutionary INDEPENDENCE iBOT 4000 Mobility System. The iBOT Mobility System has a combination of features that is unlike any wheelchair ever created.

Power across sand, gravel, grass and other uneven terrain, easily climb curbs up to 5″ and steps, rise to an ‘eye-level’ position and hold a conversation, even when you are on the move.

You can choose between 5 different operating functions:

* 4-Wheel – traveling uneven terrain
* Balance – raising yourself to eye-level
* Stair – getting you from here to there
* Standard – proceeding with confidence
* Remote – taking your iBOT with you

Created for people who want to be spontaneous and independent, the iBOT Mobility System lets you choose your own path.

This super-gadget was designed (originally) by Dean Kamen, who is using similar tech to run his Segway business. I read a couple of years ago that he’d turned it over to Johnson&Johnson for development as a medical device, wisely I think. I can’t imagine all the hurdles J&J had to surmount to bring this technology to market, through the FDA (and, no doubt, a ton of other giant bureaucracies).

Watching this machine run its paces a couple of years ago on MSNBC (cached page) was amazing, and it made me wish everyone in a wheelchair could have one. I truly hope it works for those who need it, and I’m looking forward to hearing from the first real people who have one.

Kevin MD has Christmas Bloggers

Kevin MD quite smartly decided to go on holiday and to not keep up his blog while doing it. The things bloggers do for their families.

Anyway, to keep his site from going dark for the duration, he’s assembled some excellent MedBloggers to blog in his absence:

Craig Hildreth, M.D. aka The Cheerful Oncologist
Red State Moron
Kent Bottles, M.D. from

I think that’s a pretty good idea, and having top-notch bloggers standing in doesn’t hurt a thing.

Dang, I need to try this next year.

Christmas is When?

Oh, I’d better get shopping, then.

NeutroSpec Withdrawn from Market

In the “FDA is getting serious, finally” category (via Medscape):

Dec. 19, 2005 “The US Food and Drug Administration (FDA), Mallinckrodt, and Palatin Technologies, Inc, have notified healthcare professionals regarding the immediate suspension of technetium [99m Tc] fanolesomab (NeutroSpec) from the market pending further investigation into reports of cardiopulmonary reactions associated with its use.

The action was based on the serious and potentially fatal nature of these adverse events and the availability of safer methods for diagnosing appendicitis, according to an alert sent today from MedWatch, the FDA’s safety information and adverse event reporting program.

There is no evidence of long-term risk among those who have safely received the product, according to the FDA.

The FDA has received postmarketing reports of 2 deaths and 15 life-threatening adverse events after administration of technetium [99m Tc] fanolesomab. Onset of these events occurred within minutes of injection and included cardiac arrest, hypoxia, dyspnea and hypotension requiring resuscitation with fluids, vasopressors, and oxygen.

A review of all postmarketing reports has yielded an additional 46 cases of similar but less severe adverse reactions, all occurring within minutes of technetium [99m Tc] fanolesomab administration. According to the FDA, the consistent characteristics and rapid onset of these events suggest that a causal role for the antibody component of the product is likely.

Technetium fanolesomab is a radiolabeled murine IgM monoclonal antibody indicated for use in the scintigraphic imaging of patients aged 5 years and older with equivocal signs and symptoms of appendicitis.

NeutroSpec has been taking out full-page ads in the EM trade journals touting its intended use in the diagnosis of ‘equivocal’ appendicitis. To my knowledge nobody at our joint ever used it. (And it’s too bad it’s gone, I was hoping it’d be useful in the pregnant RLQ-pain patient in which a sono didn’t help).

And, on to the rant: 10 years ago there was an ‘acceptable rate’ of about 10% for the removal of normal appendixes from patients with right lower quadrant abdominal pain. Since then there seems to be a major push to never take out an appendix without a CT or a sono confirming the appendix is the answer. This doesn’t sound like medical progress to me, it sounds a lot like CYA testing.

(We have one crusty surgeon who used to go ballistic when called that we have a positive appy on CT: “So, you had a patient with RLQ abdominal pain, rebound and guarding, and you got a CT instead of just calling me?”). He tries to assure us that none of the surgeons want a CT for appy, and we tell him, politely, that our experience with that same telephone call doesn’t bear out his assertion. (I want the crusty guy to just take mine out, thanks).

Yes, minimizing trips to the OR is arguably a good thing, and I’m not advocating needless surgery, but this is one example of the increasing applications of technology in medicine, whether it’s really needed or not.

Oh, and if you google for NeutroSpec, there’s already plaintiff atty. ads over on the right. And they have the gall to wonder why they aren’t well-regarded.

MedBlogs Grand Rounds 2:13


Welcome to Grand Rounds, where medical bloggers from around the world meet once a week to share their rants, ramblings, and observations.

This being the blogosphere, however, our ramblings and observations are not limited to doctors and nurses, but include patients and administrators, lawyers and health policy analysts, and, of course, information technology specialists. So welcome to our cocktail party, where people from all walks of life mingle and share their take on the medical world and life in general.

Another is an excellent series.

Black Widows

Everyone in Fort Worth who has an abscess was ‘bitten by a spider’. It’s a given that this will be the explanation, and it makes sense (people want to explain things, especially if it’s on their body and hurts).

Sometimes, it really is a spider bite, and occasionally they bring it in:

These folks don’t have an abscess, by the way, they haven’t had time for that to develop. They’re either worried about what could happen, or they have the actual Latrodectism, or symptoms of envenomation.

Here’s a nice table, lifted from the Texas Department of Health’s Venomous Spider page:

General Black Widow Spider Envenomization Symptoms

  • abdominal cramping
  • abdominal rigidity
  • convulsions
  • headache
  • lesion at site of bite
  • nausea
  • pain
  • profuse sweating
  • tremors
  • unconsciousness
  • vomiting

The ‘profuse sweating’ I haven’t seen, and wonder if they misunderstood one of the unique clinical features of the black widow envenomation: localized perspiration around the site of the bite, only. It’s a nice teaching point, though the patient never seems to appreciate how interesting it is.

There are a range of treatments for this, and it’s very very rarely fatal (I found one reference that said less than 1%, but that’s just a guess, as even if it’s a real number from a study it’s only studying people with known bites). I personally have had about 5 patients with Latrodectism, and they’re truly miserable and appreciative when you make the symptoms a lot better.

(I have a friend who had this, and after 20mg of IV valium was still having severe abdominal wall cramping. He then got the antivenin, and says 10 minutes later his cramping was essentially gone. He was then kept in the hospital for the next 18 hours because he was so sedated from the valium).

If bitten by one, just come on in to the ED, we’ll treat you without the spider.

Oh, and I can’t resist reproducing this table, from the TDH website just below the Black widow one, for Brown Recluse:

General Brown Recluse Spider Envenomization Symptoms

  • chills
  • fever
  • nausea
  • necrosis at the bite site
  • nothing
  • red white and blue lesion at the bite site
  • restlessness
  • weakness


We have a Winner!

Okay, thanks for all the entries to my silly caption contest, they were truly terrific.


The Winner: GoatWhacker, for the caption:
If you experience a carrot lasting greater than four hours, it is important to seek medical attention.

Honorable Mentions:
Too bad his wife is frigid by SarahW


Mr. Snowman suddenly heard the sound of a snowblower off in the distance by dribear.

Thanks for the entertainment, players!

Last Day for the Caption Contest

Frankly, I had forgotten I was going to have to announce a winner to this post’s caption contest.

So, get ’em in, and tomorrow I’ll announce the ‘winner’.