Archives for June 2008

Marianas Eye: Grand Rounds from the South Pacific (4:39)

Marianas Eye: Grand Rounds from the South Pacific

Welcome to this island edition of Grand Rounds. Yes, I really live and practice on a tropical island in the South Pacific. And yes, you can too. I’ll let you know how, in next week’s edition of Grand Rounds, which will be hosted by My Three Shrinks. But now, on to this week’s edition.

Hmm. Saipan. Sounds very nice.

Eclipse 400 – Video – Eclipse 400 over California

My brother, the Aerospace Genius, wrote last week to tell me the airplane his company was involved in, now called the Eclipse 400, is a go!

Here’s a video:

Eclipse 400 – Video – Eclipse 400 over California  and here’s some pictures:

For only about 1.3 million you can have your own personal jet.

If you get one, let me know.  I can probably get my brother to autograph it.

Cancer doctors dodge the death talk –

As I have suspected:

Cancer doctors dodge the death talk –
…Only one-third of terminally ill cancer patients in a new, federally funded study said their doctors had discussed end-of-life care.

Surprisingly, patients who had these talks were no more likely to become depressed than those who did not, the study found. They were less likely to spend their final days in hospitals, tethered to machines. They avoided costly, futile care. And their loved ones were more at peace after they died.

I’m often shocked, and saddened, that as an EM doc I’m apparently the first to discuss end of life plans with patients having terminal diagnoses.  (Yes, life is a terminal state, but don’t change the subject).  I do, as it’s what should be done, but it’s often uncomfortable for everyone.

Still, not as uncomfortable as dying in an ICU.

A minor defense of Barack Obama*

There’s some not-so-good natured chortling about Mr. Obama riding a bike while wearing a helmet, with derisory comments about an adult on a bike wearing appropriate headgear. I’m not going to link those blogs, but trust me, they’re there.

Obama's Bike Helmet

As an occasional cyclist, one who’s actually used their helmet while riding a bike, and as an Emergency Physician who sees people with head injuries, this is a practice to be promoted, not discouraged.

Now, were I to make fun of him in that photo, it’d be for wearing blue jeans on a bike. That just looks dorky. There’s a reason pro cyclists wear shorts, and it’s not for that really special tan line 2 inches above the knee. (Pro cyclists also wear helmets).

So, encourage helmet use by adults: it’s good for them directly, and doesn’t send the ridiculous message to kids that helmets are only for ‘little kids’.

* Disclaimer: I’m not an Obama fan, have utterly no intention of voting for him, but think this is an area where he’s being abusedly stupidly. For my Presidential endorsement, see my only statement to date.

A New Sign in medicine: the Tim Russert sign

Mr. Russert has a negative stress test on April 19th and died suddenly of a heart attack on June 13th.

I therefore propose a new sign in medicine, the Tim Russert sign: death (or MI) shortly after a negative stress test.

Health Blog : Tim Russert: One of a Kind; One of 300,000

Health Blog : Tim Russert: One of a Kind; One of 300,000

Prediman K. Shah, director of cardiology at Cedars-Sinai Heart Institute, Los Angeles, says it was a classic episode, the way 80% of cases of sudden cardiac arrest occur. He wasn’t impressed with the report of Russert’s recent successful treadmill test. Even if a test is normal, “You can still have plaque and be at risk,” he tells us. It wasn’t clear whether Russert had been taking a cholesterol-lowering statin, but even if his LDL or bad cholesterol was under control, that wouldn’t assure protection against a heart attack.

“Statins do stabilize plaque (and thus reduce chances of rupture), but they haven’t eliminated every heart attack or sudden death,” Shah says. “We have to look for other means.”

Bring on the coronary CT’s please.

Tim Russert cause of death: MI News News
NBC said Friday evening that Russert died of a heart attack. Russert’s internist, Michael A. Newman, said cholesterol plaque had ruptured in an artery, causing sudden coronary thrombosis.

Newman said an autopsy showed that Russert had an enlarged heart, NBC reported. Russert had been diagnosed with asymptomatic coronary artery disease, which he was controlling with medication and exercise, the doctor said.

He’s already had an autopsy? That was fast.

A video of his doctor speaking about his asymptomatic cardiac disease. Says the autopsy ruled out a PE.

Tim Russert dies suddenly afte…

Tim Russert dies suddenly after a trip to Italy. PE?

Imagine the fun

Imagine the fun
Of the deaf patient and utterly no ASL interpreter available.

Now give the patient you’re trying very hard to communicate difficulty writing, difficulty with vision, and more than three chief complaints.


I have had to be a morning per…

I have had to be a morning person for 5 days in a row now. Its not for me.

At work I’m lucky that I can give away my mornings to others …

It’s another beautiful day. A…

It’s another beautiful day. Another day spent indoors.

Funny I don’t gripe about my indoor job in January.

NHS Blog Doctor: Grand Rounds (4) 38

NHS Blog Doctor: Grand Rounds (4) 38

From across the pond.

Dumbest email spam this year: Your ATM Card Is Ready

As a nice change from the spams I get concerned about my, well, male enhancement, I got this astonishingly stupid one today:

Dear Sir,
This is to inform you that your ATM CARD has been credited with your fund
and it is ready for use. You are required to provide the ATM department with
your information such as:
FULL NAME:…………………….

NOTE; There is a delivery fee of $185 before we shall dispatch the Atm to
you by courier, please take note before forwarding your information.
Please contact the ATM department on this email {removed to protect the identity of the stupid} for
the release of your ATM CARD immediately.
Dr. Stupid,
The Director of ATM Department Zenith International Bank Plc
Umm, if it’s my ATM card, shoudn’t they already know my name?  Does anyone fall for this?

F-16 takes out tyranical suburban!! –

F-16 takes out tyranical suburban!! –
Sobering shot of an SUV that got lit up by mistake, by an F16 driver near the air-ground gunnery range outside Dugway, Utah. The ‘light paint and body damage’ is the result of a one-quarter-second burst by the fighter’s 20 mm gun, which fires about 3000 rounds per minute. An estimated 70 rounds left the gun; the results are as you see here.

Geez.  Read the article for the occupant injuries (survivable).  Friendly fire isn’t.

Sign of the Day