Wal-Mart Gets Something Right

Much has been said negatively about Wal-Mart - and much if it is deserved. They have driven out competition through aggressive marketing tactics, etc. They have pretty much put an end to the "mom and pop" store.

I also really hate that little smiley face that dances around and lowers prices.

The most recent thing they have done, however, could have real big positive effects. Effective last month, they are charging only $4 for a long list of generic prescriptions. Our local Wal-Mart has begun doing this and the response has been huge. Patients are all wanting these generic medications if possible. Other pharmacies (like Kroger) have matched these prices. Overall, the savings to patients will be great, making more drugs affordable for more people. I have done my best to try to use medications from that list when possible.

I am well aware that this is a ploy to get more people into their stores to buy other things - that is the same ploy many of the chain pharmacies use. But it is refreshing to see prices dropping rather than going up.

Generic drugs are generally overpriced. Why should a company who spent little to no money on development of a drug still charge even half of the price of the branded drug? Why? Because they can. Hopefully this move by Wal-Mart will force them to come down to a more reasonable level in their prices.

You are what you wear

Halloween is coming. As a parent, this has caused great stress in the past. Figuring out what consumes to wear for the kids was a very time consuming task for us. My wife is very creative, and hence she wants to do a "good job" on the kids' costumes. This makes us very frantic just before Trick or Treating.

Here are some sad stories about wearing abnormal things:

Man in Chicken Suit Cries Foul Over Abuse

To Steven Turnage, it was bad enough to
dress up in a chicken suit and stand along
a city street in 105-degree heat. Having passers-by shoot bottle rockets at him has him crying foul.

"People don't take this costume seriously," said Turnage, who wears the suit to promote a fast-food restaurant. "They need to understand that there's a human

underneath that suit. It's getting to the point where this is really a dangerous situation."

One rocket nearly hit him in the eye and another burned part of his suit. Police have heard Turnage's complaints but haven't issued any citations.

"Obviously it is against city ordinance to shoot fireworks inside the city limits," police spokeswoman Amber Dillon said.

Turnage said that during the two weeks he has worn the chicken suit people have thrown smokeless tobacco cans at him and tossed frozen drinks. After a bottle rocket attack, he called police.

"It's challenging," Turnage said. "You've got to be very dedicated and have a high tolerance for heat. You almost have to have a calling from the Lord to do this type of work."

OK, I have to say I do feel for this guy. It is bad enough to be humiliated by wearing a chicken suit, but to be shot at with bottle rockets? You may see that as a message from above that maybe you should change your line of work.

He did make some interesting comments, such as: "People don't take this costume seriously."
Well, I would hope not. It is a giant chicken suit, and to take it seriously would mean that they thought he really was a giant chicken. Perhaps they did take it seriously and the bottle rockets were an attempt to protect themselves from an evil mutant chicken.

The second comment worth noting is, "You almost have to have a calling from the Lord to do this type of work." This has serious theological implications. Does God call people to wear chicken suits in 105 degree weather, or does free will allow man to do things that he probably thinks are a bad idea? I'm sure somewhere there is a Sunday school teacher saying: "If you are going to wear a chicken suit in 105 degree weather and be shot at with fireworks, be the best man in a chicken suit in 105 degree weather (partially on fire) that you can!" I don't know if that works in with my theology. I don't see this situation as a means to get to heaven, it is more a foretaste of hell.

Oh yes, and note that he had smokeless tobacco thrown at him. Guess what part of the country he is from. Yes, it is the South - Arkansas. I wonder if it was snuff.

Story #2:

Clown Is Running for Mayor of Alameda

ALAMEDA, Calif. - A real clown is running for mayor of

Alameda, and even his sister won't vote for him.

Kenneth Kahn, 41, a professional joker known as "Kenny the Clown," admits he's running a long-shot campaign for City Hall's top spot. Kahn has not previously run for an elected position and has never sat on a public board.

"People ask me, 'Do we really want to elect a clown for mayor of the city?'" he said. "I say, 'That's an excellent question.'"

Kahn's mother, Barbara, said her son doesn't have a chance, and Sylvia Kahn, a teacher, said her brother's candidacy is a "mockery of our system."

"I don't think it makes any sense, because, to me, running for mayor is not where you

start as far as community involvement goes," she said.

In November, the funnyman who graduated from the University of California at Berkeley, faces incumbent Beverly Johnson and City Councilman Doug deHaan.

It would be easy to run against this guy. All you would need as a campaign slogan is: "Don't vote for that Clown!" I wonder if he has a son named Genghis.

Last, but not least:

Man Who Claims Toupee Caused Attack Sues

A man who claims he had a heart attack during a dispute over an ill- fitting hairpiece that didn't match his hair color is suing the wig shop.

Paul Lewis claims he suffered a heart attack after refusing to pay for the hairpiece that was not only the wrong size but also the wrong color. He is seeking more than $15,000 in damages.

Lewis filed a counter lawsuit in Superior Court after Paula's Wig Boutique of Orange filed a small claims action seeking $1,200 in payment for the hairpiece.

Lewis claims he fell ill in December 2004 after Paula Wood, the owner of the wig shop, threatened to call police because he refused to pay, according to court records.

Lewis told the Connecticut Post that Wood sold him the hairpiece in a darkened room and he didn't realize it was the wrong color until later. He said he put a stop payment on a check he issued to the shop.

Wood said she has no idea why Lewis suffered a heart attack over the incident and added that he was so happy with the hairpiece when he left the shop that he "hugged me and thanked me."

She added that her shop is brightly lit and Lewis left with the hairpiece during the day.

This is a fascinating story. I would think that the guy in the chicken suit would be the one with the heart attack. The guy is balding and probably rotund. He got a hairpiece and it looked bad - now that's a shocker. He blames the bad-looking hairpiece for his heart attack, failing to mention the "Monster Burger" he had on the way from the shop. I guess people started shooting bottle rockets at him because they "took it seriously" and thought he was being attacked by a rodent. Now that would make a heart attack more likely.

Having a bad hairpiece is not always a curse. I looked toupees up on Wikipedia and it had pictures of William Shatner and Donald Trump. It didn't stop them, did it?

So I end this post talking about Halloween consumes. When I was five, my mother got me a Satan costume. Now, I was a hyperactive boy (looking back, I clearly would have been medicated in today's culture), but Satan?? Hmph. It did glow in the dark, though, and I thought that was pretty cool.

Some people get consumes for their pets (see below). I don't know, but it always appears to me that the animals are really humiliated by the whole thing. Maybe they should have a heart attack and sue. Maybe they should shoot bottle rockets at their masters.

Happy Halloween! (Random Questions).

Rob

At the Movies

A friend of mine recommended I get the movie Danny Deckchair. We watched it last night and I have to say that I highly recommend it. It is a very nice romantic comedy from Australia with enough silliness to make it not just a "Chick Flick."

Here are some other less-known movies that I would recommend:

1. Mystery Men - With Ben Stiller. Very funny (and odd) movie about some non-mainstream superheroes.
2. What's up Tiger Lilly? - by Woody Allen. This was one of his very first movies. He takes a cheesy Japanese movie and dubs it with a plot in English that has nothing to do with the original script. The main character is named "Phil Moscowitz" - a common Japanese name, and they are after the famous egg salad sandwich recipe.
3. The Frisco Kid - with Gene Wilder and Harrison Ford. This gem is about a polish Rabbi who has to cross the US during the wild west days to bring a Torah to the San Francisco Jews. He meets up with a rough cowboy (Harrison Ford - well before Star Wars) who feels obligated to help the helpless Rabbi.
4. Galaxy Quest - with Tim Allen. You probably know this one, but it is one of my favorites. They do such a great job mocking the Sci Fi genre. I have watched this several times.
5. The Manchurian Candidate (the original) - with Frank Sinatra and the "Brat Pack." The newer one is very good, but the original is well worth seeing even if you have seen the latter one.

Any other recommendations?

Should I Change?

I have mentioned that I was getting frustrated with Blogger Beta and set up another blog site. Now I need to know from as many people as possible if I should make the change. The benefits of changing include:

• Getting away from the frustrations of Blogger Beta, although these have gotten some better over the past few weeks.
  
• More plug-ins and widgets on WordPress that are kind of fun (like the polls).
• The look and feel of the other site is different. I kind of like the full-screen rather than the limited width of Blogger.

The disadvantages of changing are:

• I am just getting a regular flow of people here (Random Questions) and that will inevitably decrease when I change.
• Blogger has improved some already.
• Most of my readers are in Blogger as well, so profiles are more easily seen.
• Everyone would have to change their links.
• I may be changing just because I like to change and not because things are really that bad (I have a tendency of doing that).

So I want to know if this is a good idea, OK idea, no change, or a bad idea. Please let me know.

Questions about Random Questions

I have recently noted (in my obsession with my stats) that I have been getting a ton of people coming to my blog via a Google search for the words "Random Questions" (because of a previous post entitled "Random Questions." Now I am not really sure why you would do such a search, but it has been very curious to me that this has gone on (From the Google search of "Random Questions").

I sent an e-mail to the folks at Sitemeter, and they said that I was #1 on the Google search for "Random Questions." When I looked, I had somehow slipped to 4th.

So what I figure has happened is that the more people coming to my site via that search, the higher I go on the "Random Questions" Google search. This becomes a self-fulfilling prophecy, as the ranking gives me more hits, and the hits give me a higher ranking. Being totally consumed by these stats, I figure it is a good thing to be high on the list for "Random Questions." That is why I am using the term "Random Questions" so frequently in my post. I intend on becoming a "Random Questions" tycoon, building a "Random Questions" empire based on being #1 on Google for "Random Questions." Once I have conquered the "Random Questions" market (I intend on burying the other "Random Questions" sites), I will go after other phrases (such as "Random Thoughts," "Arbitrary Questions," and "Questions that are Random"). I should be able to generate a huge revenue with the thousands of hits per day from the "Random Questions" searches along with the other non "Random Questions" searches.

I will do my best to keep in touch with my loyal readers once I become a "Random Questions" tycoon. You can tell everyone you knew me before I made my fortune on "Random Questions."

Any Questions?

Publish or Perish

In the academic world, this phrase refers to the need to be publishing articles in Journals to be able to keep one's job as a professor. Grant money often depends on a person's ability to be "productive" in their research and produce concrete results. There is even pressure to not just get "ordinary" results, but something "exciting," causing people to falsify those results to get the money and recognition they need.

To some extent, I feel that way about blogging. I have been doing this for about 6 months now and have had modest success with some regular readers. But if I now have a fear that if I don't continue to put out regular blog entries, I will lose my readers. I find myself obsessing on the numbers of my site meters, hoping to pump them up by some wonderful new post (that is even at the back of my mind on this post).

The funny thing is that I went for 44 years without ever blogging and did just fine. I did not know any of these people I now blog for and still don't know many of them. I have greatly enjoyed doing it and have to some extent become addicted to checking out others' blogs regularly (yes, Dr. A, I am thinking of joining BA). There is no real pressure for me to do this, aside from that which I put on myself. I have a need to entertain others and to be liked in the blogging realm.

I guess it is the "class clown" in me that wants to garner the attention of others. It is not necessarily a bad thing, in that my focus on the response I get out of others is the same thing that lets me be empathetic toward my patients. But it is curious to me how I start to get worried if I have not "published" recently. I would feel a great loss right now if I did not have people reading what I write. I am sure there are many of you who feel the same way.

Is it bad? Not at all. It is just amazing to me how powerful that need to maintain my readership can be. I greatly appreciate those who regularly come by this blog. Thanks for reading my goofy stuff, but also responding when I do this kind of thing. It has been quite nice to rub elbows with people I would have otherwise have not met and who are very much unlike me. The blogging world is a nice community and I am glad I am in it. I will understand if you need breaks from blogging from time to time, and promise to not hold it against you if you need to take a break.

Rob.

Whatever You Say...

From Monty Python's Life of Brian:

Brian: 'Look, you've got it all wrong! You don't NEED to follow ME, you don't NEED to follow ANYBODY! You've got to think for yourselves! You're ALL individuals!'

The Crowd (speaking in unison): 'Yes! We're all individuals!'

Brian: 'You're all different!'

The Crowd (in unison): 'Yes, we ARE all different!'

Man in crowd: 'I'm not...'

The Crowd: 'Shhh!'

I think it is important to follow instructions, but there are two stories recently that highlight the extreme of this:

Driver obeys navigation system, no matter what

An 80-year-old German motorist obediently following his navigation system ignored a motorway "closed for construction" sign and crashed his Mercedes into a pile of sand further down the road, police said Monday.

"The driver was following the orders from his navigation system and even though there was a sufficient number of warnings and barricades, he continued his journey into the construction site," a police spokeswoman told Reuters.

"His trip finally ended when he wound up crashing into a pile of sand," she added.

The driver and his wife escaped uninjured from the collision, which occurred on a motorway near Hamburg.

The funny thing here is that he went through barricades and kept on going. What did he think would happen if he did not obey?

I thought this was humorous, but then today the following article appeared:

Obedient driver follows orders, crashes car

Mon Oct 23, 8:17 AM ET

A German motorist followed the command "Turn right n

ow!" from his navigation system and crashed into a small toilet hut by the side of the road -- about 30 yards before the crossing he was meant to take.

The overly obedient 53-year-old from Freiburg drove his sport utility vehicle off the road onto into a building site, up a stairway and into the small toilet shack, police in the eastern town of Rudolstadt said Sunday.

It caused 2,000 euros ($2,500) worth of damage to the stairway, 100 euros damage to his car, and he was also fined 35 euros.

Earlier this month an 80-year-old motorist also chose to follow his navigation system and ignored a "closed for construction" sign on a Hamburg motorway. He then crashed into a pile of sand but neither he nor his passenger were injured.

Initially I thought this was the same article, but this is a much younger person. This guy actually drove up some stairs.

Here are some observations:

1. Note the German propensity for following orders (I am German, so I can say that). We Germans like things to be orderly and so tend to like strong authority. It is only natural that this happened in Germany.
2. I wonder if the navigation systems in Germany speak with a more commanding tone than those in the US. "Dumkopf! Turn Left! Now!!!"
3. That's one special SUV that can go up stairs!
4. What is a toilet shack? What is it doing along the side of the road?

Now, I have had my own problems with these navigation systems. I was in Oregon on a business trip and decided I wanted to get a car with a navigation system. All was going well, and I decided I needed to go to Wal-Mart. When I punched Wal-Mart into the Nav System, it told me the nearest one was in Las Vegas (about 900 miles away!). On the bright side, I did have very good directions to that Wal-Mart. I'm sure it had slot machines in it as well.

On the same trip, we were trying to get to Crater Lake and it gave me directions down a dirt road that had trees across it. When you turn around and try and find another route, it keeps reminding you that you are going the wrong direction. Obviously the technology needs some work.

Maybe this is why the dogs crashed their cars...

A Round by any other name is not so Grand...

Yes, it is time for Grand Rounds. Bob Coffield at Health Care Law Blog has done a bang-up job on GR with Grand Rounds 3.5: A visual Tour.

The problem for me is, between reading this and Pediatric Grand Rounds, I don't have much time to see patients. Oh well, they can wait....

On a brighter note, once more there is nothing about monkeys in Grand Rounds.

Grand Rounds, Jr.

Get out of your Tree! Pediatric Grand Rounds are now ripe and ready for your edification at The Wait And Wonder. Moreena highlights the scary parts of medicine - doctors who are clueless at times - but overall gives a very positive spin on our grand profession.

I am happy to say that there are no posts about monkeys. At least there is one area where these evil critters have not taken over.

Watch your head!

I have previously written about falling dogs as a risk we all have to face in life, but I was unaware of other things that are falling and causing significant damage.

The first story comes from Germany:

German cottage destroyed by meteor

Fri Oct 20, 10:28 AM ET

A fire that destroyed a cottage near Bonn and injured a 77-year-old man was probably caused by a meteor and witnesses saw an arc of blazing light in the sky, German police said on Friday.

Burkhard Rick, a spokesman for the police in Siegburg east of Bonn, said the fire gutted the cottage and badly burnt the man's hands and face in the incident on October 10.

"We sought assistance from Bochum observatory and they noted that at that particular moment the earth was near a field of meteoroid splinter and it could be assumed that particles had entered the atmosphere," he said.

"The particles usually don't reach the surface because they disintegrate in the atmosphere," he added. "But some can make it to the ground. We believe this was a bolide (meteoric fireball) with a size of no more than 10 mm."

OK, so I am to believe that bolides are falling on us, and that a 10mm one can burn down a whole cottage? And just what is a field of meteoroid splinter? I was not aware meteors could get splinters. Perhaps that is why they send bolides down on us, because they are angry about the splinters they get from fields. I don't know, the whole thing is a little confusing. I hope this bolide phenomenon is restricted to Germany.

I am wondering now about when my son claimed his homework was destroyed by a small meteor. I gave him 2-years of hard labor for that lame excuse. I guess maybe I was jumping to conclusions. Hmmm....

While that is somewhat disturbing, the second story hits a lot closer to home:

Toilet ice rips hole in couple's roof

Sat Oct 21, 7:57 AM ET

CHINO, Calif. - An elderly couple believe a chunk of blue ice from the holding tank of an aircraft toilet ripped a hole in their roof and destroyed a bed.

William McElroy was watching a movie with his wife, Evelyn, when the ice crashed into the house Wednesday night.

"It was a huge crash. It shook the whole building, but we thought it was a car," McElroy said. The couple went outside to investigate

but found nothing, so they returned to finish watching the movie.

They didn't discover the chunk of ice on the bed and the 2-foot-wide hole in the ceiling until Thursday morning.

"I think we had somebody extra looking over us," Evelyn McElroy said.

Federal Aviation Administration spokesman Ian Gregor said Thursday if the offending chunk of ice is from an airplane, then it is likely the cause of a leak in a holding tank of the aircraft's bathroom.

Blue ice occurs when waste leaks from a plane's bathroom onto the outside of the plane and freezes at high altitudes. The liquid begins to thaw as the plane descends, Gregor said.

This is far more disturbing. First off, it happened in California, so we cannot write it off as a Germanic problem. WE ARE ALL AT RISK FOR THIS!!

The second obvious thing is that it is "from the holding tank of an aircraft toilet." Read between the lines: POOP AND PEA IS RAINING DOWN ON US FROM THE SKY!!! (I suppose the right term here would be hail, not rain).

The most disturbing part of this is that it was big enough to tear a 2-foot hole in the roof of the house and ended up on the bed. I have heard of bed-wetting, but this is really taking it to the extreme! It was big enough to shake the whole building!

So the situation is this: we have large chunks of human waste raining down us from the sky, capable of tearing holes in our roofs and doing who knows what else. This is a dire set of circumstances for which we should be called to alarm. Why is the FAA so casual about this? We should be finding ways to protect ourselves from these falling "poolides" (I made that word up myself!), but what should we do? If our roofs are not strong enough, then what can we do??

Let me make a final comment here about the statement of Mrs. McElroy. She felt that they had "somebody extra looking over us." I hate to say it, but it was not their face that was pointed at her.

Nothing to do with the story...I just found this humorous

Wellness

My older brother, who is an ecologist (a limnologist, to be specific), once told me that he was sick of hearing people talk about the "balance of nature." He went on to point out that the natural world is in a constant state of flux - anything but balanced. Scientists believe, for instance, that when trees came into existence, they caused nearly 95% of the species present at the time to go extinct. This is not to say that you should not be responsible with the natural world we live in (he is, after all, an ecologist), but it points out the fluid nature of things; the only constant is change in our temporal world.

There is a school of thought in certain circles that embraces the idea of wellness much in the same way that certain naturalists embrace the balance of nature (see http://www.wellness.com/ and http://seekwellness.com ). Much of these ideas are put forth my more alternative practitioners (such as Andrew Weil, MD) in the guise of mainstream medicine.

Wikipedia (the ultimate source of all reliable information, of course) divides wellness into two different definitions:

1. Alternative Medicine - Wellness is generally used to mean a healthy balance of the mind-body and spirit that results in an overall feeling of well-being.
2. Mainstream Medicine (under the heading health) - In any organism, health is the ability to efficiently respond to challenges (stressors) and effectively restore and sustain a "state of balance," known as homeostasis. Sickness is merely the absence of health. All organisms, from the simplest to the most complex, reside on a spectrum between 100% health and 0% health.

These definitions beg the question: does wellness really exist? Is our goal as physicians to promote wellness, or simply more wellness? I believe that wellness is a concept, not a reality. It may be worthy of our striving, but accomplishing this is not possible. Here are the reasons I think this is the case:

1. I disagree with the Wikipedia definition of Homeostasis as a "state of balance." I prefer the dictionary definition: The ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes. The body does everything it can to get to a state of "balance," but there are constantly forces moving it out of balance. Even if balance were achieved, it would soon be out of balance again.
2. Aging - Aging is the continuing process of anti-wellness. Everyone dies due to a process that is built in to the DNA itself. This is true for every organism. Could wellness really occur when aging is happening. Even children aging, growing bigger and stronger, are in a state of unbalance (as witnessed by my 13 and 14 year olds!). The implication of growth in a child is that the current state needs to be changed. It is pathologic when change stops happening (growth delay, etc.).
3. All of nature goes against this. Organisms ultimately die, and this happens because the need for increased diversity and the need for adaptation to environmental changes. We do not exactly fit into our environment, and so there is a homeostatic force on a ecologic basis that pushes toward adaptation to these environmental mismatches.
4. Entropy - This is the tendency of things to become increasingly disordered. Although the evolutionary trend toward increasing complexity goes against this in a small area, the overall force is toward disorder. This is one of the laws of thermodynamics (and not one of the suggestions of thermodynamics).
5. It is immeasurable. Conceptually it is impossible to prove wellness, even if it were reached. Some of this has to do with the concept of observer effect (as displayed in the Heisenberg Uncertainty Principle). If we measure something, we change it by our act of measurement. This means that if homeostasis is actually attained, it will be disrupted when we assay for it. On a more basic level, however, science deals with disproof much easier than proof. To prove wellness, you have to disprove all forms of illness. This is simply impossible.

Aside: My father is a physicist, and one of his favorite signs he saw was one that read "Heisenberg may have slept here."

So what does this mean for physicians? I think it has a big effect on how we approach problems. Problems are normal and certain problems are physiologic. A good example of this is the rebellious teenager. When a person is transitioning from the dependency of childhood to the independence of adulthood (both relative), there is a period of increased disorder as this transition is made. The child acts up, but does so to some extent to make this transformation. As a parent, we do not always see this behavior as pathological (as annoying as it can be). If this disorder is not present, it is a sign of problems. Our goal as physicians is to oversee this disorder and discern if there is any signs of "abnormal disorder." This poses a great challenge, but is a very important lesson to teach parents. Expect challenges.

Another area of application is in the psychologic realm. We want everyone to be happy all the time - it is part of our natures. Yet we do very poorly when we do not go through hard times. Again, a good example is the "spoiled" child. If a child is given everything they want, they will become a pathologic personality. If a parent does not cause the child to go through sadness and anger, then they are harming the child. I always tell parents that our primary goal is not to make our children happy. Our primary goal is raise good children. If you raise a child with happiness as the primary goal, you will make them neither good nor happy. If you raise them to be good, then they will (more likely) be both.

Treating depression is always a challenge for me. Sometimes I think people are pathologically trying to avoid pain, when that may be what is best for them. But it is very hard for me to be the one to decide what they need in this arena. I do think that sometimes I am doing them a disservice to treat their depression. We need pain to allow us to grow emotionally. Pain is just evidence that we are not yet where we need to be. I use the analogy for patients of chest pain. If we seek simply to treat the pain and ignore the cause of the pain, we can kill the patient. We need to be able to feel pain so that we can know when something more serious is going on.

This is a line that all physicians must draw. To some extent, we are managers of pain, and not promoters of wellness. I do think that wellness as a goal has some merits, but I think that sometimes we "lose the forest for the trees" by not paying attention to the discreet details of illness prevention. There is no balance, just homeostasis. As we help people we need to keep in mind that we are ultimately here to relate to our patients as they go through life and not treat them as a project to complete.

You've got Questions? We've got Answers

The Answers to our quiz from yesterday:

1. The 100 Years War lasted 116 years.
2. Panama hats are made in Ecuador.
3. We get Catgut strings from Sheep and Horses.
4. The Russians Celebrate the October Revolution in November.
5. A Camel hair brush is made of Squirrel Fur.
6. The Canary Islands are named after Dogs.
7. King George IV's first name was Albert (very good, jmbree!)
8. A Purple Finch is Crimson.
9. Chinese Gooseberries are from New Zealand.
10. The 30 Years War lasted....30 years.

So how did you score? Grade yourself on the following scale:

• If you got 10 correct - Go away now! You are one of those people who really annoy me.
• If you got 8-9 correct - You are a friggen' genius and are clearly having your IQ lowered by reading this blog. Go read Clark Bartram's Blog... now there's a smart feller.
  
• If you got 5-7 correct - Stand up, jump up and down, spin around three times, and shout the words "Bowling Pin" at the top of your lungs.
• If you got 3-5 correct - Treat yourself to a bowl of Campbell's Chunky Soup. It's good and it's good for you!
• If you got 1-2 correct - You probably are at the IQ level at which I am aiming this blog. My deepest condolences!
• If you got none right- You should be running for elected office. You are a perfect candidate for a government job. You may also find good work on a computer for an HMO, telling doctors which procedures they can and cannot do.

Elementary, my dear blogees

OK, here is a quick quiz I want you to take: Questions:
1. How long did the Hundred Years War last?
2. Which country makes Panama hats?
3. From which animal do we get catgut?
4. In which month do Russians celebrate the October Revolution? 5. What is a camel's hair brush made of? 6. The Canary Islands in the Pacific are named after what animal? 7. What was King George VI's first name? 8. What color is a purple finch? 9. Where are Chinese gooseberries from? 10. How long did the Thirty Years War last?

Seems obvious? You would be shocked at how many people could not answer these questions correctly.

I will post results tomorrow.

Ground Rounds...er...Grand Rounds is up!

Open wide!

The Ever-entertaining Kim at Emergiblog, ER nurse extroardinarre, serves up a very full edition of ground rounds. The meat of the matter is that you should not grill me about the contents. Just flip on over to her website and dig in. If you don't you'll be in a pickle to ketchup with all of the content. Lettuce enjoy her wonderful job (although no one from the Mayo clinic had input).

And you can get a cup of Joe while you are at it!

One Too Many

There are many studies on the effects of alcohol on a person's health. Alcohol is a serious problem in the world, causing much pain and suffering.

On a lighter note, alcohol can make people do really stupid things:

Woman charged with drunk horse riding

Tue Oct 10, 5:19 PM ET

Well, that's a DUI of a different color. Heather Darnell, 22, of Mountain City, Ga., faces a drunk driving charge after she steered the horse she was riding onto the highway and tangled with a car, authorities said. Darnell also was cited for entering a traffic lane.

She remains in fair condition after being airlifted to the Gwinnett Medical Center in Lawrenceville, Ga.

The horse apparently survived, officials said.

Three people who were in the Pontiac Bonneville that struck the horse Friday night were treated at Mountain Lakes Medical Center in Clayton, Ga., and released: Ancella Gragg, 32, of Lakemont, Ga., who was at the wheel; and a 13-year-old girl and 9-year-old boy.

Trooper Anthony Coleman said Gragg did not see the horse until too late and was unable to avoid hitting it.

"If it's on the public right-of-way, you're under the same jurisdiction as if you're in a car," Coleman said.

I am pleased to say that this fine specimen resides in my home state, Georgia. Riding the horse while smashed is a favorite pastime in the Peach State. We sometimes like to get the horses drunk as well. The madcap adventures never stop!

Seriously, this lady ought to realize that she needs to call a cab with a large trailer whenever s

he has had too much. Someone should have taken away her saddle so she couldn't go. Now she gets her horse license suspended. Too bad!

I did find this website, which features a beer-drinking horse. The Clydesdales drink him under the table every time.

Here is a novel solution to a problem:

Man Eats Underwear To Beat Breathalyzer

A Stettler man tried to eat his underwear in the hope that the cotton fabric would absorb alcohol before he took a breathalyzer test, provincial court heard this week.

David Zurfluh was subsequently acquitted of a charge of impaired driving because he blew a .08, the legal limit.

But the testimony broke up people in Judge David MacNaughton’s provincial court

here Thursday afternoon.

Mr. Zurfluh was collared by RCMP Const. Bill Robinson after he ran from his vehicle, which had been seen weaving down the highway.

While sitting in the back of the patrol car, Mr. Zurfluh tried to eat his shorts, Const. Robinson told the court.

Mr. Zurfluh said he ripped the crotch out of his shorts, stuffed the fabric in his mouth, then spit it out.

A class of law students from William E. Hay Composite High, in court as observers, was removed by the teacher when testimony enlivened the proceedings. The Grade 11 and 12 students had difficulty maintaining composure.

"People were leaving the courtroom with tears in their eyes, trying not to laugh," said

RCMP Const. Peter McFarlane.

So Dave, what is it, boxers or briefs??

Oh boy, this one is loaded. You could say that he was short on brains. You could say he wanted a brief snack. You could say he had his daily allowance of fruit (of the loom). Perhaps he mistook the jingle for: "Wait till we get your Hanes in you."

So here is the scene in the courtroom:

Judge: "Mr Zurfluh."
Bailiff: "Gesundheit!"
Judge: "Mr Zurfluh, what did you eat under there?"
Zurfluh: "Underwear?"
Audience: "Yuck, Yuck, Yuck!"
Zurfluh: "No, seriously...."

I suppose these High School students were very impressed by this demonstration of the powerful mind-numbing effect of alcohol.

Finally, from the wonderful state of Wisconsin:

Milwaukee is named 'Drunkest City'

MILWAUKEE --Milwaukee has been ranked by Forbes.com as "America's Drunkest City" on a list of 35 major metropolitan areas ranked for their drinking habits.

Forbes said Tuesday it used numbers from the U.S. Centers for Disease Control and Prevention to rank

cities in five areas: state laws, number of drinkers, number of heavy drinkers, number of binge drinkers and alcoholism.

Minneapolis-St. Paul was ranked second overall; followed by Columbus, Ohio; Boston; Austin, Texas; Chicago; Cleveland; Pittsburgh and then Philadelphia and Providence, R.I., in a tie for ninth.

Rick DeMeyer, 28, said Wednesday as he was celebrating his birthday at G-Daddy's

BBC he could understand Milwaukee's ranking.

"I have had people stay with me from London and Chicago, and they can't get over how much we drink," he said. "I guess we do."

But officials at Visit Milwaukee, the area's conve

ntion and visitors bureau, contend

that the city has come a long way in ridding itself of its beer-guzzling image.

Milwaukeeans have plenty of other ways to entertain

themselves without drinking alcohol, said Dave Fantle, a spokesman for the group. He noted a new convention center and baseball park had been built and the Milwaukee Art Museum expanded in recent years.

"We've gone from Brew City to new city," he said.

This really comes as no surprise to me. There is no way that anyone sober would wear cheese on their head and take their shirt off in -20 degree temperature. There is no way that fans would willingly pay to watch the Brewers play. There is no way people would dress up in costumes like various types of sausage and race around the stadium.

So this causes me to ponder several other questions:

• Are people in Milwaukee allowed to ride horses?
• Are underwear sales brisk in Wisconsin?
• Is G-Daddy's BBC a Hapnin' joint?
• Can people find their way to the art museum, or do they just stand and stare at graffiti saying "Whoa. I love abstract art."?

Finally, let me ask my readers, who would you rather spend an evening with (and why)?

1. Heather Darnell, the drunk equestrian.
2. David Zurfluh, the brief gourmet.
3. Rick DeMeyer, who has a daily birthday party at G-Daddy's BBC.
4. Dave Fantle, the guy who made the lame "Brew City to New City" comment.

Polls are now open...

Blogger Beta?

I Hate Blogger Beta!

I have to try twice every time I post a picture. It messes up with other programs and forces me to use a long log-in every time. It is far more limiting than the regular blogger was.

So....

Tell me what you think about my possible new home. I will eventually be moving my blog to distractiblemind.com, but it is temporarily parked with my other blog. Unfortunately I can't import from Blogger Beta because it is so "unstable." I like the tools with Wordpress better (and have been using the new Microsoft Windows Live Writer (beta too - will I ever learn?) and I like it a lot.

Ben Stiller is "Mr. Furious"
I am now "Dr. Furious!"

Emu Brute?

I like to have fun at the expense of others. I'll admit it, I like to point and laugh. Well, that really only applies to dangerous animals who get what is coming to them. That makes me smile.

Police kill emu that bothered motorists

Packing 100 pounds on its 5-foot frame, the big bird gave police in this St. Louis suburb a mighty run, confounding them all six times someone reported the ostrich-like beast bugging motorists last weekend along busy Illinois Route 3.

Police finally caught up to the claw-footed menace Monday and ended the ruckus once and for all, cornering the emu, a cousin to the ostrich, and shooting it dead out of fear it'd again wander into traffic and kill someone.

Two days later, police on Wednesday still were pecking away at the vexing question: Where did the bird come from?

"We figured someone would call and say, `That's my bird!'" Police Chief Rich Miller said. "But we still haven't heard from anybody."

Raised for their eggs, oil and protein-rich lean meat, emus — at least the errant variety — have become a bit of a trend in southern Illinois, where they're not native.

In June, police in Carbondale, about 100 miles south of Granite City, needed five shotgun blasts and three rounds from a rifle to dispatch one of the flightless birds after cornering it in a residential area, where it was said to have even pecked on a home's window.

In both cases, police say they had no other recourse in dealing with a species known to be elusive — they're capable of moving up to 35 mph — and aggressive with anyone who gets too close.

"We figured that sooner or later our luck was gonna run out" and the emu here would cause a traffic wreck, Miller said. "If we had some way to catch it, somewhere to take it, that'd be fine. The ability for us to be second-guessed is always out there, but we decided (Monday) that now is the time to end this."

Carbondale police haven't said publicly if they ever tracked down an owner of the emu they killed, and messages with those authorities Wednesday weren't immediately returned.

Miller said Granite City police had heard rumors that someone near nearby Interstate 270 might be raising the birds, though that's not been confirmed. The American Emu Association's Web site shows no local breeders of emu, whose oil is used in cosmetics and lotions.

Clay Nielsen, a Southern Illinois University wildlife ecologist more versed about cougars and armadillos taking refuge in the state's wilds, said such wayward emus likely were former captives by breeders or families keeping them as pets.

"Throughout the Midwest and South, there have been many reports of animals on the loose," Nielsen said. "Whether they can survive long in the wild, I'm really not sure."

There have been other recent reports of errant emus elsewhere. On Oct. 5 near St. Albans, W.Va., one of the big birds wandered onto an elementary school's grounds, was caged and given to a doctor who agreed to release it on his farm. And in Wisconsin last week, an emu found wandering one town's streets was tranquilized by a veterinarian and returned to its owner after police efforts to halt the bird with a stun gun didn't work.

Meat from the emu slain here was being processed by a Granite City police officer who hunts and would be donated to local food pantries, Miller said.

So Emus are cropping up out of nowhere recently. I have yet to see one in my back yard, nor have I treated someone for an emu-induced accident, but it is only a matter of time. This ubiquitous bird seems to be getting as common as ants, covering the Midwest with a plague of large birds which cause poor innocent motorists to wreck.

I think Laundress should be alarmed, as now they are cropping up in Wisconsin as well! Do Emus like Cheese, Brats or Beer? They seem like the beer swilling type, these scoundrels!

I doubt they are part of the sinister plot of the dogs, monkeys, and cows. They don't seem to be cunning. I think Emus are basically loose-cannons, the vagabonds of the Midwest causing terror and pain wherever they tread.

This Emu is where it deserves to be: behind bars!

Good News

I have posted previously about the emotions of being a doctor, bringing the stress home, and when patients make the ultimate bad health decision. That makes it seem like all of my days are bad - they aren't. It makes it sound like I have second thoughts about being a doctor - I don't. There is no other job I can see myself doing.

But despite that, it helps to be able to have good days to offset the difficult ones. I had the opportunity lately to give good news to some of my patients. That good news followed the sinking feeling of potential bad news in both instances.

The first was a 37 year old gentleman who I had cared for the past 10+ years (both him and his family). He came in to see me for a testicular mass. Normally, testicular cancer only affects men in their 20's. Since I trained at Indiana University, home of Larry Einhorn - the doctor who discovered cis-platinum - the cure for testicular CA. This is where Lance Armstrong went for treatment of his cancer. This patient came in with a lump on his one of his testicles, worrying if it may be cancerous. Palpating it, I could not deny that it was worrisome. I sent him to get a testicular ultrasound which soon came back as "worrisome."

Then I had to make the phone call I never like to give. I called the patient and told him: "I want you and your wife to come in to talk to me." They knew what this meant. It meant that there was bad news.

I never beat around the bush when they are in the office - they know what I am going to say: "the ultrasound showed something very suspicious of cancer. I am going to send you to a urologist and he is going to set you up to have the testicle removed." I reassured them that even in the worst-case scenario, testicular cancer has a good prognosis. I knew this did not mean much to them; cancer is cancer.

My nurse, whose husband had testicular cancer at the same age, told his wife that if she could do anything for them, they just needed to call. Since he was in his upper 30's, the most common cancer is seminoma. When I trained, this was a little harder to treat than the germ-cell tumors common at younger ages. This is what my nurse's husband had, and it became metastatic after the first round of treatment. He required fairly aggressive chemotherapy, and is now a cancer survivor.

The day of the surgery, we got a call from the urologist - the diagnosis was teratoma, a benign tumor. Who knows how long it had been there, but it had probably gone from a germ-cell tumor to full maturity as a teratoma. Germ-cell tumors are similar to stem cells in that they can develop into many kinds of tissue. Teratomas are tumors resulting from the full development of germ-cells into mature non-cancerous cells. In women, these are the tumors that can contain hair and teeth. I once heard a joke that to diagnose a teratoma in women, you put some ice to the abdomen and use your stethoscope to listen for chattering teeth.

The end result: good news.

My second patient was a 65 year-old gentleman who was new to the practice. He said he had been having lower abdominal pain on the left, which he suspected was a hernia. Upon exam, he had a large mass in the left lower quadrant. It is really hard to know how to respond when you find something significantly worrisome on exam. I asked him if he had noted the mass and he said he had. I told him that this was worrisome, but we had to get a CT scan to figure out what it was.

There is not much good that it can be when there is a mass like this. I went over the possibilities - certainly there was cancer as a possibility, but maybe it was just an intestinal obstruction causing what felt like a mass. It was not real tender, so I doubted that an infectious etiology was the cause.

I usually do what I can to minimize the wait for patients in this circumstance. It is tough to say, "I think it could be cancer, but you have to wait until next week to find out." I know that every night of waiting will be sleepless, so I get it the test as quickly as possible. Yesterday I got the surprising news that the CT scan showed "probable diverticulitis." This was a shock to me, as diverticulitis is usually tender to touch on exam. But he reminded me when I called him that he was on antibiotics for his prostate. This was a phone call I was glad to make.

There is a great honor to be able to stand by people during their hardest times. I really find it is one of the more satisfying parts of what I do. But it sure feels good to take a big weight off of people's shoulders. It sure feels good to give good news.

Superstition

Today is Friday the 13th.

Yaaaaaa....!!!! Everybody run for the hills!!!

C'mon, it's just a day, right? Superstition abounds in the human heart. Even though we all realize it is just another day, it doesn't hurt to play it safe, don't you think?

Have you noticed that many buildings don't have a 13th floor? Well, they do have a 13th floor, they just call it the 14th floor. Based on Otis Elevators, nearly 85% of high-rise buildings don't have a 13th floor. In China, some buildings don't have a 4th, 14th, 24th, etc. floor because the word for 4 sounds a lot like the Mandarin word for "death."

So why Friday the 13th? Oldsupersitions.com reports:

Friday the Thirteenth - The Scandinavian's believed that the number 13 was unlucky due to the mythological 12 demigods being joined by a 13th, an evil one, who brought misfortune upon humans. It was also said that Christ was crucified on Friday and the number of guests at the party of the Last Supper was 13, with the 13th guest being Judas, the traitor.

I never knew that!

Here's another explanation:

There is a Norse myth about 12 gods having a dinner party at Valhalla, their heaven. In walked the uninvited 13th guest, the mischievous Loki. Once there, Loki arranged for Hoder, the blind god of darkness, to shoot Balder the Beautiful, the god of joy and gladness, with a mistletoe-tipped arrow. Balder died and the Earth got dark. The whole Earth mourned.

Other Common Superstitions:

• Walking under a ladder brings bad luck
• Breaking a mirror brings 7 years of bad luck
• A black cat walking in front of your path brings bad luck.

So this begs the question: is there any such thing as luck? Certainly from a human perspective it seems that some people seem to have better things happen to them than others. It also seems that there are times that just the right thing happens at the right time. I guess it depends on your world view. If you believe in providence and/or predestination, you believe God controls everything. If you are an atheistic naturalist, you think it is all random. Most people fall between these two and think there are some forces unseen that affect our day-to-day. Astrology is a good example of this.



Which reminds me of a joke:
Q: What did the Calvinist say when he fell down the stairs?
A: "Whew! I'm glad that's over with!"

OK, so I don't really want to get into a debate on the subject, but want to go into some of the stranger superstitions. So here are some odd superstitions:

• It is unlucky to let a pig onto a fishing boat because it will mean that there'll be no catch. I will try to remember that the next time I am tempted.
• It's bad luck to say the word "pig" while fishing at sea. What's with pigs and boats?
  
• Seeing an ambulance is very unlucky unless you pinch your nose or hold your breath until you see a black or a brown dog. What if the dog is driving the ambulance?
• To cure a cough: take a hair from the coughing person's head, put it between two slices of buttered bread, feed it to a dog, and say, "Eat well you hound, may you be sick and I be sound." Huh? Isn't that completely obvious??
  
• Cows lifting their tails is a sure sign that rain is coming. I'd say it is the sign of a bad smell coming.
• Pictures of an elephant bring luck, but only if they face a door. Does the elephant have to face the door, or the picture? What if the elephant is standing sideways in the picture. Do french doors count?
• The dried body of a frog worn in a silk bag around the neck averts epilepsy and other fits. Hey, how come they never taught us that in Medical School?
• If your nose itches, someone is coming to see you. If it's the right nostril, the visitor will be a female, left nostril, male. What if you have three nostrils?
• A wish will come true if you make it while burning onions. Yeah, if your wish is that everyone would go away.
• A spider is a repellent against plague when worn around the neck in a walnut shell. And that, my friends, is why I have never gotten the Plague!
• If a woman sees a robin flying overhead on Valentine's Day, it means she will marry a sailor. If she sees a sparrow, she will marry a poor man and be very happy. If she sees a goldfinch, she will marry a millionaire. If she sees a cockroach flying overhead, she'll marry a lawyer. If she sees a cow flying overhead, it means she is about to get hurt.

I had a chief resident who really thought that there was some sort of cosmic event that happened when you said "gosh, it's really slow tonight" that caused it to become busy. I would tease him, saying "gosh, we haven't had six codes in the same night for a long time!"

Any other odd superstitions?