Blogcast number 5

Two days in a row. Can you believe it? Another non-medicine and kind of introspective blogcast. Robert commented on the volume level of the file. Hopefully, I improved things a little bit. So much so that the computer fan may even be a little distracting on the audioblog. I'll keep working on the technical stuff.

Muddy left a great comment about the reasons why people blog. I reflect a little bit on why I started blogging and why I continue to blog now. The self-reflective aspect was interesting to me, but may not be interesting to everyone who listens. So, I won't be offended if you want to pass on this post.

I'm kind of enjoying the five minute unscripted format of this type of audioblog/blogcast. At least for me, it mixes up the medical commentary I do on the text blog with the personal commentary on the audio blog. We'll have to see how this thing evolves....

Just FYI, the audio file itself is about 7.5MB to download and it is in MP3 format. Enjoy! Here's the link to Blogcast #5.

TB patient in jail

I believe one of the reasons many physicians take up anonymous blogging is to complain about non-compliant patients. If a patient does not follow my recommendations, it's pretty simple. We agree to disagree and I ask the patient to find another physician. Most of the time, that works out.

Here's a story which I find very interesting. It definitely has public health implications, and is sparking quite a debate about an individual's civil rights verses the health of the public.

Robert Daniels has been in an Arizona jail since last summer. (Associated Press) He has not been charged with a crime, but what he does have is a drug resistant case of tuberculosis. It is so resistant, that it is considered untreatable. Why is he in jail? Here's why:

County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.

Though Daniels' confinement is extremely rare, health experts say it is a situation that U.S. public health officials may have to confront more and more because of the spread of drug-resistant TB and the emergence of diseases such as SARS and avian flu in this increasingly interconnected world.

"Even though the rate of TB in the U.S. is at the lowest ever this last year, we live in a globalized world where, if anything emerges anywhere, it could come to our country right away," said Mark Harrington, executive director of the Treatment Action Group, an American advocacy group.

So, the debate is what to do with this guy. On the one hand, you have a non-compliant patient who refuses to be treated. An individual has the right to refuse treatment, right? And, on the other hand, you have someone with a highly contagious disease which is incurable. You let this guy out of jail, and he will definitely infect the public, and then what do you do?

I'm all for personal sovereignty, but if this guy was in my little county jail, there would be no way that I would let this guy out. I mean, he is choosing not to be treated. There are consequences to choices, and I think remaining locked up is a small price to pay for preventing a TB epidemic.

Blogcast number 4

A little bit different post today. Yes, I'm trying audioblogging again. I'm still calling it a blogcast, but I'm not that happy with the name. It's not really a podcast. I've heard podcasts, and this audio file is not as good as some podcasts out there.

Anyway, there's no medicine in this blogcast today. I talk about blogging, specifically, my challenge in trying to keep the blog fresh and not stale with the same ideas/format.

Here's the question I pose on the blogcast: What do you do to keep from getting blog burnout? Take a blog break? Post on different subjects? Sometimes start an entirely new blog?

I close my blogcast by mentioning two of my favorite podcasts. My Three Shrinks: Great information and great banter. I can't wait for the next podcast. The Dashing MD: He's a surgeon in training on the west coast of the US. He has interesting patient stories.

Just FYI, the audio file itself is about 6MB to download and it is in MP3 format. Enjoy! Here's the link to Blogcast #4.

Gmail Paper: April Fools!

Funny stuff from Google/Gmail today. As I log out of my Gmail this morning, I see the ad below. It's worth checking out. Kind of funny....
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New! Introducing Gmail Paper

Everyone loves Gmail. But not everyone loves email, or the digital era. What ever happened to stamps, filing cabinets, and the mailman? Well, you asked for it, and it’s here. We’re bringing it back.

A New Button Now in Gmail, you can request a physical copy of any message with the click of a button, and we'll send it to you in the mail. Simplicity Squared Google will print all messages instantly and prepare them for delivery. Allow 2-4 business days for a parcel to arrive via post. Total Control A stack of Gmail Paper arrives in a box at your doorstep, and it’s yours to keep forever. You can read it, sort it, search it, touch it. Or even move it to the trash—the real trash. (Recycling is encouraged.) Keep it Secret, Keep it Safe Google takes privacy very seriously. But once your email is physically in your hands, it's as secure as you want to make it. Learn more about Gmail Paper

April fool's day

Above: April Fool's Day Joke gone bad. (Cartoon credit) Yes, I know it's tomorrow, April 1st. But, in some parts of the world, it's already April 1st, so there!

I ran into this interesting article on Yahoo news of the top pranks pulled off on April Fool's Day. I haven't heard of all of these, but here are the interesting ones (to me):

-- Sweden in 1962 had only one television channel, which broadcast in black and white. The station's technical expert appeared on the news to announce that thanks to a newly developed technology, viewers could convert their existing sets to receive color pictures by pulling a nylon stocking over the screen. In fact, they had to wait until 1970.

- In 1996, American fast-food chain Taco Bell announced that it had bought Philadelphia's Liberty Bell, a historic symbol of American independence, from the federal government and was renaming it the Taco Liberty Bell.

Outraged citizens called to express their anger before Taco Bell revealed the hoax. Then-White House press secretary Mike McCurry was asked about the sale and said the Lincoln Memorial in Washington had also been sold and was to be renamed the Ford Lincoln Mercury Memorial after the automotive giant.

-- Burger King, another American fast-food chain, published a full-page advertisement in USA Today in 1998 announcing the introduction of the "Left-Handed Whopper," specially designed for the 32 million left-handed Americans. According to the advertisement, the new burger included the same ingredients as the original, but the condiments were rotated 180 degrees. The chain said it received thousands of requests for the new burger, as well as orders for the original "right-handed" version.

-- In 1992, US National Public Radio announced that Richard Nixon was running for president again. His new campaign slogan was, "I didn't do anything wrong, and I won't do it again." They even had clips of Nixon announcing his candidacy. Listeners flooded the show with calls expressing their outrage. Nixon's voice actually turned out to be that of impersonator Rich Little.

-- Noted British astronomer Patrick Moore announced on the radio in 1976 that at 9:47 am, a once-in-a-lifetime astronomical event, in which Pluto would pass behind Jupiter, would cause a gravitational alignment that would reduce the Earth's gravity. Moore told listeners that if they jumped in the air at the exact moment of the planetary alignment, they would experience a floating sensation. Hundreds of people called in to report feeling the sensation.

I've done my share of practical jokes (the good ones I'll never admit to). But, there's always the standard changing the office furniture while someone's on vacation thing. I mean, nothing close to the level of punk'd, but stuff I thought was amusing. Any funny practical joke stories out there?

Happy Doctor's Day

Very funny at the hospital this morning. I walked into the doctor's lounge, and saw this breakfast set up. Don't get me wrong, it was the same continental breakfast stuff that is seen at every morning meeting, but the table was dressed up a little bit and a sign saying, "Happy Doctor's Day!"

Then, walking around the floors this morning, it was hilarious! People everywhere were snickering, "Happy Doctor's Day!" Hard to know who was geniune, and who had a busy night working and they're waiting to give report and go home to sleep.

But, an interesting start to my day. But, hey, it's Friday, and the weather is beautiful around here today. Of course, it's supposed to get cold and rainy tomorrow for the weekend. But, who cares! It's Friday, baby, and maybe this doctor will be able to cut out of the office early. Well.... A doc can dream, can't he? Have a great weekend everybody!

Salmonella Easter Chicks

Did you know that some people give kids little baby chicks as Easter gifts? (Image credit) I had no idea that this was happening. When I was a kid, I was content with an Easter basket with lots of chocolate and sweets in it. And then, the traditional annual Easter egg hunt. Now, that was a good time!

In this Associated Press article, the Centers for Disease Control and Prevention report that the giving of birds to kids, especially for Easter, may carry the danger of salmonella infection. Ew!

"This time of year, when everyone's wanting to give their kid a baby chick or baby duckling, that's when we start to see these outbreaks in people not accustomed to handling farm animals," said Charles Hofacre, a University of Georgia professor of veterinary medicine.

Salmonella is an infection that causes diarrhea, fever and vomiting. The bacteria live in the intestines of chickens and spread through their feces, which can cling to a bird's feet or feathers, even if it looks clean.

Children get sick by touching the birds and then putting their hands in their mouths. Young children are more susceptible than most adults, and those under 5 should not handle baby birds, officials said.

The article goes on to report recent salmonella outbreaks and how some states have passed laws discouraging giving small birds as Easter gifts. Who knew it was so common to give small birds this time of year? I guess I didn't.

So, for those of you out there who observe Easter, think twice before getting that baby chick for that young child in your life -- Better to stick with the Easter bonnet, Easter basket, and Easter candy. You'll be glad you did....

Hummer infatuation

There's nothing in the health headlines that interests me right now. So, I'll talk about this. For the past two weeks, I've kind of been "car sitting." But, of course, what you see above is not a car.

Although I don't know why, I've always been fascinated by the hummer as a production/consumer vehicle. It's completely impractical. I mean, it's huge! It only gets about 14 miles to the gallon. Yet, I've always wanted to drive one.

And, I have for the past two weeks while my friend (my new best friend, HA!) has been out of town on business. She gets back this weekend, when she'll find out that I've only put about a gazillion miles on the thing over the past two weeks.

I'm no car expert, but, to me, it's a nice ride. The color is red, like the picture above, and has black leather seats inside. I've also never experienced satellite radio before. I had no idea that satellite radio has a gazillion stations - but great sound. I could get used to that.

But, after two weeks, I think my infatuation with this vehicle is slowly dwindling. I was very interested at first, but now, I'm looking forward to getting back to my car this weekend. I wonder what this thing can do off-roading? I guess I have a couple of days to find out. HA!

Heart stent unnecessary? Maybe

More news coming out of the American College of Cardiology meeting in New Orleans. Too bad Dr. Wes is not there to give us the inside scoop (he he, just kidding).

The theory with heart stents is pretty easy to explain to patients. The paradigm has been that symptoms of angina, or chest pain, are caused by a slight blockage in the tiny heart vessles (see above - image from here). So, why not open the vessel up with a heart stent and relieve the chest pain. Simple, right?

In this Associated Press article, researchers have found that in people with stable angina, medication treatment (meaning pills) is just as good as having an angioplasty procedure and having a heart stent placed.

It involved 2,287 patients throughout the U.S. and Canada who had substantial blockages, typically in two arteries, but were medically stable. They had an average of 10 chest pain episodes a week — moderately severe. About 40 percent had a prior heart attack.

All were treated with medicines that improve chest pain and heart and artery health such as aspirin, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers. All also were counseled on healthy lifestyles — diet, exercise and smoking cessation. Half of the participants also were assigned to get angioplasty.

After an average of 4 1/2 years, the groups had similar rates of death and heart attack: 211 in the angioplasty group and 202 in the medication group — about 19 percent of each.

After five years, 74 percent of the angioplasty group and 72 percent of the medication group were free of chest pain - "no significant difference," [one of the researchers] said.

The results of this study will be published in the New England Journal of Medicine and will send shockwaves through the world of cardiology. This will be a huge paradigm shift in what is the current thinking.

This will set up a philosophical and academic war between the interventional cardiologist (those that make a lot of their living doing angioplasties and stents) and the cardiologist who do few or no angioplasties. It will also be a business war between the drug makers and the stent makers.

It will come down to this question: When a patient has chest pain, what is the better treatment? Drugs AND stent or Drugs WITHOUT stent? We'll have to see how this plays out....

Now, something I am concerned about is what the press report really passed over very quickly. (Surprised that I'm upset at the press again?) What should be emphasized is that this study relates to patients who are medically stable. Medically stable means not actively having a heart attack or actively having worsening chest pain symptoms right in front of you.

I can see a heart attack patient in the ER tomorrow saying, "I just heard this report saying that an angioplasty and stent are not needed. Plus, there have been a lot of bad press lately about stents anyway. I don't want one."

I want to emphazise that in the emergency situation (meaning heart attack and/or worsening chest pain symptoms) -- Angioplasty and stent placement are not only the mainstay of treatment, they have been shown to save lives. So, interpret these study findings how they were presented -- in medically stable patients -- and don't interpret this as a generalization on angioplasty and stents in general.

Dark chocolate saves lives

Well, not necessarily. But, that made a great title for a post, huh? Anyone that knows me knows that I have a weakness for chocolate - M&M's in particular. And, dark chocolate? Well, in moderation, this is the best chocolate of all.

And, now, I have the data to prove it. There was actually a study presented at the American College of Cardiology scientific meeting in New Orleans. In a six week trial, some study subjects were given dark chocolate and some were given placebo. (Reuters).

"In this sample of healthy adults, dark chocolate ingestion over a short period of time was shown to significantly improve (blood vessel) function," said Dr. Valentine Yanchou Njike of Yale Prevention Research Center, a co-investigator of the study.

"While the findings from this study do not suggest that people should start eating more chocolate as part of their daily routine, it does suggest that we pay more attention to how dark chocolate and other flavonoid-rich foods might offer cardiovascular benefits," Njike said.

First of all, where can I sign up for a study like this? (Call me!). And, second, I can finally feel a little less guilty when grabbing for those dark chocolate M&M's. I'm improving my blood vessel function, you know...