Wednesday, September 10, 2008
Monday, August 25, 2008
Without further warning, here it is:
Sunday, August 17, 2008
I've been in blogging rehab. Everything is okay. It's just that blogging was becoming a toxic force in my life. It was taking up way too much of my mental space. I was checking my hit counter every few hours, planning posts days in advance, writing things when I had nothing to write. And all for no clear purpose other than some narcissistic drive to climb higher in the blog rankings. It was pitiful.
I woke up and realized this, and one day, just quit. With the help of my family, I have been able to successfully withstand the pains of withdrawal, and I thank them for their loving support during this difficult time. I know that even writing this post is dangerous for me, since just a little sip has the power to strangle me in its clutches.
So, I'm not sure what the future holds. For now, I'm chilling out. I may post occasionally, when I'm compelled to share something I think is meaningful or profound, or to stay connected with family and friends in far-off lands. If you're from Saipan and you miss what you've been reading here, heck, call me up and let's go to lunch. You know how to get in touch with me.
Monday, June 30, 2008
How do we, who are having such bad economic times here, stack up compared to the rest of the world? Where are we on the world's economic development ladder? I don’t know much about economics, but these questions were recently asked of me, so I thought I’d find out. Economic development, as it turns out has a fascinating history. Economist, Jeffrey Sachs, describes a four step ladder, as a way of viewing the world in terms of economic development. The first step, which I’ll describe today, is not really a “step” because it’s not even on the ladder. It is “extreme poverty.”
Today one billion people – one sixth of the earth’s population – live in extreme poverty. This "bottom billion" is so economically destitute, that their very survival is at risk on a daily basis. Their lives are fragile. They live with drought, famine, starvation. Any small change can make the difference between life and death – a storm that wipes out meager crops, being struck with a simple disease, but having no access to medicine to treat it, late delivery of food – all of theses sorts of threats are very real, and can mean death to entire populations living in extreme poverty. If there is any income that comes into the hands of those in extreme poverty, it is counted in pennies per day.
For much of human history, the vast majority of the world’s population has lived in extreme poverty. Our ancestors struggled for their very survival, in a harsh world, with a fragile existence. Wealth, above extreme poverty, did not become accessible to common people until the mid 1700’s. It is only since about 1750 that humanity has climbed onto the first rungs of the economic development ladder.
Extreme poverty does not exist in developed countries. It is a condition that afflicts swaths of the developing world. Seventy percent of the extreme poor live in
The tragedy of our times is that such dire circumstances affect one billion of our fellow men, women and children, in a world with such vast resources.
One of the goals of the United Nations is to wipe out extreme poverty by the year 2025, and to cut it in half by 2015. It requires commitment from wealthy nations, but I think it also requires awareness by the rest of humanity that such conditions exist and that solutions are available. The bottom billion require assistance to get on the economic ladder, to move from extreme poverty to just regular poverty. It is a small step, but the most important one in terms of the survival.
Monday, June 23, 2008
Thanks for your kind comments about Medicine for the Outdoors at Grand Rounds this week. You have a great blog. If you ever encounter a marine animal sting for which you need assistance, please let me know - I serve as a consultant to the Divers Alert Network for that sort of thing.
Also, if you get any good photos of stings, eye or otherwise, it would be wonderful to see them, as I am always on the lookout for images for the textbook Wilderness Medicine and other teaching purposes. If you allow a photo to be used in a book, it would be credited as you indicate.
Divers, if you get any good photos, let me know and I'll put you in touch with Dr. Paul.
Sunday, June 22, 2008
This is all over the news in the past few days. A 52 year-old woman in Los Angeles (where else?) is suing Victoria's Secret because while she was putting on her newly purchased thong, a piece of decorative metal flew from it and struck her eye. Her attorney states that it caused "excruciating pain" and that the injury was so severe it required "steroid drops" and that she'll be living with the effects of it her whole life.
Gimme a break. I treat corneal abrasions all day long, and I'll use steroids in about 25% of them, just to get rid of any residual inflammation after the abrasion has healed. It's no big deal.
Every abrasion has a theoretical risk of becoming a "recurrent erosion." The attachments of the corneal epithelium can sort of get weak after the abrasion heals, and there is a chance that during rapid eye movement of sleep (REM sleep), the epithelium will split open again, causing a few hours of pain. Of all the thousands of abrasions I've treated I've had one patient with recurrent erosions. It's most common with abrasions caused by paper and by fingernails.
I know what it's like. I developed corneal erosions after my son poked me in the eye when he was a year old. The abrasion healed over a few days (and yes, it was very painful), but then a few months later, I'd wake up most nights with pain from recurrent erosions. But guess what? You can get the recurrent erosions fixed. I had some laser treatment done on my eye, and I never had a problem again.
So, boo-hoo is what I say. I just can't understand the mentality that sues over a thong induced corneal abrasion. The woman and her attorney are giving interviews on the morning talk shows, including the Today Show. I'm sure she'll get a book deal, which will spill over into a screenplay, a night at the Oscars, and an action hero figure whose secret weapon is a lethal metal-firing thong that gets activated when placed on a wrinkled butt.
Saturday, June 21, 2008
Friday, June 20, 2008
Remember that story about the guy who was wearing his class ring, and went up to dunk the basketball, but got his ring stuck on the rim? Not urban legend. Photos courtesy of this site. Dr. Ramona Bates, over at Suture for a Living, tipped me off to this story (pun intended).
The days are getting hotter here on Saipan. Although we have the most stable temperature in the world, staying right around 85F year round, the sun is HOT this close to the equator, and because of typhoons, houses are built of concrete, which are ovens. The utility is limping along, with power outages rotating around the island all day long to conserve the fuel supply. At the office, we have a generator, so we can keep functioning, but at the house we're in right now, no such luck. Last night, the power went out around 8 PM. I don't think it was scheduled because it was preceded by lots of browning out of the lights. It came on briefly around 10:30 PM, but went out again for the rest of the night. We slept in the sweltering heat, with damp paper towels on us to keep us cool.
Tuesday, June 17, 2008
I’ve always wanted to be a newspaper editor, not because I want to edit, but because I want to write headlines. And not for a respectable paper like the New York Times. Maybe for a newspaper, like the Enquirer -- you know, where an editor can have some creative freedom with the facts. So, finally, I get my chance with this week's Grand Rounds. Sometimes the headlines I’ve written relate to the post, sometimes, they are just a whacked out free associations. Like all headlines, their purpose is to get you to read the posts. I hope I can entice you. There are some really great writers out there. Great job everyone.
Let me know if there are any problems with the links, and let me know if you want to exchange links. Grab your beach towel and snorkel, because here we go... Leave only footprints and comments.
Life is Not Just About Breasts
“What do you think about my breasts?”Random women never asked me that question until I started offering Botox. Now I get it all the time. Let me give you some advice. Don’t even begin to try to answer it. It’s a trick question destined to land you in hot water. Just have your press secretary issue a statement that “The doctor can neither confirm nor deny that your breasts a) are as pert as a pair of saluting Marines; or b) like the jowls of a hound-dog.
If you’ve ever wondered what a set of rejuvenated boobs looks like, drive on down to Arkansas and head to the grocery store with plastic surgeon, Ramona Bates. Her patients may lift their shirts, right there next to the kumquats, just to share with Dr. Bates their joy of a job well done. Read about it, and other awkward plastic surgery moments, at Suture for a Living, on the post, aptly named, Hi!
Indiana Jones and the Kingdom of Malaria
I love Dr. Paul Auerbach’s specialty:“Wilderness Medicine.” Is that cool, or what! Sometimes I refer to myself as a Tropical Ophthalmologist (okay, actually, this is the first time), but I think I’m going to switch to Wilderness Ophthalmologist.
Paul has a great post that gives a fantastic overview of malaria, and links to an article that describes an important drug regimen for the disease. Read about it at Artesunate for Falciparum Malaria
Humanity is Good
Once in a while, I read something on a blog that brings tears to my eyes. Dr. David Loeb, a pediatric oncologist at Doctor David’s Blog, is sure to touch your heart with this post on A Different Kind of Memorial Day. He tells of the annual Memorial Day service held at Johns Hopkins Children’s Center for the families that have lost children to cancer, and the lessons learned.
Humanity is Really Good
I like Susan Palawick. She is an improbably optimistic ED chaplain, who shares a beautifully written portrait of two patients whose encounters renewed her faith in God and in humanity.Renewed Faith
Just When You Thought Humanity Was Good
Can somebody get Bongi an agent? He is a great writer, but he’s too busy opening and closing bellies to put a book together. Someone just needs to go through his blog and put it all together. His post this week, South African Crime, is not pretty in terms of the picture it paints, but like the above two posts, it gives us a peek into the human soul.
Stethoscope Doubles as MP3 Player
Dr. Joshua Schwimmer’s old stethoscope broke, and he reluctantly purchased a new electronic one. He’s a convert and explains Your Next Stethoscope Should Be Electronic. Here's Why.
Bottomless Pits + No Wits = Champion Eaters
A world-class competitive speed eater can put away 60 hot dogs in 12 minutes or 100 hamburgers in 8 minutes. Where do they put it all? (And why?) A recent peer-reviewed radiologic study sheds some light on what it takes to be a champion chomper. The Samuri Radiologist from Not Totally Rad, explains it all on the post Radiology of Competitive Speed Eating
Waiting for India on My Lap
Ian Furst over at Wait Time helps health care providers to decrease wait times and delays. He submits India's Health Care System which looks at the private/public divide in India's Healthcare system and the lessons we might learn in North America.
While you’re on his site, scroll down to Things to do while waiting at the doctors office. Shocking! There is probably some business opportunity in there somewhere.
Is Your Name on This List?
InsureBlog's Bob Vineyard is naming names. He confirms the explosion in diagnoses of ADHD and Bipolar Disorders among children, and names some of the doctors that are fueling the fire, and their payments from drug companies. Drug Money.
Wave of Bad Information Kills Web Surfer
I was impressed with the fact that Dr. Val and the Voice of Reason really is a voice of reason. This week, she writes on How Is Healthcare Like A Garden Fungus?, and points out, “Medicine is incredibly complex, and that a knowledgeable healthcare provider is critical in helping patients successfully navigate the maze. With all the health information on the Internet, it's tempting to self-diagnose. But that's a dangerous proposition - one that might lead you to presume that (to use my analogy) a poisonous mushroom is edible, or that a life threatening symptom is innocuous.”
“Art, this is Death. Say Hello.”
Talk about creative, Christian Sinclair and team have launched a new blog, Pallimed: Arts & Humanities, where palliative care meets the humanities. The underlying concept is that both death and art have been around forever, closely linked to one another. Christian submits a post about a song that discusses dying in the ICU. Included is a video representation of various instruments representing a death in the ICU. (Cool!) Check out, "What Sarah Said" by Death Cab for Cutie: "This presence at the bedside of a dying person can be a demonstration of your love, but it can also tax and exhaust family. A variation on this line ("Love is watching someone die") is occasionally heard from palliative care professionals to allow family credit for the 'work' involved in being present at the deathbed.”
Cool Kid Reject ADHD in Favor of Bipolar Disorder
Did you know that 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including over 20,000 children under age six? What I want to know is, why didn’t anyone tell me? A half-million prescriptions, and not a single one of my four kids was offered the stuff! I feel gypped. Dr. Zhang who is the author of the book, Coackroach Catcher, writes about Bipolar Disorder in Children at Cockroach Catcher Blog. "ADHD was the old black. Bipolar became the new black."
Renegade Diabetics Take Charge of Own Disease
Amy Tenderich hosts the blog, Diabetes Mine, which is “a gold mine of straight talk and encouragement for people with diabetes.” She submits the post, Diabetes... RELOADED, which includes video footage of some of the activities of this group. I deal with diabetic eye disease all day long, and I was encouraged by the innovative vision captured in the post: “Our theme was "Diabetes Reloaded", which stands for redefining not only the role of technology in managing chronic diseases, but also for the newfound self-confidence and ambitions of 21st century people living with health conditions. What’s special about this new web-enabled world of healthcare? It’s proactive, technology-based, empowered, revolutionary, against all odds, and – if needed – outside the establishment.” The blog is a 2006 Winner of LillyforLife Achievement Award for Diabetes Journalism. Congratulations, and keep up the good work.
Patient Prescribes Own Drug. Doctor Does Own Taxes.
And if the internet weren’t bad enough, people are now taking the next step:
picking up the phone, and telling doctors what to prescribe for them.
Read about this wacky patient’s expectations over at EverythingHealth
Got Munchausen’s? AMA Has Jobs Available
Did you realize that the next patient that walks into your office could be a fake, commissioned by the AMA to check the quality of care you provide? David Williams at Health Business Blog delves into the controversy, Do we really need mystery shoppers in health care?
Pharmacist Sleeps with Drug Researcher; Takes pill to blunt remorse
This doctor has one of the best named blogs ever: The Blog that Ate Manhattan. She takes on Big Pharma yet again, this time noting that Care/CVS seems to be in bed with Bayer. She parodies the "Dear Doctor" letter used to get new drugs to the medical community. A very interesting discussion in the comments section, in particular the input of a Pharma commenter who tells it like it really is in the business of making and selling drugs.CVS/Caremark – Detailing for Bayer?
Blame Informed Patient on Doc Gurley
When your next patient comes in and has a normal fasting blood sugar, then insists that you order a HbA1C, will you wonder why? It’s because they read Doc Gurley’s post, Blind Men and the Diabetes Elephant. She takes a look at this week's mammoth-sized news in diabetes research. Like the fable of six blindfolded men who tried to describe an elephant ("it's a snake!" "it's a tree!"), lots of news reports only got hold of one isolated piece of the action. Her post shows how three different news items, when viewed together, take on pachyderm-sized importance for all of us - diabetics or not.
Poor Ethicist Gets Spanked by Doctor Rich
The Right Way to Think About Medical Ethics, appears on The Covert Rationing Blog. In this post I take medical ethicists to task for promulgating a new utilitarian system of medical ethics that is a) absurd, and b) destructive; and, not wishing to leave the poor souls completely adrift (which would be unethical), Dr. Rich kindly offers for them a system of ethics that both honors the needs of society, and restores the classic doctor-patient relationship.
End Years of Debt-Free Living: Go to Medical School
Why do so many doctors struggle financially? Theresa Chan posts MEconomics, Part Two: The Long Reach of Med School on her blog Rural Doctoring. "Part Two of this series on physician compensation and my personal bottom-line addresses where all the difficulties begin: with medical school debt. Let's walk through the process of accumulating educational debt and estimate whether the published averages tell the whole story."
Cheech and Chong Appointed to Judiciary
Have I been away from America so long that I missed the legalization of medical marijuana? When do you prescribe marijuana? When not?. Theresa Chan at Rural Doctoring shares her opinion in 15 Minutes of Fame: Medical Marijuana in Rural, CA. "For the record, I support medical marijuana use for those patient populations for whom it was originally intended: for cancer and AIDS patients, in order to suppress nausea and promote appetite, and modulate pain symptoms. I have worked with these patients as a physician and a hospice volunteer, and I do believe marijuana is helpful for the nagging symptoms of people facing the end of life. However, I do not believe that marijuana should be recommended generally for chronic diseases such as…” Read the post to find out more.
Man’s Jokester Friends Name Womb Disease After Him
Dr. T posts on "Asherman's Syndrome" which is a condition related to scarring of the intrauterine cavity, usually as the result of a failed pregnancy and a D&C in the presence of infection; or another intrauterine surgical procedure, that causes hypomenorrhea or amenorrhea, infertility, and recurrent pregnancy loss as well as other pregnancy complications. It is more common than most women realize.
Ferret Diagnosed with ADHD; Parents overjoyed
This is actually a very important post. David Rabiner outlines Promising Cognitive Training Studies for ADHD. "Results from these two cognitive training studies highlight that cognitive training interventions may provide an important complement to traditional medication treatment and behavior therapy. Both studies included appropriate control groups, employed random assignment, and had outcome measures provided by individuals who were "blind" to which condition children were assigned to. They are thus well-designed studies from which scientifically sound conclusions can be drawn. They add to the growing research base that intensive practice and training focused of key cognitive skills can have positive effects that extend beyond the training situation itself."
One Should Always Have a Penguin When Needed
I didn’t even make that headline up! It’s the description of the blog, Prn Penguin. I will now start contemplating when a penguin might come in handy. In this outstanding and comprehensive post, the author gives a detailed overview of How to survive your practicum placement as a nursing student. It is also useful information for medical students, job applicants, and humans of all varieties.
That Dang Medical Records Department
Home of the Brave submits Where Are The Ellis Island Hospital Medical Records? Did you know that Ellis Island had a premier large scale hospital and contributed to major public health advances? Help solve one of its tantalizing mysteries by searching for its missing patient records and registration logs. Ten thousand patients, 3500 deaths and over 300 births, plus countless successful treatments and discharges to a new world and new lives are a testament to the hospital and its USPHS physicians and nurses.
Four out of Five Doctors Smoke Camels. (The other one smokes goats.)
I learned something by visiting Peter Zavislak’s blog, Medical PasticheI learned that a Pastiche is a pie made of many different ingredients. I did not know that. The purpose of his blog is to present medical economic analysis, personal experiences within the field of medicine, somewhat-interesting medical factoids, and slightly-humorous tongue-in-cheek medically-themed comic relief. You can find all of this in his post, "'What Cigarette Do You Smoke, Doctor?'", which looks at advertising in the 1950’s.
ER Nurse Strikes Patient
“She was telling me a story about one of her grandchildren when she stopped mid-sentence and said "oh" followed by seizure like activity. I was stunned into immobility for what seemed like an eon but really was only a second. The monitor showed v-fib, a lethal heart rhythm where the heart quivers like jello without pumping any blood. Basically the patient in v-fib is dead and will stay there unless something is immediately done.” Read more about what comes next at ERnursey, under the title, When the Precordial Thump Works
Controlling Your Urge to Control
Laura Edwards is “a 28-year-old writer and college writing instructor trying to balance multiple chronic illnesses (PCD, bronchiectasis, celiac disease, etc) with, you know, the rest of my life.” She submits In Control which explores the relationship between control and chronic illness.
Coke Shares Plummet; Rival bottles water
Nancy L. Brown, PhD writes about Sugar and Soda Free Summer. "The SF Bay Area is gearing up to have a "Soda Free Summer!" Six counties are being encouraged by the public health department and many community-based organizations to learn about the health risks associated with soda consumption and help families avoid soda."
Uninsured Mob Threatens National Security
“So now in addition to 47 million people without any health insurance at all, there are 25 million more who have health insurance but don't really have access to health care because they cannot afford to pay the high copays and deductibles on their policies. So all told that's 72 million Americans who are likely to skip routine health care and recommended non-emergency treatment because they don't know how they'll pay for it.” Read more about this outrage at Colorado Health Insurance Insider’s post, Number of Underinsureds Rising Rapidly
Canada and Australia are Different Countries?
I once made the mistake of telling an Aussie that I thought he was from Canada. He never called me "Mate” again.v(What a relief.) No such luck for Vitum Medicinus, a Canadian medical student, who tells readers of his experience shadowing a doctor in Australia, and how medicine down under differs from what he's seen in Canada. Read about it at Vitum experiences medicine down under!
From Pulp to Electrons
Are you thinking of converting to Electronic Medical Records?DrPenna discuss about advantages and disadvantages of Electronic Medical Records and his experience using them in his hospital.
“Few things in medicine are harder than trying to explain to a patient that you don’t understand what is going on.” Thus begins The Mormon MD's post, My Entire Life, where he writes, ” The art of medicine is learning solutions that don’t always involve causes. Beyond that, patient’s are not as passionless and rational as textbooks. This can be a hard thing for a scientist. After all rationality is the only virtue that matters in science. Emotions will only get in the way. On the other hand, The doctor patient relationship is deeply complex, much more that say, mechanic and automobile, or scientist and experiment.”
More Serious Feelings
In Sickness & In Health is a place for couples going though an illness experience - to find resources and advice, hear stories, and discover support. Whether the illness is chronic or acute, the result of disease or accident, couples can learn strategies for coping with the changes illness brings into our relationships and our worlds. The information provided in this blog is for educational and support purposes only. It should not be used as a substitute for seeking professional care. This weeks submission, How to Have the Hard Conversations discussed how to stay connected to your sweetie when he/she wants to go to the movies and all you want to do is lay down in a dark room with a heating pain?"
Vermox Stockpile Available
Frankly, I’m relieved to learn that Global Warming is occurring. All this time, I thought it was Global “Worming,” and was preparing for that. Fortunately, medical student Thomas Robey has a better handle on things. At Hope for Pandora, he has been considering how the lowest rung on the medical hierarchy can reduce medical procedures' carbon footprint. His latest target is the operating room. He gives tips for Reducing and Reusing, if not Recycling in the OR. For example, "If you salvage the batteries from each suction irrigator used for ectopic pregnancy or cholecystectomy cases you assist with, you'll amass 10 hours of digital camera usage per irrigator, or put another way, a lifetime powering of remote controls per surgery clerkship."
Radical Canadian Editors Blog
The editors of The National Review of Medicine have their own blog. That sort of thing is apparently allowed up there in Canada. This week they discuss, Should we screen women over 70 for breast cancer? (Just don't mention "rationing")
Neurofibromatosis Headlines Are Tough to Write
alter Jessen at Highlight HEALTH briefly reports on the 2008 Children's Tumor Foundation Neurofibromatosis (NF) Conference, the preeminent annual meeting of NF researchers worldwide, and describes the three distinct types of neurofibromatosis. Neurofibromatosis: From Genes to Complications to Treatments
Neighborhood Masochist Buys New Suit
Apparently, someone has developed a suit that mimics the pain of osteoarthritis.Read about it at Simulation Suit To Feel the Pain of Osteoarthritis . Visit the blog, The Fitness Fixer “to see how to move in healthful positioning so that your exercise is healthy rather than injurious. You don't need to get treatments, or adjustments, or surgery, or shots, or medicines. It is a win-win situation where you do not have to give up favorite activities, and can become healthier than before. Just use healthy movement as part of normal daily life and get free exercise, better physical abilities, and stop the processes that cause injury, all at the same time.”
D is for Depression
Vitamine D for Depression in the Elderly? Dr. Shock points out that a large population-based study found an association of depression status and severity with decreased Vitamin D (serum 25(OH)D) levels and increased serum parathyroid hormone (PTH) levels in older individuals. Causes of vitamin D deficiency in the elderly are: less sun exposure as a result of decreased outdoor activity, different housing or clothing habits, and decreased vitamin intake. The question remains whether the vitamin D deficiency is secondary to depression, or is depression the consequence of poor vitamin D status.
Cut from the Same Clot
The folks at Clinical Cases and Images - Blog submit Video Interview with Tim Russert's Doctor -- Cause of Death Was a Fresh Clot in LAD. The site also has useful information on studying for cardiology boards, the Mediterranean diet, and how to use Google Blogger’s schedule feature.
How to Get a Hot Body Without Resorting to Kidnapping
Crank up your metabolism, baby! Tara Gidus, who is the team dietitian for the Orlando Magic, gives 10 tips on increasing your metabolism (which is going to help you lose weight) at Turn Up The Heat
Dean Moyer of The Back Pain Blog shares a response to one reader's question about Mysterious Morning Neck Pain. In this post he attempts to reassure his readers that most neck pain is not serious and gives them some guidelines for what they should do about it. For example, "… the most common cause of neck pain is muscle or ligament strain ... In most cases the pain will subside within two to ten days without medical attention. However, if it lasts longer than that, you should see your doctor."
Thanks again, everyone for your outstanding submissions. Join the gang next week for Grand Rounds, hosted by My Three Shrinks. The theme will be the upcoming iPhone 3G.
Saturday, June 14, 2008
I'll be going along to enrich their experience. What a job description.
Last week, we unearthed these Balinese masks in the back of his car while trying to uncover a stroller.
Friday, June 13, 2008
Wednesday, June 11, 2008
I watched my team play last night, which was immensely frustrating. I want to be out there!
I also keep lobbying for a year-round co-ed league. The men's league, women's league and national teams absorb the better players during the rest of the year, but there are plenty of us in the co-ed league that aren't competitive enough for those leagues. We want to be able to play soccer year round too. Come on, NMIFA, let this be the year-round league for the rest of us.
Tuesday, June 10, 2008
Here are the guidelines:
1. Start submitting your posts to me via email: david (at) MarianasEye (dot) com. Please put GRAND ROUNDS in the subject line. The deadline is Monday June 16 at 12 noon, EDT.
2. Instead of sending me the URL of your blog and the post, please send me the hotlinks. So, instead of http://marianaseye.blogspot.com, you would send Marianas Eye. And for the post, instead of http://marianaseye.blogspot.com/2008/06/medical-whores.html, you would send Medical Whores. It will make hosting a quantum leap easier.
3. Send me a blurb about your post, or a key quote from the post that you think summarizes the content.
4. If you want to increase your Google juice, let me know that you're adding me to your blogroll, and I'll reciprocate.
I'm looking forward to reading your posts, and putting them all together. Let the submissions begin!
Monday, June 9, 2008
Saturday, June 7, 2008
We bought bikes for the two older kids, and I found out that if you want to put a bike on a plane, you have to have a box for it (or buy one from the airlines for $30); you have to be able to put the bike in the box which requires having the tools to take off the pedals and the front wheel; and you have to pay another $30 to get it on the plane. Given this combination of impediments (we rode the bikes up to the checkout counter), the bikes are still in Guam.
Thursday, June 5, 2008
When the preconditions of basic infrastructure (roads, power, and ports) and human capital (health and education) are in place,
Let’s take a closer look at this dense statement, that gives a very simple formula for economic success of a people. Development requires the combination of human capital (which consists of two parts – health and education) and basic infrastructure (which consists of three parts – roads, ports and power). Here on Saipan we lack reliable power, and therefore, we simply lack one of the key elements required for development. The lack of power is not just an inconvenience. It changes our status as a developed jurisdiction
Wednesday, June 4, 2008
Monday, June 2, 2008
The last conference I attended, a panel of such MD-whores got up and spent 45 minutes extolling the virtues of Retasis drops (a formulation of cyclosporin used to treat dry eye). Any question that came to them was answered unequivocally in favor of drug company, their almighty pimp.
"How long do you recommend using Retasis?" "Indefinitely."
"It's indicated for severe dry eye, but do you recommend it for mild dry eye too." "Absolutely."
"Are there any other indications for its use?" "It can help with scraped knees and pimples, too."
"Is there a shower outside this room, because I feel pretty dirty just listening to you guys." "Sure, first door on the left, and make sure you use the Retasis shampoo."
Why we doctors continue to attend industry sponsored CME luncheons just to listen to these medical whores is unknown. Oh, wait, it actually is known. We're such a cheap lot, we'll do anything for a free lunch, as long as the salad has nice crisp croûtons. Next time I go to one of these conferences, I'll hang a sign around my neck that says, "Will buy your drug for food," which is its own variety of medical whoring.
Just to give an idea of the scale of this disaster, as of 27 May, 68,109 people had been left dead, 364,552 injured, 20,790 missing and 15 million displaced of which five million are homeless. Five million homeless. Wow.
The massive earthquake also spawned the formation of 34 "quake" lakes, formed by rivers blocked by landslides. Water levels are rising, rains are coming, and an additional 1.3 million people in these areas are now threatened by floods.
The IFRC has issued a report, which is about 15 pages long, includes photos, the budget, and various other facets of the recovery plan.
Give while you can. Donations can be channeled through your national Red Cross societies. Click here to donate through the American Red Cross.
Sunday, June 1, 2008
As the Elephant Man famously cried, "I am not an animal! I am a human being!"
(For those of you who feel "David" is too intimate, or that it doesn't appropriately reflect your esteeem for me, I'll give you a break. You can call me "dk," which my staff does, or alternatively "Dr. K" or "Dr. D." See how flexible and accomodating I am.)
Saturday, May 31, 2008
Friday, May 30, 2008
I like the premise – find people who are change-makers, who know their communities and their problems, who are creative in coming up with solutions, and support them so they can make it happen. It’s a beautiful concept.
I do have a little bit of a different perspective, though. I think that more attention needs to be given to the average person, who doesn’t see himself or herself as a social entrepreneur. I think that the kind of change that the world needs will happen when every common citizen starts to recognize and unlock their own potential. My visit to Hopwood junior high still haunts me – all that potential, hidden even from the eyes of those who possess it. I wonder what are the keys to unlocking that potential. It has to be some combination of attitudes, insights and skills, both practical and spiritual.Any ideas on unleashing this potential in the common citizen?
Thursday, May 29, 2008
As far as I can tell, the resistance to the monument ultimately comes down to a certain psychological stance that is explained in Bornstein's How to Change the World (who is quoting from O'Toole's Leading Change).
Resistance occurs when a group perceives that a change in quesiton will challenge its "power, prestige, position, and satisfaction with who they are, what they believe, and what they cherish....The major factor in our resistance to change is the desire not to have the will of others forces on us."
I had a chance to sit down with my favorite French-Canadian general surgeon yesterday, and just chat. Carl is finishing up his stint at CHC, and his departure is a loss to the people of the CNMI. Last week Carl gave a presentation on his year in
Carl was there with an international aid organization. He was part of a three member team that consisted of a surgeon, an anesthesiologist, and an OR nurse. The project aimed to identify local people who would spend a year with them, get trained in how to be a surgeon, an anesthesiologist, and an OR nurse, and then head back into their provinces to provide service. The aid organization sent 21 of these teams throughout the country. Ideally, by the end of the year, there would be 21 local teams prepared to provide services to their people.
Carl had planned on spending his life doing humanitarian surgery. But his experience so disillusioned him, that he’s taken a break from pursuing that as a career.
He told me about how much difficulty he had when he was applying to various international agencies. He was offering his life to them, for free, and only one agency could accommodate him.
He told me that throughout
He told me that the organization he worked for failed to take the local situation into account. They sent these fancy autoclaves to sterilize instruments – fancy because they had microprocessors with them to control the sterilization process. But the chips were set for sea-level, not for the elevation of
He told me that they used sutures at the central training hospital that would never be available in the provinces.
A year after his departure, of the 21 teams that were trained, only three were still functioning. That’s better than nothing, but it doesn’t make for a success story, especially considering the talent and dedication that poured in the way of the volunteer surgeons, anesthetists and nurses, who gave a year of their lives for this project.
It again points out the need for development projects to be decided locally, on the ground. For people to become empowered to identify their own problems and create their own solutions and seek the assistance they need. Development projects imposed from the outside are simply folly.
Wednesday, May 28, 2008
Easterly's perspective is balanced by The End of Poverty: Economic Possibilities for Our Time by Jeffrey Sachs. This book extols the power of aid, and is written by the architect of the UN's Millenial Plan to end poverty by 2025.
I knew these books were at opposite ends of the ideological spectrum, and thus thought they both deserved my attention. Both are by well-respected experts/economists, experienced in aid and poverty issues.
Not wanting to get bogged down by too may graphs (which both books have), and also not wanting to get overwhelmed by the massive scope of problems that these two books are sure to address, I also ordered a couple of very practical books.
Creating a World Without Poverty: Social Business and the Future of Capitalism is by Muhammad Yunus, who won the Nobel Peace Prize for his work in "micro-finance." He has shown that the world's poorest people are outstanding credit risks, and that loans as small as $10-20 can break the cycle of poverty by allowing poor families to start their own businesses.
The one I'm reading now, How to Change the World: Social Entrepreneurs and the Power of New Ideas, Updated Edition by David Bornstein, is a collection of accounts of social innovators who through their persistence and dedication to an idea, have changed the world. I'm finding it a fascinating read. I love learning about things I know nothing about. So far, that's included rural electrification in Brazil, child protection in India, and the development of the EPA's "bubble" policies in the 1970's upon which concepts like carbon exchanges have been built. The first few chapters explore the qualities of the people who bring about these sort of social changes. I'll write more about that later.
Monday, May 26, 2008
I saw a woman recently who had blurred vision that was getting worse over a few weeks. Looking inside the eye, it looked perfectly normal, but the vision was profoundly reduced. The vision in the other eye was normal. When the eye looks normal, and the vision is reduced, then there is something behind the eye causing the reduced vision. But where?
Well, the first step in finding the location of the lesion is to perform a visual field exam. The eye chart measures your straight ahead vision, but not your peripheral vision. You might be able to see 20/20, but you might be looking through a tiny tunnel of lost peripheral vision. A visual field test checks the peripheral vision. You look straight ahead while lights of various intensities pop up in different areas of the peripheral vision, and every time you see one of those lights, you press a button connected to a fancy computer. The computer maps out your visual field.
They eyes are wired in an interesting way. All the information from the retinae of each eye gathers into the optic nerve of each eye and takes off to the brain. But then, once just inside the brain, a funny thing happens. Some of the fibers from each eye cross over to join fibers from the other eye. They "decussate" in a place called the "optic chiasm." The result is that if there is a problem behind the optic chiasm -- after the fibers have crossed -- say, on the right side of the brain, both eyes (not just the right eye) will manifest a visual field defect since fibers from the left eye have crossed over to the right and are being affected by the lesion in the brain. The wiring is so specific that you can even tell how far back the lesion is by the type of visual field pattern loss in each eye. If the damage is in front of the chiasm, the fibers haven't yet crossed over, and the field defect will show up in only one eye.
I'm thinking this as I examine this woman, and I know that in order to find the location of the lesion, I need to know the visual fields of the unaffected eye. Because if the visual field is normal, the problem is in front of the chiasm in the optic nerve of the abnormal eye. If the visual field of the good eye has a defect, then the problem is in the brain. Got it?
I get the visual field. The bad eye is totally wiped out. The good eye is completely normal. That pretty much clinches the diagnosis. Her lesion is in the optic nerve, and in a woman her age, the likely cause is optic neuritis -- actually a specific variant called "retrobulbar" optic neuritis in which the inflammation is behind the eye, not in it, therefore when you look in the eye it looks normal. The maxim for retrobulbar neurtiits is "the patient sees nothing, and you see nothing."
So she has this variant of optic neuritis. What causes optic neuritis? The most likely cause for her is multiple sclerosis -- a lousy diagnosis, but one you want to know about. The next step is to get an MRI of the brain, because the brain in MS has characteristic plaques that light up on the MRI. The MRI won't change the outcome of the optic neuritis, but it helps the patient plan for their future if it is MS.
Problem: there is no MRI machine on Saipan. The closest one is on Guam. I could get a CT here, but it might not show anything, which might mean that the MS plaques may still be there, but CT couldn't see them. If the CT is positive, it helps, but if it's negative, you just spent $800 of her money unecessarily. She makes her way to Guam and gets the MRI.
And this is what can scare the snot out of you. The MRI results come in, and it doesn't show the characteristic MS plaques. It shows a tumor the size of a fist in her brain, back behind her optic chiasm where it should have shown an abnormality in the visual fields of both eyes. Everything that I thought was right, is just plain wrong. There is no way the visual field can be normal in her good eye with a tumor this size, but it is. It's likely that the tumor itself isn't actually causing any visual field problems. The MRI shows the tumor cells have infiltrated down one of her optic nerves and is choking it to death. Thus, only the vision and the visual field in one eye is abnormal. Her body isn't following the rules. But I am.
And the most scary part is that when everything pointed to optic neuritis, I was tempted to save her the trouble and expense of going to Guam for the MRI and just admit her to CHC and treat her according to the guidelines of the optic neuritis treatment trial. That's the sort of thing we often do on Saipan where resources are limited, and people can't afford to go off-island for further testing. If she hadn't been able to go to Guam, I would have done exactly that -- treated it as MS -- and thought nothing of it, confident in the information the human body was conveying to me. What a disaster that would have been.
Sometimes, you don't conquer disease. Sometimes you just accidentally trip over it and it dies. In the instant that you realize how close you were to making a deadly mistake, you find yourself totally humbled. The tumor was found, and she's going for neurosurgical treatment, but it was just dumb luck.
I keep replaying the events, the decisions, wondering what to do differently next time, and really, there isn't much, other than to realize that the body, sometimes will smile coolly at you and just lie with the deepest deception. And there's no way to know of its betrayal, other than with luck and the help of angels.
The other method is "net metering." You buy the solar panels or windmills, but your house is still connected to the utility. The power you generate is gets fed into the city power grid. If you don't generate enough to meet your needs, you get the extra you need from the utility. If you produce more than you need, you feed it into the grid for others to use, and the utility pays you for the power. The excess feeds through your meter and runs your meter backwards, thus the term "net metering". With this method, you use the grid as your "storage" so you save the cost of batteries. Of course, without storing the power yourself, when the CUC power goes out, yours does too.
The fact that we have this net metering law opens some huge possibilities for the consumer to bring down the power rates and also to contribute to power generation for other customers. The glitch for us has been that although the law has been passed, the regulations that define the practicalities of implementing the law have yet to be written.
I fired off an email to an undisclosed source close to the issue to find out about the status of the regulations. Here is a summary of the reply I received. It looks like we're getting close.
The net metering regs are being drafted right now. They are a blend of regs from a US green power NGO and 3 or 4 states. The adminstration is committed to making net metering happening, so that the private sector can help CUC meet its customers' needs cost-effectively and reliably. Oil will soon become unaffordable to small markets like the CNMI. We will need the sun, the wind, the ocean and geothermal resources to power our lives.
Sunday, May 25, 2008
I'm not sure why I seem to be bursting upon the national scene at the moment. There was the recent interview by Ophthalmology Times, and now this piece that appears in Retinal Physician. There is also an upcoming story in Ophthalmology Management.
I'm trying to raise some money for a scholarship fund at Brilliant Star School, to allow low income children on Saipan to attend the school, so I'm hoping that the stories will lead to some benefactors. In any event, it seems to be my fifteen minutes of pseudo-fame. I can't say "fame," because, after all, these may be international magazines, but really, they're ophthalmology publications. In the Retinal Physician magazine, I'm wedged between stories titled "Antecortave Acetate Has New Target" and "OPKO Gets Key Patent for siRNA Drugs." The subtitle of the second piece is -- and I'm not making this up -- "But Controversy Erupts Over siRNA Concept." That context very nicely sums up the level of my fame.
I recently found out that the title of the story is a play on words from a 1970's sitcom called "Our Man in Rataan" about a journalist assigned to a god-forsaken post at the ends of the earth.
The best part of the story is where they refer to Marianas Eye Institute as "one of the best-equipped eyecare practices in the Asia-Pacific region." That's something Saipan can be proud of.
Dr. Khorram Finds His Tropical Island
David Khorram, MD, who received his retina training during residency at Northwestern University under Lee Jampol, MD, is the only ophthalmologist on the Pacific island of Saipan. Dr. Khorram passed up a retina fellowship because he wanted to practice in a part of the world that had a great need for an ophthalmologist. After doing some research, he chose the Pacific islands, and after a year practicing in American Samoa, he made his way to Saipan.
Over the course of the past 15 years, Dr. Khorram has built the Marianas Eye Institute into one of the best-equipped eyecare practices in the Asia-Pacific region, providing a wide range of both retina and general ophthalmology procedures.
He is also active in civic activities on the island, writing a weekly newspaper column and organizing a national soccer team [I think this is a reference to being a founding board member of NMIFA]. He recently published a collection of his columns in a book titled, "World Peace, a Blind Wife, and Gecko Tails" (available through Amazon.com). Dr. Khorram and his wife, Mara, have four children ages 3, 5, 7 and 9.
Dr. Khorram reports that he sees "a ton" of diabetes-related eyecare problems but almost no cases of macular degeneration, which he attributes to the island's relatively young population as well as genetic factors.
Saipan, which is located about 120 miles north of Guam, is the capital of the United States Commonwealth of the Northern Mariana Islands and has a population of approximately 60,000, many of whom are contract workers and not permanent residents.
The island was the site of fierce fighting in World War II as the United States established a base on Saipan for B-29 bombers that could reach the home islands of Japan.
Friday, May 23, 2008
I wrote to one of my buddies who is an executive with the American Red Cross, and here is his response, with guidance on how to donate.
Like you, I’m always a bit suspicious of anyone who tells me to “wire the funds” As you can see from news reports, the RCSC [Red Cross Society of China] has collected over a ½ billion USD’s thus far and fundraising hasn’t really started yet. American Red Cross had such a huge surge of donations for
that they’re not asking for, or establishing a campaign to raise money. China
The complexities of these relief operations are staggering. Global interest peaks for about 3 weeks, and then the disaster is relegated to just another terrible tragedy. The readiness capability of each Red Cross Society often reveals itself when a huge event like this occurs.
is in relatively good shape with a strong Red Cross infrastructure and literally millions of volunteers. They consistently operate within Sphere, IFRC [International Federation of Red Cross and Red Crescent Societies] and WHO standards. The Burma Red Cross is less fortunate having to operate under military rule and limited access to outside resources. China
Personally I would give to the IFRC directly. They can then push the funds to
in a manner that makes sense. One advantage of giving to the American Red Cross is that the donation would be tax deductible. I don’t think the IRS provides this benefit to a donation made directly to China or through the IFRC. China
1. Development projects work best when individuals at the grassroots set out to identify and solve their own problems, not when outside agencies and individuals come in to identify and solve their problems.
2. The most meaningful forms of development projects are those that unlock the capacity of the individual at the grassroots to do exactly that -- to believe in their own potential to address their own problems, and to develop the moral capacity to do so in a just and honest way.
3. Lack of money is usually not the biggest problem. There is lots of money and international aid available. The challenge is spending it in a meaningful way, and again, it goes back to having individuals within communities identify the meaningful ways to address their social and economic problems.
"The happiness and pride of a nation consist in this, that it should shine out like the sun in the high heaven of knowledge... And the honor and distinction of the individual consist in this, that he among all the world's multitudes should become a source of social good. Is any larger bounty conceivable than this, that an individual, looking within himself, should find that by the confirming grace of God he has become the cause of peace and well-being, of happiness and advantage to his fellow men? No, by the one true God, there is no greater bliss, no more complete delight."(Abdu'l-Baha, The Secret of Divine Civilization, p. 2)
Tuesday, May 20, 2008
Tuesday, May 20th, 11:45am – Hyatt Giovanni’s Restaurant
William Aila will speak to the Rotary Club of Saipan
Tuesday, May 20th, 5pm-6:30pm – Hawaii Bar & Grill, Garapan
Meet & greet for Jay and William to meet project supporters
Tuesday, May 20th, 7:15pm – American Memorial Park Auditorium
Presentation to Saipan Fisherman’s Association by Jay Nelson with special guest William Aila
Wednesday, May 21st, 7:00pm – John Gonzales Show, KSPN Channel 2
General introductions and project information the first half-hour followed by a call-in Q&A in the second half hour
Thursday, May 22nd, 7:00am – KZMI Radio Talk Show with Harry Blalock
General introductions and project information with Jay Nelson and special guest William Aila
Thursday, May 22nd, 6:00pm - American Memorial Park Auditorium
Presentation to general public by Jay Nelson with special guest William Aila
Director - Global Ocean Legacy for Pew Environment Group. Ocean Legacy originated as an outgrowth of work done by Pew in 2005–2006 to support the creation of a fully protected marine reserve in the northwestern Hawaiian Islands. Partners supporting Ocean Legacy include Pew, the Sandler Family Supporting Foundation, the Oak Foundation, and the Robertson Foundation. Inspired by this success, the Pew-managed Ocean Legacy project is dedicated to establishing, globally, over the next decade, at least three to five large, world-class, no-take marine reserves. Ocean Legacy marine reserves will provide ocean-scale ecosystem benefits and help conserve our global marine heritage.
William is a long time harbormaster on the Waianae coast of Oahu and commercial fisherman. He is well-known as an advocate for indigenous Hawaiian rights works closely with the group Na Imi Pono. In 2006 he ran for Governor of Hawai'i in the Democratic primary. William was intimately involved in advocating for the protection of the NW Hawaiian Islands for Native Hawaiian cultural and religious reasons from the late 1990's through today. He remains active in decisions about the management of the NW Hawaiian Islands today. William is very familiar with fisheries management in the Pacific through his more than ten year’s service on various Wespac advisory panels.