tag:blogger.com,1999:blog-66234156893140870262024-03-15T22:31:11.919+10:00Marianas EyeA Saipan blog about life on a tropical island through the eyes of “not your average" eye surgeon. Here find island adventure, food, culture, humor, travel, medicine, and random thoughts about living a fulfilling life (along with an occasional gory eye picture thrown in, just to keep things fresh.)Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.comBlogger304125tag:blogger.com,1999:blog-6623415689314087026.post-31425857505894513352016-10-27T22:33:00.003+10:002016-10-28T17:55:11.114+10:00Eulogy for My Father<div dir="ltr" style="text-align: left;" trbidi="on">
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Dr. Houshang Khorram</h2>
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It is a very difficult honor to have, to share with you some thoughts about my father, and his life. He led a life so full, and so full of service and dedication to this community, that it is simply moving. My father had a tender heart. He would be moved to tears, and his voice would quiver by anything that brought love. When he was preparing to retire a year ago, as he was wrapping up the last months of his life as a pediatrician, he told me he would shed tears every day – families would come into his exam room and cry at his coming retirement, and he would cry with them. For several months, he put off accepting the invitation to the retirement party the hospital wanted to hold for him, because he knew it would be an emotional evening. Now, unfortunately, I inherited my father’s heart. My children tease me about the emotion that wells up within me about the simplest things. I’ll say, “This is great popcorn,” and they’ll say, “Are you going to cry?” So today, of all days, these emotions are sure to well up. If I have difficulty speaking, bear with me, and know that this is a bit of my father coming through. Mine are not tears of sadness but of love, and fullness, and celebration of a wonderful life.<br />
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Middlesboro knew my father first and foremost as a beloved pediatrician. He grew up in Iran, in Yazd, during the 1930’s and 40’s. Yazd was probably not that different from Appalachia at that time – poverty, disease, needless suffering. And my father chose to tackle these issues by studying medicine. He was accepted to university in Shiraz, where during his medical studies he met my mother, who was a nurse. They married, they had a son, and they moved to the United States where this promising young doctor continued his studies at Johns Hopkins University. And a daughter was born. To stay in the United States, my father had to go where doctors were needed, and he came to Eastern Kentucky. He practiced medicine for 50 years, and forty six of those years were spent here in Middlesboro. Over the past few days, the tributes have poured in from this community – words like: “He was one of a kind. Touched so many lives and the little ones he took care of so tenderly for so many years.” “I loved him… He saved my baby girls life.” “Our grandson was a baby and had just started talking when we'd taken him to see Dr. Khorram. As he was leaving the room our grandson said, ‘I love you, Dr. Khorram.’ Dr. Khorram stopped, turned around and came over and hugged him. Our grandson really loved Dr. Khorram! He's 19 and would drive himself to go see Dr. Khorram when he was sick!”<br />
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This was my father. A kind, gentle man, who spent his life caring for children. There is no possible way I can capture all of the feelings that have been expressed about his passing, and I don’t think I need to, because, after all, he was a part of your lives and a part of your hearts. What can I say, that you do not already feel deeply yourselves?<br />
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Although he must have known the impact he had on this community, he never talked about it, never acknowledged that he was even aware of it. You see, he was just thankful to you, for entrusting him with the privilege of caring for your families. He was thankful for such meaningful work. He loved his life serving the children of the area. His work filled him with joy and with purpose. On weekends, he was waiting for Monday, so he could get back to doing what he loved.<br />
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When I was here five years ago, he took me to his office one weekend. And I stood in the silent office, looking at the hundreds of pictures on the walls. The pictures of his patients, who over the years, would bring in school photos for their beloved doctor. Many of the pictures were faded, some were more than 40 years old, the faces of children, with gap-toothed smiles, and lopsided haircuts, and innocent eyes, all captured in time, all a witness to his work.<br />
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From the time my dad hit sixty – that more than 20 years ago! -- we would ask him about retirement. To retire was simply not something he wanted to do, or saw the slightest reason to do. “I love my work,” he would say, “I help people. They thank me. What can I do in retirement that would be better than this?” And so he kept doing what he loved into the 83rd year of his life. He did finally retire, this January, and over these past few months, he would often talk about how much he missed his practice. I put a pause on my own practice of medicine two years ago, and I would joke with my dad that he outlasted me in the profession by 30 years.<br />
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For my dad, his work, this service, was a quiet testament to his Faith. He grew up in Iran, where Islam is the predominant Faith. He was born into a staunch Muslim family, and raised his early years as a Muslim. But something was quietly happening in the background that he was not aware of. In 1844, a new Faith had been born, the Baha’i Faith, an independent world religion that is now the most widespread religion after Christianity. It was, and remains today, reviled by the fanatic elements of Iran, with tens of thousands of Baha’is having given their lives, and many today remaining imprisoned for their Faith. It calls to mind the early years of the Christian martyrs at the hands of the Romans. Something significant had quietly happened during my father’s childhood in Yazd. His mother, at significant risk to herself, and with great courage, had embraced the Baha’i Faith. She had done so secretly because of the danger.<br />
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My father found out about this unexpectedly. He had learned a schoolyard taunt against the Baha’is and had come home happily singing it. His mother took him into the basement, away from the family, and firmly told him, that he was to never say such disrespectful words about the Baha’is again. It was then, that for the first time, my father suspected that his mother was a Baha’i. Soon thereafter, she openly proclaimed her faith before her husband’s family, who cast the entire family out of the household. It was then that my father began in earnest to learn about this Faith that his mother had embraced. This Faith , which he had been raised to ridicule, became his own, and became the motivating force of his life. If my father had not become a Baha’i, there would likely have never been a Dr. Khorram in Middlesboro. So, it is this Faith that we have to thank for this man’s presence in this community.<br />
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My father was attracted to the core tenants of this new Faith, that teaches that there is only one God, that all the religions come from the same divine source. That their spiritual teachings, that tell us to be kind, loving, just, and fair, run through them all. That they differ, not because they come from different Gods, or because some are false and others true. No, they differ because their historical contexts differed and the needs of humanity differed. It was in these teachings, the teachings of Baha’u’llah, that my father saw the renewal of the same light that shone in Christ. It was in Him that he saw the fulfillment of the prophecies of the Bible, and that all the world’s great holy books speak of: the coming of a promised time when peace shall cover the earth, when the lion shall lie down with the lamb, when swords shall be beaten into plowshares, when we shall study war no more. My father was optimistic and practical. He knew that the Kingdom would not descend magically from heaven, but would be built by our hands, through toil and effort and dedication. It would be built by each of us fulfilling our two-fold moral purpose – to refine our own characters, and to contribute to the advancement of humanity.<br />
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My father believed that the teachings that God has given for this day through the Baha’i Faith are the practical means of ushering in the Kingdom of God on earth – the teachings that there is only one God, and that all religions come from the same God. That humanity is one. He recognized that this is easy to say, but difficult to do, because we have to give up our prejudices – prejudice of race, class, religion, color, and nation. We must give up anything that allows us to feel superior to others. He believed in the equality of men and women, the harmony of science and religion, the importance of knowledge, the need for all to be educated – all tenants of this new Faith of God. My father saw that to truly incarnate the principle of the oneness of humanity, our current social structures, whether political or economic, have to be completely transformed and recreated… because you can’t have peace without justice. That’s a lot going on in the mind and heart of a pediatrician sitting at his home at 1714 Cirencester Avenue.<br />
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I share this with you, because I know that my kind and quiet father would have wanted you to know where his motivation came from. He thought about these things each day. He prayed about them each day. He gained purpose through them. He wanted the same for everyone.<br />
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When I think of my father, as a father, his gentleness and his humor are the two things that stand out. During the most difficult times of my life, he was there. I would put my head on his shoulder and cry, and even though I was in my twenties, he would comfort me, “It’s okay,” he would say, “It’s okay.” And in those tender moments, he was just as likely to say something that would make me laugh and wipe away the tears. He always made us laugh. Even in the most serious or sacred moments, he had the ability to distill a situation to its funniest elements. I keep expecting him now, to sit up and say something, to make us all laugh.<br />
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My father was not afraid of death. He spoke of the coming transition often – not because he was sick, or because he thought he would die soon, but simply because death is a practical part of life. After all, none of get out of this life alive. The Baha’i writings shed quite a bit of light on life after death, and as part of the service, we’ll share some of those insights with you. My father knew that when the body dies, the soul is like a bird that is released from a cage. The soul is eternal, a sign of God, and continues to progress towards God through all eternity. How we live our life in this world, combined with the grace of God, determines our station in the next world. The Baha’i teachings speak of nearness and distance from God – a continuum, more like a ladder, rather than just a heaven and a hell. So our work in this life, is to prepare for our next life, through worship and through service.<br />
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The Baha’i burial is a simple one. This body, which has been associated with the soul and which returns to dust, is treated with respect. It is washed and wrapped in cloth. A ring, is placed on the finger, bearing the beautiful inscription, “I came forth from God, and return unto Him, detached from all save Him, holding fast to His Name, the Merciful, the Compassionate”. There is a special prayer that is said before the burial, which will be read tomorrow at the graveside. Other than that, there is no set form. We’ve chosen the readings and prayers that we think my father would have wanted us to reflect on, and to bring us all comfort and understanding, and to advance his soul into the next world.<br />
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It broke my heart when I read the three-word message from my sister: “Pups died. Come.” But that anguish passed quickly. He often said that he hoped his end would be quick, that he did not want to become a burden for anyone or to linger. And his wish was granted. After so many years in the wards of a hospital, it seems to me somehow appropriate that he died at home, sitting in a chair, after having just gotten the mail from the mailbox. A few weeks had passed since I had last spoken to him, but by some stroke of luck, or divine grace (we never seem to know which it is) I called him just a few hours before he died. The conversation was sweet, as it always was. He asked about me, he asked about each of my four children, how they were doing, and what they were up to. He laughed that my daughter, Nava, had complained about her college applications on Facebook. He asked about Mara my wife, he asked about my sister, Jaleh, and her boys, and it always made me laugh that he would ask about Saipan, the island in the Pacific where my family and I had lived most of our lives. We laughed a lot, as we always did. And we said goodbye.<br />
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This past summer, my father had spent a week gathered together with his two children and all his grandchildren, and this brought him great happiness. Two years ago, I, along with two of his grandchildren, Wyatt and Nava, had the privilege of accompanying him to the Holy Land, to pay respects at the Baha’i holy places. He had wanted to go “one more time” as he put it, and it was a privilege to make that trip with him. There was nothing left undone. He lived as rich a life as anyone can live, surrounded by a community and an extended family that embraced him and loved him. His life was generous, and full. And that is why when my emotions well up in these days, they are not feelings of grief, but of love and gratitude.<br />
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This is a sacred time, this time of transition of the soul from its association with the body, to its full glory in the next world. According to the teachings of the Baha’i Faith, the soul continues to progress in the worlds of God, through the mercy of God, and through a combination of two things which those of us here can do: the prayers we offer, and the charitable acts we accomplish in the name of the departed. This highlights a great emphasis of my father’s Faith and of his life – the necessity to combine worship, with service. I think my father exemplified this. So please, do pray for the progress of his beautiful and radiant soul. And if you are able, illumine your prayers with some act of service in his name, some contribution to any charity in his memory. And as you do so, say, “This is for you, Dr. Khorram”. His soul will rejoice.<br />
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Thank you, Baba. Thank you for your gentle spirit, your example of a life lived in service, of faith expressed through deeds. Thank you for the gift of your humor, your generosity, your steadfastness, and loyalty. We honor you today. Thank you for honoring us.
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Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com7tag:blogger.com,1999:blog-6623415689314087026.post-20661980948768273172016-05-13T02:24:00.001+10:002016-05-20T02:11:41.440+10:00My Experience with Manual Small Incision Cataract Surgery (MSICS or SICS) Training at Arasan Eye Hospital, Erode India<div dir="ltr" style="text-align: left;" trbidi="on">
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<tr><td class="tr-caption" style="text-align: center;">Two surgeons being trained simultaneously at Arasan Eye Hospital -- one in SICS, the other in phaco. The instructor monitors the cases in progress.</td></tr>
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I'm currently finishing two weeks of training in manual small incision cataract surgery (MSICS or SICS) at Arasan Eye Hospital, in Erode, Tamil Nadu, India, and thought it would be useful to share my experience. It was a very positive experience. Before I came I had difficulty finding out much detailed information about the training or the experience, so I hope this is helpful to you.<br />
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<b>Surgical Background</b><br />
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Many of the ophthalmologists who come to Arasan to learn MSICS or phaco, often with limited experience with the procedure. I think that the experience you bring with you to the training affects your experience and the speed at which you gain mastery. <br />
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In my case, during my residency at Northwestern in Chicago in the early 1990's we were trained in ECCE and phako with a superior tunnel incision. There were no foldable lenses widely available yet. After my residency I headed out to the Pacific because of my interest to serve in an underserved area. I was for a year at the LBJ Tropical Medical Center in Pago Pago, where because of limited technology, I did ECCE with manual Simcoe I/A.<br />
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During the ensuing 5 years, I was at the Commonwealth Health Center on the island of Saipan, in the Mariana Islands. There I continued with ECCE with manual Simcoe I/A. At that time, the Blumenthal mini-nuc emerged, and I tried this technique a few times, but wasn't able to master it.<br />
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Eventually, I opened my own practice, acquired a phaco machine, and went back to phaco with a superior tunnel, but quickly transitioned to temporal clear cornea with a foldable lens through a 2.75 mm incision and topical anesthesia.<br />
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So, that's my background and skill level I brought with me. I had experience with every step of the procedure except for prolapse of the nucleus into the anterior chamber. But, it had been years since I have done the other important steps of the procedure. I hadn't made a scleral tunnel or put in anything other than a foldable IOL for at least 10 years.<br />
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<b>Why SICS?</b><br />
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My goal in getting training in SICS was to be able to take several trips a year to underserved areas for volunteer work. I have done surgical expeditions in the past with SEE International, however, they now require all their surgeons to have SICS training, as that is the primary procedure being used in most eye camps. So, that's what motivated me to spend two weeks here learning SICS.<br />
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<b>Why Arasan?</b><br />
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For some time I tried to set up "in the field" training with SEE International, but it just didn't work out. Although I am American, I am living in Europe now, and while SEE offers wet-lab training in MSICS in the US once or twice a year, it was too far to travel simply for a weekend of wet-labs. I did a bit of research, and there are quite a few hands on training programs in India, but most of them are a month or longer in duration. Arasan, however, provided a 2 week training program in MSICS. That was doable for me. I emailed Arasan, and got initial information from Anitha, who manages the doctors who visit. I wanted to talk to some of the other people who had done the training, and Anitha sent me the emails of all the doctors who had been here over the past year. Everyone I heard from was generally positive, so I decided it would be a good way to get training.<br />
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<b>Cost</b><br />
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At Arasan, the cost of all their training programs are on a "per case" basis, and they guarantee you that number of cases during your time here. If you want additional cases than the minimum amount, there are additional charges. The prices fluctuate from year to year, and I think are adjusted somewhat according to country of origin, or level of training. Information is available through contacting Arasan. In my situation, a US trained experienced ophthalmologist, seeking MSICS training in 2016, the price for 30 MSICS cases was $2,500, with additional cases at $100 per case. While I was here, there was also a physician here from Germany who had no surgical experience (apparently in Germany, you complete your residency without any intraocular surgical experience) who was here for two weeks of SICS training, and three weeks of phaco training. There was also an ophthalmologist here from Jordan who had come for one month of PPV training. The costs of phaco is higher than for SICS, and the cost of PPV higher still. They were both very happy with their experience here, and felt it was a very good value, as did I. The course fee needs to be transferred to Arasan to confirm your participation ahead of your arrival. It actually goes to Arasan's charitable branch, Save Sight Foundation. Contact Arasan for the costs for your situation.<br />
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This cost does not include lodging, food, airport transport, medical license, etc. It's just for the training. <br />
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<b>Medical License and Visa</b><br />
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Anitha will hook you up with an application for a temporary medical license. Arasan will front the cost, and you'll repay once you arrive. It does take a few months to get it though, so you need to plan ahead.<br />
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There seems to me one official, and one unofficial route to get a visa. Officially, Anitha told me I had to get a student visa, which required that I go to the Indian Embassy and apply in person. That was a pain, but I did it. Unofficially, you can do the training on a 30 day tourist visa, which you can apply for online, at much less expense. One of the doctors while I was here had come in on a tourist visa. He had put is address as "Arasan Eye Hospital", and when he was coming in, they asked him what kind of tourism he was doing there, but he got through.<br />
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<b>What to Bring</b><br />
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You don't need to bring any surgical instruments. You don't need to bring scrubs or lab coats (even though they tell you to bring two -- I did and never wore them, nor did anyone else). You don't need to bring formal clothes. You just need cool "business casual" clothes -- khakis or pressed pants, with polo shirts or short-sleeve button-down shirts. That's how most of the people in India are dressed, as are all the doctors at the hospital. The women, of course, wear sari's or kurti's, which you can buy here, but it's not really expected. Most people in Erode wear sandals. Because I was walking in the streets, I felt more comfortable wearing casual close-toed shoes. In the OR, you'll wear slippers that are provided. No one wears short pants despite the heat. I brought a couple of pair, and wore them in the apartment.<br />
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If you're from a country that uses toilet paper, bring a role. If you're staying in the guest house, let Anitha know you'll need some and she'll send someone out to get it. It's not easy to find in the small shops that line the walk to the hospital.<br />
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If you have an interesting case to present, bring the presentation with you. On Wednesday mornings, there is no surgery, but instead is a case conference at 9 AM. It's nice to participate in, and they welcome a presentation of 10-15 minutes -- either a case, or a topic of interest. Throw in some slides of your home country or your practice, as it makes it more interesting. After the conference, everyone has breakfast together on the second floor.<br />
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<b>Preparation</b><br />
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Although the surgical experience, and operating room mentorship was excellent, I think Arasan fell a bit short in helping you prepare to get the most out of your training. I took the initiative to download Aravind Eye Hospital's free SICS book, which is quite good, but it is "the Aravind way", not the Arasan way of doing the surgery. I also spent a lot of time watching videos online of MSICS to get a sense of the procedure. However, I think that the program would be strengthened if they recommended some reading themselves, and more importantly, had their own surgical videos online so that you could be better prepared to have a knowledgeable start once you got here. For a teaching center, it has very few online surgical videos. Although this was not so critical in my case, I imagine that for those learning phaco or PPV, it would be most useful to be given some recommendation of books to read, as well as surgical videos to review prior to arrival. The better prepared you are, the more you'll get out of the training.<br />
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<b>Duration</b><br />
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Initially I was told it was a 15-day training course, running from a Monday, through a Tuesday. I thought it was odd, as I would have preferred to not have to stay around for another weekend, but I thought it was a set program. As it turns out, it's really not. You can tell them how much time you have, and they will work to get the minimum number of cases to you in that time. In my case, a special election was called, which meant that there would be no surgery during the final Monday and Tuesday, so the hospital worked to get me the 30 cases within a 12 day period. Now, the ability to accomplish this may test your abilities. In my case, I did the 30 cases within six OR days. My case load per day went like this: 2, 3, 3, 5, 8, 9. Those last two days were a killer. So, don't be in a hurry. <br />
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It's nice to work out some of these details of how many cases to expect per day, and how many days you can stay, before your arrival. After I arrived, I had to change my tickets because of the election. If I had known of the possibility of having a trip of two-weeks duration, I would have planned accordingly, and avoided the extra cost of changing my flight. Now, as it turns out, I finished my 30 cases on a Tuesday, with a new ticket to leave on the coming Saturday. Anitha said that I could operate on a "regular" schedule of 3 cases per day for the remainder of the time, but if I wanted more than that, I'd have to pay the additional $100 per case. I asked for 5 cases per day, and pointed out that I had spent $400 to change my tickets because of the election, and Arasan graciously agreed to give me 5 cases per day for each of my last two OR days, instead of 3, at no extra cost. By the end of my time here, I had completed 40 SICS cases, which is higher than the average 30 cases.<br />
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<b>Arrival</b><br />
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Coimbatore is the nearest major airport, about 100 km away. Anitha arranged for a driver to pick me up. It was about a 1.5 hour drive to Erode. I arrived in Erode in the early afternoon. We stopped by the hospital to say hello, and to meet the chairman, Dr. Paneer Selvam. Anitha collected the money I owed for the medical license, and the transportation, as well as the stay in the guest house. I asked Anitha ahead of time how much it would all come out to, so that I could bring enough cash with me. They accept USD and EUR for this payment. I asked about where to exchange currency and the hospital's accounting office exchanged some money for me just so that I'd have some cash over the weekend. The exchange was 5% less than the published rate online, which is pretty typical for currency exchanges.<br />
<br />
One thing worth mentioning is that very few places in Erode accept credit cards. There are a few ATM's available. But I'd recommend bringing enough cash to last you.<br />
<br />
<b><br /></b>
<b>Guest House vs. Hotel</b><br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8DXCy4M0LLMPiz3CVc8jjkvCbfc5kt1QrFswbt7FCDyDO3ReA66bdNEx_QOWZZZbLPiAHsphfOI7FzfviSpGIUNyENn_dF6gMB1VR61HRoHXRG-wwmo5mUJHWGXKK3d5FndjWDjMZRdw/s1600/2016-05-13+11.17.55.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8DXCy4M0LLMPiz3CVc8jjkvCbfc5kt1QrFswbt7FCDyDO3ReA66bdNEx_QOWZZZbLPiAHsphfOI7FzfviSpGIUNyENn_dF6gMB1VR61HRoHXRG-wwmo5mUJHWGXKK3d5FndjWDjMZRdw/s200/2016-05-13+11.17.55.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Dining area at the guest house</td></tr>
</tbody></table>
Before I arrived, one of the doctors that had written me suggested that many choose to move into a hotel after a few days in the hospital's guest house (actually guest apartments, owned by the Chairman). When I looked online at hotels, it looked like they were a bit far from the hospital, so I decided I would start at the guest apartment and get a lay of the land. My concern was that the guesthouse would be on the hospital premises, which could feel a bit claustrophobic. The one I stayed in was a 10-15 minute walk from the hospital. It is a very basic apartment, clean, but a bit sparse. Two of us were staying here, each with our own room. The hospital also provided a housekeeper who came by a couple of times a day to cook lunch and dinner for us and to clean our rooms, and do laundry. She was a lovely woman, even though we didn't speak one another's languages. The rooms each had a bed and a bathroom and importantly, an air-conditioner and ceiling fan. The living-room, dining-room, and kitchen did not have air-conditioning. It would have been nice to have one in the living room area, just to make it nicer to socialize. Because we're here at the hottest time of year, my colleague and I would eat together, and then go to our rooms where it was cool. I recommend that you pay it "as you go" in case you decide to move out to a hotel. There are two guest apartments, one for men and one for women. I believe we actually stayed in the one designated for the women, and from what I understand, this is the only one that has a cook. Clarify that with Anitha when you talk about the details.<br />
<br />
The wireless internet at the apartment was pretty good, but would tend to drop out at times. It was fast enough for most everything, but it was a too choppy to do video Skype.<br />
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6393s8mHYUnP9ohbNlClL-xKHWAZixdZ_kYRgO-g_MhKZ_6Tfbw2e1WHp9MI_1hL8lHiM4kjOssdZd3kAhbFrOSOxCpmtei7yzGCOjvL85N5Mc4aFla2PeRW05SeZa-5eW8A2mcQBmEw/s1600/2016-05-13+11.17.11.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6393s8mHYUnP9ohbNlClL-xKHWAZixdZ_kYRgO-g_MhKZ_6Tfbw2e1WHp9MI_1hL8lHiM4kjOssdZd3kAhbFrOSOxCpmtei7yzGCOjvL85N5Mc4aFla2PeRW05SeZa-5eW8A2mcQBmEw/s200/2016-05-13+11.17.11.jpg" width="150" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Bedroom at the guesthouse</td></tr>
</tbody></table>
The other doctor, who was here for a month, stayed at the <a href="http://www.hotelradhaprasad.com/erode/" target="_blank">Radha Prasad Hotel.</a> It was quite a nice place, with fairly modern rooms, cable TV, a nice restaurant and rooftop swimming pool, and it only cost $20 per day (welcome to India!). The hotel is too far from the hospital to walk in the heat and the traffic, so he took rickshaw taxis back and forth a total of four times a day, for about 50 rupees (or 75 cents) a ride. The meals at the hotel are inexpensive, and they have room service, so you don't have to sit and order for every meal. Because he was staying for so long, they gave him courtesy English speaking channels on the TV and did his laundry for free. He had internet, but I'm not sure how good it was. I think with meals and transportation, his costs were $30 per day. The hotel is quite a bit nicer than the guest apartment. You can compare that with the costs they give you for a room in the guest apartment. There are other hotels around, but I'm not familiar with them.<br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbjd4QbtQE_VsznIouAp0amd0lq9Z5MKYZvstti0zIDBSs8n58yeF08tL82VoX2w88Mx22in1DwMekCk2ZqCss1UkwbWYfRS0QKBLYm0VWmuBozSH_CXwhbxAFb5U0napHLNt9OoX6gaM/s1600/2016-05-13+11.18.02.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbjd4QbtQE_VsznIouAp0amd0lq9Z5MKYZvstti0zIDBSs8n58yeF08tL82VoX2w88Mx22in1DwMekCk2ZqCss1UkwbWYfRS0QKBLYm0VWmuBozSH_CXwhbxAFb5U0napHLNt9OoX6gaM/s200/2016-05-13+11.18.02.jpg" width="200" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Living room at the guest house</td></tr>
</tbody></table>
<div style="text-align: left;">
</div>
In the end, I decided to remain at the apartment for a few reasons. First, I liked being within walking distance of the hospital and not having to deal with taking transport back and forth. Second, I really liked our cook. She made Indian food for every meal, which I love. (We each paid 1200 rupees for two weeks worth of meals, which is about $20.) And it was easy to just walk out into the dining room and eat whatever she had made instead of going through a menu for every meal. I enjoyed having meals with my colleague who was staying in the apartment. Our schedules did not always match, but we usually ate together once a day. I am also the kind of guy that likes being in the neighborhood rather than a hotel, and my needs are pretty basic, so the room in the apartment suited me well.<br />
<br />
I am glad I brought earplugs. It is a bit noisy at night, and though I never sleep with earplugs other than on a plane, I'm glad I had them with me. They helped block out the noise and I slept soundly. The Radha Prasad Hotel, though also on a busy street, seemed quiet inside.<br />
<br />
<b><br /></b>
<b><br /></b><br />
<b>The Daily Schedule</b><br />
<br />
You're here to learn surgery. So, your main time is in the operating room. Every evening, Anitha will send you a message telling you what time your cases start the next morning. In terms of required time, you just need to be there for your cases. That's all. But there are some other learning opportunities available.<br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8ccovpUDSIcqmCf02eukB4KHAgBWVcxYJfZfxftXnhugNO5CYqGwKg0m1l3WBYXbyJI4FYoSbA09SmSjMMkq-4z9vfZfcMkUpsRfPZE6cQbl1eKEDwIe2TrCQVuCsfQ_5GU-vFwQxMvw/s1600/2016-05-11+10.48.56.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj8ccovpUDSIcqmCf02eukB4KHAgBWVcxYJfZfxftXnhugNO5CYqGwKg0m1l3WBYXbyJI4FYoSbA09SmSjMMkq-4z9vfZfcMkUpsRfPZE6cQbl1eKEDwIe2TrCQVuCsfQ_5GU-vFwQxMvw/s320/2016-05-11+10.48.56.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">With some of the OR staff</td></tr>
</tbody></table>
The morning OR time is for residents and people receiving training. There are two operating rooms, each with up to three surgeries going simultaneously. Morning surgery starts around 7 AM, and can go until 2 PM. The hospital closes from 2-4 PM for lunch. At 4 PM, the attending physicians (or "consultants" as they are called here), do their surgery until 6 PM or later. If you are here to learn phaco, it's good to attend the afternoon surgery and watch. There are monitors connected to most of the microscopes. For SICS, I did not find it very useful, because most of the attendings are doing phaco. I did attend a few sessions of surgery in the afternoon, but for me, who already is well-versed in phaco, it was more social than surgical. I did enjoy watching a combined phaco-trab. I also discovered that the residents do surgery on Saturday mornings. This isn't time that we had surgery scheduled, and I realized that for those of us learning SICS, sitting in and watching the resident's surgery would be very useful. Unfortunately, this opportunity wasn't communicated.<br />
<br />
In the evening, if you wish, you can also go to the post-op ward. The "sisters," as the nurses are called, will ask you for your initials and how many cases you did that morning. They will then round up your patients and bring them for you to examine. Post ops are not typically seen by the operating surgeon, but rather examined two days post op by the residents in the post op clinic. I went every day. It's good feedback to see how your patients look after your surgery, and I would highly recommend doing this. You don't see the patients pre-op. You just do the surgery.<br />
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There is also the opportunity to attend the outpatient clinics. I never did. If you are early in your career, or have a particular interest, I suppose it could be enjoyable.<br />
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Apparently, there are also lectures at 4 PM on most days. I probably would have attended some if I had known about it earlier in my stay. This is the sort of thing I think could be improved -- being handed a written schedule of the hospital happenings upon arrival, so you can know what opportunities are available.<br />
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdr4BQojxtXOkx406duXWg8ajKf6nWpC-QLfzJkKoVbaakUTsvje25_8YkOG7Y-GMGvTxIBI1Y5fxSvDq6J0O5rvUzge8338eHVofQSOFlUHaxmM98RAynJDMOErsPhUtvAL_vsfYC4GU/s1600/2016-05-11+11.00.30.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjdr4BQojxtXOkx406duXWg8ajKf6nWpC-QLfzJkKoVbaakUTsvje25_8YkOG7Y-GMGvTxIBI1Y5fxSvDq6J0O5rvUzge8338eHVofQSOFlUHaxmM98RAynJDMOErsPhUtvAL_vsfYC4GU/s320/2016-05-11+11.00.30.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Outpatient clinic area</td></tr>
</tbody></table>
So, at the fullest, you could arrive for your surgical cases in the morning at 7 AM, stay on for morning clinics, have a lunch break from 2-4 PM, be back in surgery to observe at 4 PM, see your post ops at 6 PM, and then go home for the evening.<br />
<br />
Of the three of us who were here this month, none of us did all of that. I went for my surgical cases, finishing up by 9-10:30 AM or so on the days when I had 3-5 cases, and finishing at 1-2 PM on the days I had 8-9 cases. And then I came briefly back to the hospital at 6 PM to see my post ops. The first two or three days I went to watch surgery at 4 PM. So, basically, I was in surgery for a part of the morning, and the rest of the entire day was free, except for 15 minutes seeing the post-op patients in the evening.<br />
<br />
The doctor that was learning PPV only went to the operating room for his cases, which were for a few hours in the mornings.<br />
<br />
And the third doctor that was here to learn SICS and phaco did what I did, although he usually attending the 4 PM OR time to watch phaco, and also attended some clinics.<br />
<br />
The OR is open for surgery in the mornings on Monday, Tuesday, Thursday, and Friday. Nothing on Wednesday or Saturday (except resident cases Saturday mornings). So, putting this all together, what it means is that you have a lot of free time. A lot. If you have an average of 4 cases a day, you'll be done before noon every day, and you may choose to come for 15 minutes in the evening to see post ops. So, bring something to keep yourself busy. I was a bit puzzled by this, wishing the surgical schedule was more full, but on the days I did do 8 or 9 cases, I was totally exhausted, and it really was too much. You do need to start off slowly. So just have some things to occupy yourself. It's unusual to have as many as 8 cases a day. Because my stay was unexpected cut short by the election, they wanted to make sure I got my allotted 30 cases while I was here, so they loaded the cases heavy at the beginning of that week.<br />
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<b><br /></b>
<b>Erode</b><br />
<b><br /></b>
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<div style="text-align: left;">
</div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left; margin-right: 1em; text-align: left;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgWbKokLb_AgUc0WrCg6_n_H2iBjs5FSOgZqLo9RBcSmxJFhyphenhyphenUbv6XvQ5fG2DsFShMzVGMid87IH5slpoeXfF_I0f-xWrKcUBzyh-9xXhXTLJBawJCgoweUBwUB-cz-UsvqGnRk3Puxvs/s1600/2016-05-13+11.02.18.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgWbKokLb_AgUc0WrCg6_n_H2iBjs5FSOgZqLo9RBcSmxJFhyphenhyphenUbv6XvQ5fG2DsFShMzVGMid87IH5slpoeXfF_I0f-xWrKcUBzyh-9xXhXTLJBawJCgoweUBwUB-cz-UsvqGnRk3Puxvs/s320/2016-05-13+11.02.18.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The walk to the hospital. The road doubles as the sidewalk.</td></tr>
</tbody></table>
The town is a bustling mid-size Indian city. If you are from the West, you'll be shocked by the seeming random pattern of the traffic, the absence of sidewalks, the noise. I loved it all. But I'm sure some could find it overwhelming. And the town does not really have much in it, in terms of tourist sites. Take a look at Trip Advisor to get a sense of things you might want to do. North of the guesthouse, there is a park, and on the weekend I took a walk through it, and paid 10 rupees to enter some kind of a sanctuary, which was a nice walk. And I did some shopping for my family. But other than that, there was not much else to see or do. So again, bring something to keep yourself occupied.<br />
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<b><br /></b>
<b>Extra Touches</b><br />
<br />
The hospital has a few SIMS cards available which you can use while you are here and insert in your phone. This gives you a local number while you are here, and makes it easier to communicate with the hospital and gives you internet data access at local rates. <br />
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The hospital also has a driver, and on a couple of occasions, Anitha arranged for him to take me to some shops to buy souvenirs for my family. That was nice, and I enjoyed getting to know the driver.<br />
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<b><br /></b>
<b>Trip to the Eye Factory</b><br />
<br />
One of the things that Anitha does is to arrange a weekend trip for you to a company that produces IOL's and other surgical equipment and ophthalmic products. I remember visiting the Alcon headquarters in Fort Worth, Texas many years ago, and I imagined it would be a similar experience. I didn't go, because I didn't want to spend 5 hours driving there and 5 hours driving back. But the week before my arrival, one of the other doctors went, and he said that other than the drive, which was painful, it was an enjoyable excursion. The company puts you up in a nice resort hotel, pays all the expenses for the weekend, and has some executives dine with you. It's in Pondicherry, which is on the ocean, and supposed to be a nice resort town.<br />
<b><br /></b>
<b><br /></b><br />
<b>The Training</b><br />
<br />
The training itself was quite good, and I would recommend it. After all, there are few places you can go, and get hands-on experience, with good instructors, for 2-4 weeks. The primary instructor for me was Dr. Vinit, who had completed his residency at Arasan just 6 months ago. The residents get tremendous surgical experience here. Dr. Vinit was great surgeon, and a helpful teacher. He did the first case, explaining each step, then let me loose to do the rest. During the first week, he was always gloved and gowned, and I had him step in quite a few times when I was uncertain, mostly because it is a human being that you're operating on, and I didn't want to risk complications. So, if a capsulorhexis was going astray and I was having difficulty getting it to recover, or if I noticed a zonular dialysis, or was having difficulty prolapsing the nucleus, I'd have him step in and show me how to do it. After all, I'm not here to prove anything. I'm here to learn. <br />
<br />
By the end of the first week I felt fairly comfortable with all the steps of the surgery, and had quite a few cases that went comfortably from start to finish. But I did find that it was a difficult transition to make from phaco, mostly because once you have gotten the hang of it, phaco is so nice. Easy incision, nice getting the lens out, a tiny incision with a foldable lens, and you're done! Dr. Vinit told me, as I was sharing my frustration, that SICS is much harder to master than phaco, and takes much longer to learn. The incision has blood, the tunnel takes time, the incision is large, prolapsing the nucleus can be challenging, it can be awkward getting the lens in, so generally, it can feel frustrating. It's all part of the process. He also told me that if it were easy, I wouldn't have to come here to get training. Good point. By the end of the second week, I was comfortable and confident, which I did not expect to happen in just two weeks, but it did. My cases were going smoothly, and I realized, "wow, I've learned how to do this!"<br />
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<b><br /></b>
<b>Extra Steps to Improve Your Learning</b><br />
<b><br /></b>
Besides the instruction, there are a few things you can do yourself to improve your learning experience.<br />
<br />
1. Record and watch your cases. One thing that one of the doctors I had contacted before I arrived told me was to bring a USB stick (thumb drive, pen drive, flash drive) and ask them to record your cases. Give them the "pen drive" (which is what they call them here -- if you use one of the other terms, no one will know what your'e talking about), and ask them to put your cases on it. They will have the pen drive ready for you around 4 PM, and that evening, it can be useful (but painful) to review your cases to look for areas of improvement.<br />
<br />
2. Get recordings of your instructor's cases. One of the things that I found even more useful was to ask them to put a few cases from your instructor on the pen drive. Most of them have a case file on the computer, and it can be a great help to study these. Even though there are lots of videos on YouTube, there is nothing like watching the specific technique of your instructor. I wish I had been able to do this in advance, and it's one area where Arasan needs to raise its presence -- more online videos.<br />
<br />
3. Use the wet-lab. I incidentally found out that there is a wet lab available. I spoke to the Chairman about getting in there, and so he arranged for one of the senior residents to accompany me one evening. They gave me three cadaver eyes, and I spent 45 minutes or so practicing tunnel incisions. It was very worthwhile, and I went into surgery the next day, much more confident about that step of the procedure. The senior resident guided me and made recommendations and answered questions I had very ably.<br />
<br />
4. Ask for fresh blades when you need them. Blades are reused. If you are used to using a fresh blade with each case, you'll find this a struggle. I had a lot of trouble with my scleral tunnels, but when I realized that a big part of it was because of the dullness of the blade, and I asked for a new blade, everything went so much better. You're paying for the training, so don't worry about the cost of the blades. <br />
<br />
<b><br /></b>
<b>Things Arasan Could Do Better</b><br />
<b><br /></b>
Based upon some of the things mentioned above, there are some things that Arasan could do better. They are not major, and could probably be fully implemented within 2 weeks. I think they would significantly improve the experience of those being trained, and also just give a sense that things are well-organized.<br />
<br />
1. Add some formal elements to the training.<br />
<ul style="text-align: left;">
<li>Recommend texts or videos for candidates to study before arrival.</li>
<li>Make recordings of cases available online for candidates to study before arrival.</li>
</ul>
<div>
2. Improve organizational elements</div>
<div>
<ul style="text-align: left;">
<li>Prepare a printed weekly hospital schedule for candidates so that they know what is going on throughout the hospital each day and what learning opportunities are available to them.</li>
<li>Have a formalized system where their cases are automatically recorded and the nurses automatically ask them for a pen-drive and put the cases on it for them. Right now, if this happens, it is completely at the initiative of the doctor being trained, and the nurses seem a bit unsure about recording, transferring files to the USB, etc. It's an important teaching tool. Make it a part of the program.</li>
<li>Make a folder of video recording, by instructor and case type, available to all candidates upon their arrival. The nurses should ask each doctor for their USB drive, and transfer the folder onto it for them.</li>
<li>Make candidates aware of the free time before they arrive for their training and encourage them to come prepared with something to keep them occupied.</li>
</ul>
<div>
3. Generally, I think if Arasan thought of it as a "course" instead of simply "surgical training", it would help them develop the program. A "course" implies formal organizational elements, which currently are a bit lacking. It is currently mentorship in the operating room. Having the organizational elements above, and perhaps adding time where the instructor would review your surgical recordings with you, or go over the instructor's surgical recordings would add a didactic element that could greatly improve the teaching.</div>
</div>
<div>
<br /></div>
<b><br /></b>
<b>A Great Experience, and Solid Training</b><br />
<br />
In my two weeks at Arasan, I completed 40 cases. After the last day of surgery (today), I felt like I had mastered the surgery. I'm sure there will still be a lot to learn in the next 100 cases. I would definitely recommend the training at Arasan. Both my colleagues felt the same. The one who got phaco training hopes to come back in a few months, after having done some cases in his home country. He felt the same as I did -- the instructors were exceptional, and the volume was great. My colleague who received PPV training spoke very highly of it. He now feels comfortable doing basic PPVs -- enough to clear out a vitreous hemorrhage, or to removed a dropped nucleus/IOL, and to fix retinal detachments without PVR. He felt it was very worthwhile, and relatively inexpensive. <br />
<br />
It was a great experience. There are a few things Arasan could to do make the experience better and smoother, but the key elements are here: the quality of the instruction and the volume of the cases.<br />
<br />
Info about Arasan can be found on their <a href="http://www.arasan.org/" target="_blank">website</a>, and on their <a href="https://www.facebook.com/Arasan-Eye-Hospital-224280254294236/?fref=ts" target="_blank">Facebook page</a>.<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEKEPxgktTRr3oLH_1zI4QuwvW2T7_6Em5e5Sk7KwTbIR0UjyLHAwp5LT1GnvIdPqc0Iy2mAGjYDam4g1zLT6vZAgMjYnC7LMfShQ9RifvCT-wO7xJqHTsgObYJVuJAXQSmenytrYFT8Q/s1600/13147430_1020376884684565_1104578249092362887_o.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEKEPxgktTRr3oLH_1zI4QuwvW2T7_6Em5e5Sk7KwTbIR0UjyLHAwp5LT1GnvIdPqc0Iy2mAGjYDam4g1zLT6vZAgMjYnC7LMfShQ9RifvCT-wO7xJqHTsgObYJVuJAXQSmenytrYFT8Q/s640/13147430_1020376884684565_1104578249092362887_o.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Our trainer, Dr. Vinit, in the center.</td></tr>
</tbody></table>
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<br />
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Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com0tag:blogger.com,1999:blog-6623415689314087026.post-10309343447651012692013-05-21T21:12:00.000+10:002013-05-21T21:12:20.381+10:00Diabetic Eye Disease - My New Book, Website and Blog<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDtBe8pODeMsTmGI5D_HaEWf-c-QYWiv27jaAIL24wbvkUCz1wxvqJ0wiuGrMmstdtA2fqfxbYQU5qk-nvR-_FPGsPA-5-qw1-YoDw6GmJ5u_vjklJctnFzy61sbSq08KCVHopTz26UpA/s1600/Local+Version.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDtBe8pODeMsTmGI5D_HaEWf-c-QYWiv27jaAIL24wbvkUCz1wxvqJ0wiuGrMmstdtA2fqfxbYQU5qk-nvR-_FPGsPA-5-qw1-YoDw6GmJ5u_vjklJctnFzy61sbSq08KCVHopTz26UpA/s400/Local+Version.jpg" width="308" /></a></div>
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It's finally happening. I'm two days away from the launch of my new book, <i>Diabetic Eye Disease - Don't Go Blind From Diabetes.</i> <br />
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I have set up a new blog and website, <i><a href="http://diabeticeyeexpert.com/" target="_blank">Diabetic Eye Expert</a>, </i>dedicated to the topic, and will be offering online courses and webinars through the site. <br />
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Take a look, and make sure to sign up for a list of courses!Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com0tag:blogger.com,1999:blog-6623415689314087026.post-84445507864260579982011-08-07T08:57:00.005+10:002012-03-11T08:04:41.203+10:00Guamology Interview for World Peace, a Blind Wife, and Gecko Tails<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2xR1IrZHg_KFi7Mr-bT7mOcYPWhrkEAPFeXKaYTWW-z10QQ_gZUdWS53VGOYnqjwuCghDgS_1GDvyAWME2XlNv2g6DPUT131n6xu78zRAVt0_ANRKk_BdhVZv98X62fWgnARajJ1HqUA/s1600/CoverFinal1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2xR1IrZHg_KFi7Mr-bT7mOcYPWhrkEAPFeXKaYTWW-z10QQ_gZUdWS53VGOYnqjwuCghDgS_1GDvyAWME2XlNv2g6DPUT131n6xu78zRAVt0_ANRKk_BdhVZv98X62fWgnARajJ1HqUA/s320/CoverFinal1.jpg" width="211" /></a>I was interviewed about <a href="http://www.amazon.com/World-Peace-Blind-Gecko-Tails/dp/0980053102/ref=sr_1_1?ie=UTF8&qid=1331416589&sr=8-1" target="_blank">my book</a> back in 2009 by Kel Muna, a film-maker, and host of the Guamology.com website. Since then, Guamaology has gone off-line, as Kel has become busy planning the Guam International Film Festival. I enjoyed the interview, and thought I'd post it here since Guamology is no longer around.<br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b>World Peace, A Blind Wife and Gecko Tails. It's such a great title. How did you come up with it? Did you have any alternate titles before settling on your final choice?</b> <o:p></o:p></span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">As I was having friends review the book, I'd ask them, "What is this book about?" and the typical answer was that because the pieces covered a potpourri of subjects, the title would have to be reflective of that. I also wanted the title to be a bit intriguing and memorable. Someone suggested that many of the pieces were about world peace, so that became the opening of the title. The blind wife and gecko tails are references to specific pieces in the book. I also wanted to give reference to our tropical location, and that's why I chose "Gecko Tails" as part of the title. My first thought for a title was simply, "Thoughts from an Island".<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">How does it feel to know that Blind Wife is required reading for sociology students at the University of Guam, where before Blind Wife it had been Mitch Albom's "Tuesdays With Morrie"? <o:p></o:p></span></b><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Honestly, I'm a bit stunned. I'm always surprised when someone tells me that something I've written is meaningful to them. I receive the reflection papers that the students write after reading the book, and it's both rewarding and humbling to know that something I've written has in some way touched someone's life. "Tuesdays with Morrie" is such a powerful book. I can't really get my head around the fact that Blind Wife has displaced it from the reading list.<o:p></o:p></span><br />
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<o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">I understand that Blind Wife is a compilation of all of your most popular columns from the Saipan Tribune. When and how did you come to write for the paper?</b> <o:p></o:p></span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">I started writing for the Tribune as a columnist in 2004. I had wanted to be more disciplined in my writing, and I felt like having a weekly deadline would help. I also am a curious person by nature, and like to pull ideas from various places, so the column provided me a place to share the things I was learning or thinking about.<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">When did you get the idea and interest of turning your columns into a book? How long did the process take to put the book together? <o:p></o:p></span></b><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">The book came about as a result of panic. About a year before it was published, I decided to take more time off from work and write a book I had been thinking about for some time. I had given a series of talks on the subject of establishing unity in communities. People told me that I should turn that into a book -- "7 Habits of Unity" or something like that. So I took time off to write this book, but really didn't have a clear idea of where I was going with it -- the tone, the audience, the purpose. And because of this uncertainty I began to have all kinds of personal doubts and misgivings while trying to write it. I spent a lot of time just staring into past my computer screen into space. After nine months, I realized that the year was coming to a close, and I had nothing to show for it, and that I'd feel like a total loser if the year ended and I hadn't published a book. So, I realized I could pull together my columns, which were already written and which had been well-received in the community, and publish them. So this book came about because I wimped out at writing the other one. <o:p></o:p></span><br />
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<o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></div>
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<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Your writing style is very easy to relate to as well as reflective. Did you have a formal education in writing? <o:p></o:p></span></b><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">I got the same training that we all get by virtue of going to school. I didn't take any special writing courses or workshops. But I did have some terrific teachers who taught me the value of re-writing, and the need to read your own writing out load to make sure it makes sense and that it flows. One of my comparative religion professors had a journalism degree, and he emphasized the need to write clearly for a broad audience, even in a term paper. So, I think that's where the conversational tone of my writing comes from. I also believe in being authentic. Even though at times I write about some lofty principles (like being truthful 100% of the time, or not dwelling on the faults of others, or eating well and exercising daily) I know it's difficult, because I fail with the same struggles. I try to make sure I'm conveying that I know I'm on the same human level as my reader.<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">How did you decide on the number of entries to include in the book? Did an editor choose for you? <o:p></o:p></span></b><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">I wanted to have about 50 pieces, just because it was a nice round number. I went with 52, because that's the number of weeks in a year, so it's like a year of columns.<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Your writing style and reflection of topics are uplifting and the overall tone reminds me of one of my inspirations, Seth Godin, a blogger who totally thinks outside the box. What is your source for inspiration when it comes to writing your entries? <o:p></o:p></span></b><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">I've never really thought about this before. I think my writing is just a reflection of me, my thoughts, my surroundings and my responses to them. So, in some way, the answer to the question of what inspires my writing is the same as what inspires my life. The biggest sense of inspiration for me is a conviction that the world is moving inexorably toward a fully integrated global society, and that the social structures of old are crumbling, making way for new paradigms, and ultimately for a spiritually rooted civilization. That's what I see when I see the current economic collapse -- the collapse of a system that was not based on sound spiritual principles, and so, it's collapse provides the opportunity for a new, more holistic one, to emerge. The source of this mindset and this perspective -- this overall optimism -- is my exposure the the writings of the Baha'i Faith. Check them out. They are revolutionary both in terms of social organization and human relations, and in terms of the individuals relationship to his or her own existence. <a href="http://www.bahai.org/">www.bahai.org</a>.<o:p></o:p></span><br />
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<o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">Do you get writer's block? If so, what do you do to get over it?</b> <o:p></o:p></span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">I do have difficulty writing at times, but I don't like to call it "writer's block" because that phrase formalizes the simple fact that at times, everything is difficult. It turns it into a monster. I mean, there are some days I don't want to go to work, but I don't call it "worker's block". That's just an excuse to stay home. "Sorry, can't come in today. I've got worker's block." The best way to get over difficulty writing is to write. It's that simple. As one writer has succinctly phrased the remedy, "ass to chair". <o:p></o:p></span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">I<b style="mso-bidi-font-weight: normal;">f you had to choose only one favorite entry from your book which one would it be and why? <o:p></o:p></b></span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">That's a little like being asked, "of all your children, which is your favorite?" Because the pieces are so diverse, can I pick a favorite from a few categories? Of the serious pieces, my favorite is "Thoughts of a Father" which is what I wrote down while awaiting a diagnosis of cancer in my six-year old son. It was a very personal piece and a very raw reflection of the horrors and doubts of such an experience. Of the humorous pieces, the one that is my, and most people's favorite is "The Relationship Between Moral Health and a Blind Wife," which depicts a Saipan scene of the pitfalls of multicultural communication. Of the medical stories, I like "Sweet Sight" which depicts the drama of a blind man regaining his sight.<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Tell us about your writing process. How do you find the time to write with a busy schedule/family life? <o:p></o:p></span></b><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Most of the time, I'll write about something that has been on my mind for a while. It takes time for ideas to percolate. I start the writing process inside my head. I have a loose idea of what I want to say, but it really evolves as I'm writing. The act of writing is a sort of unveiling. I'm not sure at the start how it will turn out. The interaction between the writer and the page determines the end result. The page is an active participant, molding the writer's words as they emerge. At least that's how it happens for me. When do I find the time to write? When everyone is asleep. I also write on Thursday mornings. It's my operating room day, and in the 20 or so minutes between surgical cases, I'll pause and write.<o:p></o:p></span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">You are a very respected ophthalmologist. I'm sure you could have your choice to practice anywhere in the world, so why Saipan? </b><o:p></o:p></span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Are you kidding? Because Saipan is the greatest place in the world! I'm living on a beautiful tropical island, serving people who need and appreciate my services. I live in a community that values human relationships, where my kids are growing up without fear. What more could a person want? One of my professional goals was to work in an under-served area, which is why I left the US after I completed my training. Sometimes I think back on the life I could have had -- working in an academic medical center, teaching, publishing scientific papers -- and all the prestige that comes from that. It can be seductive, but I truly believe that I'm in the setting that gives me happiness, which is much more important, ultimately than prestige.<o:p></o:p></span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">How big of a role does Saipan play in your writing? </b></span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">How has your experience growing up as an Iranian boy in Kentucky contributed to your unique views on life?</b> </span><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">I think more than anything else (and I think this is common among many immigrants), it gave me the perspective of an outsider -- of someone who had to work to fit in, to be accepted. Immigrants were rare in Appalachia when we moved there in the 60's. People didn't know how to categorize us. It was still a time of racial tension, and here was this brown family -- neither black nor white, with strange accents, strange foods, strange religion, strange names, strange strange strange. I carried that sense or having to work to just fit in around with me through my 20's. But once I left the United States, I lost that sense of being an outsider. I think the ethnic diversity of Saipan, where there is no clear majority, is unifying. People are used to people of various colors, with funny names. Here, I'm no more a stranger than anyone else, and ultimately, I imagine many parts of the world will be like Saipan -- a true mix of cultures and peoples. Growing up in rural Kentucky also gave me a sense of appreciation for small towns and tight communities, which is one of the reasons Saipan resonates with me.<o:p></o:p></span><br />
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<o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></div>
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<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">What future projects of yours can we look forward to? <o:p></o:p></span></b><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">I'm not sure. I've been on pause in terms of writing for almost a year. I'm trying to create more space and quite time in my life, and I'm very careful about the things I undertake. I'm contemplating writing some columns again, but not with the same weekly frenzy as before. I'd also like to get back to the "7 Habits of Unity" book, but I'm in no hurry.<o:p></o:p></span><br />
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<o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></div>
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<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Is there anything else you'd like to add? <o:p></o:p></span></b><br />
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">This is my first interview by a famous film-maker!<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">Finally,</b><b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">Our version of James Lipton’s/Bernard Pivo Questions (one word, or short answers please): </b><b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
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<b style="mso-bidi-font-weight: normal;"><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">What does the Chamorro culture mean to you? <o:p></o:p></span></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Search<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">Who’s your favorite local artist?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Greg Elliott<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">Do you speak Chamorro?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Some<o:p></o:p></span><br />
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<o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">As a person, what turns you on?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Contentment<o:p></o:p></span><br />
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<o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">As a person, what turns you off?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Poverty<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">What’s your favorite curse word?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Booger (my kids might read this).<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">What sound or noise do you love?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Laughter<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">What sound or noise do you hate?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">The sound of surgical scissors removing an eye.<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">What profession other than your own would you like to attempt?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Stand-up comic<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">What profession would you not like to attempt?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Hitman -- boss is too demanding.<o:p></o:p></span><br />
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<b style="mso-bidi-font-weight: normal;"><o:p><span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"> </span></o:p></b></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;"><b style="mso-bidi-font-weight: normal;">If heaven exists, what would you like to hear God say when you arrive at the pearly gates?</b> <o:p></o:p></span></div>
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<span class="Apple-style-span" style="color: #333333; font-family: arial; font-size: 100%;">Welcome!</span></div>
</div>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com0tag:blogger.com,1999:blog-6623415689314087026.post-7647265165794319052009-06-11T08:56:00.002+10:002009-06-11T08:59:31.574+10:00Patients Gone Wild and Healthcare Reform(I'm blogging from the operating room. Here's my Saipan Tribune column for this week.)<div><br /></div><div><!--StartFragment--> <p class="MsoNormal">I recently had the opportunity to read President Barak Obama’s letter on Health Care Reform, dated June 3, 2009.<span style="mso-spacerun: yes"> </span>There is one paragraph in particular that jumped out at me, because it seeks to identify the “root cause” of rising health care costs.<span style="mso-spacerun: yes"> </span>Here it is:</p> <p class="MsoNormal" style="margin-left:.5in;mso-pagination:none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none"><span style="font-family:Times; mso-bidi-font-family:Times">“At this historic juncture, we share the goal of quality, affordable health care for all Americans.<span style="mso-spacerun: yes"> </span>But I want to stress that reform cannot mean focusing on expanded coverage alone.<span style="mso-spacerun: yes"> </span>Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach.<span style="mso-spacerun: yes"> </span>So we must attack the root causes of the inflation in health care.<span style="mso-spacerun: yes"> </span>That means promoting the best practices, not simply the most expensive.… That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.”</span></p> <p class="MsoNormal" style="mso-pagination:none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none"><span style="font-family:Times; mso-bidi-font-family:Times">First, let me say, that I agree with the gist of the statement.<span style="mso-spacerun: yes"> </span>Rising health care costs are killing our economy (well, that and a few other things), and medical care can definitely be improved so that it is more cost effective.</span></p> <p class="MsoNormal" style="mso-pagination:none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none"><span style="font-family:Times; mso-bidi-font-family:Times">But here’s the truth.<span style="mso-spacerun: yes"> </span>The single best way to reduce the cost of healthcare is to reduce the <i style="mso-bidi-font-style:normal">need</i> for healthcare.<span style="mso-spacerun: yes"> </span>We are a sick bunch of people, and for the most part, it’s because of our own behavior – we’re all “patients gone wild.”<span style="mso-spacerun: yes"> </span>The majority of us are sick, not because we’re out doing healthy things and suddenly get struck down by some horrific disease.<span style="mso-spacerun: yes"> </span>No, we’re sick because we eat too much, sit around too much, eat the wrong foods, smoke, consume alcohol, and generally ignore the things that lead to good health.<span style="mso-spacerun: yes"> </span>We’re sick because of the wild and crazy choices we make.<span style="mso-spacerun: yes"> </span>The vast majority of healthcare costs in America and the CNMI are tied to chronic “lifestyle” diseases.<span style="mso-spacerun: yes"> </span>The top ten causes of death in the US include heart disease, stroke, diabetes, and cancer.<span style="mso-spacerun: yes"> </span>And every single one of these has been incontrovertibly linked to how we live our lives – whether it’s what we eat, what we do, what we drink or what we inhale.<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal" style="mso-pagination:none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none"><span style="font-family:Times; mso-bidi-font-family:Times">To a large extent, we’re digging our graves with our spoons and forks.<span style="mso-spacerun: yes"> </span>Last year, we spent over $20 billion dollars on cholesterol lowering drugs.<span style="mso-spacerun: yes"> </span>That’s billion, with a “B”.<span style="mso-spacerun: yes"> </span>If you had $20 billion dollars, and decided to burn a million dollars a day, every single day, it would take you 55 years to spend $20 billion!<span style="mso-spacerun: yes"> </span>Why is our cholesterol high and why does it need to be lowered at a tune of $20 billion a year?<span style="mso-spacerun: yes"> </span>High cholesterol is a major risk factor for heart disease and stroke.<span style="mso-spacerun: yes"> </span>Our bodies produce some cholesterol, but most of the problem comes from what we eat.<span style="mso-spacerun: yes"> </span>Only animals have cholesterol in them.<span style="mso-spacerun: yes"> </span>Vegetables have no cholesterol at all.<span style="mso-spacerun: yes"> </span>We’ve known for decades that the most effective way (and the cheapest way) to lower cholesterol is to lower our consumption of animal products – animal flesh, animal milk, animal cheese, animal crackers, etc.<span style="mso-spacerun: yes"> </span>But you know what? We’d rather not make that kind of change.<span style="mso-spacerun: yes"> </span>We’d rather pop a pill and keep eating whatever we want to eat.<span style="mso-spacerun: yes"> </span>And that’s $20 billion dollars we spend so we can do what we want to do, which is to eat lots of animals.<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal" style="mso-pagination:none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none"><span style="font-family:Times; mso-bidi-font-family:Times">The same is true for diabetes, which is devastating our community, and growing at an alarming rate.<span style="mso-spacerun: yes"> </span>We know that for most of us, the adult onset variety can be controlled, or at least hugely improved, with diet and exercise.<span style="mso-spacerun: yes"> </span>Yet we choose not to make these difficult changes.<span style="mso-spacerun: yes"> </span>We choose to eat what we want, and take pills and go on dialysis and lose our vision and our feet and our erections.<span style="mso-spacerun: yes"> </span>And we spend untold billions on the cost of care for diabetes and its related problems.<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal" style="mso-pagination:none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none"><span style="font-family:Times; mso-bidi-font-family:Times">A diet high in animal fat is also linked to a slew of cancers.<span style="mso-spacerun: yes"> </span>Pass the processed meat that starts with “S” and ends in “M” and rhymes with “PAM”.<span style="mso-spacerun: yes"> </span>Or just pass a burger or wiener or any other chunk of meat.<span style="mso-spacerun: yes"> </span>Alcohol consumption is linked to many cancers.<span style="mso-spacerun: yes"> </span>Pass a Bud (better make that a Bud Lite).<span style="mso-spacerun: yes"> </span>Tobacco is irrefutably linked to cancer.<span style="mso-spacerun: yes"> </span>But we can’t seem to manage to pass legislation to ban smoking in public spaces.<span style="mso-spacerun: yes"> </span>Pass the votes. </span></p> <p class="MsoNormal" style="mso-pagination:none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none"><span style="font-family:Times; mso-bidi-font-family:Times">I admire efforts to improve the cost-effectiveness of the healthcare we deliver, but I know that the “root cause” of the mess includes our culture of indiscretion, of consumption, of sitting around.<span style="mso-spacerun: yes"> </span>Any serious effort to fix the healthcare mess must include a change in our culture – what we eat, what we do, what we drink and what we inhale.<span style="mso-spacerun: yes"> </span>These changes won’t solve all the problems, but they’ll make a huge dent in the demand for and the cost of healthcare.<span style="mso-spacerun: yes"> </span>A major portion of the responsibility to “reform” belongs on our shoulders -- those who end up needing healthcare. <span style="mso-spacerun: yes"> </span>Reduce the need, and you reduce the cost.<span style="mso-spacerun: yes"> </span>It’s simple.<span style="mso-spacerun: yes"> </span>But it’s not easy.<span style="mso-spacerun: yes"> </span>We humans typically don’t like change.<span style="mso-spacerun: yes"> </span>Yet failure to change our behavior will result in more and more people needing healthcare every year, rising costs, and eventually, not enough doctors, hospitals or other resources to take care of so many sick people.<span style="mso-spacerun: yes"> </span>We’re experiencing the fallout right now, right here in the CNMI.<span style="mso-spacerun: yes"> </span></span></p> <p class="MsoNormal" style="mso-pagination:none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none"><span style="font-family:Times; mso-bidi-font-family:Times">Addressing our behavior needs move to the front and center in the public policy discussion on healthcare reform.<span style="mso-spacerun: yes"> </span>It’s a nut we must crack.</span></p> <p class="MsoNormal" style="mso-pagination:none;tab-stops:28.0pt 56.0pt 84.0pt 112.0pt 140.0pt 168.0pt 196.0pt 224.0pt 3.5in 280.0pt 308.0pt 336.0pt; mso-layout-grid-align:none;text-autospace:none"><span style="font-family:Times; mso-bidi-font-family:Times">_______________________________________________________________________<o:p></o:p></span></p> <p class="MsoNormal">David Khorram, MD is the co-founder and medical director of Marianas Eye Institute.<span style="mso-spacerun: yes"> </span>He is the author of the book, <i style="mso-bidi-font-style:normal">World Peace, a Blind Wife, and Gecko Tails</i>, which is available on Amazon.com and at Marianas Eye Institute.<span style="mso-spacerun: yes"> </span>Dr. Khorram can be emailed by visiting <a href="http://www.MarianasEye.com">www.MarianasEye.com</a>, or by phone at 670-235-9090. © David Khorram, 2009.</p> <!--EndFragment--> </div>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com3tag:blogger.com,1999:blog-6623415689314087026.post-38154627342057751352009-05-02T16:51:00.003+10:002009-05-02T16:54:23.927+10:00Risk Factor for Swine Flu<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikn79cpGADEVkoahjRw7YLbap1tL7GvuX1aIJ7l8TUJMc8CJ7OxKDUj_3dMH1fR1oLnEPAzpvLwYXMkz7xW9JBPbhqK18QTrOMdjBS9fyIE8lAj35dkOqU-XFBl0ky972JHwg74A4TGc4/s1600-h/image001.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 302px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEikn79cpGADEVkoahjRw7YLbap1tL7GvuX1aIJ7l8TUJMc8CJ7OxKDUj_3dMH1fR1oLnEPAzpvLwYXMkz7xW9JBPbhqK18QTrOMdjBS9fyIE8lAj35dkOqU-XFBl0ky972JHwg74A4TGc4/s400/image001.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5331116049116165458" /></a>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com0tag:blogger.com,1999:blog-6623415689314087026.post-32194834769036208272009-05-01T17:03:00.002+10:002009-05-01T17:08:18.612+10:00What they're not telling you about Swine Flu<span class="Apple-style-span" style="font-family: Helvetica; font-size: 12px; ">Here's a portion of an email I got from one of our public health officials, just to put things in perspective:</span><div><span class="Apple-style-span" style="font-family: Helvetica; font-size: 12px;"><br /></span></div><div><span class="Apple-style-span" style="font-family: Helvetica; font-size: 12px; "><blockquote>I am getting more than 8 Swine Flu "Updates" per hour. Good grief. This is a true epidemic, likely soon to be a global pandemic. My guess is that we'll be in Phase 6 next week. But the relatively minor human toll (low morbidity and low mortality) does not yet justify the resource allocation, nor the media attention that we have all seen.<br /><br />We need to insure that we have a "measured response" that is commensurate with the real, not the perceived, threat. And responding appropriately, in the face of media hype and patient worry and governmental involvement, is a real art. I am hoping to hear your opinions on this.<br /><br />In the past six weeks, Swine Flu has killed between 20 and 80 people. More than 2000 have had clinically significant infections. In the same time period, more than 40,000 people have died from routine influenza. Millions were infected. More than 40,000 died from TB just last week. 40,000 more died from malaria last week.</blockquote><br /></span></div>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com2tag:blogger.com,1999:blog-6623415689314087026.post-71279113985669908872009-03-13T10:45:00.006+10:002009-03-13T10:52:45.253+10:00Jerks Die YoungerThe next time some jerk is yelling at you for no good reason, you can smile, knowing that they'll be off the planet sooner than you.<div><br /></div><div>A new study published in the Journal of the American College of Cardiology finds that people who are angry and exhibit hostility have a 19% higher risk of dying from coronary artery disease -- i.e. a heart attack.</div><div><br /></div><div>The average person hopes that future studies will show an increased risk.</div><div><br /></div>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com1tag:blogger.com,1999:blog-6623415689314087026.post-64548909920208673052009-03-12T21:31:00.003+10:002009-03-12T21:42:00.716+10:00Sexualization of Young GirlsI was at the Thursday night street market, where every week on Saipan you'll find food vendors and live entertainment. Tonight, a dance schools performed. I'll tell you, it was a sad scene. There were kids, girls, six, seven, eight years old, dressed like teenagers, with short skirts, makeup, and shin-high boots, and dancing suggestively to lyrics like "Let's make love, ooh, baby, let's make love."<div><br /></div><div>When did this happen? When did parents start looking the other way, and give their assent to the sexualization of their young girls? It's like they all went out for a walk, let some stranger called a dance instructor come into their house, and in the name of "developing talent" twist their kids into these vacant performers. It disgusts me. What happened to protecting innocence? What are these parents thinking? Do they think this is okay? To have their young daughters thrusting their pelvises while lip-synching these overtly sexual lyrics? I don't get it.</div>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com1tag:blogger.com,1999:blog-6623415689314087026.post-61041565696923182392009-02-28T12:59:00.006+10:002009-02-28T13:16:24.147+10:00Nagoya City University HospitalA few years ago, I needed some surgery that wasn't available on Saipan, so I was faced with finding a surgeon to undertake my care. Part of the issue for me was that I wanted to get the care close-by, and being self-insured, I needed it to be cost effective.<div><br /></div><div>My main four choices came down to Australia, Hawaii, Manila and Japan. I visited one of the top surgeons in Sydney during a trip there, and I wasn't impressed. I scratched Manila off the list pretty quickly. I've had a fair bit of experience with patients going to Manila for care, and although one of the surgeons I've worked with there is good, I've found that in general, the delivery was not up to the standards I expect when sending a patient to a major medical referral center. Sorry guys, but that's the truth. I wouldn't go to Manila unless it was a last resort. I'm sure many have had good experiences there, but seeing many of my patients return, I haven't been too happy with the quality of care they received.</div><div><br /></div><div>Hawaii was an obvious choice because, well, it's US quality medical care. The problems with US care is that it's expensive. If I'd had the procedure in Hawaii, it would have cost me $10K. If I had had insurance, my 20% co-payment would have been $2K, for an outpatient procedure. So, I just held this option in reserve.</div><div><br /></div><div>I started to look seriously at Japan. In the world of medicine, Japan is one of the areas, along with the US and parts of Europe, that lead medical research and publish in medical journals. I know the quality of care there is top-notch, and that the cost is reasonable. I ended up finding one of the best surgeons in the world for my condition, and headed there for my surgery. I was very happy with the quality of the care I received, and the cost was only $2K. That included the surgery, and five days in the hospital, getting fed and watered. The system of care in Japan is a little antiquated, and many expatriates in Japan complain about it for this reason, but as someone in the medical field and as someone who has experienced the care first-hand, I think that the care is on par with anyplace in the US, and even better than the US, it's cost effective.</div><div><br /></div><div>After I returned, I tried to convince the powers that be to start looking at Japan as a place to send our medical referral patients from the CNMI. It close, it's cheap, and the quality of care is outstanding. It's taken a while, but finally the CNMI has a relationship with the Nagoya City University Hospital (NCUH), and we have liaison people on the ground to help patients navigate a foreign country.</div><div><br /></div><div>Nagoya City University Hospital is an 800 bed medical center (CHC has 72 beds). The first patient from the CNMI that went there was an infant, a few days old, who was on the way to Hawaii for cardiac surgery, decompensated while on the tarmac in Nagoya, and was taken to the NCUH where the pediatric cardiac surgeons did an outstanding job on a very complex surgical procedure. Since that time, the relationship has deepened, and in the next few weeks, I hope to send the first ophthalmology patients there. This should provide closer and less expensive care than is available in Hawaii, and as high a quality of care. I'm looking forward to using NCUH as a referral center.</div>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com2tag:blogger.com,1999:blog-6623415689314087026.post-45531097971517608132009-02-22T10:12:00.004+10:002009-02-22T10:32:22.121+10:00Truth, Death, Unity and Classroom Cataract SurgeryBecause of my book, I was invited to give the keynote address to the University of Guam during their faculty development day on Friday. I just shared some thoughts that were on my mind. I think in some way, the points I raised had to do with some of the anchoring principles of my life. It was also an opportunity for me to try out some of the stand-up comedy material I had been working on, and most of the jokes got laughs. Here were my key points.<div><br /></div><div>1. "Truthfulness is the foundation of all human virtues. Without truthfulness, progress and success in all the worlds of God are impossible for any soul." Before I really started to think about this principle in my own life, I used to "fib" so much to avoid embarrassment or to stay out of trouble. Being committed to total truthfulness required me to change the way I did a lot of things, but it was a liberating process. It's a pain, and I feel I sell out pretty easily at times. But it's still one of the key principles that I think everyone can benefit from.</div><div><br /></div><div>2. We're all gonna die. Really. Remaining conscious of this truth on a daily basis helps lend clarity to life. This can be done by bringing oneself to account each day. "Bring thyself to account each day, ere though art summoned to a reckoning, for death unheralded shall come upon thee and thou shalt be called to give account for thy deeds."</div><div><br /></div><div>3. The motto of UOG is "Unity in Diversity." Unity requires that as individuals we refrain from faultfinding. The process of higher education gears us toward "critical analysis" which makes faultfinding a natural way of life. Faultfinding is an intellectual activity that is quarantined to one's mind. But the real problems arise when we mention the faults of others -- when faultfinding moves to backbiting. It's endemic in our culture, and there is a need to establish "no backbiting zones" around our mouths, and even our ears, so we don't participate in this corrosive force.</div><div><br /></div><div>4. Cataract surgery brings vision. Teaching brings vision.</div><div><br /></div><div>The faculty were appreciative of having a speaker who wasn't there with charts and numbers, and as someone said, "we're all human, and it's nice to remember that at times."</div>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com1tag:blogger.com,1999:blog-6623415689314087026.post-49725232654182464292009-01-31T07:00:00.004+10:002009-01-31T07:29:04.753+10:00Gory Eye Picture - Dermoid from Hell<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQr5EyN1o5OItAUpBGL0GWPP5KY6hicGa7fT62_xfdiJHkUfv7mBso3NM4-d4cekRd_eYEGIaEOKFg8GtrOD9ilAXXatQvNe3mwu1RPauk9sayUg9Ki6jin_PMePJFgE9Ks1kPosOB90c/s1600-h/Dermoid.jpg"><img style="display:block; margin:0px auto 10px; text-align:center;cursor:pointer; cursor:hand;width: 400px; height: 300px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQr5EyN1o5OItAUpBGL0GWPP5KY6hicGa7fT62_xfdiJHkUfv7mBso3NM4-d4cekRd_eYEGIaEOKFg8GtrOD9ilAXXatQvNe3mwu1RPauk9sayUg9Ki6jin_PMePJFgE9Ks1kPosOB90c/s400/Dermoid.jpg" border="0" alt="" id="BLOGGER_PHOTO_ID_5297198409742636802" /></a><br />This is a weird growth that some people are born with. It's called a dermoid. It can enlarge over time, as this one has. (This guy walked in this week is in his 20's. Time to remove it, don't ya think?) You can see it has hair growing on it. Sometimes there's bone and teeth and cartilage and other Frankensteinian components in them. Growths like this that consist of tissue not normally found at the site are called "choristomas". One choristoma made it to the big screen in the movie, "My Big Fat Greek Wedding," where the Aunt is telling the fiance of the lump that was removed from her back that had teeth and hair in it, and that it was the remnants of her twin that was never born. It was a great scene, and a proud day for choristomas everywhere.<div><br /></div><div>Often, ocular dermoids go deep into the substance of the eye wall, so despite it's "stuck-on" appearance, you can't just slice it off, (or lacking instruments, pluck it off), because you could end up with a hole in the eye. So you have to have donor tissue available to patch up the hole at the time of surgery. They occur in about one per 10,000 people. <div><br /></div><div><br /></div></div>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com5tag:blogger.com,1999:blog-6623415689314087026.post-54078145269781605572008-10-23T14:56:00.000+10:002008-10-23T14:58:40.840+10:00<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_4zXdizMrLz4sZTwvVxlaenr_g-mMsYiieSOoLcbAbcg30WJ3aB2ooZ4Tzw34oRZaUOaeS2DfDO6MlWMUID1aVajdsI39C4boo02W9bTBl-eK_CdLcfIfij2VDzRwnhJsFBv3GazEzoA/s1600-h/homer_simpson31.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer; width: 300px; height: 303px;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_4zXdizMrLz4sZTwvVxlaenr_g-mMsYiieSOoLcbAbcg30WJ3aB2ooZ4Tzw34oRZaUOaeS2DfDO6MlWMUID1aVajdsI39C4boo02W9bTBl-eK_CdLcfIfij2VDzRwnhJsFBv3GazEzoA/s400/homer_simpson31.jpg" alt="" id="BLOGGER_PHOTO_ID_5260209258215350114" border="0" /></a>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com3tag:blogger.com,1999:blog-6623415689314087026.post-84198681749869993192008-09-10T19:15:00.002+10:002008-09-10T19:18:26.490+10:00Happiness"The fact is that without inner peace and wisdom, we have nothing we need to be happy. Living on a pendulum between hope and doubt, excitement and boredom, desire and weariness, it's easier to fritter away our lives, bit by bit, without even noticing, running all over the place and getting nowhere. Happiness is a state of inner fulfillment, not the gratification of inexhaustible desire for outward things." <br /><br /> ~Matthieu RicardMarianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com2tag:blogger.com,1999:blog-6623415689314087026.post-63826097421631351862008-08-25T21:33:00.004+10:002008-08-25T21:43:14.113+10:00Gory Eye PictureI'm amazed by how many people complain to me that I don't warn them that these pictures might give them nightmares and why don't I warn them of the graphic nature. What do you think it means when the title of the post is "gory eye picture," kittens?<br /><br />Without further warning, here it is:<br /><br /><div style="text-align: center;"><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyXqrLpuEpPvwItXiYy355jkBhGgzJUyVhXtDWGzezhqZG4LOGQPgdNBaRS9ZkF8ofeBWGnAI3oF1W2M1uWMHa-knBDV7c5EDqhNLNoK8zmqHwqeJLJbpT55-nfXSLovWFeA-l0djwkfg/s1600-h/fishhook+in+eye.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyXqrLpuEpPvwItXiYy355jkBhGgzJUyVhXtDWGzezhqZG4LOGQPgdNBaRS9ZkF8ofeBWGnAI3oF1W2M1uWMHa-knBDV7c5EDqhNLNoK8zmqHwqeJLJbpT55-nfXSLovWFeA-l0djwkfg/s400/fishhook+in+eye.jpg" alt="" id="BLOGGER_PHOTO_ID_5238418010728099794" border="0" /></a> <a href=http://13gb.com/media.php?media_id=1909>(photo credit)</a><br /></div>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com11tag:blogger.com,1999:blog-6623415689314087026.post-78691652781484968762008-08-17T05:31:00.004+10:002008-08-17T05:50:37.019+10:00I'm BackSort of... maybe... in a different way.<br /><br />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. <br /><br />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. <br /><br />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.Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com10tag:blogger.com,1999:blog-6623415689314087026.post-70895848148813839082008-06-30T11:48:00.002+10:002008-06-30T11:51:27.457+10:00The Bottom of the Economic Development LadderHere is my <a href="http://saipantribune.com">Saipan Tribune</a> column from Friday.<br /><br /><div style="text-align: center;">***<br /> </div><p class="MsoNormal">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.<span style=""> </span>Economic development, as it turns out has a fascinating history.<span style=""> </span>Economist, Jeffrey Sachs, describes a four step ladder, as a way of viewing the world in terms of economic development.<span style=""> </span>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.”</p> <p class="MsoNormal">Today one billion people – one sixth of the earth’s population – live in extreme poverty.<span style=""> </span>This "bottom billion" is so economically destitute, that their very survival is at risk on a daily basis. Their lives are fragile. <span style=""> </span>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.<span style=""> </span>If there is any income that comes into the hands of those in extreme poverty, it is counted in pennies per day.</p> <p class="MsoNormal">For much of human history, the vast majority of the world’s population has lived in extreme poverty.<span style=""> </span>Our ancestors struggled for their very survival, in a harsh world, with a fragile existence.<span style=""> </span>Wealth, above extreme poverty, did not become accessible to common people until the mid 1700’s.<span style=""> </span>It is only since about 1750 that humanity has climbed onto the first rungs of the economic development ladder.</p> <p class="MsoNormal">Extreme poverty does not exist in developed countries. <span style=""> </span>It is a condition that afflicts swaths of the developing world.<span style=""> </span>Seventy percent of the extreme poor live in <st1:place>Africa</st1:place>.<span style=""> </span>Ten to fifteen thousand of them die of preventable causes, like hunger, malaria, and dysentery every single day, day after day, year after year.</p> <p class="MsoNormal">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.</p> <p class="MsoNormal">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.<span style=""> </span>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.<span style=""> </span>The bottom billion require assistance to get on the economic ladder, to move from extreme poverty to just regular poverty.<span style=""> </span>It is a small step, but the most important one in terms of the survival.</p>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com6tag:blogger.com,1999:blog-6623415689314087026.post-66887980809624150312008-06-23T06:02:00.002+10:002008-12-11T10:18:41.638+10:00Marine Sting Photos Wanted<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjePwo3iLRswz1gmM-cj3d6fLlC4j6ApmyF_P-ioLPGhheuKQ3IitYSdqnbYlP03fdwZlMBEmfD1jd-7ll8v6xo4VBY6O2GVcJV2V8pFEw1aoMsRo6RnywStC13dJ4Iyh55ZLv9p361EMU/s1600-h/Sea+Urchin.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjePwo3iLRswz1gmM-cj3d6fLlC4j6ApmyF_P-ioLPGhheuKQ3IitYSdqnbYlP03fdwZlMBEmfD1jd-7ll8v6xo4VBY6O2GVcJV2V8pFEw1aoMsRo6RnywStC13dJ4Iyh55ZLv9p361EMU/s200/Sea+Urchin.jpg" alt="" id="BLOGGER_PHOTO_ID_5214427787006439986" border="0" /></a>I got an email from Dr. Paul Auerbach from Stanford University Medical Center. He hosts the blog, <a href="http://www.healthline.com/blogs/outdoor_health/">Medicine for the Outdoors</a>. He's looking for photos of stings from marine animals.<br /><br /><blockquote>Thanks for your kind comments about Medicine for the Outdoors at <a href="http://marianaseye.blogspot.com/2008/06/grand-rounds-from-south-pacific.html">Grand Rounds</a> 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.<br /><br />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.</blockquote><br /><br />Divers, if you get any good photos, let me know and I'll put you in touch with Dr. Paul.Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com1tag:blogger.com,1999:blog-6623415689314087026.post-14446753937418437512008-06-22T07:33:00.003+10:002008-12-11T10:18:41.968+10:00Victoria's Secret to Include Free Safety Goggles with Thong Purchases<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsod5jlWMXX9omMLmUjRCRLEA8S2lMltUaIuCzDYskAuwRjrxTh85nx3Y5eYJw3wBD4oOByHcSv5OQvCouR-yYEpwue5J4s3jCNNZEsTOsgTWy3p-fqGOzMko6ZuFQVz0SrtE6NHcilNM/s1600-h/safety.gif"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsod5jlWMXX9omMLmUjRCRLEA8S2lMltUaIuCzDYskAuwRjrxTh85nx3Y5eYJw3wBD4oOByHcSv5OQvCouR-yYEpwue5J4s3jCNNZEsTOsgTWy3p-fqGOzMko6ZuFQVz0SrtE6NHcilNM/s200/safety.gif" alt="" id="BLOGGER_PHOTO_ID_5214287007504358882" border="0" /></a><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgDSdRaYnXVGg95TVtYn2unx-34Mbw-sIA52JuK5mpFSqber010U982d2Txm2gkNsp00eIu_eZynfgtyxj3J4ZMmgWss8amZbvWva0yzeQDOvhAuRrPO0VxMKaE_3fObN1jEtCVqVl1JY/s1600-h/thong.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjgDSdRaYnXVGg95TVtYn2unx-34Mbw-sIA52JuK5mpFSqber010U982d2Txm2gkNsp00eIu_eZynfgtyxj3J4ZMmgWss8amZbvWva0yzeQDOvhAuRrPO0VxMKaE_3fObN1jEtCVqVl1JY/s200/thong.jpg" alt="" id="BLOGGER_PHOTO_ID_5214287007187541970" border="0" /></a>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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com6tag:blogger.com,1999:blog-6623415689314087026.post-41081744348852403622008-06-21T14:10:00.001+10:002008-06-21T14:10:01.026+10:00My Blog Knows Me So WellBlogging really is a weird kind of sickness -- sort of like love. Bloggers will recognize themselves in this post by The Blog that Ate Manhattan, titled, <a style="font-style: italic;" href="http://theblogthatatemanhattan.blogspot.com/2006/01/i-love-my-blog.html">I Love My Blog</a>.Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com1tag:blogger.com,1999:blog-6623415689314087026.post-47274664204446357932008-06-20T12:32:00.004+10:002008-12-11T10:18:42.777+10:00Gory Finger PictureIt's been a long time since I've posted a gory eye picture. Having had nothing gory to present, I'm resorting to gory finger pictures. <br /><br />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 <a href="http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijos/vol8n1/ring.xml">this site</a>. Dr. Ramona Bates, over at <a href="http://rlbatesmd.blogspot.com/">Suture for a Living</a>, tipped me off to this story (pun intended). <br /><br /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6mz3icdGZ692yqXBaH-AsCZYNgDGkzSYlwdjWzG6v-TftjPvnquu10lylk7yEyLASE2TaK8h7loCOKjaTPEByFnIhZQaxPkTCjSxzfN9uhGK9tA33ZzhWgNzCAhbjukx7CTqI9MUzqJg/s1600-h/ring-fig1.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi6mz3icdGZ692yqXBaH-AsCZYNgDGkzSYlwdjWzG6v-TftjPvnquu10lylk7yEyLASE2TaK8h7loCOKjaTPEByFnIhZQaxPkTCjSxzfN9uhGK9tA33ZzhWgNzCAhbjukx7CTqI9MUzqJg/s400/ring-fig1.jpg" alt="" id="BLOGGER_PHOTO_ID_5213787831264262130" border="0" /></a><br /><br /><img src="file:///C:/DOCUME%7E1/ADMINI%7E1/LOCALS%7E1/Temp/moz-screenshot.jpg" alt="" /><img src="file:///C:/DOCUME%7E1/ADMINI%7E1/LOCALS%7E1/Temp/moz-screenshot-1.jpg" alt="" /><br /><a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj833DYd68lBbCmXtUxLCMXqte5eOiiDvh0yicEq6gjutRZBjSVzxMZigNbBXoZr33mlCJzCSU1iPxPkZQOUsUAmUgJTJqyUqXXf8_qzFaLj0GU_23OTld8uteVPVJtv2qrV81s_YTAy6I/s1600-h/ring-fig2.jpg"><img style="margin: 0px auto 10px; display: block; text-align: center; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj833DYd68lBbCmXtUxLCMXqte5eOiiDvh0yicEq6gjutRZBjSVzxMZigNbBXoZr33mlCJzCSU1iPxPkZQOUsUAmUgJTJqyUqXXf8_qzFaLj0GU_23OTld8uteVPVJtv2qrV81s_YTAy6I/s400/ring-fig2.jpg" alt="" id="BLOGGER_PHOTO_ID_5213787835754023234" border="0" /></a>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com6tag:blogger.com,1999:blog-6623415689314087026.post-19953835300227423832008-06-20T10:45:00.002+10:002008-06-20T10:48:23.552+10:00Hiccups during surgeryYesterday was my surgical day. My last case of the day, a cataract patient, got the hiccups during the surgery. Under the operating microscope, it was like a series of earthquakes. It made for an interesting few minutes until the anesthesiologist could give him enough sedation to put the hiccups to sleep. The patient looked great this morning, except that the hiccups woke up after the surgery and are still there.Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com1tag:blogger.com,1999:blog-6623415689314087026.post-15070436511414485922008-06-20T10:37:00.003+10:002008-06-20T10:43:45.095+10:00Recovering from the Heat of Grand RoundsI'm still recovering from all the work of putting Grand Rounds together. It was fun, but I needed to be away from the keyboard for a few days. On Tuesday, the day Grand Rounds was posted, I got over 1,000 visits to my blog, which is a testament to how well organized this carnival is. I'm still catching up with all the comments and email I received as a result.<br /><br />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.Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com0tag:blogger.com,1999:blog-6623415689314087026.post-58366036024986407392008-06-17T06:00:00.012+10:002008-06-18T01:31:00.815+10:00Grand Rounds from the South PacificWelcome to this island edition of Grand Rounds. Yes, I really live and practice on a tropical island in the South Pacific. And yes, you can too. I’ll let you know how, in next week's edition of Grand Rounds, which will be hosted by <a href="http://psychiatrist-blog.blogspot.com/2008/06/submit-your-grand-rounds-for-next.html">My Three Shrinks</a>. But now, on to this week’s edition.<br /><br />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 <i>New York Times</i>. Maybe for a newspaper, like the <i>Enquirer</i> -- 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.<br /><br />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.<br /><br /><br /><b>Life is Not Just About Breasts</b><br /><br />“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.<br /><br />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 <a href="http://rlbatesmd.blogspot.com/">Suture for a Living</a>, on the post, aptly named, <a href="http://rlbatesmd.blogspot.com/2008/06/hi.html">Hi!</a><br /><br /><br /><b>Indiana Jones and the Kingdom of Malaria</b><br /><br />I love <a href="http://www.healthline.com/blog_profile/paul_auerbach">Dr. Paul Auerbach’s</a> 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.<br /><br />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 <a href="http://www.healthline.com/blogs/outdoor_health/2008/06/artesunate-for-falciparum-malaria.html">Artesunate for Falciparum Malaria</a><br /><br /><br /><b>Humanity is Good</b><br /><br />Once in a while, I read something on a blog that brings tears to my eyes. Dr. David Loeb, a pediatric oncologist at <a href="http://doctordavidsblog.blogspot.com/">Doctor David’s Blog</a>, is sure to touch your heart with this post on <a href="http://doctordavidsblog.blogspot.com/2008/05/different-kind-of-memorial-day.html">A Different Kind of Memorial Day</a>. 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.<br /><br /><br /><b>Humanity is Really Good</b><br /><br />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.<a href="http://improbableoptimisms.blogspot.com/2008/06/renewed-faith.html">Renewed Faith</a><br /><br /><br /><b>Just When You Thought Humanity Was Good</b><br /><br />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, <a href="http://other-things-amanzi.blogspot.com/2008/06/south-african-crime.html">South African Crime</a>, 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.<br /><br /><br /><b>Stethoscope Doubles as MP3 Player</b><br /><br /><a href="http://www.healthline.com/blog_profile/joshua_schwimmer">Dr. Joshua Schwimmer’s</a> old stethoscope broke, and he reluctantly purchased a new electronic one. He’s a convert and explains <a href="http://www.healthline.com/blogs/medical_devices/2008/06/your-next-stethoscope-should-be.html">Your Next Stethoscope Should Be Electronic. Here's Why</a>.<br /><br /><br /><b>Bottomless Pits + No Wits = Champion Eaters</b><br /><br />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 <a href="http://nottotallyrad.blogspot.com/">Not Totally Rad</a>, explains it all on the post<a href="http://nottotallyrad.blogspot.com/2008/06/radiology-of-competitive-speed-eating.html"> Radiology of Competitive Speed Eating</a><br /><br /><br /><b>Waiting for India on My Lap</b><br /><br />Ian Furst<span style="font-weight: normal;font-size:100%;" > over at <a href="http://www.waittimes.blogspot.com/" target="_new">Wait Time</a> helps health care providers to decrease wait times and delays. He submits <a href="http://waittimes.blogspot.com/2008/06/indias-health-care-system.html">India's Health Care System</a> which looks at the private/public divide in India's Healthcare system and the lessons we might learn in North America.<br /><br />While you’re on his site, scroll down to <a href="http://waittimes.blogspot.com/2008/06/things-to-do-while-waiting-at-doctors.html">Things to do while waiting at the doctors office</a>. Shocking! There is probably some business opportunity in there somewhere.<br /><br /><br /><b>Is Your Name on This List?</b><br /><br />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. <a href="http://insureblog.blogspot.com/2008/06/drug-money.html">Drug Money.</a><br /><br /><br /><b>Wave of Bad Information Kills Web Surfer</b><br /><br />I was impressed with the fact that <a href="http://www.revolutionhealth.com/blogs/valjonesmd">Dr. Val and the Voice of Reason</a> really is a voice of reason. This week, she writes on <a href="http://www.revolutionhealth.com/blogs/valjonesmd/how-is-healthcare-lik-14163">How Is Healthcare Like A Garden Fungus?</a>, and points out, “<a href="http://www.revolutionhealth.com/blogs/valjonesmd/oversimplifying-medic-13649">Medicine is incredibly complex</a>, 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.”<br /><br /><br /><b>“Art, this is Death. Say Hello.”</b><br /><br />Talk about creative, Christian Sinclair and team have launched a new blog, <a href="http://arts.pallimed.org/">Pallimed: Arts & Humanities</a>, 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, <a href="http://arts.pallimed.org/2008/04/what-sarah-said-by-death-cab-for-cutie.html">"What Sarah Said" by Death Cab for Cutie</a>: "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.”<br /><br /><br /><b>Cool Kid Reject ADHD in Favor of Bipolar Disorder</b><br /><br />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 <a href="http://cockroachcatcher.blogspot.com/2008/06/bipolar-disorder-in-children.html">Bipolar Disorder in Children</a> at Cockroach Catcher Blog. "ADHD was the old black. Bipolar became the new black."<br /><br /><br /><b>Renegade Diabetics Take Charge of Own Disease</b><br /><br />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, <a href="http://www.diabetesmine.com/2008/06/diabetes-reloaded.html">Diabetes... RELOADED</a>, 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 21<sup>st</sup> century people living with health conditions. What’s special about this new web-enabled world of healthcare? It’s <em>proactive, technology-based, empowered, revolutionary, against all odds, and – if needed – outside the establishment.”</em> The blog is a 2006 Winner of LillyforLife Achievement Award for Diabetes Journalism. Congratulations, and keep up the good work.<br /><br /><br /><b>Patient Prescribes Own Drug. Doctor Does Own Taxes.</b><br /><br />And if the internet weren’t bad enough, people are now taking the next step:<br />picking up the phone, and telling doctors what to prescribe for them.<br />Read about this wacky patient’s expectations over at <a href="http://healthwise-everythinghealth.blogspot.com/2008/06/telephone-medicine.html">EverythingHealth</a><br /><br /><br /><b>Got Munchausen’s? AMA Has Jobs Available</b><br /><br />Did you realize that the next patient that walks into your office could be<span style=""> </span>a fake, commissioned by the AMA to check the quality of care you provide? David Williams at <a href="http://www.healthbusinessblog.com/">Health Business Blog</a> delves into the controversy, <a href="http://www.healthbusinessblog.com/?p=1812">Do we really need mystery shoppers in health care?</a><br /><br /><br /><b>Pharmacist Sleeps with Drug Researcher; Takes pill to blunt remorse</b><br /><br />This doctor has one of the best named blogs ever: <a href="http://theblogthatatemanhattan.blogspot.com/">The Blog that Ate Manhattan</a>. 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.<a href="http://theblogthatatemanhattan.blogspot.com/2008/06/cvscaremark-detailing-for-bayer.html">CVS/Caremark – Detailing for Bayer?</a><br /><br /><br /><b>Blame Informed Patient on Doc Gurley</b><br /><br />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 <a href="http://www.docgurley.com/">Doc Gurley</a>’s post, <a href="http://www.docgurley.com/2008/06/14/blind-men-and-the-diabetes-elephant/">Blind Men and the Diabetes Elephant</a>. 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.<br /><br /><br /><b>Poor Ethicist Gets Spanked by Doctor Rich</b><br /><br /><a href="http://covertrationingblog.com/medical-ethics/the-right-way-to-think-about-medical-ethics">The Right Way to Think About Medical Ethics</a>, appears on <a href="http://covertrationingblog.com/">The Covert Rationing Blog</a>. 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.<br /><br /><br /><b>End Years of Debt-Free Living: Go to Medical School</b><br /><br />Why do so many doctors struggle financially? Theresa Chan posts <a href="http://www.ruraldoctoring.com/2008/06/meconomics-part-two-the-long-reach-of-med-school.html">MEconomics, Part Two: The Long Reach of Med School</a> on her blog <a href="http://www.ruraldoctoring.com/">Rural Doctoring</a>. "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."<br /><br /><br /><b>Cheech and Chong Appointed to Judiciary</b><br /><br />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 <a href="http://www.ruraldoctoring.com/">Rural Doctoring</a> shares her opinion in <a href="http://www.ruraldoctoring.com/2008/06/15-minutes-of-fame-medical-marijuana-in-rural-ca.html">15 Minutes of Fame: Medical Marijuana in Rural, CA</a>. "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.<br /><br /><br /><b>Man’s Jokester Friends Name Womb Disease After Him</b><br /><br />Dr. T posts on <a href="http://www.healthline.com/blogs/pregnancy_childbirth/2008/06/ashermans-syndrome.html">"Asherman's Syndrome"</a> 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.<br /><br /><br /><b>Ferret Diagnosed with ADHD; Parents overjoyed</b><br /><br />This is actually a very important post. David Rabiner outlines <a href="http://www.sharpbrains.com/blog/2008/06/12/promising-cognitive-training-studies-for-adhd/">Promising Cognitive Training Studies for ADHD</a>. "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."<br /><br /><br /><b>One Should Always Have a Penguin When Needed</b><br /><br />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 <a href="http://prnpenguin.wordpress.com/2008/06/12/dont-panic-how-to-survive-your-prac-placement-as-a-1st-year-nursing-student/">How to survive your practicum placement as a nursing student</a>. It is also useful information for medical students, job applicants, and humans of all varieties.<br /><br /><br /><b>That Dang Medical Records Department</b><br /><br /><a href="http://revolutionredux.wordpress.com/">Home of the Brave</a> submits <a href="http://revolutionredux.wordpress.com/2008/06/06/where-are-the-ellis-island-hospital-medical-records/">Where Are The Ellis Island Hospital Medical Records?</a> 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.<br /><br /><br /><b>Four out of Five Doctors Smoke Camels. (The other one smokes goats.)</b><br /><br />I learned something by visiting Peter Zavislak’s blog, <a href="http://medicalpastiche.blogspot.com/">Medical Pastiche</a>I 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, "<a href="http://medicalpastiche.blogspot.com/2008/05/what-cigarette-do-you-smoke-doctor.html">'What Cigarette Do You Smoke, Doctor?'</a>", which looks at advertising in the 1950’s.<br /><br /><br /><b>ER Nurse Strikes Patient</b><br /><br />“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 <a href="http://ernursey.blogspot.com/">ERnursey</a>, under the title, <a href="http://ernursey.blogspot.com/2008/06/when-precordial-thump-works.html">When the Precordial Thump Works</a><br /><br /><br /><b>Controlling Your Urge to Control</b><br /><br />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 <a href="http://achronicdose.blogspot.com/2008/06/in-control.html">In Control</a> which explores the relationship between control and chronic illness.<br /><br /><br /><b>Coke Shares Plummet; Rival bottles water</b><br /><br />Nancy L. Brown, PhD writes about <a href="http://www.healthline.com/blogs/teen_health/2008/06/sugar-and-soda-free-summer.html">Sugar and Soda Free Summer</a>. "The SF Bay Area is gearing up to have a "<a href="http://www.sodafreesummer.org/">Soda Free Summer</a>!" 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."<br /><br /><br /><b>Uninsured Mob Threatens National Security</b><br /><br />“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 <a href="http://www.blogger.com/Application%20Data/Microsoft/Word/tr_1213370659096">Colorado</a><a href="http://www.healthinsurancecolorado.net/blog1/"> Health Insurance Insider</a>’s post, <a href="http://www.healthinsurancecolorado.net/blog1/2008/06/12/number-of-underinsureds-rising-rapidly/">Number of Underinsureds Rising Rapidly</a><br /><br /><br /><b>Canada and Australia are Different Countries?</b><br /><br />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 <a href="http://blog.vitummedicinus.com/">Vitum Medicinus</a>, 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 <a href="http://blog.vitummedicinus.com/2008/06/vitum-experiences-medicine-down-under.html">Vitum experiences medicine down under!</a><br /><br /><br /><b>From Pulp to Electrons</b><br /><br />Are you thinking of converting to Electronic Medical Records?<a href="http://www.drpenna.com/">DrPenna</a> discuss about advantages and disadvantages of <a href="http://www.drpenna.com/2008/06/15/electronic-medical-records/">Electronic Medical Records</a> and his experience using them in his hospital.<br /><br /><br /><b>Serious Feelings</b> <br /><br />“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, <a href="http://mormonmd.wordpress.com/2008/06/10/my-entire-life/">My Entire Life</a>, 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.”<br /><br /><br /><b>More Serious Feelings</b><br /><br /><a href="http://insicknessinhealth.blogspot.com/">In Sickness & In Health</a> 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, <a href="http://insicknessinhealth.blogspot.com/2008/06/how-to-have-hard-conversations.html">How to Have the Hard Conversations</a> 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?"<br /><br /><br /><b>Vermox Stockpile Available</b><br /><br />Frankly, I’m relieved to learn that Global Warming is occurring. All this time, I thought it was Global “Worming,” and was preparing for <i>that</i>. Fortunately, medical student Thomas Robey has a better handle on things. At <a href="http://hope-for-pandora.blogspot.com/">Hope for Pandora</a>, 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 <a href="http://hope-for-pandora.blogspot.com/2008/06/reducing-and-reusing-if-not-recycling.html">Reducing and Reusing, if not Recycling in the OR</a>. 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."<br /><br /><br /><b>Radical Canadian Editors Blog</b><br /><br />The editors of <i>The National Review of Medicine</i> have their own blog. That sort of thing is apparently allowed up there in Canada. This week they discuss, <a href="http://canadianmedicine.blogspot.com/2008/06/should-we-screen-women-over-70-for.html">Should we screen women over 70 for breast cancer? (Just don't mention "rationing")</a><br /><br /><br /><b>Neurofibromatosis Headlines Are Tough to Write</b><br /><br />alter Jessen at <a href="http://www.highlighthealth.com/">Highlight HEALTH</a> 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. <a href="http://www.highlighthealth.com/diseases-and-conditions/neurofibromatosis-from-genes-to-complications-to-treatments/">Neurofibromatosis: From Genes to Complications to Treatments</a><br /><br /><br /><b>Neighborhood Masochist Buys New Suit</b><br /><br />Apparently, someone has developed a suit that mimics the pain of osteoarthritis.Read about it at <a href="http://www.healthline.com/blogs/exercise_fitness/2008/06/simulation-suit-to-feel-pain-of.html">Simulation Suit To Feel the Pain of Osteoarthritis </a>. Visit the blog, <a href="http://www.healthline.com/blogs/exercise_fitness">The Fitness Fixer</a> “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.”<br /><br /><br /><b>D is for Depression</b><br /><br /><a href="http://ectweb.blogspot.com/2008/06/vitamine-d-for-depression-in-elderly.html">Vitamine D for Depression in the Elderly?</a> 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.<br /><br /><br /><b>Cut from the Same Clot</b> <br /><br />The folks at <a href="http://casesblog.blogspot.com/">Clinical Cases and Images - Blog</a> submit <a href="http://casesblog.blogspot.com/2008/06/video-interview-with-tim-russerts.html">Video Interview with Tim Russert's Doctor -- Cause of Death Was a Fresh Clot in LAD</a>. The site also has useful information on studying for cardiology boards, the Mediterranean diet, and how to use Google Blogger’s schedule feature.<br /><br /><br /><b>How to Get a Hot Body Without Resorting to Kidnapping</b><br /><br />Crank up your metabolism, baby! <a href="http://www.healthline.com/blog_profile/tara_gidus">Tara Gidus</a>, 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 <a href="http://www.healthline.com/blogs/diet_nutrition/2008/06/turn-up-heat.html">Turn Up The Heat</a><br /><br /><br /><b>Stiff</b><br /><br />Dean Moyer of <a href="http://www.rebuildyourback.com/">The Back Pain Blog</a> shares a response to one reader's question about <a href="http://www.rebuildyourback.com/neckpain/2369643.php">Mysterious Morning Neck Pain</a>. 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."<br /><br /></span><div style="text-align: center;"><span style="font-weight: normal;font-size:100%;" >***</span><br /></div><span style="font-weight: normal;font-size:100%;" ><br />Thanks again, everyone for your outstanding submissions. Join the gang next week for Grand Rounds, hosted by <a href="http://psychiatrist-blog.blogspot.com/2008/06/submit-your-grand-rounds-for-next.html">My Three Shrinks</a>. The theme will be the upcoming iPhone 3G.<br /></span>Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com23tag:blogger.com,1999:blog-6623415689314087026.post-52650631084328527172008-06-14T22:29:00.009+10:002008-12-11T10:18:43.053+10:00Bali Bound<a onblur="try {parent.deselectBloggerImageGracefully();} catch(e) {}" href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSpeevOAkgSYBiGKyubBcJCp74yzP7YQ1tVmaND_Y1bJolrp0qrVdh3a-IpL7P9mHfKcJmsgKDMyW2iTUb8tYrd-5bbkFGYhaKOzCPGTjtpPKz3l1q52q_YRc_7HAwSo6Eh-y1CxcaJBA/s1600-h/Bali+Masks.jpg"><img style="margin: 0pt 0pt 10px 10px; float: right; cursor: pointer;" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSpeevOAkgSYBiGKyubBcJCp74yzP7YQ1tVmaND_Y1bJolrp0qrVdh3a-IpL7P9mHfKcJmsgKDMyW2iTUb8tYrd-5bbkFGYhaKOzCPGTjtpPKz3l1q52q_YRc_7HAwSo6Eh-y1CxcaJBA/s320/Bali+Masks.jpg" alt="" id="BLOGGER_PHOTO_ID_5211720973941641154" border="0" /></a>My friend, sociology professor <a href="http://www.fhsu.edu/sociology/kirk.shtml">Kirk Johnson, PhD</a>, has invited me to go along with his Globalization and Social Change class to Bali next spring and to be a guest lecturer during the trip. They'll be using <a href="http://blindwife.blogspot.com/">my book</a> as part of the reading for the class. <a href="http://blindwife.blogspot.com/2008/03/foreword.html">Here's why</a>. (You can skip to the last paragraph in the link.)<br /><br />I'll be going along to enrich their experience. What a job description.<br /><br />Last week, we unearthed these Balinese masks in the back of his car while trying to uncover a stroller.Marianas Eyehttp://www.blogger.com/profile/00754236373708613994noreply@blogger.com1