Grand Rounds from the South Pacific

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

I’ve always wanted to be a newspaper editor, not because I want to edit, but because I want to write headlines. And not for a respectable paper like the New York Times. Maybe for a newspaper, like the Enquirer -- you know, where an editor can have some creative freedom with the facts. So, finally, I get my chance with this week's Grand Rounds. Sometimes the headlines I’ve written relate to the post, sometimes, they are just a whacked out free associations. Like all headlines, their purpose is to get you to read the posts. I hope I can entice you. There are some really great writers out there. Great job everyone.

Let me know if there are any problems with the links, and let me know if you want to exchange links. Grab your beach towel and snorkel, because here we go... Leave only footprints and comments.


Life is Not Just About Breasts

“What do you think about my breasts?”Random women never asked me that question until I started offering Botox. Now I get it all the time. Let me give you some advice. Don’t even begin to try to answer it. It’s a trick question destined to land you in hot water. Just have your press secretary issue a statement that “The doctor can neither confirm nor deny that your breasts a) are as pert as a pair of saluting Marines; or b) like the jowls of a hound-dog.

If you’ve ever wondered what a set of rejuvenated boobs looks like, drive on down to Arkansas and head to the grocery store with plastic surgeon, Ramona Bates. Her patients may lift their shirts, right there next to the kumquats, just to share with Dr. Bates their joy of a job well done. Read about it, and other awkward plastic surgery moments, at Suture for a Living, on the post, aptly named, Hi!


Indiana Jones and the Kingdom of Malaria

I love Dr. Paul Auerbach’s specialty:“Wilderness Medicine.” Is that cool, or what! Sometimes I refer to myself as a Tropical Ophthalmologist (okay, actually, this is the first time), but I think I’m going to switch to Wilderness Ophthalmologist.

Paul has a great post that gives a fantastic overview of malaria, and links to an article that describes an important drug regimen for the disease. Read about it at Artesunate for Falciparum Malaria


Humanity is Good

Once in a while, I read something on a blog that brings tears to my eyes. Dr. David Loeb, a pediatric oncologist at Doctor David’s Blog, is sure to touch your heart with this post on A Different Kind of Memorial Day. He tells of the annual Memorial Day service held at Johns Hopkins Children’s Center for the families that have lost children to cancer, and the lessons learned.


Humanity is Really Good

I like Susan Palawick. She is an improbably optimistic ED chaplain, who shares a beautifully written portrait of two patients whose encounters renewed her faith in God and in humanity.Renewed Faith


Just When You Thought Humanity Was Good

Can somebody get Bongi an agent? He is a great writer, but he’s too busy opening and closing bellies to put a book together. Someone just needs to go through his blog and put it all together. His post this week, South African Crime, is not pretty in terms of the picture it paints, but like the above two posts, it gives us a peek into the human soul.


Stethoscope Doubles as MP3 Player

Dr. Joshua Schwimmer’s old stethoscope broke, and he reluctantly purchased a new electronic one. He’s a convert and explains Your Next Stethoscope Should Be Electronic. Here's Why.


Bottomless Pits + No Wits = Champion Eaters

A world-class competitive speed eater can put away 60 hot dogs in 12 minutes or 100 hamburgers in 8 minutes. Where do they put it all? (And why?) A recent peer-reviewed radiologic study sheds some light on what it takes to be a champion chomper. The Samuri Radiologist from Not Totally Rad, explains it all on the post Radiology of Competitive Speed Eating


Waiting for India on My Lap

Ian Furst over at Wait Time helps health care providers to decrease wait times and delays. He submits India's Health Care System which looks at the private/public divide in India's Healthcare system and the lessons we might learn in North America.

While you’re on his site, scroll down to Things to do while waiting at the doctors office. Shocking! There is probably some business opportunity in there somewhere.


Is Your Name on This List?

InsureBlog's Bob Vineyard is naming names. He confirms the explosion in diagnoses of ADHD and Bipolar Disorders among children, and names some of the doctors that are fueling the fire, and their payments from drug companies. Drug Money.


Wave of Bad Information Kills Web Surfer

I was impressed with the fact that Dr. Val and the Voice of Reason really is a voice of reason. This week, she writes on How Is Healthcare Like A Garden Fungus?, and points out, “Medicine is incredibly complex, and that a knowledgeable healthcare provider is critical in helping patients successfully navigate the maze. With all the health information on the Internet, it's tempting to self-diagnose. But that's a dangerous proposition - one that might lead you to presume that (to use my analogy) a poisonous mushroom is edible, or that a life threatening symptom is innocuous.”


“Art, this is Death. Say Hello.”

Talk about creative, Christian Sinclair and team have launched a new blog, Pallimed: Arts & Humanities, where palliative care meets the humanities. The underlying concept is that both death and art have been around forever, closely linked to one another. Christian submits a post about a song that discusses dying in the ICU. Included is a video representation of various instruments representing a death in the ICU. (Cool!) Check out, "What Sarah Said" by Death Cab for Cutie: "This presence at the bedside of a dying person can be a demonstration of your love, but it can also tax and exhaust family. A variation on this line ("Love is watching someone die") is occasionally heard from palliative care professionals to allow family credit for the 'work' involved in being present at the deathbed.”


Cool Kid Reject ADHD in Favor of Bipolar Disorder

Did you know that 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including over 20,000 children under age six? What I want to know is, why didn’t anyone tell me? A half-million prescriptions, and not a single one of my four kids was offered the stuff! I feel gypped. Dr. Zhang who is the author of the book, Coackroach Catcher, writes about Bipolar Disorder in Children at Cockroach Catcher Blog. "ADHD was the old black. Bipolar became the new black."


Renegade Diabetics Take Charge of Own Disease

Amy Tenderich hosts the blog, Diabetes Mine, which is “a gold mine of straight talk and encouragement for people with diabetes.” She submits the post, Diabetes... RELOADED, which includes video footage of some of the activities of this group. I deal with diabetic eye disease all day long, and I was encouraged by the innovative vision captured in the post: “Our theme was "Diabetes Reloaded", which stands for redefining not only the role of technology in managing chronic diseases, but also for the newfound self-confidence and ambitions of 21^st century people living with health conditions. What’s special about this new web-enabled world of healthcare? It’s proactive, technology-based, empowered, revolutionary, against all odds, and – if needed – outside the establishment.” The blog is a 2006 Winner of LillyforLife Achievement Award for Diabetes Journalism. Congratulations, and keep up the good work.


Patient Prescribes Own Drug. Doctor Does Own Taxes.

And if the internet weren’t bad enough, people are now taking the next step:
picking up the phone, and telling doctors what to prescribe for them.
Read about this wacky patient’s expectations over at EverythingHealth


Got Munchausen’s? AMA Has Jobs Available

Did you realize that the next patient that walks into your office could be a fake, commissioned by the AMA to check the quality of care you provide? David Williams at Health Business Blog delves into the controversy, Do we really need mystery shoppers in health care?


Pharmacist Sleeps with Drug Researcher; Takes pill to blunt remorse

This doctor has one of the best named blogs ever: The Blog that Ate Manhattan. She takes on Big Pharma yet again, this time noting that Care/CVS seems to be in bed with Bayer. She parodies the "Dear Doctor" letter used to get new drugs to the medical community. A very interesting discussion in the comments section, in particular the input of a Pharma commenter who tells it like it really is in the business of making and selling drugs.CVS/Caremark – Detailing for Bayer?


Blame Informed Patient on Doc Gurley

When your next patient comes in and has a normal fasting blood sugar, then insists that you order a HbA1C, will you wonder why? It’s because they read Doc Gurley’s post, Blind Men and the Diabetes Elephant. She takes a look at this week's mammoth-sized news in diabetes research. Like the fable of six blindfolded men who tried to describe an elephant ("it's a snake!" "it's a tree!"), lots of news reports only got hold of one isolated piece of the action. Her post shows how three different news items, when viewed together, take on pachyderm-sized importance for all of us - diabetics or not.


Poor Ethicist Gets Spanked by Doctor Rich

The Right Way to Think About Medical Ethics, appears on The Covert Rationing Blog. In this post I take medical ethicists to task for promulgating a new utilitarian system of medical ethics that is a) absurd, and b) destructive; and, not wishing to leave the poor souls completely adrift (which would be unethical), Dr. Rich kindly offers for them a system of ethics that both honors the needs of society, and restores the classic doctor-patient relationship.


End Years of Debt-Free Living: Go to Medical School

Why do so many doctors struggle financially? Theresa Chan posts MEconomics, Part Two: The Long Reach of Med School on her blog Rural Doctoring. "Part Two of this series on physician compensation and my personal bottom-line addresses where all the difficulties begin: with medical school debt. Let's walk through the process of accumulating educational debt and estimate whether the published averages tell the whole story."


Cheech and Chong Appointed to Judiciary

Have I been away from America so long that I missed the legalization of medical marijuana? When do you prescribe marijuana? When not?. Theresa Chan at Rural Doctoring shares her opinion in 15 Minutes of Fame: Medical Marijuana in Rural, CA. "For the record, I support medical marijuana use for those patient populations for whom it was originally intended: for cancer and AIDS patients, in order to suppress nausea and promote appetite, and modulate pain symptoms. I have worked with these patients as a physician and a hospice volunteer, and I do believe marijuana is helpful for the nagging symptoms of people facing the end of life. However, I do not believe that marijuana should be recommended generally for chronic diseases such as…” Read the post to find out more.


Man’s Jokester Friends Name Womb Disease After Him

Dr. T posts on "Asherman's Syndrome" which is a condition related to scarring of the intrauterine cavity, usually as the result of a failed pregnancy and a D&C in the presence of infection; or another intrauterine surgical procedure, that causes hypomenorrhea or amenorrhea, infertility, and recurrent pregnancy loss as well as other pregnancy complications. It is more common than most women realize.


Ferret Diagnosed with ADHD; Parents overjoyed

This is actually a very important post. David Rabiner outlines Promising Cognitive Training Studies for ADHD. "Results from these two cognitive training studies highlight that cognitive training interventions may provide an important complement to traditional medication treatment and behavior therapy. Both studies included appropriate control groups, employed random assignment, and had outcome measures provided by individuals who were "blind" to which condition children were assigned to. They are thus well-designed studies from which scientifically sound conclusions can be drawn. They add to the growing research base that intensive practice and training focused of key cognitive skills can have positive effects that extend beyond the training situation itself."


One Should Always Have a Penguin When Needed

I didn’t even make that headline up! It’s the description of the blog, Prn Penguin. I will now start contemplating when a penguin might come in handy. In this outstanding and comprehensive post, the author gives a detailed overview of How to survive your practicum placement as a nursing student. It is also useful information for medical students, job applicants, and humans of all varieties.


That Dang Medical Records Department

Home of the Brave submits Where Are The Ellis Island Hospital Medical Records? Did you know that Ellis Island had a premier large scale hospital and contributed to major public health advances? Help solve one of its tantalizing mysteries by searching for its missing patient records and registration logs. Ten thousand patients, 3500 deaths and over 300 births, plus countless successful treatments and discharges to a new world and new lives are a testament to the hospital and its USPHS physicians and nurses.


Four out of Five Doctors Smoke Camels. (The other one smokes goats.)

I learned something by visiting Peter Zavislak’s blog, Medical PasticheI learned that a Pastiche is a pie made of many different ingredients. I did not know that. The purpose of his blog is to present medical economic analysis, personal experiences within the field of medicine, somewhat-interesting medical factoids, and slightly-humorous tongue-in-cheek medically-themed comic relief. You can find all of this in his post, "'What Cigarette Do You Smoke, Doctor?'", which looks at advertising in the 1950’s.


ER Nurse Strikes Patient

“She was telling me a story about one of her grandchildren when she stopped mid-sentence and said "oh" followed by seizure like activity. I was stunned into immobility for what seemed like an eon but really was only a second. The monitor showed v-fib, a lethal heart rhythm where the heart quivers like jello without pumping any blood. Basically the patient in v-fib is dead and will stay there unless something is immediately done.” Read more about what comes next at ERnursey, under the title, When the Precordial Thump Works


Controlling Your Urge to Control

Laura Edwards is “a 28-year-old writer and college writing instructor trying to balance multiple chronic illnesses (PCD, bronchiectasis, celiac disease, etc) with, you know, the rest of my life.” She submits In Control which explores the relationship between control and chronic illness.


Coke Shares Plummet; Rival bottles water

Nancy L. Brown, PhD writes about Sugar and Soda Free Summer. "The SF Bay Area is gearing up to have a "Soda Free Summer!" Six counties are being encouraged by the public health department and many community-based organizations to learn about the health risks associated with soda consumption and help families avoid soda."


Uninsured Mob Threatens National Security

“So now in addition to 47 million people without any health insurance at all, there are 25 million more who have health insurance but don't really have access to health care because they cannot afford to pay the high copays and deductibles on their policies. So all told that's 72 million Americans who are likely to skip routine health care and recommended non-emergency treatment because they don't know how they'll pay for it.” Read more about this outrage at Colorado Health Insurance Insider’s post, Number of Underinsureds Rising Rapidly


Canada and Australia are Different Countries?

I once made the mistake of telling an Aussie that I thought he was from Canada. He never called me "Mate” again.v(What a relief.) No such luck for Vitum Medicinus, a Canadian medical student, who tells readers of his experience shadowing a doctor in Australia, and how medicine down under differs from what he's seen in Canada. Read about it at Vitum experiences medicine down under!


From Pulp to Electrons

Are you thinking of converting to Electronic Medical Records?DrPenna discuss about advantages and disadvantages of Electronic Medical Records and his experience using them in his hospital.


Serious Feelings

“Few things in medicine are harder than trying to explain to a patient that you don’t understand what is going on.” Thus begins The Mormon MD's post, My Entire Life, where he writes, ” The art of medicine is learning solutions that don’t always involve causes. Beyond that, patient’s are not as passionless and rational as textbooks. This can be a hard thing for a scientist. After all rationality is the only virtue that matters in science. Emotions will only get in the way. On the other hand, The doctor patient relationship is deeply complex, much more that say, mechanic and automobile, or scientist and experiment.”


More Serious Feelings

In Sickness & In Health is a place for couples going though an illness experience - to find resources and advice, hear stories, and discover support. Whether the illness is chronic or acute, the result of disease or accident, couples can learn strategies for coping with the changes illness brings into our relationships and our worlds. The information provided in this blog is for educational and support purposes only. It should not be used as a substitute for seeking professional care. This weeks submission, How to Have the Hard Conversations discussed how to stay connected to your sweetie when he/she wants to go to the movies and all you want to do is lay down in a dark room with a heating pain?"


Vermox Stockpile Available

Frankly, I’m relieved to learn that Global Warming is occurring. All this time, I thought it was Global “Worming,” and was preparing for that. Fortunately, medical student Thomas Robey has a better handle on things. At Hope for Pandora, he has been considering how the lowest rung on the medical hierarchy can reduce medical procedures' carbon footprint. His latest target is the operating room. He gives tips for Reducing and Reusing, if not Recycling in the OR. For example, "If you salvage the batteries from each suction irrigator used for ectopic pregnancy or cholecystectomy cases you assist with, you'll amass 10 hours of digital camera usage per irrigator, or put another way, a lifetime powering of remote controls per surgery clerkship."


Radical Canadian Editors Blog

The editors of The National Review of Medicine have their own blog. That sort of thing is apparently allowed up there in Canada. This week they discuss, Should we screen women over 70 for breast cancer? (Just don't mention "rationing")


Neurofibromatosis Headlines Are Tough to Write

alter Jessen at Highlight HEALTH briefly reports on the 2008 Children's Tumor Foundation Neurofibromatosis (NF) Conference, the preeminent annual meeting of NF researchers worldwide, and describes the three distinct types of neurofibromatosis. Neurofibromatosis: From Genes to Complications to Treatments


Neighborhood Masochist Buys New Suit

Apparently, someone has developed a suit that mimics the pain of osteoarthritis.Read about it at Simulation Suit To Feel the Pain of Osteoarthritis . Visit the blog, The Fitness Fixer “to see how to move in healthful positioning so that your exercise is healthy rather than injurious. You don't need to get treatments, or adjustments, or surgery, or shots, or medicines. It is a win-win situation where you do not have to give up favorite activities, and can become healthier than before. Just use healthy movement as part of normal daily life and get free exercise, better physical abilities, and stop the processes that cause injury, all at the same time.”


D is for Depression

Vitamine D for Depression in the Elderly? Dr. Shock points out that a large population-based study found an association of depression status and severity with decreased Vitamin D (serum 25(OH)D) levels and increased serum parathyroid hormone (PTH) levels in older individuals. Causes of vitamin D deficiency in the elderly are: less sun exposure as a result of decreased outdoor activity, different housing or clothing habits, and decreased vitamin intake. The question remains whether the vitamin D deficiency is secondary to depression, or is depression the consequence of poor vitamin D status.


Cut from the Same Clot

The folks at Clinical Cases and Images - Blog submit Video Interview with Tim Russert's Doctor -- Cause of Death Was a Fresh Clot in LAD. The site also has useful information on studying for cardiology boards, the Mediterranean diet, and how to use Google Blogger’s schedule feature.


How to Get a Hot Body Without Resorting to Kidnapping

Crank up your metabolism, baby! Tara Gidus, who is the team dietitian for the Orlando Magic, gives 10 tips on increasing your metabolism (which is going to help you lose weight) at Turn Up The Heat


Stiff

Dean Moyer of The Back Pain Blog shares a response to one reader's question about Mysterious Morning Neck Pain. In this post he attempts to reassure his readers that most neck pain is not serious and gives them some guidelines for what they should do about it. For example, "… the most common cause of neck pain is muscle or ligament strain ... In most cases the pain will subside within two to ten days without medical attention. However, if it lasts longer than that, you should see your doctor."

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Thanks again, everyone for your outstanding submissions. Join the gang next week for Grand Rounds, hosted by My Three Shrinks. The theme will be the upcoming iPhone 3G.