Lenk

On January 27, 2013 By SW101In change, family, health, learning, medicine, politics4 Comments

I recently returned from a church Men’s Retreat in the resort town of Lenk, Switzerland. This was MY kind of ‘retreat.’ The majority of our two days was spent on the ski slopes, not talking about God and theology and right and wrong.

I’ve been a Christian since I was 8, so the pastoral lectures and Bible verses never feel especially new to me.

I routinely enjoy the music, and in our case a great band led those times in the evenings, but I was happy to attend a retreat that was mostly just a cheap ski vacation. I met some cool guys, got a little better on a snowboard, and stood in absolute awe at some of the most beautiful scenery I have ever known.

I don’t worship God very well through study, or through listening to lectures from pastors. Lectures, ever, haven’t worked well with my brain. Ask any teacher of mine all the way back to 1st grade and you’ll probably get some version of the same mildly exasperated half-smile, and a reply along the lines of, “he really, really TRIED to give a crap.”

But when I’m in the shadow of the Swiss Alps, with 1,000 year old glaciers clinging to jagged sawtooth ridges in a 300-degree ring all around me, I pay attention. Somehow, breathing in crystal-pure air, with rolling forests and organic dairy farms dotting the countryside in every direction far below me, I have no problem thinking about God and wondering how I couldn’t possibly be closer to His almighty Spirit for that moment.

So, it was a spiritual time for me, but with very little preaching or Bible-studying. Perfect.

I was also struck by the unity and beauty of the towns we passed through on our way to Lenk. Switzerland has been highly resistant to change over the years, from what little I’ve read of the country. It is fairly hard to immigrate there, and once you ARE there, good luck building consensus around any particular idea or religious creed that departs from the time-honored ways of the Swiss. Du willst ein Minaret? Das wird nie passieren!

In Switzerland, you know you are in Switzerland. Especially in the countryside. The buildings are stirringly beautiful, most made of a light-colored wood sometimes set on dazzling white painted rock or concrete bases. The barns looks related to the houses. Everything is clean, ordered, pristine.

This unity isn’t by accident. But it takes enormous force of will to maintain a cultural identity in an increasingly pluralistic and mobile society. To do so inevitably becomes political, with increasingly volatile arguments on either side.

My homeland, America, has never really had a unity of culture and history to this degree. We’re a nation of very few subjugated natives, and very very many immigrants. To walk through my country – or any large American city – is to walk around the world.

Both have their merits (except for our treatment of the natives). But there’s something so deeply peaceful about meandering through a place that knows itself so well. A place that is OLD, and has not forgotten the value of of old things. King Solomon was rewarded by God with power and money because when God offered to give Solomon anything he wanted, the young man asked for wisdom. Any place that honors age, honors wisdom, and God seems to have blessed the Swiss accordingly.

I’m not saying Switzerland is paradise or utopia. There are problems. But they’re getting lots of things right. Here, walking is revered over driving. Food is valued for quality and purity rather than quick access or cost.The country has some of the best health care access in the world, with 3.6 doctors and 10.7 nurses per 1000 people. Life expectancy is around 73 years old. Obesity is less than 8% (it’s almost 50% in the U.S.), and it is estimated that 100% of the population has access to clean drinking water and sanitation facilities.

As a Caucasian from the American suburbs, with no knowledge of my heritage further back than my grandparents, this place holds an impossible appeal for me. I don’t know my family history, whether a story of thieves or kings. My nation’s history doesn’t even span 300 years.

As our retreat drew to a close, I knew I could never truly be a part of a place like Lenk, Switzerland. I could only marvel and yearn, watching that priceless world slip past my car window, as we hurried home.

Reader Q: Why Did You Sign with the Army?

On December 24, 2011December 25, 2011 By SW101In Army, disease, family, health, jobs, learning, life, medicine, Military, residency, science, Uncategorized2 Comments

Hi Dr. SW101,

Enjoyed reading some of your blog posts both older and the newer army related ones today. Lots of smiles and chuckles, Thanks.

Laughter? In response to this blog? That’s TERRIBLE. This was supposed to be serious stuff. Like taxes. This is information. Data. Recommend re-read.

I’m curious to know why you signed up?

I signed up for the Army for one major reason and one minor reason.

The major reason was the craven want of money. I wish it was something more patriotic, but the primary motivation was an offer of a loan repayment grant and monthly stipend during my years in residency. The Army required nothing in return during my training years. Faced with sneaking my 6-member family into a 2-bd apartment that allows only 4 people, I took the money. Instead of the apartment, I was able to put my family in a cute 3-bd home on a quiet corner two blocks away from my training hospital.

The second reason was patriotic. Despite my vehement opposition to the war in Iraq, and moderate opposition to the war in Afghanastan, I was fully aware that primary care was severely lacking in the U.S. Army at a time when young Americans were throwing themselves into war. Irrespective of how I felt about those conflicts, I remain an American. News of my countrymen dying or suffering partially due to lack of good medical care was something I couldn’t tolerate.

I have always been taken with depictions of how our nation pulled together and sacrificed during the second world war. Back then, those war efforts were truly a national affair. Virtually everyone gave to the effort in some fashion. And, I think a huge reason for the wealth and power we have enjoyed for the past 60 years are a direct result of those sacrifices made by our Greatest Generation.

“Earn this,” CPT John Miller, dying from a mortal wound during the Battle of Ramelle, implored Private Ryan in the Spielberg movie. The message, as I took it, was our generation (and the Boomers before us) must understand that great sacrifices were made to allow us to live on the top of the world as we have as Americans. It remains our mandate to earn that sacrifice; it was made before we even deserved it.

So I signed.

I saw posts about officer training and an earlier one about trying to figure out the military scheme as a civilian. What got you in?

I think you’re referring to how I got into the Army as a civilian. If so, the answer is website: http://www.usajobs.com. Everything runs through this site. I applied to this site in the winter of my senior year of residency, and forgot about it. Literally. When I was called by the clinic here in Germany for an interview in MARCH the following year, I had no idea why.

If you want to get a job overseas, however, this is one of THE best routes. You can’t work for the State Dept as a doctor until you’ve been in practice out of residency for 5 years. You can’t get a job with any of the aid organizations unless you know someone AND don’t need money. So, this is a good option because the pay is steady, only slightly beneath the national average, and comes with perks that don’t usually accompany private-sector jobs.

There’s lots of archane goofiness that come with Army medicine. There’s lots of unusual quirks that are a result of non-medical “commanders” decreeing all kinds of demands from on-high.

But, in reality, every managed care organization functions like this these days. I wouldn’t put Army medicine behind or beneath any of the major HMO’s (in principle, I haven’t worked with any of them). I think Army Med is about on-par with most of American medicine…approximately 18th best in the world.

Also wondering why Olympia was your first choice? You’ve said elsewhere that Ventura is probably the best FM program in the US. I’ve heard of a number of graduates going to Tacoma Family Medicine and lots of interest in Alaska, too. Can you comment on them?

I am very proud of my FP training program, and maintain the belief that it is one of the best programs on Earth, and THE best on all outlying planets. I firmly believe that Providence is one greatest healthcare organizations anywhere.

But in all honesty, I have to say that Olympia is not the best. Just MY best.

Ventura is better. Better than anywhere else I know of (and I practically got a PhD in FP residency research during med school). The hands-on experience they allow there, assuming times haven’t changed, is second to none. The faculty are top-notch; some are dual-certified, etc. Facilities suck, too, which is great. I can think of no better means of preparing an FP to deal with a crappy, under-funded, under-supplied environment where the only thing you have to give to patients is your training.

I was told I had a shot there. What they told me likely sounded MUCH like what they tell EVERY short-white coat wearing minion worshipping at the altar of VCMC during their exit interview. But I still like believing I coulda made it in there. I never ranked them, however, because my large family would have needed to live in a box on the beach to afford the cost of living in Ventura. And, truth be told, since I could have reasonably placed that box at the point at Fairgrounds (read: KILLER surf spot), residency would have been AWESOME for me. Just not for my kids waking up with sand fleas in their eyes and facing yet another breakfast of seaweed and/or Wonderbread bologna plus peanut butter sandwiches at the local Rescue Mission.

One nuance Ventura is the dual FP/MPH program at Dartmouth which is as good as it gets if policy and health system design is your calling. Love it or hate it, the Obama Health Care plan wisely referred to the health resources utility research out of Dartmouth. Although barely ranked, I am of the opinion that Dartmouth is actually one of the best – if not THE best – MPH program in the country because the research and work they do is prescient, unassailable, repeatable, tested and longstanding.

Tacoma is a great program, but they have nothing on Olympia. Their city smells weird, their facilities aren’t any better than ours, and we do rotations at the Peds ER up there anyway. So I recommend ranking them 1/2 with the top choice going to the town you like best.

Alaska is probably a lot like Ventura. Sans wicked right point-break and unfortunate box.

Yesterday O’Clock

On August 25, 2011August 22, 2011 By SW101In Army, humor, life, medicine, Military4 Comments

: This guy was dead asleep in his underwear exactly 33 seconds ago.

Doing Army stuff is awesome. Except that it starts so early, the time is best described as “yesterday.”

It’s not uncommon to hear (through my ears), something along the lines of “Formation at Yesterday O’Clock, soldiers! Then we head to the range for M-16 qualifying.”

I assume he means we will be qualifying with the rifles by the light of Orion’s belt, since that will be the major source of target illumination for the next 5 hours.

My particular training class has a group of Army Rangers in it, along with some Special Forces guys too. They all decided to hang up the guns and take up stethoscopes as P.A.’s and pursue things in life, like hobbies and families. As you might expect, these guys can handle Yesterday O’Clock better than anyone.

It’s a bit mystical, really. In our tent of 30 men, someone starts to stir at the ungodly prescribed hour, and everyone just organically follows suit. Soon every guy in the tent is methodically working step-wise to primp themselves (Army-style, more on that later) for another dimly lit Army morning.

Everyone except the 4 Rangers. They stay there, still as statues, enshrouded in their sleeping bags while the tent becomes a kicked anthill of activity. The minutes tick by, the spectre of arriving to formation suffusing the humid tent’s air.

Maybe these Ranger guys so easily stare down scary things like being late to formation because they’ve stared down much scarier things, like death via hot shrapnel. Whatever. Fine. But here in our little AMEDD training world, being late to formation is scary. And being late is easy, because it’s scheduled so freaking early, it’s yesterday o’clock.

As the appointed “time” (more of a philosophical concept, this early in the morning) approaches, a frantic rush ensues. In desperation, we huff out to stand in our little box of humans, also called “formation.” And guess who’s standing there, looking sharp and ready to plant a spear in a saber-tooth bear?

The Rangers. 2 minutes ago these guys were lined up on their cots like 3-toed sloths on an ativan drip. The rest of us have been running around for 45 minutes.

“Where you guys been?” One of them asks, as I run up, wild-eyed and still priffing with my uniform. “We’ve been here since yesterday.”

Smarching

On August 23, 2011August 22, 2011 By SW101In Army, family, humor, jobs, life, Military1 Comment

“1^st Platoon! Atten-SHUN!”

We all throw our shoulders back and stare straight ahead into nothing. And we don’t move. Leaders mill about, thinking about things, looking over their retirement accounts, playing Tetris on their phones.

But we, the little people, just stand there. Sweating. Sweat runs in what feels like lightning patterns down my face. Down my neck. My back. My rear…and down my legs. I stand there taking a sweat-shower. Spin me around fast enough and I’d fling so much water in every direction I think I could personally ease the drought problem in Texas.

“SMAAAARCH!”

Well, he actually say ‘march,’ but, really, you just can’t call it that. No nuance. We aren’t marching. We’re walking around in 104 degree F heat, with sweat pouring from our bodies on par with your average Bangladeshi monsoon. So we’re sweating. With a little marching thrown in.

It’s smarching.

Officer Basic Training – Day 1 (or, The Subjugation of Befuddlement)

On August 11, 2011 By SW101In family, humor, life, medicine, politics, Uncategorized7 Comments

I have left my family in Germany and successfully arrived in tepid San Antonio, TX for 28 days of training to become an officer in the U.S. Army Medical Corps (pronounced ‘core’ not ‘corpse,’ though both work pretty well).

On my flight over here, I called some in-charge guy from Oh-Hare airport in Chicago to ask him where to go when I arrived last night because I was a day early.

***note to friends and family who know anything about me…I showed up EARLY for something I regard as totally stupid. Note that. Somewhere. Just get it down for posterity somehwere. Not just on-time. Early. Me.***

A guy actually picked up his phone when I called and told me to go to building #596, which is an Army hotel on Ft. Sam Houston.

“Nice,” I think. “I’ll be staying there for a month.” I take a cab from the airport to the hotel. The cab driver drives away. I walk up to the counter, am asked for a copy of my orders, then am told that my room is at the Holiday Inn next to the airport.

“I was just at the airport.”

“Yep.”

“I just paid a cab guy to get me out here.”

“Yep.”

“Thank you, so much, ma’am, for your help. Can I have my orders back? And, could you call me a cab…maybe even THAT GUY driving away over there who just dropped me off?”

She calls a cab, but not that guy. It will be a half-hour, she says, until a cab can get here.

Hmmm. K.

Then, feeling Army-saavy, I ask her to COPY the copy of my orders she asked me for, and make me a few extra, AND SHE DOES!

We’ve been told to come here, inexplicably, with 10 copies of the orders telling us to come here. The need for a billion copies of paper orders is one of the many stipulations that totally befuddles me. I am actively in the process of subjugating all sense of confusion, befuddlement, and mystification, with mixed results.

But with respect to my orders, I’m making it my personal goal to leave this course with MORE copies of my orders than I arrived with. If I get back home with more than 10 copies of my orders…I’m taking my wife to dinner or something.

Anyway, it’s a nice hotel, and I have to keep reminding myself that I am NOT here for the usual blah-blah conference. For example, our day starts tomorrow at oh-430…well before the “free” breakfast I’m entitled to. And some of the classes we’re supposed to take start at 6pm or later. So, it ain’t a cardiology meeting in Oahu.

I’m in SanAntonio, in August, in a heat-wave that is about to break historic records. So yes, it is butt-hot outside. And I’m the kind of person who thinks PERFECT weather is overcast, rainy and 65 degrees F. Seriously.

But it turns out that the heat actually doesn’t bother me, so far. Mostly just feel like I’m back in Beer Sheva, Israel where I went to medical school. I haven’t been running around in it yet, but so far it hasn’t really phased me. It’s hot. Like med school. Who cares.

I met a guy at breakfast this morning who is also in the class. Cool. Older. Knows stuff, like what he “makes” per day and that it’s good to bring a roll of toilet paper when we go “to the field.”

As he sits there describing Army stuff, I wonder what my problem is with details and why I’m so averse to them. He’s talking about tax-deductions for military pay or something and I’m thinking…”Kyle Orton, he’s really the guy who needs to play for Denver this year”…and…”At some point, this guy is gonna tell me how to get out of deployment AND monthly drilling and when he does, boy, I’ll be RIGHT HERE ready to pay attention…but he just said ‘requisition’ so no need to tune in yet.”

His name’s “Ray” and I’m extremely proud of myself that I remembered it. I came up with “First-day Ray” and now it’s in my head forever.

Ray assures me that since we’re off-post, I won’t be given a roommate. That was an “on-post” stipulation because it was a barracks environment. The hotel lady yesterday told me otherwise, saying that I would be getting a roommate and I had not choice in the matter and would not be allowed to pay extra for my own room.

So, the jury’s out on “Ray.” If my single room survives today…he wins. Stud. Fount of knowledge. I’ll actually like him at that point. And he won’t be placed in my category of people who talk like they know stuff but who I ignore for your own safety.

Having my own room is pretty cool. I can sit here, for example, completely naked and type my little blog. I’m NOT, actually. It’s just that I COULD if I wanted to…which is the whole point.

It’s the Manhattan Effect…the desire of millions of people to live in Manhattan so they can be near museums, shows, galleries and restaruants and theaters even though they won’t patronize even 5% of what’s available to them for the entirety of time they actually there. It’s just that the CAN go if they want to.

‘s called freedom, and I’m rather partial to it.

So, my own room is nice in that way. Doesn’t sound like I’ll be in it much, though. Class starts at 430 in the morning, and the last class starts at 7pm. So it doesn’t really matter who’s in here.

And I suppose I won’t type naked anyway. I’m afraid that as the hard drive warms up, a film of sweat will form between the laptop and the actual “lap”, as it were, and the machine will short itself out in an explosion of wicked-blue electricity bolts right into an area that really should have been covered out of respect for my readers, for God’s sake, if not for my own sense of Fallen-Man shame.

I do have a sense of pleasant anticipation as the day gets started. I’m like any average boy who grew up crawling around fields and forests “fighting” Nazi’s and aliens and dragons. Already I was “ordered” to buy a pocket knife, which definitively makes this better than your average medical seminar.

So as I enter day 1, I can say that if over the next 28 days there’s firing of weapons – of any kind – any choppers, night-vision goggles, topo maps, compasses, smoke, explosions, crawling on elbows and knees, face paint, knives, matches, tents, or at least 11 copies of my orders…this little month away from my family might just be worth it.

‘Concierge’ Medicine – A De Facto Manifesto

On July 16, 2011 By SW101In change, disease, family, health, life, medicine, money, Uncategorized4 Comments

My blogging output has been at an all-time low since moving to Europe. Who knows why…this place is such a bore. I continue to hack away at my book, which never seems to get close to done – the literary equivalent of Sisyphus’ ever-rolling stone.

The other day a reporter contacted me to hear my thoughts on so-called “concierge” medicine. It was a timely query, since I’m considering a loose offer to join a concierge practice back in the States. In my email reply to him, I found myself writing my own little manifesto on the subject. A treatise, if you will. A declaration. A primer? A resolution, a promulgation…

I’m a big believer in concierge medical practice, although I use the term “concierge” only as a nod to already-established norms. Really ‘concierge’ medicine is a throw-back to true primary care medicine before it was ruled by other industries. So the idea isn’t new. It’s old – old as William Osler and Johns Hopkins and William Carlos Williams.

This industrial “take-over” I mention isn’t entirely due to craven insurance businessmen. It’s also due to the allure of “Wal-Mart” pricing that so captivates Americans. I suppose you’ve heard the adage that as a consumer, you can only have 2 out of 3 options in the market: Fast, Good and Cheap. If you want something fast (hamburger), you can get it cheap (McDonald’s) but it won’t be good. Or, you can have it fast and “good” (quality, taste, etc), but it won’t be cheap (maybe, Red Robin?).

This principle is true in medicine too. Americans, over the past 20 years, have been trending toward Fast and Cheap medicine, just like they want clothes, household goods, food, etc. quickly and cheaply. Hence, the rise of WalMart, which provides easily acquired things of questionable quality.

Concierge medicine isn’t “cheap,” by WalMart standards. It requires real cash investment. But it IS better. And, while there is little problem with wearing nondescript, zero-style golf shirts to work every day, primary care is different. We’re talking about your life, here. Not only are you likely to live longer and healthier with good primary care, but it really is cheaper over time because it is so effective in offsetting gigantic medical calamities later.

I dispute the notion that no one can afford concierge medicine, by the way. Most people in the richest nation on earth perceive they can’t afford it, but really can. I blame this perception on the invention of the 10-dollar co-pay. This idea was such poison in American medicine. It made medical care seem like the equivalent of a few iTunes, or sunglasses from a roadside gas station – just another in the ocean of cheap, disposable and generally worthless products. Yet so many Americans shell out enormous amounts of money on alcohol, cigarettes and fast food. They don’t think twice about coming up with over a thousand dollars to fix the clutch on their car, or to trick it out with lights and racing wheels. But when it comes to good, relationship-based primary care, they resent anything more than “10 bucks.”

I’m currently in a line of work that provides “free” care to everyone (the military), so at the moment I have no vested interest in the above comments. But I continue to feel strongly that it is not immoral to require a reasonable, even significant, amount of money for true primary care, especially when obtaining that care may require cutting out things that are terrible for your health. I see major problems with a medical system that tries to provide unlimited access, especially when coupled with zero perceived cost for that access and care.

More health care is not better health care; worse, it can be dangerous. On a daily basis, people needlessly lose breasts, prostates (read: sex life), resistance to microbes, and countless other quality of life measures in the process of hunting down phantom maladies or responding to false-positive tests. High-quality primary care offers good, analytically based work ups of genuine symptoms that justify that work up. NOT investigating something further can often be the best medical care available.

I mention ‘analytically based’ decisions because most mid-levels (a cost-cutting invention in American medicine) are trained to provide algorithmic decision-making: that is, if X symptom, then Y action with little analysis involved. recipe medicine.

Often algorithmic medical decision-making is just fine, but it easily leads to over-testing and over-treatment. When it comes to possibly dying from cancer, for example, most of us want someone who knows us, knows how we communicate, and what is important to us (e.g. dignity vs. “full court press”). Further, we want that same person to be well-trained in weighing the risks vs. the benefits of treatment vs. non-treatment, based on the latest available medical knowledge.

Doctors seeing 20 patients a day can’t provide this adequately. Mid-levels are not trained to provide this type of risk-benefit analysis, and don’t have the hours of training experience even if they wanted to.

Disclaimer: I’m speaking in generalities here; there are fantastic PA’s and NP’s out there, many of whom are compassionate and professional; better than many physicians. Most I’ve met are smarter than me. But in general, the care from a mid-level is fundamentally of less quality because the training of a doctor is an average of 3 times more than any mid-level (roughly 3,000 hrs vs. 12,000). This differential limits mid-levels to algorithmic, rather than analytical, decision-making. When it comes to your health care, the mantra should be “reason, not recipes.”

These days, you can’t get this care from HMO’s (Group Health in Seattle is getting very close), you can’t get it from mid-levels. The only place I know where you can get this level of care, is in a ‘concierge’ practice, where the benefits of the increased cost are immeasurable.

DIE-Tunes

On April 4, 2011March 29, 2011 By SW101In change, internet, learning, life, media, money3 Comments

I believe I have just witness the beginning of the death of iTunes. As much as I’ve tried and tried to like iTunes, I can’t express how happy I am to see a true and valid competitor emerge to thwart them. And, I think this will DESTROY them.

Amazon, you rule.

Now you can buy Mp3’s from Amazon.com and – here’s the sell – store your tunes to the cloud, not on your own hardware. I’ve been begging (in my head) for this for YEARS. The cost and hassle of trying to constantly figure out where to store my songs and shows that I’ve downloaded from iTunes has been one endless headache. This has as much to do with the fact that I’M MAKING A GENUINE EFFORT NOT TO STEAL THEN (in all honesty, this is my big mistake). Being legit, I’m constantly plagued with copyright protections on iTunes products that makes storing and moving MY copies of digital media almost impossible.

The obvious solution (one that still supports the artists and their decadent renunciation of most human moral codes) is to simply quit making me store the songs in the first place. Just stream them from some central server that I never even deal with. Amazon Cloud Player (actually real, actually available, actually currently playing 1 of 100 of the top trance tunes of 2011 that I just bought as a collection for…9 bucks) does just that. Finally.

One example: I had a tiny netbook, with virtually zero hard drive space. So I tried to store all my tunes (and shows) on an external hard drive. Then I switched computers, and wanted to move that data. Tough. Sounds easy, but it ain’t. To Apple, it looks like I’m stealing them, or selling them in some virtual dark alley, furtively looking over my shoulder and waiting to hear Hugo Weaving bellow, “Mr. ANDERSON!” If I’d just legitimately STOLEN the damn songs in the first place, I could play them wherever I wanted, moving them like so many Word files.

Another example: If ruining ipods (usually by jogging in the rain) was a God-like attribute, I’d be warming up a U-haul for my move to Mt. Olympus. I just sorta never believe water is actually bad for anything. It’s a swimmer thing. Anyway, my iTunes can only be played on 5 players unless I “de-authorize” a player. This sounds find, but how do I de-authorize a player that has suddenly transformed into really unique thin mint? I can’t even turn it on long enough to de-authorize the glorified aluminum can. Same for my original computer that held the results of my first foray into iTunes psychosis. It suffered a massive “heart” attack at some point. That’s 1 authorized player I’ll never get back.

Six hard disk drives with cases opened showing... — Hard Drives, Hard Drives Everywhere...

Now it doesn’t matter. My tunes are floating out there, in the beloved cloud. Free from the confines of my cheap, inefficient hard drives that never seem to have enough space. With Cloudplayer, the tunes stream, so presumably, copying them illegally is much harder. So, I would hope that Amazon will be HELPFUL when I try to use one device or another, or when I mistakenly put my Mac Mini in the microwave, expecting a nice melty pizza in 2 minutes and 30 seconds.

Plus, it’s Seattle busts Cupertino. Kurt Cobain vs. The Grateful Dead. The Sound vs. The Bay.

Die. Die Tunes. You had your chance, Appletini.

Bye Bye iTunes, Hello Amazon Cloud Drive (web2.sys-con.com)
Amazon Cloud Player: First Impressions (mashable.com)
iTunes, Amazon and Spotify Controlling Digital Music Revenues in the UK (crenk.com)
Amazon Music Cloud (kennykellogg.com)
Stream all Your Music with Amazon Cloud Player (blogher.com)

Health Report – Mickey Mouse

On March 27, 2011March 27, 2011 By SW101In disease, family, health, humor, learning, life, media, medicine, science, Uncategorized, writing4 Comments

Our family just returned from Disneyland Paris. We had a great time. As a doctor, however, I just couldn’t ignore the many health problems clearly evident in the thousands of images I saw of the world’s most famous mouse.

I can say with confidence that this will be the first and only time that I publish the health record of a patient without his/her consent. But then again, I’m not even sure this little rodent was my patient at all. Furthermore, I can’t vouch for my physical exam of our storied mouse – given his rather cavalier take on the idea of ‘physical’ – but I do believe we should all be alarmed at the probable health status of our big-eared friend.

Of greatest concern is what can only be described as HUGE feet. Unfortunately, this does not suggest enviable male endowment, as it is sometimes rumored in those with enormous paws. Rather, these feet are swollen. A close look at most pictures of this patient suggest that he in fact can’t wear shoes at all, but instead some sort of stretchy slipper.

I Kept Seeing This Instead Of Enjoying Space Mountain

The best explanation for feet this swollen is congestive heart failure. This is a situation where the heart has pumped against a dysfunctional circulatory vessel pressure for so long that the muscle fibers have becomes stretched out and weak. Eventually, the heart becomes incapable of pushing blood around the body effectively, causing pooling of fluids in the extremities, especially the feet. Judging by the thousands of pictures of him, most drawings were likely done after this patient had been on his feet all day. Let’s face it, an 80 year old mouse can only walk around smiling waving at kids for so long before problems arise.

CHF is progressive (meaning it just gets worse over time). Elizabeth Taylor just died from this, for example. Mick could use any of a number of meds to lower his blood pressure, and (arguable, these days) something to strengthen the contractions of whatever functioning heart muscle fibers he still has. He should also go with low-salt cheese, lean scraps and whatever else a billionaire mouse might eat.

The little guy also has disturbingly white hands. Leaving aside the perplexing question of how a rodent has human hands (and feet), what we’re probably seeing here is Reynaud’s phenomenon.

In itself, this is a circulatory system peculiarity that is not medically-concerning. However, it can be very painful. Mickey appears to be in the early stages of the process. Likely shortly after his portrait sittings, his hands turned bright blue, then eventually into a deep red. Throughout the process, he would be in quite a bit of pain.

Of course, I can’t be sure if he isn’t wearing gloves (assuming that garish white color IS his skin, frequent glove use makes sense). Gloved or not, we still have the problem of clearly HUGE hands, suggesting edema like that described above in his feet. Assuming, however, that we do in fact have Reynaud’s here, the concern is of an autoimmune disease in the category of lupus. “Lupus” is a reference to the facial rash often seen in the disease and how it mimics the fur-pattern of the red wolf. Given that wolves engorge themselves on mice whenever possible, this diagnosis is insult to injury for our poor little entertainer.

Furthermore, lupus typically causes joint and connective tissue pain. It can lead to heart problems, anemia, serious lung problems including emboli and hemorrhages, kidney damage and neurological problems. There is no known cure, although the disease can be managed usually to good effect with oral steroids (not of the Lance Armstrong type…we’ll get to that), but the Mickster here clearly needs to get them started.

Next, the rotund belly. This is the physical sign most associated with diabetes and other metabolic diseases (or could be another sign of his CHF). Termed by doctors as “central obesity,” this malady affects a HUGE proportion of American men, especially. To our knowledge, little else puts a person more at risk for big metabolic problems. Mickey lives at Disneyland, where he can expect to eat things like spun sugar, rock candy-encased apples (I presume of the sort that felled Ms. S. White) and shovel-fulls of sweetened popcorn. So, as a nearly 90 year-old mouse, he can be forgiven the “Gaston Gut,” as it were. Still, a strict diet is highly recommended.

Another thing: look carefully, and you’ll realize that Mickey’s head is larger than his entire thorax (body sans legs). Babies exhibit this phenomenon – watch a toddler reach overhead…only the hands extend beyond the giant head itself – but adults don’t. Mickey may have been born with something called hydrocephaly that was inexplicably untreated for 80 years. Maybe he was too busy as a child prodigy mouse, or maybe everyone thought it was “cute.” He may also be suffering from Cushings, an overabundance of the steroid cortisol. He has some other physical signs to support that diagnosis too.

But he also could be doping. By doping, I specifically mean HGH, or human growth hormone. Lots of athletes do (or did) it, like Barry Bonds (yep, I passed judgement…don’t care about some goofy trial) and probably Lance Armstrong. Here a note to Armstrong supporters: almost EVERY top-5 pro cyclist, and every one of Lance’s main competitors over his winning years, has been busted for doping of some sort. Except him. Savvy, not legitimacy, I say.

Anyway, HGH makes you huge, but it can disporportionately affect the bones, especially in the head. Of note, HGH isn’t bad in itself, per se. It stimulates muscle growth in a way that can be very helpful to geriatric patients, for example. And, as with many Hollywood elites, The Mickster shows his age about as much as Dick Clark who looks 40 but was actually personal friends with Moses. So, I think Mickey can be forgiven for taking a shot or two from the possible fountain of youth. But, unfortunately, that HUGE noggin gives it away…to me at least.

So, let me say that DisneyLand was a great adventure for our 4 kids. I, however, kept getting dragged into unnecessary endeavors like rides or shows even as I frantically searched high and low my latest, and sickest, patient. Sadly, I never had a chance to warn him of his predicament. So, the onus is now on you, dear SW101 nation. Find him. Tell him. He’s sick. He needs help.

Next Week: Goofy comes out of the closet and reveals that he has Marfan’s Disease…and everyone pretends to be surprised.

XBox – A Medical Necessity

On March 11, 2011 By SW101In disease, family, health, humor, learning, life, media, medicine, money, politics, scienceLeave a comment

“Dr. SW101,” Says the curly-haired assistant, “will you sign this memo.”

I don’t look up. As usual, I don’t read the memo, reaching for the closest pen and signing as fast as possible. I look up at him, smiling cheerfully. “What’d I just authorize?”

“Oh, you just told General Forth that the unit has medical need for 6 additional XBoxes.”

I pause, wondering why I’m so morally opposed to all paperwork that I can’t bring myself to even look at paperwork unless I absolutely have to.

“Xbox,” I say, brows furrowing. “Do you get ’em at the pharmacy?”

“No!” He says, cloyingly earnest. “You’re SO funny, Dr. SW101. You should write a blog!”

“I do.” I say, feeling sardonic, looking dour. I reach for Volume I of Harrison’s Internal Medicine. I lick a thumb and start flipping through the thousand-page tome. “Hmmmm, Xbox. Nope. Nothing here.”

Assistant waits dutifully, no doubt inwardly rolling his eyes while clutching his well-typed letterheaded memo, with my signature still drying at the bottom.

“OH! Right. I’m only in Volume I. Stupid me. I should be in Volume II, where the X’s are.” I pause. “Just a minute,” I say, reaching for the second book. A few minutes of earnest searching, “Nooh. Darn. I just don’t see anything talking about how XBox is an accepted therapy for anything. Not even my favorite disease of all time – mitochondrial infectitis.”

“You’re kidding, right?” He says, now looking worried. “We can get the Red Cross to buy XBoxes for the unit if you say they’re medically warranted.”

“So, my patients – most of whom have seizure disorders, PTSD and post-combat anxiety – can sit around all day blowing each other up and staring at flickering lights? Maybe I should prescribe a Rave too, so we can add drugs to the strobe lights. Or would they be used for the Xbox version of Myst or something?”

Assistant gets all serious, fearing the loss of his beloved memo. He starts reading some of the Pulitzer Prize material, “Gaming has become a central element to the Soldier’s past time. When they return from war zones, the lifelike quality of the Xbox combat games approximate the environment they just left. For many, this represents a “return” to their former lives, thus producing a sense of calm and reassurance.”

“I said that?!” I exclaim, eyes wide. “What kind of crap-pile hash was I smokin’ when I wrote that letter?”

“Oh, huh. Um. Well, if you didn’t notice…I wrote it.” Says the assistant, looking dejected.

Short of tearing the letter out of his hands, and no doubt derailing an already fast-moving train with lots of passengers, I know I’m on the hook.

“Ok. You win. Xboxes all around! On me.”

Relief, profusion, gagging urgency and more of that I-want-to-help-soldiers-but-won’t-listen-to-reason earnestness. “Oh, THANK you! Man, you have no idea what this will mean to the guys.”

“Can we just agree that you got me to sign yet another of those goofy Army things where you’re not really asking for medical opinion but if I sign the memo about 25 people will have busy stuff to do and somebody somewhere will get something to further the impression that they’re entitled to things that the average American pays for?”

“Um. Sure.”

“Can we further agree that Xbox is not an accepted medical therapy for anything?

“Yep.” Confidence growing…clearly the doctor is too weak to actually stop any administrative freight trains now.

“Fine. You have your memo.”

He turns to leave. Then turns back, “Oh, and about that memo for the massage chairs…”

But I don’t hear him. I’ve crawled under my desk, looking for the Lost Thumbtack. I don’t “find” the thing until I hear my door open and close. Carefully I look up….he’s standing there, hand on the doorknob. He’s smiling, one of those serious smiles that makes perfectly clear that nobody’s fooling anybody. “Find your thumbtack?”

I sigh. The sound is tired in my ears. “Yes. But I just tossed another one down there to go look for later.” He doesn’t say anything. “Yeah, the massage chairs. Bring me the memo. Until then, take this script-” I scribble onto a piece of paper.

He crossed the room and takes the script from my hand, smiling.

Massage Chair
1, bid. Do not swallow.

Interview with A Virus

On February 23, 2011 By SW101In disease, family, health, humor, learning, life, medicine, pregnancy, red blood cell, science, sex, UncategorizedLeave a comment

SW101: I’m sitting here today with Herpes Simplex Virus, type 2. It has agreed to answer a few questions for SW101 Nation. Thanks for joining us today, um, is it…Mr. Simplex?

HSV: “Mr.” Simplex. Sure. I’ll go with that. (rolls eyes, muttering “humans”).

SW101: Tell me, what do you regard as some of your greatest accomplishments, to date?

Mr. Simplex: We’re awesome, basically. We like to consider ourselves ubiquitous, yet cosmopolitan. We are particularly fond of the human idea of “make love, not war.” mmMM. Huge for us, that one.

SW101: Ubiquitous?

Mr. Simplex: You got an ulcer on your nether-parts after a groovy night wearing nothing but beer goggles? Probably us. Any version of sexually active with any version of human being (we don’t like animals)? Excellantae! 30% chance we’ll be right there with you. Me and my posse are hanging out with 30-45 MILLION Americans. And that just in the, ah, “middle” parts of the human landscape. We got some cousins who live in the windy North quite happily. We cross paths from time to time.

SW101: Wow. Qute a party.

Simplex: Yep. And we’re inviting picking up around 300,000 new groupies every year.

SW101: How’s that?

Simp: We’re launching out all over the atmosphere much more often than people realize. Those blistery sores we cause? Well call ’em “pleasure domes,” referring to what they do for us as well as how our gracious hosts acquired them in the first place. Anyway, we don’t just blast out from the popping penile blisters. Usually, we send out early drones before the sore even forms. We’re terribly proud of this tactic.

SW101: Soo, when does the ‘party’ end?

Simplex: That’s the best part. Pretty much never.

SW101: Like, never?

Simplex: Oh sure, we take a break sometimes. Lots of times, actually. We hide most of the time. But once we’re in a body, we don’t really ever leave.

SW101: What do you hide from?

Simp: There’s two things we don’t like in this world, and the Great White Army is the main one.

SW101: Um, you refer to Tsar Ivan III‘s anti-Bolshevik Imperial Russian Army in the 1920’s?

Simp: What?! What kind of freak-show wonk are you? No! The human immune system. All the cells in that army are white. Or clear. Or something. Scary, those guys. They can blow us up, eat us, chew us up, spit out pieces of us so their comrades can eat the rest of us…it’s disgusting, really. It’s like a bad horror movie. Ugh! Look at that picture of the immune cell! Don’t you have any shame? I didn’t walk in here holding up pictures of car accidents, or guys who accidentally fell into meat grinders, did I? Why don’t we just sit around and ponder Charles Manson, and all his fabulous exploits? Oh, actually, that guy was pretty good for us, as I recall.

Anyway, where was I? (fans self, leans back weakly). Oh yes, when it’s up and running full-bore, the human immune system it a giant headache for us. We try to lay low. No sense in getting our heads knocked off. The good news is that it gets stretched pretty thin trying to cover all the problems that come up in those unnecessarily complex organisms of yours. It’s pretty easy to come out and play once the person is stressed, sick, too hot or cold or with some disease that naturally keeps the White Army back in the barracks, so to speak.

SW101: So, you hide in the nerves, right?

Mr. Simplex: (looks left and right conspiratorially) Yep. Broadly speaking. This is the secret to our survival, by the way. Our lair. Your nerves.

SW101: And, specifically?

Simplex: Well, you guys have no hope of actually finding us, so I’ll just go ahead and tell you. My guys hang out in the roots of the nerves that extend from the sacrum. S2-5, usually. In the ganglion. It’s nice there. Our version of what you’d call waterfront property, I’d imagine. Our cousins hang out in similar nerves in the face.

SW101: You mentioned two things you don’t like, what’s the other?

Simplex: Condoms. We hate ’em.

SW101: That bad, huh? Your great nemesis?

Simplex: Well, actually, our relationship to them is a bit complicated. Maybe like Ariel Sharon vs. Yassir Arafat.

SW101: Surely you’re referring to the Israeli-Palestinian former leaders…both dead now?

Yasser Arafat at 'From Peacemaking to Peacebui... — Ariel Sharon thinks I'm a punk. I told him the feeling was mutual over tea this afternoon.

Simplex: Dead? Really? I don’t think we had anything to do with that. We try not to kill our hosts…bad for real estate, as you can imagine. But yeah, them. They hated each other, but at the same time, they created lots of business for each other too. Get it? People don’t like using condoms, for some reason. But those that do are WAY lax about concerning themselves with us. Since we don’t just hang out in areas covered by those suffocating, smothering latex udders, we get around pretty well when condoms are in the mix. People jump into their illicit affairs, thinking they’re safe…and forget to ask anything about us.

So, it’s a love-hate thing. Overall, condoms are probably pretty good for business.

SW101: So, you hate condoms. What do you love?

Simples: Promiscuity. We’re BFF’s. Make love, not war, dude. Preferably, don’t even look down at what you’re doing.

It’s not personal, by the way. We’re just doing what we are meant to do…which is reproduce. Everyone who is living with us now should understand that. It’s one big happy family of organisms doing what they were meant to do…mate, and reproduce. It’s natural. When you’re mating…so are we. All I can say is, sorry for the inconvenience.

Herpes – Are bleeding lesions around the genitals a sign of herpes? (zocdoc.com)
Can a herpes outbreak cause one to cough? (zocdoc.com)
Can oral herpes be transferred to the genitals? (zocdoc.com)
Herpes – How long does itchiness last for those infected with Herpes? (zocdoc.com)
“AIDS breakthrough: African study offers hope to women by helping prevent HIV, herpes” and related posts (taragana.com)

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