Sunday, January 29, 2006

MaladyLink: Surgery in the Postwar Years

UCSF Oral History Program presents: Surgery in the Postwar Years.

"More than any other category of clinician, surgeons throughout history have elicited responses from their colleagues in other clinical disciplines and from the general public, ranging from admiration and gratitude to resentment, envy and scorn. It is especially important, consequently at the turn of the twentieth century to go beyond the stereotypes and to document the clinical science of surgery in its full historical and human context directly in the voices of those who practice and research surgery."

Friday, January 27, 2006

People: Life as a Doctor with Asperger's Syndrome

People: Dr. Ed Friedlander, the "Pathology Guy"

Perhaps the most addictive site out there, for me, is that of Ed, the Pathology Guy. His site is so copious and diverse in its pathology information that PathGuy is the first place I turn to when researching a new Malady to post.

Ed Friedlander, MD, is a clinical and anatomic pathologist, and also chairman of pathology for Kansas City University of Medicine and Biosciences. His personal interests vary from fantasy role-playing games, skydiving, and Shakespeare, and his site is a treasure trove of pathology pictures, lecture notes/outlines, and of course, copious writings on a number of diverse topics.

Some gems from his site:
Perspectives on Disease
The Kansas City Field Guide to Pathology
Ed's Pathology Notes

Then, there's all the non-medicine-related stuff:
Flat-top haircuts
and "Why I am not a Postmodernist".

There's a lot more there, but I'll leave it up to you. Just be sure you have a few days.

Wednesday, January 25, 2006

Today's Malady: Babies of Stone

Imagine being pregnant... and then never giving birth. It is not until years later that an x-ray reveals a calcified mass... that of your baby.

This phenomenon is known as lithopedion or "stone baby",
and in the case of this Zairian woman, the calcified fetus was fully recognizable as a fetus.

Cases of lithopedion frequently arise where there has been an ectopic pregnancy and the fetus has died.

The fetus is too large to be reabsorbed by the body, so the tissues are gradually replaced by calcium. The lithopedion is not discovered until other problems (related or unrelated) bring the woman in to see the doctor. A lithopedion can easily be mistaken for a tumor; in the case of the Zairian woman, the truth of the matter was discovered during surgery.

It occurs roughly once every 20,000 pregnancies, and is more common in developing nations where there is less rigorous prenatal monitoring.

Lithopedion was featured in an episode of Nip/Tuck.

The earliest stone baby is one reported to have been found in an archaeological excavation of a site dating to 1100 BCE, and women have been known to carry lithopedia for over 60 years.

MaladyLink: Virology!

Monday, January 23, 2006

MaladyLink: Peau d'Orange

I commented in someone's journal that an image they posted looked like something called "peau d'orange".

This is peau d'orange. It's... not something you really want.
peau d'orange from large cell lymphoma.
another. Probably inflammatory breast cancer.

Peau d'orange is commonly associated with inflammatory breast cancer, one of the deadliest forms of BC; fortunately it's also one of the rarest.

disclaimer: I'm not a doctor, I don't play one on TV, and nothing I post should be constituted as medical advice.

Today's Curiosity: Feral Children!

Feral Children.
Feral children, also known as wild children or wolf children, are children who've grown up with minimal human contact, or even none at all.
They may have been raised by animals (often wolves) or somehow survived on their own.
In some cases, children are confined and denied normal
social interaction with other people.


This is a fascinating, scholarly and very resource-rich site which relates accounts of "wild children" in legend, history and fiction.

You'll meet Victor, the Wild Boy of Aveyron, who is described in many first-year General Psych textbooks, and is considered to be the first documented case of autism.
We also learn about wild children in popular fiction - from Tarzan to Hayao Miyazaki's film Princess Mononoke.

Yesterday's Malady: Immortalized by the Blues

I can't eat, I can't talk, Been drinkin' mean jake, Lord, now can't walk.
- the Allen Brothers, 1930

In addition to today's usual malady, I give you a malady from the past: Jake Leg.

"Jake Leg" is a toxic neuropathy which caused paralysis. In cases of partial paralysis, there was a characteristic limp - the "jake walk".

Jake leg was a major catastrophe of the 1930s, a direct result of the Prohibition. Originally a medicine, "Ginger Jake" skirted Prohibition laws at first. Later, adulteration with neurotoxic chemicals brought on the paralysis sung of in a number of blues songs of the 1930s.

If not for its memorialization by the Blues, Jake Leg might have dissappeared from the public consciousness altogether.

Today's Malady: the sore that killed Superman

Today's malady is dedicated to all of you computer geeks who spend all of your time seated, unmoving, in one position - which is to say, a large majority of my Livejournal readers ;)

Today's malady is the decubitus ulcer, also known as the "pressure ulcer" or "bedsore".

It is one of these which contributed to the death of Christopher Reeve; as with any open wound, a decubitus ulcer can go septic - in which case, you're in big trouble.

Why did I choose bedsores of all things, and not some exotic tropical fever, for today's malady?

On the forums over at The StudentDoctor Network, ER folk describe advanced sacral decubitus ulcers as some of the most horrifying things they've ever seen - in one case, the bone was visible and urine was leaking out of the hole in the poor soul's back.

Decubitus is often political, as it can be one of the hallmarks of elder abuse and neglect, especially in nursing homes.

Today's Insect: the Sweet n' Low Bug!

In honor of one of my LJ-friends (you know who you are!), I bring you:

Today's Bug.

Today's bug is the silverfish, lapisma saccharina.

See? It's actually a very pretty bug, with sinuous, slithery movements and a bright, silvery body. It should, in my opinion, be called rather the quicksilverfish.

But living with these buggers isn't fun, either, especially since some people mistake them for a type of cockroach.

Silverfish are not cockroaches.

Curious things about silverfish:

* L. saccharina are named because of their affinity for artificial sweetener.

* They breed by artificial insemination. They do not copulate. The male deposits sperm packets, which the female inseminates herself with.

* They are among the most primitive of insects, having first appeared in the Devonian period. They retain many primitive and vestigial features, such as vestigial legs.

* Their natural enemy is the spider.

* You often find them in sinks and bathtubs at night, because they most often travel by night, but can't move easily across smooth surfaces. Thus, they often fall into bathtubs and sinks, but find themselves unable to escape.


References:
Ohio State University Extension Fact Sheet, by William F. Lyon
Texas A&M University Department of Entomology's Field Guide entry
Silverfish, Bristletail & Firebrat by Stephen Boyd
Virginia Polytechnic Institute & State University Department of Entomology entry on Thynasurans
Thynasura Fossil Gallery

Today's Malady: when the treatment is what ails you

After a bit of a hiatus (due to being seriously busy), I bring you:

(drum roll please)

Today's Malady!

Imagine that you've gone to the doctor for a sore throat. Or perhaps a bladder infection. You get sent home with the usual course of antibiotics. You take them, and figure that soon you'll be feeling better.

Instead, within a day or so, you begin to feel hot, and sick to your stomach. You begin breaking out in blisters: at first your face, then they spread. And that's just the beginning.

What began as a simple bladder infection or strep throat, ends up with you spending a week or more in intensive care. As the condition peaks, you may be admitted to a burn unit. You may end up blind. You may end up with permanent scars. If you're immune-compromised, elderly, or a child, you may die.

You have just become a victim of Stevens-Johnson Syndrome - an allergic reaction to antibiotics.

A particularly severe form of the condition, toxic epidermal necrolysis, may result in all of the skin being shed which, just as in the case of burn victims, leaves the sufferer vulnerable to infection.

Treatment dominantly consists of good supportive care, although intravenous immunoglobulin therapy shows potential for early treatment.

Today's Malady: the tumor that can enter the kingdom of heaven

Warning: some images are graphic.

This is an example of a teratoma.

What's so interesting about teratomata?

1. This anecdote cites that the author recalled that up until recently, the Roman Catholic Church required that teratomas be baptized... "just in case" the tumor was a product of conceptus, and not a tumor.

2. It may have a few things to teach us about stem cells.

Some images of teratomata (not for the queasy):

These, from Atlas of Pathology.
This specimen, from Eccles Health Sciences Library, shows what is, to me, the most interesting thing about teratomata - that they may consist of a variety of different tissues, including skin, sebum, hair, and they may even have...

...teeth, as evidenced by this image which is brought to us by Dr. T, who posts Imaging Case of the Week.

MaladyLink: Plastination! No fuss, no muss.

(originally posted 06/19/05, which is why I'm referencing an event which has long since come and gone. "The Universe Within" was *amazing*, by the way.)

Soon, I'll have the pleasure of visiting The Universe Within at the Nob Hill Masonic Center. The Universe Within is described as "an educational exhibit
comprised of actual human bodies and organs that have been preserved using a method known as plastination."

This lead to some curiosity on my part: what is plastination?

It turns out, plastination is a technique of anatomical preservation pioneered in 1978 by anatomist Gunter von Hagens of the University of Heidelberg.

The technique is actually fairly simple. Plastination basically involves ultimately replacing the body fluids with a plastic, in a four step process that takes about 1500 hours:
fixation, dehydration (with acetone), forced impregnation (in which vacuum is used to replace the acetone with a polymer) and hardening or curing.

The process results in a specimen which is safer, and of course, less smelly, than a conventionally preserved body part.

Some digging around, yielded these tidbits:

The International Society for Plastination.

University of Michigan Medical School: Plastination Laboratory

Gunter von Hagen's BodyWorlds: The Anatomical Exhibition of Real Human Bodies. This is the original anatomical exhibit, which preceded The Universe Within.

Plastination at University of Vienna. Human anatomy atlas featuring images of plastinated specimens.

Today's Malady: the Bubble Blues

Today's malady is Severe Combined Immunodeficiency or SCID - the "Bubble Boy Disease".

There are about ten known types of SCID; roughly 45% of the cases (including David Vetter's) are due to an X-linked congenital condition, which is passed on by the mother.

SCID is chiefly characterized by a severe defect in T-cell production and function.
These are the same cells that are destroyed by the virus which causes AIDS, and some of SCID's symptoms are similar: an inability to withstand infection. As a result, children with SCID, left untreated, invariably succumb to pneumonia, meningitis or a score of other opportunistic infections which plague the immunodeficient - for example, pneumocystis carinii pneumonia, a common cause of death among AIDS sufferers.

Until recent years, SCID was invariably fatal within the first few months of life.

The aforementioned real-life "Bubble Boy" was David Vetter. In a sense, his very existence could be construed as an experiment. The Vetters had lost an infant to SCID, and the doctors from Baylor College of Medicine suggested to the Vetter family that any future offspring who suffered from SCID, might be raised in a specially designed sterile environment.

Since David's death, new and novel treatments for SCID have been successful; matched-donor bone marrow transplant has been curative in many individuals, provided it is administered in the first few months of life.

Gene therapy holds great promise, as do any advances - if we allow them - in stem cell research.

David Vetter's life remains the stuff of controversy. His psychologist, Mary Murphy, paints a picture of a deeply unhappy child who was psychologically damaged by his isolation.

The "bubble boy disease" remains a fascination for the American media. However, David Vetter was the only SCID patient to ever be raised in a "bubble".

MaladyLink: more fun from Ed, the Pathology Guy

Dr. Ed Friedlander is my hero. He is one of the most interesting people I've ever encountered on the web.

More amusement from his website:
A friend of his gets tasered

Today's Malady: The Timebomb in Your Brain

You're a small child when the clock begins ticking.

Years and years later, you've forgotten all about those few boring, housebound, feverish days of your childhood, when you were kept occuppied by videos and PlayStation games.

You're a teenager when you notice that you lose a few words here and there. Or perhaps your memory isn't what it used to be.

It will progress until you fall into a coma from which you will never awaken.

You are one of those unlucky measles survivors who has gone on to develop subacute sclerosing panencephalitis.

SSPE is caused by infection with a mutant form of the measles virus (rubeola).

Unfortunately, all diagnosed with it (and it's not an easy diagnosis), die - this boy was among the unlucky ones to contract this condition which is relatively rare in developed nations.

A heartbreaking true case of SSPE is featured in the book The Woman With the Worm In Her Head by Dr. Pam Nagami, who describes her experience diagnosing and managing SSPE in a young woman who had first contracted measles prior to her adoption, while a young orphan in India. It would seem that many cases of SSPE in the United States occur among adoptees who contracted the initial infection abroad.

People: Dr. Max Aguilera-Hellweg, doctor and photojournalist

Dr. Max Aguilera-Hellweg, photographer of these beautiful images for National Geographic's article on stem cells, was a successful photojournalist before he decided to become a doctor. He went back to school for the first time, and enrolled in pre-algebra, at age 39, and enrolled in medical school at 44. He was given the assignment by National Geographic while in his first year of residency.

Cool, huh?

Miscellany: Don't put that there!

More proof that people will never stop sticking things that don't belong in certain places, into the places in which those things don't belong. At the very least, please make sure that whatever you put there, 1) is manufactured expressly for that purpose or at the very least 2) belongs to your own species.

Eating disorder expert collapses at market. An expert in eating disorders collapsed in a supermarket after inhaling propellant from whipped cream cans, according to police.

Perspectives: Monk Tales & Eggs at Twelve

This comes to me courtesy of one of my buddies over at LiveJournal:

Thin Sandar, a chicken seller in Myanmar, had always dreamed of being a
man. When she inexplicably grew a penis last month, the 21-year-old
treated it as an awe-inspiring omen -- as have the thousands of stunned
villagers who have traveled to a pagoda to see him.


This made me consider something.

As I wrote to my LJ buddy:

I have heard that in order to become a Buddhist monk or nun, you must not have changed sex more than three times.

Once, I asked a Tibetan monk if what I had heard, were true.

He affirmed that it was.

So I asked, how did they go about gender reassignment back in the Buddha's day?

He said it happened spontaneously. That it just happened.

He personally knew of a case: a monk he had known who suddenly started transforming into a woman.

"What happened to him?" I asked.

He said, in his unassuming Tibetan accent, "Well, she became a nun."

While this doesn't explain the Myanmar case, my new pet theory is that the laws of physics in Tibet function in a manner significantly different from those elsewhere. [This is neatly explainable to anthropologists and other people familiar with the concept of 'world view', but it's downright incredible to the rest of us.]

That is, if something seems improbable, it is probably happening in Tibet, or at least anywhere where there is a
significant Tibetan population, as almost every Tibetan I have ever met has affirmed they either 1) saw or 2) knew someone who saw something very, very improbable elsewhere.

Spontaneous sex change? People flying? Seems it happens in Tibet all the time.

Maybe I should go there, one of these days. Unfortunately, though, Tibetan physics don't seem to have protected them from occupation by foreign powers.

That said, there is a condition that is responsible for some people appearing to spontaneously change physical sex.

People who have 5-alpha reductase deficiency are born with the appearance of girls, but at about the normal age of puberty, their testes descend, the penis begins growing, and they otherwise mature as cosmetically and functionally inconspicuous men.

This is apparently more common in Dominica than elsewhere, where these individuals are called guevedoce - "eggs at twelve".

Addendum:

Guevedoce is referenced as "eggs at twelve" (correction: some say "penis at twelve") at the following links: 1, 2.
It is referenced as "penis at twelve" at all of these places, however.

So it would appear that I owe somebody a cookie.

MaladyLink: Tapophilia

Taphophilia.com
Thanatology and tapophilia related stuff. All you ever wanted to know about death, but were afraid to ask.

Today's Curiosity: What's That Bug?

What's That Bug?. Just look.

MaladyLink: Do-It-Yourself Guide to Clinical Medicine

...well, actually UCSD's Practical Guide to Clinical Medicine, but I have a rather demented sense of humor, as everyone who knows me can attest to.

But, nonetheless, you should all be thankful there was no internet when I was a small child. Given I actually enjoyed the idea of dissection and had a somewhat antisocial disposition. I'm very glad there was no internet, and thus I did not find this site.

That said, as an adult who is a biology major and soon to be an emergency medical technician, and as a medical geek, it's extremely interesting.

PopMed: Phlebotomy is Love

Made this. :) Yes, there is a significance to the pattern of colors - any phlebotomists want to take a whack at it?

Image hosted by Photobucket.com

MaladyLink: Nurse Minerva

Nurse Minerva answers questions about biology in a health care context. As much focus on the human side of disease, as on pathology. Great site.

People: Bruce Stafford, DO

Bruce Stafford, DO
This man entered medical school at age 48. There's hope for me yet.

Amusements: A Cat's Life

The Private Life of a Cat comes to us courtesy of Archive.org.

Enjoy!

MaladyLink: The Dead Teach The Living

WARNING:
Today's curiosities may offend/sicken some sensitive viewers. And you might not want to look at them at work. Unless you work in a morgue.

Since I can never predict what direction in which my morbid curiosity will lead, I bring you:

Dr. Ed Friedlander, pathologist, is one of the most fascinating people I've ever heard of - one of those people I would love to have at my dinner table next to the Dalai Lama and Stephen Hawking.
I will allow his words to introduce today's curiosities:

In doing around 700 autopsies, I have always found something worth knowing that
wasn't known during life. Even at major hospitals, in about one case in four we find
major disease which was unknown in life. Giving families the explanations they want is one of the most satisfying
things that I do.


With that, first we'll let him tell us how an autopsy is done.

Now, we can see some actual autopsies - the real thing.

Skull autopsy.
In this video, South American medical students are getting an education.

Another autopsy video, featuring the famous y-cut.

More autopsy videos.

Finally:

Dr. G, Medical Examiner is one of my favorite shows on TV. For those of us who are a little more queasy, the actual autopsies are always shown discreetly.

MaladyLink: Trauma Gallery, lung sounds

Trauma gallery.

Lung sounds in .wav format.

EMS: Respiratory Difficulties

(originally posted 09/12/05)

This is all stuff we covered in EMT class, but because I'm a nerd/geek/whatever I had to go look for pictures and stuff on the internets. ;)

First off, the intercostal spaces are those spaces between your ribs. Auscultation (listening with a stethoscope) of lung sounds is done over the intercostal spaces.

Intercostal retractions are one of the signs of breathing difficulty. This man has two commonly observed signs of breathing difficulty: intercostal retractions (visible) and he is also sitting in the tripod position.

The tripod position is when a person sits leaning forward, with their hands on their knees or on another surface. This is a commonly observed sign of breathing difficulty.

The man in tripod position in this picture also has pursed lips, another sign of breathing difficulty. Note the presence of a nasal cannula. Perhaps he has emphysema.

The site referenced immediately above also shows an image of the nail beds in the state of cyanosis (another sign of breathing difficulty).

Here is yet another resource online, for the EMS-student community.

Dr. Ed Friedlander on respiratory pathology. Links to many great photos.

People: Practicing medicine in the dark, on the edge

(originally posted 09/06/05)

Practicing Medicine in the Dark, on the Edge - from NY Times.

Practicing Medicine in the Dark, on the Edge
By PERRI KLASS, M.D.
Published: September 6, 2005

They're heroes, all of them, the doctors and nurses taking care of patients in the hurricane zone, the ones you read about in the newspapers, ventilating the intensive care unit patients by bag and mask when the generator fails, or binding up wounds by flashlight.

It's a very particular kind of heroism - doing what you were trained to do, but doing it under circumstances where you are pitting your standard professional skills against unimaginable disaster.

The doctors and nurses in those hospitals and clinics have been fighting the right and proper ancient battles of the medical profession - and in many places, fighting them under horrifically ancient conditions.

Some of the most important, most necessary medical specialties - performing life-and-death operations, providing life support for the desperately ill - are the very fields most handicapped by the loss of technology; in those battles, fought out on the edge of what is possible, you need every advantage.

Dr. Manish Jain, a third-year neurosurgery resident at Tulane, who spent the days after the hurricane at the Veterans Affairs Hospital in New Orleans, described taking care of intensive care unit patients on "drips" - intravenous hookups meant to deliver tremendously potent drugs at scrupulously measured rates, so that every detail of the patient's heart rate and blood pressure can be monitored and bring about an appropriate adjustment in dosage.

Without working monitors, he said, without the machines that dole out the drugs by the milligram, by the minute, they managed the drips by literally counting the drips of medication into the IV. "Everyone from respiratory therapists to nurses to pharmacists to physicians," he said, "we used our collective skills to ovecome the deficits."

Outside intensive care, doctors and nurses are struggling to provide very basic care: people are sick, people are hurt, people are scared, and they need care. Children need their chests listened to, their asthma treated, their skin infections managed with the proper antibiotics; they need the right fluids if they're dehydrated. And even that is hard to do properly without technology so basic that we don't even notice it till it's gone.

A couple of days after the hurricane hit, I talked with Dr. Cindy Sheets in the pediatric clinic at the University of South Alabama Children's and Women's Hospital in Mobile, where the hospital was running on generator power.

"You end up trusting more in your judgment," she said, "relying less on the backup tests you do sometimes for medicolegal reasons. Over time, you know, we all have a fair amount of experience to tell us what's going on."

But the truth is that the way we deliver care has come to depend extensively on technology, not just the imaging miracles of radiology and the subtleties of serology, but on the whole electronic network of communication and commerce that keeps our world turning.

So Dr. Sheets was busy seeing patients, worrying about the risk of heat exhaustion to the people without power in the hot city around her. She was listening to chests and looking in ears and examining children's bodies.

It wasn't the diagnostic technology that was most on her mind. She was worried about the pharmacies: Without power, she said, many of the bigger chain pharmacies could not dispense pills or print labels.

She and her colleagues were dispensing the powdered antibiotic samples they had on hand, and directing patients to the few open pharmacies which were willing to compound prescriptions and provide medications without their own technological supports.

Most of us know, when we train as doctors in this country, that along with our phenomenal professional arsenals - our diagnostic tests, our imaging machines, our life-support systems, our wonder drugs and even our not-quite-wonder drugs - comes a certain dependence on the complex web of technical support.

Even in the kind of relatively low-tech, relatively old-fashioned medicine I practice - primary care pediatrics - there's an inexorable tendency to move away from relying on your own medical skills and get the extra test.

When I was a resident, in the relatively low-tech 1980's, there were plenty of senior doctors to point out to us, with a little bit of regret, that the art of physical diagnosis, for so many years the great point of medical professional pride, was getting lost in the newer technologies.

Those doctors showed us, over and over, how much you could infer from the appearance of the patient, from what you could palpate, from carefully assessing the different pulses around the body, from listening - really listening - with a stethoscope. And they worried that those skills would be lost in an era when you could easily obtain unimaginably sophisticated images of the heart and its blood flow, when you could look to definitive diagnoses by technology that answered every question you had thought to ask, resolved every diagnostic ambiguity.

Some teachers made a special point of teaching cases where too much reliance on diagnostic tests had led to wrong treatment or overtreatment or missed diagnoses. It's still a teaching truism: "When all else fails, look at the patient."

And there is no question that the technology, while it makes it possible to look inside a patient, to quantify ever more obscure shadowy presences in a patient's bloodstream, also tends to change the way you do - or do not - look at your patient.

You trust your own eyes and ears a little less. You look for confirmation from machines before you act. You ask clinical questions partly because you know they can be answered and you want to "document" the answers.

So yes, for example, "pneumonia is a clinical diagnosis," as I punctiliously remind the residents and medical students. And, yes, this is supposed to mean that if you listen with your stethoscope and hear pneumonia in a child's chest, you treat it. But the truth is, I often end up checking the X-ray and letting that guide me.

Sometimes it's uncertainty: did I really hear what I thought I heard? Sometimes it's that medicolegal desire to check every box. Suppose the child gets sicker, could I really justify not having gotten an X-ray? And sometimes, I confess, it's just the awareness that the X-ray is possible, the X-ray is there, the X-ray is easy.

Dr. Marsha Raulerson, a pediatrician in rural Alabama, remembers vividly when Hurricane Ivan devastated the small town of Brewton. Practicing in a rural area, she said, she probably relies less on technology than many other doctors.

"I depend on my physical exam, not an X-ray," she said.

But she was terribly upset by the idea that she was truly and profoundly out of touch.

"I'm always with my cellphone, I'm always with my beeper," Dr. Raulerson said. "They wouldn't work, phone lines were down. My husband said I lost my mind; I was just frantic.

"I ended up the day after the storm going to the office just sitting there in the dark, wondering if people were going to find me. A few wandered in, children injured during the storm, but I was just worried that if they needed help they wouldn't be able to call or to get there, so I was sending out people to check on all my high-risk babies that were at home."

That was the biggest anxiety. Not that she would have trouble diagnosing an illness, even if she was armed only with her five senses, her stethoscope and her clinical experience, but the sense of being out of touch, unreachable, unavailable to someone in trouble.

It was the sense, I think, of wanting to use what you were trained to do, what you know, who you are, wanting to fight that battle, in which the stake of a single life matters so surpassingly, even in the setting of overwhelming disaster.

There are many kinds of heroism, and even many kinds of medical heroism. There is the true drama of what we actually call, in the hospital, "heroic" surgery - high stakes, high tech, life and death. And there is also the everyday one-on-one heroism of truly looking at the patient, listening to the patient, even when you're both in semi-darkness.

PopMed: don't it make my brown eyes blue...

In today's "What the Heck??" category, I present to you...

Anal bleaching. No explanation needed.

MaladyLink: Bogota Bag; vascular surgery; childbirth

photo library of trauma. One image shows a person who has undergone the "Bogota Bag" procedure.

Here is a description of temporary abdominal closure, using the "Bogota Bag" procedure.

Library of case studies from the Peripheral Vascular Surgery Society.

Extremely graphic imagery of childbirth.

MaladyLink: more pathology stuff!

First of all: today's site is TumorBoard.
"Tumorboard is an idea originally conceived and developed by Dr. John Minarcik, a pathologist from Florida. Dr.Minarcik wanted to provide an online pathology image forum whereby pathologists from all over the world could come together and discuss their cases without fear of liability, consultant fees, or ego issues."
Great cases and images, such as the colon of Brian the Beef Man; and like many pathologists' homes on the web, this site evidences some amount of dark humor.

But wait! There's more. During my surfing today, I encountered:

Arms of a heroin user.

Another heroin user's arm.

Article about urban home care nursing for those living close to the street in downtown Vancouver. Article discusses a few things which are interesting because they highlight the differences between Canadian and American treatment of drug users.

This child apparently has a severe form of eczema. Can anyone here understand French?

Images of Burkitt's Lymphoma from Africa. While these images are dramatic, Burkitt's is one of the more treatable cancers.

Addendum:
I had no trouble accessing the first two links - who all can't see them?

Perspectives: "What are ya in for?"

(originally posted 10-17-05)

He moved slowly and carefully.

As I palpated to find his veins, I felt the heat pouring off of him. His skin was delicate and papery; he was old before his time. I didn't get the vein, despite the fact of thinking I had found a good one. I asked a staff phlebotomist to come help me.

He sat there, cooperative and patient, and smiled wanly with thin lips.

The staff phlebotomist told me she'd be "right there".

Sweat began to stand out on his face. He looked up at me with large eyes set in a thin face.

"Would you like some water?" I asked.

He nodded. "Yes please."

I got him a cup of water. The staff phlebotomist came and resumed the draw.

I can't get his face out of my mind.

I wondered what was the matter with him. I always wonder. I read the patients' labels and see if the test being ordered can give me any clue, but it doesn't.

I always wonder.

The large eyes are stuck in my mind.

Perspectives: They can't save our souls.

(originally posted 10/13/05)

Of note today was the man who came in for what I thought was going to be a routine blood draw. He was about the same age as my stepfather, and he looked healthy enough. After I draw the blood, he says, "It's nothing to me, now."

He goes on to tell me that he has a fifteen percent chance of surviving the next four years, even though the surgeons "got it all out".
When someone tells you something like that, you don't need to ask what "it" is. There could only be one "it".

I didn't know what to say to him. Finally, I asked, "Does it put things into perspective?"

"What? Put WHAT into perspective? Know what it all means? NADA. Nothing. It all means NOTHING."

There was that.

There was also realizing that the tall, musclebound gentleman I later drew blood from (who was very nice, and an all around pleasure of a patient) was somebody of some note in the sporting world, *after* the fact of having drawn his blood.

Then there is seeing a middle aged man or woman lying in a bed, wearing a diaper, with an IV hooked up to them, and realizing that this person is somebody's mother or father, and that this person has been laying here all day probably bored out of their mind and that the only people who see very much of them are the nurses who come and go. Some of these people have been in the hospital for a month or much, much longer. Doesn't anybody come at least and play cards with these people?

I can only imagine how boring and lonely it must be. The treatment somehow almost seems worse than the disease, sometimes.

One man was crying out for the ER doctor to come over and give him some painkillers for his stomach. The doctor couldn't do so, and finally, he firmly said, "I can't do that, you KNOW I can't do that, and I NEED YOU TO BE QUIET!".

After the doctor left, the man cried, "I can't go on like this anymore. Nobody should have to live like this."

The guy needed something, I thought, and it wasn't painkillers.

We make doctors into priests, but it's not their job to be priests. We get angry when they can't save our souls. And certainly the lone doctor on the floor in that ER, can't save every soul in every room, particularly the ones who don't want to be saved.

Why does the woman who keeps ODing on vicodin, keep coming back? Why didn't she find a more efficient means of killing herself? That's something my mentors in the clinical lab keep discussing.

I think she looks for something. They all look for something. That's how they end up here.

The problem is, we're all of us looking for something.

That man who found out he was dying, though.

I don't think he was looking for anything.

I think for once, he'd finally figured it all out.

He didn't seem sad, to me.

PopMed: Men unable to repulse potential lovers?

(originally posted 11/18/05)

According to Russian experts, men are physically unable to repulse potential lovers, and wearing a wedding ring reduces virility.

PopMed: Men unable to repulse potential lovers?

(originally posted 11/18/05)

According to Russian experts, men are physically unable to repulse potential lovers, and wearing a wedding ring reduces virility.

Public Health: Oliver Sacks discusses new flu threat

(originally posted 11/16/05)

Waking to a new flu threat
(Op/Ed)
Oliver Sacks discusses the relationship between the 1918 flu epidemic and the epidemic of encephalitis lethargica which followed soon after.

Sacks is one of my favorite authors.

Living Beautifully Together with Bicornate Uterus

(originally posted 12/04/05)
When I saw this image over at Engrish.com, I looked at that logo and the first thing that came to mind was Bicornate Uterus.

Living Beautifully Together with Bicornate Uterus

(originally posted 12/04/05)
When I saw this image over at Engrish.com, I looked at that logo and the first thing that came to mind was

MaladyLink: Marfan's Phenotype

Some examples of some of the physical characteristics of Marfan's Syndrome.

arachnodactyly or "spider fingers", a common feature of Marfan's.

More a note for myself, than anything else.

Example of the Marfan's phenotype in a woman. Note the length of the arms, and general narrowness of the body.

arachnodactyly in a Marfan's sufferer.

Another arachnodactyly example.

Public Health: School nurse shortage puts kids at risk

(originally posted 12/14/05)
School nurse shortage puts kids at risk.

People: one osteopath's approach to GERD

Dr. Kurt Barrett is a doctor of osteopathic medicine. He discusses Gastroesophageal Reflux Disease and its relationship to other conditions.

PopMed: Jewellery for your favorite geek!

Just in time for Valentine's Day.

Serotonin and Dopamine jewellery

DNA jewellery

MaladyLink: The Museum of Human Disease

UNSW Museum of Human Disease. Great site brought to you by the University of New South Wales; great pictures.

People: Liver Lovers

(originally posted 12/19/05)
Husband-wife liver transplant team.

I really don't know what else to say.

What else is there?

MaladyLink: Faceblindness/Object Recognition

(Originally posted on December 22)
Brain region used in face recognition is active in new object recognition, Brown University study says.

This may particularly be of interest to some of my online friends who are active in autism and faceblindness communities, as many people with faceblindness also have some form of agnosia.

MaladyLink: Spaying and Neutering

The procedure of cat spaying and neutering, step-by-step with pictures.

Today's Curiosity: Dining on a Can of Disease

Steve (of "Steve, Don't Eat It!") introduces us to the wonders of cuitlacoche, also known as the Mexican corn truffle.

Cuitlacoche or Huitlacoche is a fungus which is a bane to American farmers, but a boon to Mexican ones, as in Mexico, the stuff is considered a great delicacy.

What would this post be without some recipes?

Huitlacoche tamales
Huitlacoche soup

Actually, I think I'd like to try it.

MaladyLink: Genetic Mosaics and Chimeras

A good friend of mine introduces us to genetic mosaics and chimeras, in this post over at the LiveJournal Medical Geeks community.

MaladyLink: Killer Plants!

Killer Plants is where you go to find out how the Star Anise was used to keep time, the origins of the Chia pet, or how grape thieves saved the wine industry.

Enjoy!

Today's Malady: Keeping One Eye Open

After much hullabaloo over Cy, the kitten born with one eye, I bring you Today's Malady: Holoprosencephaly, which is the condition that Cy suffered from.

What are the characteristics of Today's Malady?

According to this article by the National Institute of Neurological Disorders and Stroke, holoprosencephaly is the failure of the prosencephalon or forebrain to divide properly. A brain with holoprosencephaly may look like this, this (quite dramatic - this is the alobar form, meaning there is no division into hemispheres) or perhaps this (semilobar - there is a cleft representing some, but not sufficient, separation of hemispheres).

Causes of holoprosencephaly include chromosomal disorders such as trisomy 13, maternal diabetes, and of course, sporadic occurance with no known cause. Alobar and semilobar holoprosencephaly with features like those of Cy the Kitten are more common among embryos than among live births, as the conditions are generally incompatible with life.

This article over at Zygote: a Developmental Biology Website is quite informative, and includes pictures of the spectrum of holoprosencephaly from severe afflictions incompatible with life, to the more mildly afflicted who may have less severe facial deformities, but may have epilepsy, hydrocephalus (fluid on the brain), varying degrees of mental retardation, and other abnormalities.

MaladyLink: Pathology Outlines; ER Stories

PathologyOutlines.com
Self-explanatory. Subscribe to get their "Pathology Outline of the Week".

Things I Learn From My Patients, the infamous thread on StudentDoctor.net's forums. You may have to sign up for a (free) membership to see this, I don't know. But this thread alone is worth it: these are the real stories of people who work in ERs across the country. The thread will make you cringe, laugh or both.

Science: sniffing for love in all the right places.

From a recent BBC News article:
A woman's body odour can help her attract men when she is at her most fertile and repel them when she is not, scientists have said.

According to an article printed in June, women sniff out perspective partners, as well:

Fertile women prefer the scent of dominant men.

MaladyLink: Craniofacial Disorders.

The World Craniofacial Foundation has a lot of information about various craniofacial syndromes, including pages for each, with descriptive information and support contacts.

MaladyLink: Tropical Diseases.

Index of Diseases from the Tropical Medicine Central Resource. An enlightening site with tremendous amounts of detail.

Welcome to Today's Malady

FAQ: Today's Malady

1. What is "Today's Malady"?

Today's Malady
is the feature which up to now, I regularly posted on another blog. I would consider it a "tabloid style" feature aimed at the general public. This is not a serious medical journal, and please don't construe it as such. In "Today's Malady", I chose a factoid from contemporary public health news, medical history, or pathology and posted it. I will continue this format. I have moved the feature over here for personal ease, and so I and readers can find the medical posts without sifting through all of the other posts.

2. Are you a doctor? Do any of these posts constitute medical advice?

I am not a doctor, nor do I play one on TV. I am however a non-traditional-aged Biology major, as well as phlebotomist and EMT-in-training, who once-upon-a-time was a dotcommer.
This feature is a personal hobby of mine and in no way constitutes medical advice. I also can't vouch for the veracity of the medical professionals whose links I post. If you have to sue someone, sue them, not me.

3. Can I suggest a malady?

Of course.