MedWorm: Urologists and Nephrologists

Introducing the efficient md wiki

Kidney Notes — Mon, 12 May 2008 04:00:00 +0100

Visit the Efficient MD Wiki at http://wiki.efficientmd.com.Wikis — collaborative websites — are powerful tools for education. The Efficient MD Wiki is designed to help healthcare professionals and medical students discover clinical pearls, useful resources, life hacks, and strategies to improve the practice of medicine.Although this Wiki is currently in its infancy, it is growing rapidly and needs your help. Please post your ideas, mnemonics, best practices, tricks, timesavers, presentations, helpful links, or other advice you'd care to share. (Don't worry if your writing is disorganized. Someone will always edit it later.)While posting anonymously is allowed, if you'd like to have a link to your personal website added to the home page — as our way of saying thanks — please join the wiki and send us a message.Please see the posting guidelines and disclaimer. The Efficient MD Wiki is an ongoing experiment, and comments are welcome.Sincerely,Joshua Schwimmer, MD, FACP, FASN; The Efficient MD Blog (in association with the American College of Physicians); Clinical Instructor in Medicine, Columbia University College of Physicians & Surgeons and Clinical Assistant Professor of Medicine, New York University School of MedicineVes Dimov, MD; Clinical Cases and Images; Clinical Assistant Professor of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University(Also posted on The Efficient MD Blog.) (Source: Kidney Notes)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Currently reading: little brother

Kidney Notes — Sat, 10 May 2008 04:00:00 +0100

(Source: Kidney Notes)

"lipitor titration is a failed step."

Kidney Notes — Wed, 07 May 2008 04:00:00 +0100

Lipitor Image via WikipediaThree Vytotin/Zetia reps just came to me and said, "When do you feel comfortable using Zetia? After all, Lipitor titration is a failed step. It only reduces LDL by 6%."I gently referred them to the PROVE IT trial, asked them to come back when they had positive mortality data, and walked away.Has anyone else encountered this strategy by the Zetia reps?Related articlesCholesterol Drug Has No Benefit in TrialData About Zetia Risks Was Not Fully RevealedTrial of Cholesterol Drug Gets House ScrutinyCardiologists Question Delay of Data on 2 Cholesterol Drugs (Source: Kidney Notes)

You'd never confuse diabetes mellitus with diabetes insipidus. the new york yimes has it wrong.

Kidney Notes — Tue, 06 May 2008 04:00:00 +0100

Image via WikipediaI'm still puzzling over this article in the New York Times, "Some Diabetics Don't Have What They Thought They Had." The article seems to imply -- and some other news outlets have picked up -- that some children diagnosed with type 1 diabetes mellitus (DM) actually have diabetes insipidus (DI). What the article means to imply, I think, is that some children with type 1 DM actually have maturity onset diabetes of the young (MODY). (I've looked, but I could not find a situation in which you'd ever confuse type 1 DM and DI. In DI, for example, you wouldn't have glucose in the urine.)Why is this important? Because if the myth propagates through the media that you can easily confuse DI and DM, countless younger adult patients with DM will approach their doctors demanding that they be tested for DI, which will require a lengthy explanation of how the two could not be confused...On the other hand, I've seen patients with MODY misdiagnosed as having type 1 DM -- and they eventually are able to stop insulin and switch to oral therapy. This is the real message of the NYT article, I think, and it's great when it happens. (Source: Kidney Notes)

How to tell you are married...

UroStream — Thu, 01 May 2008 17:16:00 +0100

Our nightly bedtime ritual involves my husband lovingly putting a Breathe-right strip on my nose. (allegedly, I snore, though I'm not convinced) .Before my LASIK surgery, I used to fall asleep next to my husband with my glasses on. Really sexy...When I reach over to cuddle with my husband, I also try to sneak in his monthly testicular exam.Hubby now feels perfectly comfortable to inform me that I look like a "car accident victim with a head injury" when I wake up in the morning. Granted I'm not a morning person and my AM conversation usually involves unintelligible monosyllabic grunts (hence the head injury part), and I guess I don't look so hot either.I sleep with all 9 (yes, that's nine) of my stuffies (stuffed animals) at night and hubby doesn't complain. In fact he encourages this behavior by periodically adding to the collection. Thank goodness for our king size bed.So all I want to say today is: Happy Anniversary honey, and thank you so much for the awesome new wallpaper!!! PS: to celebrate our wedding anniversary, we are going on vacation and I will be out for the next two weeks. I will try to post if I have access to a computer, but I can't promise anything. (Source: UroStream)

Trm awards 2008: funding for up to 20 awards and research groups

ESAO - Liver Support Working Group — Thu, 01 May 2008 15:21:00 +0100

The Translational Centre for Regenerative Medicine (TRM) Leipzig, funded by the German Federal Ministry of Research and Education and the Free State of Saxony, is charged with the development of new diagnostic and therapeutic technologies as well as preclinical models in regenerative medicine. For its new funding period that starts in 2009, researchers are invited to apply for awards to pursue research from bench-to-bedside. Funding is available for up to twenty awards and research groups in the four research areas of the centre: * Tissue Engineering and Materials Science (TEMAT) * Cell Therapies for Repair und Replacement (CELLT) * Regulatory Molecules and Delivery Systems (REMOD) * Imaging, Modelling and Monitoring Regeneration (IMONIT) Goal orientation with clearly defined milestones will be an inherent task in all approaches. While applicants are asked to apply with clear therapeutic or diagnostic concepts from all four research areas above, applications within the following subjects are particularly encouraged: * Scaffolds for stem cell differentiation * Novel bioreactor technologies * Innovative drug-delivery systems * Target molecules for regenerative medicine and transplantation * Angiogenesis * Reprogramming stem cells (iPC) * In vitro organ development * Aspects in Xenotransplantation * New microscopic and imaging technologies Individual researchers as well as research groups headed by a leader may apply for this programme. Awards start from 2009 for 3 years initially and can be extended, depending on external review, for up to 7 years. Funding is available for the researcher’s own salary (usually ranging from 35.000€ to 60.000€ p.a.), additional staffing, consumables, and equipment. Salaries and funding volume are adjustable depending on experience. The application form and additional information to the awards can be found on our homepage: http://www.trm.uni-leipzig.de/awards2008 For further information, please feel free to contact us: ++49 341 97 39658 or awards2008@trm.uni-leipzig.de Attention: The application deadline is10 p.m. German time (GMT + 1 hour) on June 15th 2008. We promote excellence through diversity and encourage all qualified persons to apply. Translational Centre for Regenerative Medicine (TRM) Leipzig UNIVERSITÄT LEIPZIG Semmelweisstraße 14 D-04103 Leipzig Germany 1409 - 2009 Alma Mater Lipsiensis – 600 years UNIVERSITÄT LEIPZIG (Source: ESAO - Liver Support Working Group)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Acute renal failure associated with cosmetic soft-tissue filler injections of silicone in the buttocks

Kidney Notes — Thu, 01 May 2008 04:00:00 +0100

The moral of the story? Do not to get injections of silicone in the buttocks by an unlicensed practitioner. Via the MMWR:Soft-tissue fillers are substances injected to augment or enhance the appearance of lips, breasts, buttocks, or other soft tissues. Previous reports have linked the administration of soft-tissue fillers, usually liquid silicone, by unlicensed practitioners to severe adverse events, including death On December 27, 2007, the North Carolina Division of Public Health (NCDPH) was notified of three cases of renal failure occurring among women who had received cosmetic soft-tissue filler injections at a facility in North Carolina (facility A). This report summarizes the clinical findings for these cases and describes the subsequent public health investigation. All injections were administered by a practitioner with no medical training or supervision (practitioner A). Investigators were not able to identify the substances injected. Although records indicated that the injections contained liquid silicone, this substance has not been associated previously with renal failure. These findings underscore the risks posed by cosmetic injections administered by unlicensed practitioners. Public health officials should be alert for adverse events associated with these injections and take all necessary actions to prevent additional injuries.Case ReportsCase 1. On December 8, 2007, a District of Columbia woman aged 42 years, who was previously healthy except for a history of anemia, received cosmetic soft-tissue filler injections in her buttocks at facility A. Records specifying the substance injected were unavailable. On December 22, the woman received additional injections at facility A. According to facility records, 300 mL of "dermal silicone/saline solution" were injected into each buttock (600 mL total) during the December 22 visit. The woman experienced headache and vomiting within 30 minutes of these injections and noted that her urine looked like purple blood. She went to an emergency department (ED) in Maryland on December 24 with fatigue, vomiting, and headache and was found to be in acute renal failure, with a serum creatinine level of 4.2 mg/dL (normal: 0.8--1.4 mg/dL). Laboratory investigations, including urine testing for heavy metals, did not reveal a specific etiology. Her serum creatine phosphokinase (CPK) level was 411 U/L on the day of admission (normal: 25--200 U/L). She remained hospitalized for 10 days. Hemodialysis was not required, and her serum creatinine level subsequently returned to normal.Case 2. On December 8, 2007, a previously healthy Illinois woman aged 26 years received cosmetic soft-tissue filler injections in her buttocks at facility A. Records indicated that she received 500 mL of "25% silicone dermal filler and 75% saline solution" in each buttock (1,000 mL total). She received additional injections at facility A on December 22. Records from December 22 indicate that 400 mL of a "50% concentration of silicone oil dermal filler and saline solution" were injected into each buttock (800 mL total). Within 1 hour of these injections, she experienced headache and nausea and noted that her urine had a burgundy color. She went to an Illinois ED on December 23 with nausea, headache, and fatigue and was found to be in acute renal failure, with a serum creatinine level of 4.0 mg/dL. Serum CPK was 517 U/L on the day of admission. The patient's renal function worsened, and hemodialysis was initiated. A renal biopsy on December 27 revealed severe acute tubular necrosis with cast formation. The casts were not myoglobin or hemoglobin; pathologists were unable to determine their composition, despite the use of specialized stains. No heavy metals were identified in urine specimens, and no other specific etiology was identified. The woman remained in the hospital for 13 days. Hemodialysis was discontinued after 5 weeks, and the woman subsequently regained normal kidney function.Case 3. A previously healthy Maryland woman aged 26 years received soft-tissue filler injections in her buttocks at facility A on December 8, 2007, and again on December 22. No records were available from either date. The woman developed abdominal pain, lightheadedness, and nausea within 1 hour after the second procedure. She went to an ED on December 26 with fatigue and vomiting and was found to have a serum creatinine level of 11 mg/dL. Hemodialysis was initiated. A renal biopsy on January 11, 2008, demonstrated acute interstitial nephritis with substantial numbers of eosinophils, consistent with a toxic or allergic etiology. Eosinophilia was not found on peripheral blood smears. No heavy metals were identified in urine specimens. She remained in the hospital for 14 days; hemodialysis was discontinued within 1 week after discharge, and her serum creatinine level subsequently returned to normal.Image: Wikipedia (Source: Kidney Notes)

Hepawash and ii. medical department, university hospital rechts der isar awarded € 425,000 grant from the bayerische forschungsstiftung (bfs) for a € 0.9 mio collaborative preclinical study on acute liver failure

ESAO - Liver Support Working Group — Tue, 29 Apr 2008 15:16:00 +0100

Hepa Wash GmbH (Hepa Wash), a medical device company developing an innovative liver support device announced today that it has received a € 425,000 grant from the Bayerische Forschungsstiftung (BFS) to test the safety and efficacy of its laboratory prototype in a preclinical animal model for acute liver failure in collaboration with the II. Medical Department, University Hospital Rechts der Isar. The grant will be used to develop an improved animal model for acute liver failure in pigs that resembles much more the clinical situation of acute liver failure in humans than currently available models. This new model will allow to analyzing and evaluating the safety and efficacy of the Hepa Wash® treatment on the function of vital organs during acute liver failure, results that will be very important for the further development and optimization of the Hepa Wash® device. In addition, these data will also be very helpful to gain a better insight into the underlying pathology of acute liver failure, a disease that is still only partially understood.Bernhard Kreymann, CEO and founder of Hepa Wash, comments “We are very proud that our efforts in the development of a new and innovative liver therapy will be supported by the Bayerische Forschungsstiftung. This grant will help us significantly in our attempt to achieve a breakthrough in the current therapeutic practice for patients with severe liver failure. In addition, it demonstrates the commitment of the BFS to support innovative applied research projects thereby not only contributing to the development of small, high-potential companies but also further strengthening medical technology as one of the future key technologies for the benefit of patients as well as Bavaria as a business location. We are also very delighted to have the opportunity to work together on this project with several prestigious partners, especially Prof. Dr. med. Roland M. Schmid from the University Hospital Rechts der Isar, PD Dr. Bernhard Michalke from the GSF, Neuherberg, and Prof. Dr. Dr. med. h.c. Peter Rademacher from the Clinic for Anaesthesiology in Ulm.” End-stage liver disease Liver failure is one of the dominant causes of death worldwide. In the eight economically leading countries of the world alone, more than 100,000 patients die from liver diseases each year. Despite numerous efforts, at present, the only reliable curative therapy is liver transplantation. However, transplantation is and will be in the future only a therapy for a minority of patients. Thus, there is an urgent need for a liver assist device to reduce the very high mortality and morbidity of liver patients. About Hepa Wash Hepa Wash GmbH, a Munich-based medical device company, is dedicated to the development and commercialization of its innovative liver assist technology that is expected to be several times more effective than currently available treatments and to create a breakthrough in the treatment of liver patients that will change current medical practice. For more information, please contact: PD Dr. Bernhard Kreymann Phone +49.89.32709586 bernhard.kreymann@hepawash.com Mobile +49.170.4944742 www.hepawash.com (Source: ESAO - Liver Support Working Group)

Gratis

UroStream — Thu, 24 Apr 2008 20:28:00 +0100

I encountered a somewhat difficult patient the other day to whom I recommended a standard of care cystocopy as part of a hematuria (blood in the urine) workup. He proceeded to question everything I was doing and my decisions for doing so. I usually encourage these questions, but I had the sense that this patient was extremely anxious and was just talking himself into an even higher state of anxiety.Finally, after all the relevant medical questions were exhausted, he asked me how much the procedure was going to cost, and I told him that "it depended but I could give him a ballpark figure". He then flew off the handle and ranted about how medicine is the only business where the key players don't know how much things are going to cost and how could such a business survive etc...I gently corrected him by saying I knew very well how much my practice charges for the procedure, but how much he was actually going to pay out of pocket (and conversely what I would get paid) for the procedure depended entirely on his individual insurance plan, his co-pay and our contract with said insurance company. I can charge whatever I think is appropriate, but that does NOT mean I'm getting paid that amount due to the third party payer system we have here. The only people immune to this are plastic surgeons or other doctors who have a strict fee-for-service business and don't have to deal with insurance at all. They can post their fees openly because they will get what they ask, just like other regular businesses.As his final trump card, he exclaimed: "well, what do you do for people who don't have insurance?", to which my immediate response was: "if it is medically necessary, then I would do it for free, and have done so many times.". My response seemed to subdue him, as if he had never thought of that possibility.Indeed he was correct about one thing: there is no business like medicine. Who else would spend countless hours working (oft in the middle of the night) with patients euphemistically referred as "self-pay" knowing full well that they will not get paid at all? Your lawyer? Your plumber? Your favorite movie actor? I dare say nay. I honestly cannot think of many examples, yet almost all of the physicians I know do pro bono work frequently; it's just another part of being a physician in the 21st century... (Source: UroStream)

Kidney dissection

Kidney Notes — Tue, 22 Apr 2008 04:00:00 +0100

Photo: William B. Gruber"This dissection of the kidneys was done after red latex was injected into the arteries and blue latex into the veins."See The Body in Depth from The New York Times. (Source: Kidney Notes)

Russian starbucks, brighton beach, brooklyn

Kidney Notes — Mon, 21 Apr 2008 04:00:00 +0100

.flickr-photo { border: solid 2px #000000; }.flickr-yourcomment { }.flickr-frame { text-align: center; padding: 3px; }.flickr-caption { font-size: 0.8em; margin-top: 0px; } Russian Starbucks, Brighton Beach, Brooklyn, originally uploaded by KidneyNotes. (Source: Kidney Notes)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Six word memoir meme

UroStream — Sat, 19 Apr 2008 22:42:00 +0100

I'm very late in the game as this meme came out a few weeks ago, but I got tagged by Seaspray, and since I've let her down so many times before, I thought I would give this one a try.The Rules are:1. Write your own six word memoir.2. Post it on your blog and include a visual illustration if you want.3. Link to the person that tagged you in your post and to the original post if possible so we can track it as it travels across the blogosphere.4. Tag at least five more blogs with links.5. Leave a comment on the tagged blogs with an invitation to play.I've been very busy these past few weeks, to the extent that I've even had to do an elective surgery this saturday (my off day since I'm not even on call!) because my regular weekday schedule has been triple booked....So I was tempted to write something pithy like:Sacrificing saturday for nephrolithiasis is worthwhileBut after some thought, I came up with:Personal and professional life? Never dull. (Source: UroStream)

Hilarious journal articles #98: in jazz, brain takes five

Kidney Notes — Thu, 17 Apr 2008 04:00:00 +0100

Image via WikipediaNeural Substrates of Spontaneous Musical Performance: An fMRI Study of Jazz Improvisation:To investigate the neural substrates that underlie spontaneous musical performance, we examined improvisation in professional jazz pianists using functional MRI. By employing two paradigms that differed widely in musical complexity, we found that improvisation (compared to production of over-learned musical sequences) was consistently characterized by a dissociated pattern of activity in the prefrontal cortex: extensive deactivation of dorsolateral prefrontal and lateral orbital regions with focal activation of the medial prefrontal (frontal polar) cortex. Such a pattern may reflect a combination of psychological processes required for spontaneous improvisation, in which internally motivated, stimulus-independent behaviors unfold in the absence of central processes that typically mediate self-monitoring and conscious volitional control of ongoing performance. Changes in prefrontal activity during improvisation were accompanied by widespread activation of neocortical sensorimotor areas (that mediate the organization and execution of musical performance) as well as deactivation of limbic structures (that regulate motivation and emotional tone). This distributed neural pattern may provide a cognitive context that enables the emergence of spontaneous creative activity.The collection of Hilarious Journal Articles is here.Related articlesBrainscans of future thought (Source: Kidney Notes)

Hilarious journal articles #96: chocolate milk better than no milk at all

Kidney Notes — Wed, 16 Apr 2008 04:00:00 +0100

Image via WikipediaFrom The Journal of the American Dietetic Association, "Drinking Flavored or Plain Milk Is Positively Associated with Nutrient Intake and Is Not Associated with Adverse Effects on Weight Status in US Children and Adolescents":Children and adolescents who included flavored milk in their diets reported higher total milk intakes than consumers of exclusively plain milk. Intakes of vitamin A, calcium, phosphorus, magnesium, potassium, and saturated fat (adjusted for energy intake and age) were generally comparable among milk drinking groups, whereas intakes by milk nondrinkers were significantly lower. Among females aged 12 to 18 years, calcium intakes by flavored and exclusively plain milk drinkers were 992+/-41.5 and 1,038+/-22.5 mg/day, respectively, whereas intake by nondrinkers was 576+/-11.7 mg/day. Intake of added sugars did not differ between flavored milk drinkers and milk nondrinkers. BMI measures of milk drinkers were comparable to or lower than measures of nondrinkers.The collection of Hilarious Journal Articles is here.Related articlesThe calorific coffees that are a meal in a cupHealthy breakfast tips to keep you fueled all dayKids Fed Lots Of Junk-Food Ads On Saturday (Source: Kidney Notes)

Drug advertising has gone viral: anti-claritin pro-zyrtec ad in nyc

Kidney Notes — Wed, 16 Apr 2008 04:00:00 +0100

"Missing: 2 hours. Last seen: while waiting for Claritin to start working. If found please call: 1-800-4-ZYRTEC." Apparently, drug advertising has gone viral. (Source: Kidney Notes)

Hilarious journal articles #95: other people slow you down

Kidney Notes — Tue, 15 Apr 2008 04:00:00 +0100

Seeing vs. believing: Is believing sufficient to activate the processes of response co-representation?:It has been suggested that the observation of another person's action affects the behavior of the observer because the observation of action leads to the excitation of similar response codes in the observer. It is unknown, however, if one must witness the action or if it is sufficient for one to believe that the other agent is responding for response co-representation to occur. To this end, participants in the present study performed a joint spatial-compatibility task with a confederate when: (1) the confederate sat beside the participant; and, (2) the confederate left the room and told the participant that they would continue to perform their component of the task on a networked computer in another room. Even though participants believed that the confederate performed the task in another room, joint spatial-compatibility was only observed when the confederate was present. These results reveal that the actions of another person may only be represented by the observer when the observer is able to witness a portion of the action. (Source: Kidney Notes)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Hilarious journal articles #94: roads not taken disappear more quickly than we realize

Kidney Notes — Mon, 14 Apr 2008 04:00:00 +0100

Image via WikipediaWhy People Misimagine the Future: The Problem of Attentional Collapse:Gilbert presents the results of four experiments, all involving predicted versus actual enjoyment of a very simple experience—eating potato chips. In three of the experiments, participants predicted how much they would like eating potato chips before, after, or instead of eating a much better food (chocolate) or a much worse food (sardines). They then ate the chips and reported how much they liked them. The results showed that the chocolate and the sardines had a large impact on participants’ predictions, but no impact whatsoever on their actual experiences. Those participants who compared the chips to sardines overestimated how much they’d enjoy eating the chips, and those who compared them to chocolate underestimated how much they’d enjoy eating the chips.The collection of hilarious journal articles is here.Related articlesCan You Predict Happiness? (Source: Kidney Notes)

Bruce sterling on the future of things

Kidney Notes — Sat, 12 Apr 2008 04:00:00 +0100

Bruce Sterling from Innovationsforum on Vimeo.Related articlesBruce Sterling on the freaky future of installation design [via Zemanta]The videos of Innovationsforum are online (finally!) [via Zemanta] (Source: Kidney Notes)

Vocabulary lesson

UroStream — Thu, 10 Apr 2008 03:49:00 +0100

Presenting some new medical verbiage in the field of urology, as introduced to me by numerous patients:Prostrate:Male gland that likes to worship face down on the ground. Frankly it makes me feel uncomfortable when I encounter it because my god complex is not that highly developed.Sphinxter:Enigmatic yet strong lion-like little muscle in control of certain nether functions. May have egyptian etymology.Urether:In-betwixt a urethra and a ureter! It transports urine directly from the kidney straight out into the toilet!Blatter:Can be used to store and hold urine, as well as carry food on special occasions.Penes:A multi-purpose instrument. Urination, reproduction, calligraphy... (Source: UroStream)

Information overload

UroStream — Fri, 04 Apr 2008 03:12:00 +0100

We are required by law to give an informed consent on any medical procedure/surgery we perform. This involves explaining in detail what the procedure is, what the risks and benefits are, and what other alternatives are available for treating the ailment. It's something we are taught to do very early on in our career, not only because it's a requirement, but it's also the correct course of action in order for the patient to make an informed decision about his/her medical care. Should you fail to do so, not only would you be deemed a bad doctor, but there are many unpleasant legal ramifications that can await you...I take care to go into great detail about each surgery I am about the perform. I really want the patient to understand exactly what is going to happen, what the expectations are after surgery, and all the potential risks attributable to the surgery.The questions is: when is it too much information?My answer is NEVER, but there are many times when I feel like I am really putting the patient off by describing too many "gory" details. For example, when I describe a ureteroscopy with a stent placement to a male patient with a stone, I have to tell him that I am going to place a long thin scope up into his penis, find his ureteral orifice, go up the ureter to find the stone and laser it, then end the procedure by leaving a long plastic tube inside that will span his entire ureter from the kidney to the bladder. Albeit all under general anesthesia, but I can usually see the patient physically wince and cross his legs... and this is even before I go into all the potential risks and complications from the procedure...But what else can I do? The patients needs to know, and I want them to know. That's part of practicing medicine in the 21st century. Gone are the paternal days of medicine when the doctor decided what was best for the patient without any questions asked. (Source: UroStream)

Tactical internet pants by merlin mann

Kidney Notes — Thu, 03 Apr 2008 04:00:00 +0100

Tactical Internet Pants from merlinmann on Vimeo. (Source: Kidney Notes)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Hilarious journal articles #93: gossip boosts cognitive functioning

Kidney Notes — Tue, 01 Apr 2008 04:00:00 +0100

Image from WikipediaVia the Personal and Social Psychology Bulletin:Social interaction is a central feature of people's life and engages a variety of cognitive resources. Thus, social interaction should facilitate general cognitive functioning. Previous studies suggest such a link, but they used special populations (e.g., elderly with cognitive impairment), measured social interaction indirectly (e.g., via marital status), and only assessed effects of extended interaction in correlational designs. Here the relation between mental functioning and direct indicators of social interaction was examined in a younger and healthier population. Study 1 using survey methodology found a positive relationship between social interaction, assessed via amount of actual social contact, and cognitive functioning in people from three age groups including younger adults. Study 2 using an experimental design found that a small amount of social interaction (10 min) can facilitate cognitive performance. The findings are discussed in the context of the benefits social relationships have for so many aspects of people's lives.The collection of Hilarious Journal Articles is here.Thanks to Joe. (Source: Kidney Notes)

New articles of note from the new england journal of medicine

Kidney Notes — Mon, 31 Mar 2008 04:00:00 +0100

Image from WikipediaTelmisartan, Ramipril, or Both in Patients at High Risk for Vascular EventsACE Inhibitors in Cardiovascular Disease — Unbeatable?Treatment of Hypertension in Patients 80 Years of Age or Older (Source: Kidney Notes)

I've changed my middle name

UroStream — Thu, 27 Mar 2008 04:30:00 +0100

I've come to realize that I have become increasingly obsessive-compulsive in my old age. I don't know exactly when this change occured, but I can assure you that I wasn't born this way. Procrastination was my middle name. Growing up, I always did my homework at the last minute, waited until the very end to send in college applications and always pulled all-nighters to finish up papers and other assignments due to poor time management. Medical school wasn't much of an improvement, and the lack of sleep and constant fatigue during residency ensured that I rarely did anything ahead of time. Utility bills were often paid late and I once had my hot water shut off because I wasn't home enough or even cared enough to dig through the mail. I could hardly call myself a very organized person.However, I've had an almost 180 degree change in character since starting my practice. Some might even call me "anal" these days and I would not dispute that description. Certain facts indubitably point to this metamorphosis:- I've already submitted my tax return for 2007.... one month ago.- I check labs and vital signs on my inpatients from home every night even though one of my partner is on call.- I pack for trips on the eve of my departure. (trust me, huge improvement!)- I try on outfits and pack for longer trips at least 3 days before departure day.- I brush my dogs teeth almost every day.- I brush my own teeth BID. OK, I've always done that, but some might consider that "anal".- The cat gets a manicure/pedicure (by me) once every two weeks. Actually, so do the dogs.- I frequently wake up before the alarm clock goes off.- I set my alarm clocks on weekends... even when I'm not on call.- I arrive to appointments on time, often even a few minutes early.- I get really annoyed when other people are late.- Online bill pay has ensured that I pay 100% of my bills 100% on time. But I still check.- I know when my next haircut will be (May 24th if you were curious)Is this enough proof? The scary thing is that I could go on...Why have I turned into a Blackberry?Perhaps it's because I have lost the "student mentality" and feel more like a responsable member of society. Perhaps it's that electric jolt I got at work from a defective toaster a few years ago. Perhaps it's the core strength finally going to my head after years of Pilate. I don't really have an answer, but in any case, I want to believe this change is for the better.PS: I'll write again in exactly 5 days 9 hours and 35 minutes. See you then... (Source: UroStream)

Questionable choice for doctor's lobby decor

Kidney Notes — Tue, 25 Mar 2008 04:00:00 +0100

.flickr-photo { border: solid 2px #000000; }.flickr-yourcomment { }.flickr-frame { text-align: center; padding: 3px; }.flickr-caption { font-size: 0.8em; margin-top: 0px; } Questionable Choice for Doctor's Lobby Decor, originally uploaded by KidneyNotes. (Source: Kidney Notes)

Please don't press that button

UroStream — Mon, 24 Mar 2008 17:07:00 +0100

PCA (Patient Controlled Analgesia) is a godsend for most patients and nurses. It's a pump attached to your IV that contains your narcotic of choice (usually morphine or dilaudid), and by pressing a button whenever you need it, you are able to get a preset amount of pain med into your system.You can order the settings in a variety of ways, from the dose of each pain med, to how often it can be administered, to a four hour maximum dose limit. This way, no matter how many times a patient pushes on the button, you only get a certain set amount, and very rarely do you see overdoses. And if you don't need any pain meds, you just don't push on the button. Simple as that.I almost always use a PCA pump for my post-operative patients. This way, they don't have to call the nurse and wait for them to come around with pain meds. My standard setting is 1mg morphine every 8 mins, with the ability to increase to 2mg q8 mins if necessary, with 20mg to 30 mg maximum 4 hour dosage. I don't like continuous delivery settings because frankly, I don't think it's safe. Naturally I adjust accordingly to the size of the patient and other medical factors.The system usually works beautifully. The patients are in charge of one aspect of their care, which is so important in a hospital environment where they usually feels as though they have relinquished all control of their lives. In addition, the immediate relief of the surgical pain can really help in the post-operative course. The whole concept of a PCA works when the patient is the one pushing the button whenever there is a need.The system goes awry when well-intentioned family members want the patient to feel as comfortable as possible, and will push the PCA button for him/her, even when the patient is asleep or not in any obvious pain. The family will keep a vigil over the patient's every single facial expression, and if there is a suspicion of an involuntary grimace, or a little moan that escapes during the nap, they will press the button. Certainly well-meaning, but probably not the wisest course of action especially when the patient goes into respiratory depression and Narcan has to be administered rapidly. (Source: UroStream)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Just call me bozo

UroStream — Mon, 17 Mar 2008 02:59:00 +0100

For those of you who don't give a hoot about women's hair issues, you can stop reading now. This post is for the 51% of the population who can commiserate with me. I had a somewhat eventful trip to my hair stylist yesterday whom I love and who usually does a top-notch job. She just returned from an 8 month hiatus and had been sorely missed. Since I was overjoyed at seeing her again, I decided to entrust fully in her artistic flair and became putty in her capable hands. She cut my hair to perfection, but when I mentioned I wanted "vibrant highlights" in my hair, she interpreted this to mean "fiery orange-red".To my dismay, as I stepped out of the salon, my hair actually glowed in the sunlight. I admit that the effect was rather striking, and would have been perfect had I worked in a creative field such as advertising, designing, or even at the circus. Alas, the medical world is rather conservative, and I didn't know how my colleagues and more importantly how my patients would react to such a innovative hair color. Perhaps things would have been a tad easier had I been a pediatrician, since kids tend to like clowns....I decided to see if my hair would magically tone itself down during the wondrous process of sleep restoration, but when I woke up this morning, the combination of orange-red with bed hair did little to calm my disquietude. Again, perfect if I were working at an art gallery expounding on the juxtaposition of the artist's angst and loneliness demonstrated by his use of color and stippling effects throughout the canvas. However, not ideal if I'm trying to instill confidence in Mrs Jones so I can operate on her kidney stones.Thankfully husband extraordinaire saved the day. He did a lot of research online about "hair coloring gone wrong" (I can attest that there is a TON of information on this subject!) and "consulted" with le couleur expert Christophe from L'Oreal (great interactive website where you can plug in your questions, and Christophe will magically come up with a decent solution). We went to our local drugstore and purchased the recommended subduing color. Husband applied the stuff while I prayed out loud and 30 minutes later, the results far surpassed my expectation! I had a great color with desirable highlights!!! (Source: UroStream)

Green urine. happy st. patrick's day!

Kidney Notes — Wed, 12 Mar 2008 04:00:00 +0100

Via The New England Journal of Medicine. Thanks to my wife, who's great at finding stuff like this. (Source: Kidney Notes)

"what would new york women do in bed with eliot spitzer for $5,500?"

Kidney Notes — Tue, 11 Mar 2008 04:00:00 +0100

It turns out, a whole lot.(From the New York Observer, and very not safe for work. But hilarious.) (Source: Kidney Notes)

Merlin mann's flocked up presentation at sxsw (worst website ever)

Kidney Notes — Tue, 11 Mar 2008 04:00:00 +0100

(Source: Kidney Notes)

Recent reviews in the field of liver support

ESAO - Liver Support Working Group — Thu, 06 Mar 2008 09:37:35 +0100

Recently several interesting reviews on liver support concepts have been published. Roger Wiliams, Institute of Hepatology, University College London Medical School, London, UK, reported on "Acute liver failure--practical management". John O'Grady, Institute of Liver Studies, King's College Hospital, London, UK, gave an overview on the management of acute or fulminant liver failure: "Modern management of acute liver failure". J.P. Vacanti and H.I. Pryor, 2nd, reviewed the significant clinical findings of ALF, as well as, the non-biologic liver support systems and the bioartificial liver devices that have been clinically tested to support patients with this disease: "The promise of artificial liver replacement". A.C. DuPont provides the critical care clinician with a comprehensive review entitled "Extracorporeal treatment of intoxications" reproting on the indications for extracorporeal elimination of toxic substances, summarizing the different techniques and the intoxications for which these techniques are suitable. H.C Fiegel reviews latest developments in "Hepatic Tissue Engineering". (Source: ESAO - Liver Support Working Group)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Bizarre interruption

UroStream — Sat, 01 Mar 2008 06:53:00 +0100

I've already discussed this topic on one of my previous posts, but I always shudder when I get a consult from the locked psychiatric ward. No matter which hospital you happen to be in, the locked ward is always the same. First of all, it's a veritable hassle to enter, as you have to call from the phone outside of the impressive-looking set of steel doors, and wait for someone from the central desk/tower to let you in. It's the same process (though perhaps more frantic) when you are trying to exit the ward as well.Inside are rather depressing bare rooms with unmade beds, while heavily-medicated lost souls slowly wander around the hallways, looking quite pitiful in their ill-fitting hospital gowns. There is a general sense of bone-deep weariness and even hopelessness. There is no pretense here. The walls are universally grey and there are no pretty flowers or get well cards by the bedsides to liven up the atmosphere. At one point during med school, I was actually very interested in psychiatry as a possible career option, but my first rotation on psych quickly relieved me of that notion.Anyway, I heard those dreaded words again this morning: "There is consult for you in the locked psych ward". My latte was starting the churn uncomfortably in my stomach. I gathered up the courage to call the psychiatrist (nice guy, as are most psychiatrists that I have met) who told me about an inpatient complaining of left testicular tenderness and swelling. I asked him what had prompted the admission to the psych ward in the first place, and he told me the patient was suffering from "severe depression manifesting itself into a psychotic episode". I guess I must have sounded perplexed as he explained that the patient was hearing voices...Upon entering the ward, I found my patient who happened to be a particulary pleasant and cooperative young man. I was able to do a full history and physical and diagnosed him with as simple case of epididymitis.The lone incident occured when he suddenly paused during our conversation and tilted his head slightly as though he was hearing something. After a few seconds, his gaze returned to me and he apologized for the interruption, but his left testis was talking to him and he had to listen.I'm proud to say that I cracked a smile only after leaving the locked ward. (Source: UroStream)

Nyc subway ads -- lung cancer

Kidney Notes — Thu, 28 Feb 2008 05:00:00 +0100

.flickr-photo { border: solid 2px #000000; }.flickr-yourcomment { }.flickr-frame { text-align: center; padding: 3px; }.flickr-caption { font-size: 0.8em; margin-top: 0px; } NYC Subway Ads -- Lung Cancer, originally uploaded by KidneyNotes. (Source: Kidney Notes)

Nephritic syndrome workup

Kidney Notes — Tue, 26 Feb 2008 05:00:00 +0100

.flickr-photo { border: solid 2px #000000; }.flickr-yourcomment { }.flickr-frame { text-align: center; padding: 3px; }.flickr-caption { font-size: 0.8em; margin-top: 0px; } Nephritic Syndrome Workup, originally uploaded by KidneyNotes. (Source: Kidney Notes)

Smug and proud of it.

UroStream — Mon, 25 Feb 2008 19:33:00 +0100

At the risk of sounding extremely smug and self-satisfied, I have to tell you that I had a very productive Saturday morning this past weekend. Alas, I happened to be on-call, and there were several patients at different hospitals that needed to be seen, in addition to new consults and procedures to be done.Nevertheless, before 11:00 AM, I was able to:-Wake up at 6:45 AM. (Come on! Remember that this was a SATURDAY... this should be considered a major achievement already!!!!)-See a trauma consult for a bladder rupture and meatal stenosis (tightness at the opening of the urethra, making insertion of a foley catheter impossible). I reviewed the CT scan, evaluated the patient, dilated his urethra (some might say 'tortured with barbaric instruments") and placed a foley. Thankfully the ICU nurse was kind enough to give the patient ample amounts of morphine and versed.-Round on the patients at that hospital and write semi-legible notes and orders.-"Speak" to a Russian-only speaking inpatient. Through a combination of slow english, bad russian (from my residency days), miming, facial and body contortions, I was able to make myself understood. I discharged her from the hospital and arranged for follow-up with my partner. (at last, those acting classes taken during high school extracurricular activities are finally paying off!!!!)-Crush and stamp out a painful kidney stone via a ureteroscopy with holmium laser lithotripsy in the OR.-Eat a banana and drink a latte in under 2 minutes flat while driving over to a second hospital.-See a fresh post-op patient in the ICU of above mentioned hospital.-Rush over to a third hospital whilst avoiding any speeding tickets to see a couple more patients. Wrote illegible chicken scratch notes. Spoke to many nurses. Resisted the temptation to nibble at the most enticing chocolate-frosted donut in the staff lounge. (Probably the proudest achievement of my day)-Stop by my favorite frozen yogurt place for THE most amazing honey frozen yogurt. Tart, just slightly sweet with a hint of honey, and fat-free!!! This is a weekly saturday pit stop, whether I'm on call or not.-Returned home to kiss my dogs, cat and hubby. (in that order!) (Source: UroStream)

Jonathan coulton, merlin mann, leo laporte, and veronica belmont perform "still alive"

Kidney Notes — Mon, 25 Feb 2008 05:00:00 +0100

More thoughts on "Still Alive" and Portal here. (Source: Kidney Notes)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Arbios receives conditional approval from the fda to initiate pivotal clinical trial for sepet™

ESAO - Liver Support Working Group — Sat, 23 Feb 2008 09:10:00 +0100

Arbios Systems, Inc., announced that the Company has received conditional approval from the U.S. Food and Drug Administration (FDA) of an Investigational Device Exemption to begin the pivotal clinical trial for SEPET™, Arbios’ extracorporeal artificial liver assist device for blood purification of chronically ill patients suffering from acute liver failure. Permission was granted to initiate the trial while the Company responds to the FDA’s conditions and request for additional information. In particular, FDA has requested a survival primary endpoint, which could potentially increase the total number of patients required for the trial. The trial design proposed by the Company has a primary endpoint of a two-stage drop in hepatic encephalopathy and its secondary endpoints include several survival based endpoints. More information here. (Source: ESAO - Liver Support Working Group)

Lunar eclipse

UroStream — Thu, 21 Feb 2008 18:34:00 +0100

Was anyone else able to catch a view of the lunar eclipse last night? It was quite amazing! I was worried that clouds would obscure our view, but it was an unusually clear night, and the event was wonderous.We have a telescope that I bought as one of my better christmas present for hubby several moons ago, that is now mainly used as a decorative accent to our living space. I always feel like Jimmy Stewart from "Rear Window" when I look through it, but this was the perfect opportunity to use it as it was originally intented. The shadow of the earth eclipsing the moon is a sight to behold! (Source: UroStream)

Girll's best friends

UroStream — Wed, 20 Feb 2008 19:42:00 +0100

No, not diamonds, but high heels!!!I just read this little article on high heels from BBC online which suggests that "high heels may improve sex life".An Italian urologist and self-professed lover of the sexy shoe set out to prove that high heels are not as bad for women's health as some suggest. Although high heels can cause a host of problems, Dr Maria Cerruto asserts in her letter to European Urology (an academic journal) that they improve pelvic muscles (Kegels anyone?), which can assist in sexual performance and satisfaction, and provide support to the pelvic organs, including the bladder.I'm inferring from the article that if high heels tighten pelvic muscles, they can help with urinary incontinence. Who'd have thought that those Manolo Blahnik heels would actually become a useful urological device? I could write prescriptions for Jimmy Choos! I could finally combine my unnatural love of shoes (or so my husband says... I don't think it's so strange) with my work!My dreams would come true if I could submit my Nordstrom shoes receipts as a bona fide tax-deductible medical expense!!! Never mind the footaches, the constant risks of ankle injuries and the slight deformity on my little right toe (who needs little baby toes anyway?), I am a fan of high heels. Being burdened with the genetics of average height, and having a hubby over 6ft tall, I like to boost my standing with the magic of heels. I love all shoes, but hold a special fondness for heels. I usually wear comfortable low-heeled clogs in the OR, but I have been known to do some of my shorter cases in heels...And you can guess what I wore to work today... (Source: UroStream)

Green iphone camera problem

Kidney Notes — Mon, 18 Feb 2008 05:00:00 +0100

(Source: Kidney Notes)

Hilarious journal articles #91: parkinson's disease patients benefit from tango

Kidney Notes — Mon, 18 Feb 2008 05:00:00 +0100

Via the Journal of Neurologic Physical Therapy:Effects of Tango on Functional Mobility in Parkinson's Disease: A Preliminary Study.Recent research has shown that dance, specifically tango, may be an appropriate and effective strategy for ameliorating functional mobility deficits in people who are frail and elderly. Individuals with Parkinson's disease (PD) experience declines in functional mobility that may be even more pronounced than those experienced by frail elderly individuals without PD. The purpose of this study was to compare the effects of two movement programs: tango classes or exercise classes. Nineteen subjects with PD were randomly assigned to a tango group or a group exercise class representative of the current classes offered in our geographical area for individuals with PD. Subjects completed a total of 20 tango or exercise classes and were evaluated the week before and the week following the intervention. Both groups showed significant improvements in overall Unified Parkinson's Disease Rating Scale (UPDRS) score and nonsignificant improvements in self-reported Freezing of Gait. In addition, the tango group showed significant improvements on the Berg Balance Scale. The exercise group did not improve on this measure. Finally, the tango group showed a trend toward improvement on the Timed Up and Go test that was not observed in the exercise group. Future studies with a larger sample are needed to confirm and extend our observation that tango may be an effective intervention to target functional mobility deficits in individuals with PD.The collection of hilarious journal articles is here. (Source: Kidney Notes)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

"street" diagnosis

UroStream — Sun, 17 Feb 2008 02:54:00 +0100

I was walking around my little part of town this Saturday with Hubby, doing a little shopping--embracing the clinical benefits of retail therapy, not to mention fulfilling my patriotic duty to help out ailing retailers in these dog-days of looming recession.I was feeling just a tad sorry for myself since the last three pairs of jeans I tried on were far from flattering, emphasizing the less desirable aspects of my physique. Try as I might to shift the blame on the jeans themselves, still, I could not help being just a little sulky. Hubby attempted to convince me that my thighs were not hideously obese and lard laden, but I could not be persuaded...We then simultaneously noticed another pedestrian walking towards us, with the biggest bulge EVER in the crotch area of his jeans. Incredulously, hubby looked at me and mouthed the question: "is that an erection?", to which I immediately replied: "no silly, that's just a huge hydrocele!"For those in the dark, a hydrocele is a fluid collection around the testes that accumulates in the scrotum. They can range in size, from minimal and asymptomatic to gigantic. They are benign, but as you can well imagine, they get uncomfortable once they grow past a certain size, and can cause difficulties with routine activities such as fitting into your pants. They can only be repaired with a simple outpatient surgery called -suprisingly- a hydrocelectomy.Well this guy's hydrocele was gargantuan!!! Probably the size of a medium honeydew melon. Though I may be occasionally prone to hyperbole, this is NOT one of those times. He could hardly walk, and that big bulge in his pants could only be politely described as "obscene".As a physician, I make "street diagnosis" all the time. They are mostly dermatological in nature since that is what is most readily apparent: acne vulgaris, vitiligo, rosacea, rheumatoid arthritis, hemangioma, acute ETOH intoxication etc... but this must be the first time that I've made the "street diagnosis" of a hydrocele! (Source: UroStream)

Project runway

UroStream — Fri, 15 Feb 2008 03:01:00 +0100

Why hasn't anyone told me about this show before??????I just discovered it last night because hubby was working late, and I was listessly flipping through channels, looking for anything of interest. I suddenly happened upon Heidi Klum looking annoyingly perky and blonde amidst a group of anguished would-be designers, and the remote control locked itself in place.There is so much drama, cruelty, back-stabbing and tears!!! I was immediatly hooked.I admit that I don't usually watch the "popular" TV shows. I've never seen "Grey's Anatomy", don't know that the big deal is about "Lost" and couldn't tell you what "Desperate Housewives" is about (though I have a pretty good idea from the title...) The resolved writer's strike really did not affect my viewing options at all.But I have to admit that I will most likely continue to follow this reality show. It's addictive and absolutely fabulous!!! (Source: UroStream)

Currently reading: shaping things by bruce sterling

Kidney Notes — Thu, 14 Feb 2008 05:00:00 +0100

(Source: Kidney Notes)

To mitigate pains in the kidneys (from 1696)

Kidney Notes — Wed, 06 Feb 2008 05:00:00 +0100

Via Google Book Search. (Source: Kidney Notes)

Heath ledger's drug interactions

Kidney Notes — Wed, 06 Feb 2008 05:00:00 +0100

According to the Chief Medical Examiner of New York, Heath Ledger "died as the result of acute intoxication by the combined effects of oxycodone (Percocet), hydrocodone (Vicodin), diazepam (Valium), temazepam (Restoril), alprazolam (Xanax), and doxylamine (Unisom)."To illustrate why he died, the following is a list of potential drug interactions from Epocrates, an online drug database. Nearly everything interacted with everything else:1. diazepam oxycodonecaution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)2. diazepam temazepamcaution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)3. diazepam Vicodincaution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)4. diazepam Xanaxcaution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)5. oxycodone temazepamcaution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)6. oxycodone Vicodincaution advised, consider dose reduction: combo may incr. risk of CNS and resp. depression, profound sedation, hypotension, other adverse effects (additive effects)7. oxycodone Xanaxcaution advised, especially w/ IV benzodiazepines and IV opioids, consider dose reduction: combo may result in vasodilation, severe hypotension, CNS and respiratory depression, psychomotor impairment (additive effects)8. temazepam Vicodincaution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects)9. temazepam Xanaxcaution advised: combo may incr. risk of CNS depression, adverse effects (additive effects)10. Vicodin Xanaxcaution advised: combo may incr. risk of CNS depression, psychomotor impairment (additive effects) (Source: Kidney Notes)

MedWorm Sponsored Message: Find out how you can get your message across here by sponsoring this MedWorm news feed.

Mr. grumpy

UroStream — Wed, 06 Feb 2008 03:17:00 +0100

I've known Mr Grumpy for a little while now, and he didn't come by this nickname because I love Snow White. (well, I actually do love classic Disney animated movies, but that's beside the point). Mr Grumpy always comes to my office full of piss and vinegar, generally annoyed at the whole world. The 30 minutes office visits consist of a litany of grumbles about everything, even when I try to direct the conversation to pleasant topics like kittens and pink cotton candy. Perhaps he is allergic to cats, but then again, he would have to be allergic to the whole world to excuse his mindset.Mr. Grumpy has cancer, and I have to operate on him. The thought fills me with some trepidation because I can predict with great certainty that his mood will not improve with the presence of a large surgical incision.I meet Mr. Grumpy's family. I'm pleasantly surprised when I find them all rather nice. Naturally they are all concerned about the cancer and the visit is very serious, but I find them all to be naturally optimistic people. (how did this happen?) They all shake their heads good-naturedly when they listen to Mr. Grumpy's constant gripes. They understand that the post-operative course will not be easy for anyone, and my thoughts are mostly with Mrs. Grumpy (who is not grumpy herself) since she will have the bear the brunt of the recovery process.So I perform the surgery, and everything goes quite well. However, as anticipated, Mr. Grumpy does not suddenly develop a sunny disposition on the ward. He goes through several different nurses throughout the day and my daily rounds consist mostly of listening to his *long* list of complaints. Certainly I can appreciate that some of them have merits, such as the "quality" of the hospital food, but when he starts ranting about the nurses, some of whom are amongst the best surgical nurses I've met, my patience wears thin.I'm hoping for him to crack a smile, or at least stop complaining for one short minute when I tell him that the pathology has returned and the cancer is completely gone. He is cured! He grants me a few seconds of reprieve before he tells me how bad the coffee tastes. I, like his family, can only shake my head.As the leopard cannot changes its spots, Mr. Grumpy cannot change his demeanor. (Source: UroStream)

Frozen grand central (from improv everywhere)

Kidney Notes — Tue, 05 Feb 2008 05:00:00 +0100

(Source: Kidney Notes)

Why you must read intueri

Kidney Notes — Tue, 05 Feb 2008 05:00:00 +0100

Maria writes:Hospital staff can easily tell when the medical center has hired new telephone/paging operators: They sound absolutely terrified when they announce codes.To their credit, they try to speak calmly and clearly, but their voices invariably betray their fears:“Code one-nine-nine, second floor, south wing, room twenty… code one-nine-nine, SECOND floor, SOUTH wing, room TWENTY… CODE ONE-NINE-NINE SECOND FLOOR SOUTH WING ROOM TWENTY—”oh my GOD someone just told me that someone is dying will you PLEASE hurry up and DO SOMETHING (Source: Kidney Notes)

Pedialyte pops

Kidney Notes — Mon, 04 Feb 2008 05:00:00 +0100

Note: If you're sick, frozen pedialyte pops aren't half bad. (Source: Kidney Notes)