MedWorm: Urologists and Nephrologists

Info-Snack

Kidney Notes — Sun, 09 Oct 2011 04:00:00 +0100

Visit Info-Snack, my new blog, to read these new posts and more. (Source: Kidney Notes)

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Mobile Post

Kidney Notes — Wed, 20 Oct 2010 23:00:00 +0100

Bingo: Gmail now automatically filters and forwards fascinating but lengthy mailing list discussions to @Instapaper. (Source: Kidney Notes)

Test.

Kidney Notes — Sat, 21 Aug 2010 23:00:00 +0100

Please ignore. (Source: Kidney Notes)

Early Dialysis

Kidney Notes — Thu, 12 Aug 2010 23:00:00 +0100

In this study, A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis, by Cooper et al., adults with progressive chronic kidney disease and an estimated glomerular filtration rate between 10 and 15 ml per minute per 1.73 m2 (stage V chronic kidney disease) were randomly assigned to early or late initiation of dialysis. Early initiation of dialysis was not associated with an improvement in survival or clinical outcomes. (Via the NEJM.) (Source: Kidney Notes)

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Kidney Notes — Thu, 03 Jun 2010 23:00:00 +0100

A patient saw the "Salt Must Die" billboards and slashed their intake, assuming it was a public health campaign. (Source: Kidney Notes)

Pseudohypercreatininemia

Kidney Notes — Tue, 01 Jun 2010 23:00:00 +0100

Via the Renal Fellow Network:In the Jaffe reaction, creatinine reacts with picric acid to form a colored complex. This forms the basis for the commonest methods for measuring serum creatinine. However, this test has well known limitations. Under normal circumstances, the Jaffe reaction overestimates the serum creatinine concentration by 10-20% because of the presence of endogenous chromogens. These chromogens include acetone and acetoacetate which, in the case of diabetic ketoacidosis, can lead to a significant overestimation of the serum creatinine. Similarly, certain drugs, including cephalosporins, flucytosine and barbiturates, can interfere with the assay. (Source: Kidney Notes)

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Kidney Notes — Sun, 30 May 2010 23:00:00 +0100

Have we reached the point where detonating an underground nuke to contain the spill is now the best option? (Source: Kidney Notes)

XXXVII ESAO Congress in Skopje, R. Macedonia, on September 8-11, 2010

ESAO - Liver Support Working Group — Wed, 31 Mar 2010 15:07:00 +0100

The XXXVII ESAO Congress will take place in Skopje at the Macedonian Academy of Sciences and Arts on September 8-11, 2010. Skopje is the capital of Macedonia and the centre of the political, cultural and social life. It is a modern, urban city with a history dating more than 2000 years back. Skopje, once called Skupi, over the history was conquered and ruined several times, but always rebuilt again. It has suffered several natural catastrophes, the last being the earthquake in 1963. Some of the monuments from long ago have still remained: the remainings from the old city, the roman architecture, the fortress, the stone bridge, many churches and monasteries, frescoes and carvings from the middle ages, mosques and amams built by the ottomans in the old bazaar. Old Skopje with its v...

New Blog: Healthy Info-Snacks

Kidney Notes — Sat, 27 Mar 2010 00:00:00 +0100

Hungry for new content? Visit Healthy Info-Snacks. See you there. (Source: Kidney Notes)

New Blog: Info-Snacks

Kidney Notes — Sat, 27 Mar 2010 00:00:00 +0100

Hungry for new content? Visit Info-Snacks. See you there. (Source: Kidney Notes)

New Blog: Info-Stream

Kidney Notes — Sat, 27 Mar 2010 00:00:00 +0100

Hungry for new content? Visit Info-Stream. See you there. (Source: Kidney Notes)

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Kidney Notes — Fri, 26 Mar 2010 00:00:00 +0100

Bant: "A Free Diabetes App for the ePatient" http://ping.fm/yl8T4 (Source: Kidney Notes)

XXIII International Congress of The Transplantation Society

ESAO - Liver Support Working Group — Tue, 02 Mar 2010 16:06:00 +0100

The XXIII International Congress of The Transplantation Society, the leading international congress on transplantation biology and medicine, will be held in Vancouver, Canada from 15 - 19 August 2010. The translational program will draw together experts from around the world, and will encompass innovations in genomics and proteomics, molecular analyses of human diseases, innovations in biological and pharmacological immunosuppression, novel approaches to tolerance induction, technical advances in robotic surgery and imaging, advances in clinical practice and many other topics at the cutting edge of stem-cell, cellular and solid organ transplantation.The XXIII Congress will be one of the largest and most exciting international gatherings of clinicians and scientists in the field ...

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Kidney Notes — Wed, 17 Feb 2010 00:00:00 +0100

Follow @kidneynotes on Twitter for interesting medical links (not just kidney-related) posted automatically. (Source: Kidney Notes)

"Uric Acid, Fructose and Hypertension" by Joel Topf

Kidney Notes — Sat, 30 Jan 2010 00:00:00 +0100

Uric Acid, Fructose and HypertensionView more presentations from Joel Topf. (Source: Kidney Notes)

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Kidney Notes — Mon, 25 Jan 2010 00:00:00 +0100

Nephrologists Using Social Media (from Nephrology Times). http://ping.fm/lWBEJ (Source: Kidney Notes)

"Universal Health Care", a Tee-Shirt by Warren Ellis

Kidney Notes — Mon, 23 Nov 2009 00:00:00 +0100

(Via Warren Ellis, who is British. And not entirely sane.) (Source: Kidney Notes)

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Kidney Notes — Sat, 21 Nov 2009 00:00:00 +0100

"An antimicrobial tie with a graphic design based on the H1N1 virus." http://ping.fm/sTbMN (Source: Kidney Notes)

Analgesic Nephropathy (via The Renal Fellow Network)

Kidney Notes — Sat, 21 Nov 2009 00:00:00 +0100

"Anyway, after some probing, he admitted to taking a drug called Vanquish regularly (i.e. daily for over 20 years). I had to look it up, but it turns out to be a compound analgesic (acetaminophen, aspirin and caffeine). I was surprised, as I thought these compounds were off the market, as they are in Europe. So beware, analgesic nephropathy is alive and well in 2009!" — The Renal Fellow Network (Source: Kidney Notes)

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Kidney Notes — Thu, 19 Nov 2009 00:00:00 +0100

"Google just released a new research study on how physicians use the Internet. http://tr.im/FfNp ” -@skypen (Source: Kidney Notes)

Halloween at the White House

Kidney Notes — Sat, 07 Nov 2009 00:00:00 +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; } P103109PS-0527, originally uploaded by The White House. (Source: Kidney Notes)

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Kidney Notes — Sat, 07 Nov 2009 00:00:00 +0100

Today's xkcd (my favorite webcomic): "Organ Donor." http://xkcd.com/659/ (Source: Kidney Notes)

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The Uroplakins (Via the Renal Fellow Network)

Kidney Notes — Wed, 04 Nov 2009 00:00:00 +0100

The uroplakins form tiny, hexagonal arrays of particles--visualized best by electron microscopy (see figure taken from this excellent recent KI review by Wu et al)--which comprise structures called "urothelial plaques" that overlie the plasma membrane of superficial umbrella cells of the urothelium...Read more here. (Source: Kidney Notes)

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Kidney Notes — Wed, 04 Nov 2009 00:00:00 +0100

Amazon Best Books of 2009: http://ping.fm/soOWG (Source: Kidney Notes)

Fall

Kidney Notes — Wed, 04 Nov 2009 00:00:00 +0100

Credit: Baard Overgaard Hansen http://www.pixum.comhttp://bestc.am/LUN5 (Source: Kidney Notes)

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Kidney Notes — Fri, 30 Oct 2009 00:00:00 +0100

Bodybuilding with steroids damages kidneys. http://ping.fm/cgLJs (One of the more unusual & controversial papers I've co-authored.) (Source: Kidney Notes)

Atypical Hemolytic-Uremic Syndrome in the New England Journal of Medicine

Kidney Notes — Tue, 27 Oct 2009 00:00:00 +0100

Image by roboonya via FlickrEvery physician has diseases they see improbably often. For me, one of these conditions is hemolytic-uremic syndrome. Since writing one of my first papers on HUS as a resident — "De novo thrombotic microangiopathy in renal transplant recipients" — I've seen way more of it than you'd expect.For kidney fans, this review article on atypical hemolytic-uremic syndrome in this month's New England Journal of Medicine (subscription required) is a must read. It details recent advances in the genetics of atypical hemolytic-uremic syndrome. What was previously a confusing mess of similar-appearing diseases — hemolytic-uremic syndrome, atypical hemolytic-uremic syndrome, drug-induced hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura — may finally be...

Flu Virus Animation

Kidney Notes — Sun, 25 Oct 2009 00:00:00 +0100

Via NPR. (Source: Kidney Notes)

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Kidney Notes — Tue, 20 Oct 2009 23:00:00 +0100

Dr. Brad Berk, University of Rochester Medical Center CEO, discusses his spinal cord injury on YouTube: http://ping.fm/x7hp2 (Source: Kidney Notes)

List of Kidney Diseases Updated

Kidney Notes — Sun, 11 Oct 2009 23:00:00 +0100

Image via WikipediaI've updated the list of kidney diseases for patients. Please let me know if I missed anything. (Source: Kidney Notes)

"Regulation Works."

Kidney Notes — Sat, 10 Oct 2009 23:00:00 +0100

"Regulation works." (via @jayparkinson) (Source: Kidney Notes)

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Kidney Notes — Fri, 09 Oct 2009 23:00:00 +0100

8 Ways Physicians Can Use Evernote. http://ping.fm/zNjGj (Source: Kidney Notes)

Swine Flu on Twitter (by xkcd.com)

Kidney Notes — Fri, 02 Oct 2009 23:00:00 +0100

(original here) (Source: Kidney Notes)

Surgery (by xkcd.com)

Kidney Notes — Fri, 02 Oct 2009 23:00:00 +0100

(original here) (Source: Kidney Notes)

List of Kidney Diseases

Kidney Notes — Fri, 02 Oct 2009 23:00:00 +0100

Image by Getty Images via DaylifeDid I miss anything on this list of kidney diseases? (I intentionally left out a few rare disorders.)If you know of other links to patient information I might include, please post a comment. Thanks. (Source: Kidney Notes)

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World Conference on Regenerative Medicine 2009 in Leipzig, Germany

ESAO - Liver Support Working Group — Fri, 02 Oct 2009 15:05:00 +0100

The World Conference on Regenerative Medicine (WRM) will be held from October 29th to October 31st, 2009 in Leipzig. The Fraunhofer Institute for Cell Therapy and Immunology is once again organizer and host of this scientific event and the Translational Center for Regenerative Medicine (TRM) Leipzig has become co-organiser of the event. Main topics will be stem cells, tissue engineering, technology development, immunology, signaling, and regulatory affairs. The final program is now available - more information via www.wcrm-leipzig.com (Source: ESAO - Liver Support Working Group)

Sarah Illenberger: knit wool organs

ESAO - Liver Support Working Group — Wed, 23 Sep 2009 15:04:00 +0100

In her Berlin studio, Sarah Illenberger created wonderful delicate knit wool organs. Unfortunately al liver is still pending:Wool organs by visual artist Sarah Illenberger. Photographed by Andreas Achmann for Süddeutsche Zeitung Magazin. (Source: ESAO - Liver Support Working Group)

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Kidney Notes — Fri, 18 Sep 2009 23:00:00 +0100

"Is an efficient physician necessarily a good doctor?" http://ping.fm/0c9HQ (Source: Kidney Notes)

High Potassium and Kidney Failure Due to Matchstick Ingestion

Kidney Notes — Thu, 17 Sep 2009 23:00:00 +0100

The Renal Fellow Network Blog is essential reading, part 426...Matchstick heads are comprised of over 50% potassium chlorate (KClO3); it is an oxidizing agent which makes matches flammable and can also be found in many explosives and fireworks. Unfortunately, it also happens to be nephrotoxic. In this interesting case report by Mutlu et al, the authors describe a 21-year-old man who attempted to commit suicide by ingesting 120 matchsticks... (Source: Kidney Notes)

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Kidney Notes — Fri, 11 Sep 2009 23:00:00 +0100

Hilarious Journal Articles and NCBI ROFL. http://ping.fm/G9fTn (Source: Kidney Notes)

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One Day on the Liver 2009

ESAO - Liver Support Working Group — Thu, 27 Aug 2009 15:03:00 +0100

The traditional One Day on the Liver will be part of the XXXVI Annual Meeting of the European Society for Artificial Organs ESAO 2009 at the Université de Technologie de Compiègne in France. ODOL 2009 will take place September, 3rd focussing on "Cells, Hybrids, and Machines".The following keynote lectures will be given:Clinical Results of Liver Cell Therapy in Children with Urea Cycle Defect by Dr. Dr. W. Rüdinger, Weinheim, Germany,Xenotransplantation. Where are we in 2009 ? by Dr. A. Billiau, Leuven, Belgium,Problems and Opportunities: Perspectives of Bioartificial Liver Support by Dr. R. Hoekstra, Amsterdam, Netherlands,New perspectives of artificial liver support by Prof. Dr. D. Falkenhagen, Krems, Austria. We expect to present you al...

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Kidney Notes — Sat, 22 Aug 2009 23:00:00 +0100

Robin Williams talks about his aortic valve replacement: http://ping.fm/H9OHR (Thanks, to Dr. Wes at http://ping.fm/41AQU) (Source: Kidney Notes)

Differential Diagnosis of Urine Color and Odor

Kidney Notes — Mon, 10 Aug 2009 23:00:00 +0100

Via the Primer on Kidney Diseases. (Love that text.) (Source: Kidney Notes)

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Kidney Notes — Sat, 01 Aug 2009 23:00:00 +0100

Ben Franklin in the NYT Pursuit of Happiness Blog (http://ping.fm/pUvLu) (Source: Kidney Notes)

Updated iPhone Home Screen

Kidney Notes — Sat, 18 Jul 2009 23:00:00 +0100

(Source: Kidney Notes)

Show Me Something New (from "Reaching the Animal Mind")

Kidney Notes — Sat, 18 Jul 2009 23:00:00 +0100

(Source: Kidney Notes)

Manhattanhenge 2009

Kidney Notes — Sat, 11 Jul 2009 23:00:00 +0100

(Source: Kidney Notes)

ESAO 2009 - Program online

ESAO - Liver Support Working Group — Fri, 03 Jul 2009 15:02:00 +0100

The XXXVI Annual Meeting of the European Society for Artificial Organs ESAO 2009 will take place at the Université de Technologie de Compiègne in Compiègne/France, September 3-5, 2009. The program of the ESAO 2009 meeting is now available here . (Source: ESAO - Liver Support Working Group)

Brain with Atherosclerosis

Kidney Notes — Wed, 01 Jul 2009 23:00:00 +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; } NCP 1277, originally uploaded by otisarchives1. (Source: Kidney Notes)

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A Mindmap Containing All Major Topics in Biology, Chemistry, and Physics.

Kidney Notes — Wed, 01 Jul 2009 23:00:00 +0100

Structure of the Kidney. (Source: Kidney Notes)

Why Doesn't This Catheter Work?

Kidney Notes — Fri, 19 Jun 2009 23:00:00 +0100

Have I mentioned recently that you must read Nathan Hellman's Renal Fellow's Blog? (Source: Kidney Notes)

Steve Jobs' Liver Transplant

Kidney Notes — Fri, 19 Jun 2009 23:00:00 +0100

Image via CrunchBaseVia Daring Fireball:Yukari Iwatani and Joann S. Lublin, reporting for The Wall Street Journal: Steve Jobs, who has been on medical leave from Apple Inc. since January to treat an undisclosed medical condition, received a liver transplant in Tennessee about two months ago. The chief executive has been recovering well and is expected to return to work on schedule later this month, though he may work part-time initially. This must be a deliberate, timed leak from Apple. The timing is simply perfect from Apple’s perspective — midnight on the Friday of what appears to be the most successful new product launch in company history. (Source: Kidney Notes)

Marlo Isis Armstrong

Kidney Notes — Thu, 18 Jun 2009 23:00:00 +0100

in the middle of the nightOriginally uploaded by dooce (Source: Kidney Notes)

Manhattanhenge 2009

Kidney Notes — Sun, 31 May 2009 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; } manhattanhenge 2009, originally uploaded by mudpig.© 2009 Steve Kelley, posted using Flickr's "Blog This" feature. Please see the original on Flickr. (Source: Kidney Notes)

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Dude Fest!

UroStream — Tue, 28 Apr 2009 03:24:00 +0100

I'm attending a complete dude fest, also known as the annual American Urological Association (AUA) meeting. It's held in the illustrious city of Chicago this year, and it's been quite fun and informative so far. Though it has "american" as part of its acronym, the AUA is actually quite an international event with tons of international urologists in attendance. I'm constantly hearing Spanish, Portuguese, Arabic, French, Korean, Japanese, German and many other languages in the meeting halls. It's quite impressive and makes for a nice multi-cultural event.However, I'm never more amazed at the paucity of women in urology than when I attend a meeting like this. There are literally thousands of urologists buzzing around at the convention center, most in a conservative (and dare I say unfashionab...

Clowns vs. Cops. In a Hospital.

Kidney Notes — Thu, 23 Apr 2009 04:00:00 +0100

There are no words. (Source: Kidney Notes)

Show and tell

UroStream — Thu, 16 Apr 2009 01:39:00 +0100

Doctors love it (NOT) when patients come into the office carrying jars or other homemade specimen containers holding all manners of bodily fluids.I am sure that the average PCP or ENT doc has seen their share of "funny-looking" or -insert favorite color- sputum that the patient carefully brought with them to the office, after they had been saving the used Kleenex for a day or so....or perhaps the occasional stool specimen.You can see where this is going, since I am a urologist....I actually encourage patients to bring me the kidney stones they have passed. We can get those analyzed, and the information is quite useful in terms of preventing new stones. I've also had patients bring me samples for semen analysis, and it never fails, but these patients always seem to bring the specimen in a b...

New favorite website of the day

UroStream — Tue, 07 Apr 2009 04:36:00 +0100

This is why you're fat.It's like watching a car accident in slo-mo – I just can't take my eyes off of it. It makes my stomach churn, but I can't figure out whether it's in a good or a bad way. (Source: UroStream)

Picture perfect

UroStream — Thu, 02 Apr 2009 18:04:00 +0100

Imagine this scenario:Two hard-of-hearing patients both in a crowded clinic waiting room.... (sounds like the start of a good joke, doesn't it?) The nurse opens the door and calls out a name: "Mr. Will Shakespeare!!!" An elderly patient stands up and walks into the exam room. The nurse proceeds to take vital signs and obtains a urine sample and other pertinent information before informing the doctor that the patient is ready to be seen.The doctor walks into the room and says: "Hi Mr. Shakespeare, how are you doing today?" to which the patient promptly replies: "Huh??? My name's not Shakespeare, it's Andre Gide!"Yes, indeed, the wrong patient got up from the waiting room after mishearing the name (though the two names did NOT sound alike in the very least), and no-one figured this out until...

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Happy National Doctor's Day!

UroStream — Tue, 31 Mar 2009 02:26:00 +0100

I know this was the main thought of your day today, with March 30th being national doctor's day. And there was great celebration and rejoicing!!! ...huh, not really. Despite the fact that this has been an annual event for the past several years, I'm only really aware of it when I start getting letters from my hospitals telling me how much they appreciate me.So I did a little internet research regarding this so-called holiday. Apparently this got started on March 30, 1933, a date which marks the anniversary of the first use of general anesthesia in surgery. However, the first national doctor's day was not officially celebrated until 1991.Anyway, the perks for me include cafeteria coupons from two hospitals for $2.50 and $5.00, and another hospital actually offering a free lunch today (!...

Redemption

UroStream — Sat, 28 Mar 2009 00:19:00 +0100

Despite the nature of my job, and despite what some of my readers may think, I don't actually enjoy causing pain and suffering. In fact, I'm barely able to watch a gory horror movie though I know intellectually that special effects and acting (some of it bad) are creating the images.I'm acutely aware that some surgeries/procedures hurt more than others, whether the pain be purely physical, or with a significant psychological aspect. I think orchiectomies (removal of testes) definitely fall into this category.Even though an orchiectomy is technically a very simple procedure, most patients (especially the male patients) tend to cringe more at the very thought of it, as opposed to something like a nephrectomy (removal of a kidney), even though the latter is a much bigger and complex operation...

Out of Jail!!!

UroStream — Thu, 12 Mar 2009 04:02:00 +0100

I would like to say that I was pitifully huddled on a pallet in a Singapore jail, awaiting my sentencing for smuggling illegal chewing gum, but the truth is much more simple: I have just been busy and preoccupied. Thanks for all the caring and concerned messages you have left on my last post. It's really nice to feel loved...I am very much alive and doing quite well.The last time I wrote was before my trip to Southeast Asia, which now seems such a long time ago. How did we get to be in March already? AND it's the year 2009???? Yikes... Time really seems to fly by when you are busy. And please, don't think that I am complaining about being busy. Au contraire, I say a daily prayer of thanks for having a steady job that allows me to pay my bills... And more importantly, brings out the creativ...

Bizarre Devices from Medicine's Dark Past

Kidney Notes — Wed, 04 Mar 2009 05:00:00 +0100

From the New Scientist Web site. Not entirely safe for work. (Via Warren Ellis.) (Source: Kidney Notes)

Nephrology Calculators for the iPhone

Kidney Notes — Wed, 04 Mar 2009 05:00:00 +0100

My colleague Joel Topf over at Precious Bodily Fluids reviews three nephrology calculators for the iPhone. He likes Neph CalcMedCalc the best. (Source: Kidney Notes)

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ESAO - Liver Support Working Group — Fri, 27 Feb 2009 16:00:00 +0100

On behalf of the European Society for Artificial Organs (ESAO), it is our great pleasure and honour to welcome you to the XXXVI ESAO Congress, which will take place at the University of Technology (UTC) in Compiègne, France. The University of Technology of Compiègne (UTC) has a special position among the French Universities. Founded in 1973, one of its duties was to link student training, research and industry. More specifically, UTC pioneered the field of biomedical engineering in France, hosting specialists in solid and fluid biomechanics, biomaterials, artificial organs, physiology, medical signals and images, and further areas. The occasion of the present Congress will allow a unique analysis of the “Past and future roles of artificial organs in engineering for health". We wil...

"13 Things I Hate about Nephrology" (by Nephrogirl)

Kidney Notes — Sat, 07 Feb 2009 05:00:00 +0100

Image via WikipediaIn a recent post, "nephrogirl" — who is either a nephrology fellow or younger nephrologist — listed the "13 things [she hates] about nephrology." I appreciate that she took the time to vent her unhappiness. And while her experiences with nephrology aren't mine — which might have to do with differences in our patient populations and many other factors — I understand her perspective. Here's the list, along with my comments.1) The incessant checking of labs, powerlessly watching the kidney function slowly deteriorate. [I'd say the ratio of patients for whom I make a significant difference to patients that I feel powerless to help is well over 50:1.]2) Sending patients for the critical intervention which you feel is going to make the difference, only to see them suff...

Electronic Stethoscope Oddities

Kidney Notes — Thu, 01 Jan 2009 05:00:00 +0100

Happy New Year!If acoustic stethoscopes — the kind physicians have used for over two hundred years — are the equivalent of typewriters, then electronic stethoscopes are like word processors. Okay, this analogy is non-intuitive, but hear me out. Electronic stethoscopes, like word processors, are newer, more expensive than the previous generation, and are — well — electronic, with all the advantages and disadvantages this implies.The advantages to electronic stethoscopes are many. As I've written previously in my review of the Littman Electronic Stethoscope Model 3000, it's simply easier to hear heart and lung sounds with an electronic stethoscope than it is with an acoustic stethoscope. (For real-world examples of this, see the previous review.) Plus, some models, like the Littmann ...

Happy Holidays!

UroStream — Sat, 20 Dec 2008 22:27:00 +0100

I will be taking a short break over the holiday season. We are traveling to Southeast Asia for the very first time, and I am really looking forward to all the new culture, colors and culinary delights awaiting us. Moreover, we will be traveling with my parents, which should make it an even more interesting trip.I will be back the first week of January to give a mini trip report. Hope everyone has a safe and happy Christmas/Hanukkah/New Year!!! (Source: UroStream)

Radiation scare

UroStream — Thu, 11 Dec 2008 17:40:00 +0100

Recently, I have begun to see more and more patients who are sent to my office from the ER with presumed renal/ureteral stones without a CT scan.They present with typical symptoms such as blood in the urine, sudden flank pain and mild nausea, and if they've had a stone in the past, some ER physicians will not order a CT scan for fear of radiation exposure, and subsequently will send these patients to see me as an outpatient. With mounting evidence on the risks of radiation, especially after multiple studies, I can understand the reluctance. However, what am I supposed to do with the patient? How can I offer them any medical advice, including the likelihood of spontaneous passage, if I don't know where the stone is located, what the size of the stone is and assess the presence of hydroneph...

A. Jörres, C. Ronco, & J. Kellum (Eds.): Management of Acute Kidney Problems

ESAO - Liver Support Working Group — Wed, 10 Dec 2008 15:59:00 +0100

Acute kidney failure is an important clinical area in the intensive care unit setting. An estimated 5–20% of critically ill patients experience an episode of acute kidney failure during the course of their illness, and about 5% of patients admitted to an ICU will eventually require renal replacement therapy. In these patients, in-hospital mortality is extremely high, exceeding 50%. Thus, the early detection and causal treatment of acute kidney problems is vitally important for a successful outcome. Written by internationally renowned experts, this clinical reference offers helpful advice with the most recent information on definition, epidemiology, pathophysiology, clinical causes of acute kidney failure, differential diagnostic approaches for patients with acute renal failure, and var...

Pantomime

UroStream — Tue, 02 Dec 2008 17:51:00 +0100

Though one of my nice older patient does not speak a word of English, this has never been a problem since he is always accompanied by a bevy of daughters who provide excellent translational services. However, communication issues arose after his admission to the hospital, when his relatives were not always present as I made rounds. Though I speak four languages pretty fluently (including English!) and know a smattering of words in a dozen other languages, Vietnamese is not one of them... In order to ask a few basic questions, I resorted to pantomiming at his bedside.As I was trying to ascertain whether he had ambulated that day, I did my version of the moonwalk. Then I asked him whether he had lunch by putting an imaginary spoon to my mouth and masticating imaginary yummy hospital food. Th...

Giving thanks

UroStream — Thu, 27 Nov 2008 22:54:00 +0100

I am on call this year for Thanksgiving, and it's already been mildly painful and busy (an exploratory laparotomy AND a kidney transplant last night!). The even more painful part is that this call lasts from wednesday until monday morning!!! Yikes....But as I was rounding at the hospital today and encountering sick patients and their families, I became profoundly thankful that my loved ones are in good health. Perhaps I am getting more emotional in my dotage, but I was feeling almost teary as I was walking through the wards, as there are few places sadder and lonelier than a hospital during the holiday season. (Source: UroStream)

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Harley riders: beware!

UroStream — Mon, 24 Nov 2008 17:54:00 +0100

I have to admit that I've never liked motorcycles, especially Harleys since their riders seem to derive great enjoyment at making their machines be as loud as possible. I find it rather obnoxious. However, as this new information is coming to light, it might be possible they are trying to compensate for something????This information is straight from the AUA (American Urological Association) Daily Scope: "Australia's The Age (11/23, Benson) reported that a survey found that men who ride motorcycles "risk impotence and urinary problems because the engine vibration damages nerves in their penises." For the survey, researchers looked at "more than 230 motorcyclists who ride for about three hours every weekend." They "found that almost 70 percent had problems getting an erection or emptying the...

Not looking foward to it yet....

UroStream — Sat, 22 Nov 2008 05:54:00 +0100

As the appointment with a follow-up patient was nearing its end, he suddenly quipped: "I gotta tell you doc, I don't know what you did to yourself but you look about 20 years younger than when I last saw you. I hardly recognized you...."Considering that I just saw him only a month ago, that comment took me somewhat aback. I could take it as a very nice compliment, or it meant I simply looked like hell a month ago...After trying to convince him there had been absolutely no recent plastic surgery involved, I informed him it was actually my birthday today, but that I was really not too excited about this event ever since I turned 35 years old a few years ago.The patient then told me he reached the point where he was actually looking forward to each of his birthdays, as an acclamation of being...

What do you do for a living?

UroStream — Sun, 09 Nov 2008 17:18:00 +0100

Simple question for most people.... However, this seemingly innocuous question used to stress me out when I first began training as a urologist. I was raised by my very conservative parents that talking or even mentioning certain areas of your anatomy was taboo, or at the very least, not an appropriate subject to bring up. Yet, the very essence of my job entails a journey into a realm which produces squirming in a polite society.Inevitably, this question would be raised in public setting such as in a plane, at a bar or some sort of social gathering where escape was not a possibility.I thought about lying outright and feigning to be an actuary, but I couldn't come to terms with that deceit (thanks mom!). So I usually tried to reach a compromise by trying to be vague and mentioning that I m...

Hope

UroStream — Thu, 06 Nov 2008 02:23:00 +0100

I have been criticized for talking politics on my blog (though my long-time readers will know that it's certainly not the first time). We have just voted for the new president of the most powerful nation on the earth. How could I not speak about it today unless I lived with my head buried in the ground?I know we cannot agree on everything politically. This very choice is what makes this country so great!!! We have the freedom to research and make informed decisions based on it. It is the basis of a democratic nation...I love this country, as I am sure all of you do as well, and I want the best for it. Whether you are blue or red, I think we can all agree on that premise. I just happen to feel that Bush was not the best choice for our country. No matter what the spin is, a lot of us will ag...

A new day has arrived...

UroStream — Wed, 05 Nov 2008 04:58:00 +0100

With tears in my eyes and a soaring heart, I extend a huge welcome to President Barack Obama!I feel that I have just been part of a historical and unforgettable moment in the history of the United States of America. He ran an amazing, almost flawless campaign, but the victory truly belongs to the man himself. He is smart, thoughtful, eloquent and inspirational, basically the anti-thesis of Bush. He is a breath of fresh air after eight years of a truly horrendous and corrupt administration.I even liked John McCain tonight during this concession speech, though I cannot feel the same generosity towards Sarah Palin. What an odious woman...Finally our beautiful glorious country can begin to unite and heal. (Source: UroStream)

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Hallelujah!!!

UroStream — Tue, 28 Oct 2008 17:58:00 +0100

O Most glorious of days!!! Most anticipated time since AD 1991!!! Sweet bright light at the end of the tunnel!!! Most welcoming of happenings!!!I just officially paid the last cent off my medical student loans today!!! And I thought this day would never come...I started med school in 1991, right after graduating from college, and I didn't want to burden my parents for additional funds after they had generously paid my college tuition in full. I distinctly remember the first loan check I got for my medical tuition, and feeling scared... very scared... (but not as scared as some of my medical colleagues who went to private med school and racked up >$125,000+ in loans). With each additional year of schooling, I saw my debt mounting into a mini version of Mount Everest (at least in my mind), a...

Risk management

UroStream — Mon, 27 Oct 2008 17:51:00 +0100

I recently attended a risk management workshop with presentations from various medical professionals and attorneys (both plaintiff and defense) regarding ways to avoid being sued. It's an absolutely lovely way to start your saturday morning (7:30AM!!!)This is especially apropos after reading Shadowfax from Movin' Meat receiving his first lawsuit notice. I really feel for him, since this is one of the most dreaded event in the career of a physician.The workshop consisted of impromptu video interviews from people off the street who were invited to talk about their doctors, and what they considered good and bad medical care.One major theme began to emerge from these interviews about being a good doctor: spending enough time with the patients without feeling rushed, good communication using e...

Shot interrupted

UroStream — Mon, 20 Oct 2008 21:41:00 +0100

It's flu shot season again, and I know I've covered my morbid fear of injections in prior posts ad-nauseam, but here we are once more. Doesn't it seem to come sooner every year???Yes, call me a hypocrite, a poltroon, a coward, but whereas I have no trouble wielding a scalpel or a hypodermic syringe on my patients, the thought of getting an injection on my tender deltoid puts me into a hyperventilating diaphoretic mess. Mind you, it's not the pain, because truth be told, the stupid injection does not hurt a bit. I've had more painful sessions with a pedicure... But it's just the thought of a needle... going into my flesh... argh... My nurse just announced today that we got our flu shots delivery for the office, and wanting to change my usual pattern of endless rumination and worry leading t...

PhD Student Award in Regenerative Medicine

ESAO - Liver Support Working Group — Sat, 18 Oct 2008 10:20:00 +0100

The Berlin-Brandenburg School for Regenerative Therapies (BSRT) offers youngtalented scientists in Berlin and Brandenburg: Best Publication Award: The award will be granted for the most outstandingpaper for progress in Regenerative Medicine accepted by a peer reviewjournal in the last two years. The award comprises 1.500 Euro. Best Presentation Award: The award will be granted for the best posterpresented at an international conference with a peer review system withinthe last two years. The award comprises 500 Euro. Info & Contact:BSRT, Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin,E-Mail: award@bsrt.de, Web: www.bsrt.de (Source: ESAO - Liver Support Working Group)

No need for thanks

UroStream — Thu, 16 Oct 2008 04:04:00 +0100

I was finishing up a clinic visit with a new patient, when, as I was heading towards the door, she uttered these parting words: "Thank you for seeing me and taking my insurance."Since I don't personally check ahead of time what insurances my patients have, I was intrigued by her comment and asked her who provided her healthcare coverage. She answered Tricare, which is the healthcare insurance provided to the United States Armed Forces and their families.The reason for her gratitude was because she was finding it progressively more difficult to find physicians who would accept Tricare. Though it pays marginally better than Medicaid (not Medicare), it is one of the worst insurances around, with notoriously finicky pre-authorization requests and terrible reimbursements for doctors (usually le...

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Netter for the iPhone

Kidney Notes — Wed, 15 Oct 2008 04:00:00 +0100

Would have loved this during anatomy. Looking at the video, I can almost smell the gristle and formaldehyde again. This is one of the few medical apps I haven't used, though — any medical students find it helpful? (Source: Kidney Notes)

Please don't make me cry...

UroStream — Tue, 07 Oct 2008 22:03:00 +0100

Though no death is ever easy to deal with, I find it particularly emotional when it's one of my older patient who has recently lost their spouse. It's absolutely devastating to see the sorrow etched on their face, the dazed and lost look they have in their eyes and the palpable grief emanating from their body.One of my patient had recently lost her husband of 59 years. Thankfully he passed away gently in his sleep, but it had obviously taken a toll on my patient. A normally brave, independent and spry woman in her 80s, she looked incredibly vulnerable and tiny that day. She could not help the tears that slowly rolled down her face as she told me their story.And I have to tell you, this is a surefire way to make me lose my composure in the exam room. (Source: UroStream)

Precious Bodily Fluids, a New Nephrology Blog

Kidney Notes — Sat, 04 Oct 2008 04:00:00 +0100

Image via WikipediaDr. Joel Topf is one of only two or three blogging nephrologists (including Dr. Arnold Kim, who publishes MacRumors.com, so that may not count). Joel writes the excellent Precious Bodily Fluids blog. PBF not only contains a wealth of clinical information, but scores huge points for the Dr. Strangelove banner. He's also the author of The Fluid, Electrolyte, and Acid-Base Companion, perhaps the easiest-to-understand primer on these brain-twisting disorders. Via Precious Bodily Fluids:Yesterday I gave a great lecture on interpreting ABG results. I added a problems set for gap-gap analysis and added a section on the osmolar gap. I also improved the anion gap section with my new favorite mnemonic. Forget PLUMSEEDS, forget MUDSLEEPS, forget MUDPILES. The new hotness is GOLD MA...

Urinary Tract Wallpaper

Kidney Notes — Thu, 02 Oct 2008 04:00:00 +0100

Via the talented Shannon Wright: (Source: Kidney Notes)

Sparklines and Hantavirus Nephropathy

Kidney Notes — Thu, 25 Sep 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; } Sparklines and Hantavirus Nephropathy, originally uploaded by KidneyNotes. (Source: Kidney Notes)

How to Blog, by Merlin Mann

Kidney Notes — Mon, 15 Sep 2008 04:00:00 +0100

How To BlogView SlideShare presentation or Upload your own. (tags: advice blogging)And the talk itself, here. (Source: Kidney Notes)

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Alternative treatments

UroStream — Fri, 12 Sep 2008 15:03:00 +0100

Few things frustrate me more than patients diagnosed with cancer that could be cured via conventional medical therapy, who end up resorting to alternative "treatment" options.I could learn to accept these decisions if these were real legitimate treatments they were exploring, as opposed to the utter quackery offered by exploitative and unscrupulous individuals.I'm already distraught enough when I have to reveal the diagnosis of cancer to a patient, and I usually spend a good amount of time in clinic discussing the problem, prognosis and various legitimate treatment options. But then my distress turns to perplexity and disbelief when the patient wants to try the new "cancer-fighting" minerals found only in the jungle of Ecuador, or the all juice antioxidant diet or the mind-over-matter canc...

Shivers

UroStream — Fri, 05 Sep 2008 19:01:00 +0100

There are few things as horrific as seeing a patient with advanced penile cancer. Thankfully, it's not a common disease, and over the last 6 years, I've only seen a handful of cases, which is to say a handful more than I want to see...The horror comes not only in the diagnosis of cancer in such an unusual area (most people are probably shocked to learn that there even exists such a condition), but also in the treatment for this diagnosis which, even in the best possible scenario, can only be called mutilating.Unfortunately, the best cure lays in surgical extirpation of the cancer. In lay terms, that means we have to cut it out... If the cancer only involves the foreskin, then a simple circumcision can be enough, but unfortunately, a lot of these cancers affect the glans or shaft of the pen...

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ESAO - Liver Support Working Group — Mon, 01 Sep 2008 13:36:00 +0100

(Source: ESAO - Liver Support Working Group)