MedWorm: Urologists and Nephrologists

Kidney Notes — Thu, 05 Nov 2009 00:00:00 +0100

Receiving the H1N1 nasal vaccine is anticlimactic. "Flu nasal drowning" was a misnomer. (Source: Kidney Notes)

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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)

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

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

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)

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)

Kidney Notes — Wed, 28 Oct 2009 00:00:00 +0100

WolframAlpha Searches: Potassium in Lime Juice? http://ping.fm/kdW7Q (Source: Kidney Notes)

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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...

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

"Does anyone have any ideas about how to reconstruct my abdomen?" Heart-wrenching necrotizing fasciitis case in NEJM. http://ping.fm/PCQHp (Source: Kidney Notes)

Flu Virus Animation

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

Via NPR. (Source: Kidney Notes)

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)

Kidney Notes — Mon, 19 Oct 2009 23:00:00 +0100

David Pogue Interviews Dr. Blumenthal, US Electronic Medical Records Czar http://ping.fm/Y7t1G (Source: Kidney Notes)

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Kidney Notes — Tue, 13 Oct 2009 23:00:00 +0100

The Electrolyte Composition of the Dead Sea. http://ping.fm/muQcP (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)

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

A med/peds hospitalist writes on resources for nephrology: http://ping.fm/94qYQ (Source: Kidney Notes)

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

“Medical students at UMDNJ required to have an Apple iPhone or iPod touch http://bit.ly/103xEw” -@DrJosephKim (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)

Kidney Notes — Sun, 04 Oct 2009 23:00:00 +0100

"New York Health Department study shows how blended drinks from coffee chains foster calorie overload." http://ping.fm/g4Nk5 http://ping.fm/PVnqP (Source: Kidney Notes)

Kidney Notes — Sat, 03 Oct 2009 23:00:00 +0100

HealthGrades makes it difficult for physicians to edit their info. Here's the link: http://ping.fm/5YvPo (Source: Kidney Notes)

Kidney Notes — Sat, 03 Oct 2009 23:00:00 +0100

"The Burger That Shattered Her Life." (Hemolytic Uremic Syndrome in the New York Times) — http://bit.ly/xxBPM (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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Surgery (by xkcd.com)

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

(original here) (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)

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

The New PubMed. http://ping.fm/ttUHZ http://ping.fm/YWixu (Source: Kidney Notes)

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)

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)

Kidney Notes — Tue, 18 Aug 2009 23:00:00 +0100

New favorite fountain pen, 77¢: http://ping.fm/keDdE (Source: Kidney Notes)

Kidney Notes — Sat, 15 Aug 2009 23:00:00 +0100

"We have contests in which we decide who is the most beautiful woman in the world... We should be able to have a World's Most Perfect Kidney contest." -- David Cronenberg, in Aphrodites of the Operating Theater: La Specola Museum of Natural History of the University of Florence, BoingBoing. http://ping.fm/IS4Kd (Source: Kidney Notes)

Kidney Notes — Thu, 13 Aug 2009 23:00:00 +0100

Someone please prove me wrong: A table of the benefits of common medical therapies (aspirin, statins, etc.) DOESN'T EXIST. (Source: Kidney Notes)

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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)

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)

Kidney Notes — Mon, 27 Jul 2009 23:00:00 +0100

"NIH is encouraging its scientists to edit and even initiate Wikipedia articles in their fields." http://tr.im/uuyw (Source: Kidney Notes)

Kidney Notes — Mon, 27 Jul 2009 23:00:00 +0100

Information Overload, the Index Medicus, and PubMed http://ping.fm/wnBvT (Source: Kidney Notes)

Kidney Notes — Sat, 25 Jul 2009 23:00:00 +0100

Brooklyn Bridge via Moving Car (Source: Kidney Notes)

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

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

(Source: Kidney Notes)

Updated iPhone Home Screen

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)

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)

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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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)

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)

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)

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...

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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...

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 (!...

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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...

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)

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)

"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...

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

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

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 ...

Electronic Stethoscope Oddities

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

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...

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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)

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...

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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)

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...

MedWorm Message: Get the very latest Swine Flu news via the MedWorm Swine Flu RSS news feed - updated hourly from thousands of authoritative health and news sources.

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...

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)

Netter for the iPhone

Kidney Notes — Tue, 14 Oct 2008 23:00:00 +0100

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)

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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...

Precious Bodily Fluids, a New Nephrology Blog

Kidney Notes — Fri, 03 Oct 2008 23:00:00 +0100

Urinary Tract Wallpaper

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

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

Urinary Tract Wallpaper

Kidney Notes — Wed, 01 Oct 2008 23:00:00 +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)

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Sparklines and Hantavirus Nephropathy

Kidney Notes — Wed, 24 Sep 2008 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; } 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)

How to Blog, by Merlin Mann

Kidney Notes — Sun, 14 Sep 2008 23:00:00 +0100

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

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)

Right Now: What Are You Doing?

Kidney Notes — Mon, 01 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; } Right Now: What Are You Doing?, originally uploaded by merlinmann. (Source: Kidney Notes)

Transitioning Blog Comments to Disqus

Kidney Notes — Sat, 30 Aug 2008 04:00:00 +0100

I'm transitioning Kidney Notes' blog commenting system to Disqus. The old comments will — hopefully — still be there, but things may look strange for a bit. (Source: Kidney Notes)

Transitioning Blog Comments to Disqus

Kidney Notes — Fri, 29 Aug 2008 23:00:00 +0100

I'm transitioning Kidney Notes' blog commenting system to Disqus. The old comments will — hopefully — still be there, but things may look strange for a bit. (Source: Kidney Notes)

Atonement

UroStream — Fri, 15 Aug 2008 03:33:00 +0100

Med list for my new patient:-Omega 3 fish oil-Gingko biloba-Green tea extract-Centrum multivitamin-Saw PalmettoHe's actually quite healthy without any serious medical issues. Yet despite all these nutritional supplements that would seemingly identify him as a health-conscious individual, I also noticed that he smokes a pack a day for the last 40 years....I'm always a little amused yet perplexed when I see something like this. Do the supplements somehow "atone" for all those cigarettes? Do the antioxidants negate the carcinogenic effects of tobacco? If only it were that easy...Perhaps this line of thinking is akin to ordering a double burger with fries and a diet coke. Drinking a regular coke with that meal would put it over the edge!!!! Or taking cholesterol lowering medication without cha...

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Summer fare

UroStream — Sat, 09 Aug 2008 05:01:00 +0100

I'm just writing a little warning note for my readers. Don't expect any insightful posts (have I ever written one?), or even any posts at all over the next 17 days. Didn't you hear? The summer Olympics just started tonight!!!!I absolutely ADORE the Olympics, especially the summer games. There is something almost surreal about thousands of athletes from hundreds of different countries coming together for a little over two weeks to compete. I love the individual stories of people who, against all odds, are able to make it to the games. There are people who know they are never going to win a medal, yet still compete just for the sake of participating in this global event.Despite the fact that this year's Olympics is fraught with political undercurrents, I love the fact that during the competi...

Tardiness

UroStream — Sun, 03 Aug 2008 18:40:00 +0100

One of my biggest pet peeves is tardiness. As a rule, I am a fairly punctual person, and I like to be even a little early for my appointments. Call it my obsessive-compulsive nature, or a lifelong fear of displeasing others, but few things stress me out more than being late. I think my upbringing also plays a crucial role, since my parents are known to show up at the airport a minimum of two hours before their flights. They both have type A personalities that will not allow them to be tardy for anything.There are lots of surgeons who are known in the OR for showing up chronically late to their cases, which drives me crazy since by a cascading series of events, they end up delaying everyone who follows them. I am proud to say that I have a reputation for being on time.But enough about me a...

The ESAO One Day on the Liver 2008 in Geneva - Thursday, Sept. 4th, 2008

ESAO - Liver Support Working Group — Fri, 01 Aug 2008 13:35:00 +0100

As all the recent years the “One day on the liver” – a day dedicated to liver support systems and therapeutic strategies in the case of a failing liver - will take place during the ESAO 2008 meeting in Geneva.For the first time we organised the "Young investigators' Liver Session". We asked the heads of several groups working in the field to send one of their best students to present their latest results. This session is dedicated to PhD students and is chaired by PhD students involved in liver support research. Of course all participants of the meeting are invited to attend!The ESAO One Day on the Liver 2008 (ODOL) will take place Thursday, Sept. 4th, 2008. 08:30 – 09:30 Plenary Session Chair: Falkenh...

Hello Health

Kidney Notes — Thu, 31 Jul 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; } Hello Health, originally uploaded by KidneyNotes. (Source: Kidney Notes)

Hello Health

Kidney Notes — Wed, 30 Jul 2008 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; } Hello Health, originally uploaded by KidneyNotes. (Source: Kidney Notes)

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E-mail funnies

UroStream — Sun, 20 Jul 2008 17:02:00 +0100

Two e-mails put a smile on my face today:The first came from my AUA Daily Scope (daily news bites and articles of interest from the American Urological Associations) with a bold title that announced:"Global warming may increase kidney stone rate!"Mind you, not that global warming is funny at all, but the headline just sounded so unnecessarily alarmist, and so unlike the usual "less sensational" articles the AUA presents. And as a side note, I do believe that global warming will make us urologists busier.The second came from one of my bestest of friends, whose mother actually reads my blog! Mom came to visit her, and said:"I don't like it when she (meaning me) writes about penises."Yikes, that puts a severe restriction on the variety of my posts..... (Source: UroStream)

Not so insignificant

UroStream — Sun, 13 Jul 2008 20:12:00 +0100

Even though I'm just a dumb surgeon-type, and not a clever endocrinologist or nephrologist, I still need to know all my patients' medical history in detail. (I've always thought the specialities mentioned above attracted the super intellectual types...Urologists are more akin to the humble plumbers whereas the nephrologists are considered the engineers...) Yes, I like to be in the operating room and I like to use a scalpel to help people, but that doesn't mean I don't do some thinking of my own.I am always astounded at the details that patients omit on their medical history form. I'm clued in when I look at their medication list and see 3 different antihypertensive medications, yet they don't list hypertension as one of their medical condition. Usually the explanation is something like: "b...

The Controvery Over Cardiac CTAs

Kidney Notes — Mon, 07 Jul 2008 04:00:00 +0100

Image via Wikipedia Weighing the Costs of a CT Scan’s Look Inside the Heart - NYTimes.com: A few minutes later, Dr. Hecht studied the results. As he had expected, the angiogram revealed that Mr. Franks’s arteries were healthy. In some places, plaque had blocked 25 percent of their blood flow, but in general, cardiologists do not consider blockages clinically relevant until they reduce blood flow at least 70 percent. After Mr. Franks finished dressing, he joined Dr. Hecht, who went over the results, explaining that his heart appeared healthy and that he would not need a stent. Still, Dr. Hecht recommended that Mr. Franks have another CT angiogram next year to check that the plaque was not thickening. Mr. Franks agreed, pronounced himself satisfied and left. For Mr. Franks, the test wa...

The Controvery Over Cardiac CTAs

Kidney Notes — Sun, 06 Jul 2008 23:00:00 +0100

Image via WikipediaWeighing the Costs of a CT Scan’s Look Inside the Heart - NYTimes.com:A few minutes later, Dr. Hecht studied the results. As he had expected, the angiogram revealed that Mr. Franks’s arteries were healthy. In some places, plaque had blocked 25 percent of their blood flow, but in general, cardiologists do not consider blockages clinically relevant until they reduce blood flow at least 70 percent.After Mr. Franks finished dressing, he joined Dr. Hecht, who went over the results, explaining that his heart appeared healthy and that he would not need a stent. Still, Dr. Hecht recommended that Mr. Franks have another CT angiogram next year to check that the plaque was not thickening. Mr. Franks agreed, pronounced himself satisfied and left.For Mr. Franks, the test was quic...

Apprehension

UroStream — Sat, 28 Jun 2008 15:46:00 +0100

You know my previous post about the rule of three? Well, I just took care of two penile fractures in a 24 hour period of time.OK, technically the human penis does not have a bone (though other animals like dogs do), hence a "fracture" is somewhat of a misnomer. However, this is the correct medical term for a rupture or tear in the tunica albuginea, which is the tough yet elastic sheath that surrounds the erectile tissues in the penis called the corpora cavernosum. (I admit that there is a tremendous amount of incomprehensive medical mumbo jumbo, but don't blame me for the nomenclature since I wasn't the one who thought up of all these names. Blame it on some dead white guys. If it were up to me, I would have chosen much better and cuter gwords...)There are certain sexual positions associa...

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Resistant Hypertension: Diagnosis, Evaluation, and Treatment, from the AHA

Kidney Notes — Thu, 26 Jun 2008 04:00:00 +0100

Image via WikipediaResistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research -- Calhoun et al. 51 (6): 1403 -- HypertensionResistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 20% to 30% of study participants. As older age and obesity are 2 of the strongest risk factors for uncontrolled hypertension, the incidence of resistant hypertension will likely increase as the population becomes more elderly and heavier. The prognosis of resistant hypertension is unknown, but car...

Resistant Hypertension: Diagnosis, Evaluation, and Treatment, from the AHA

Kidney Notes — Wed, 25 Jun 2008 23:00:00 +0100

Gastric Bypass May Improve Renal Function in Obesity Related Glomeruopathy

Kidney Notes — Tue, 24 Jun 2008 04:00:00 +0100

Image via WikipediaGastric Bypass Can Improve Renal Function in Patients With Morbid Obesity, Via Medscape:Patients with morbid obesity who also have chronic renal disease (CRD) may improve or stabilize renal function after gastric bypass, according to a study presented here at the American Society for Metabolic & Bariatric Surgery 25th Annual Meeting.[Interesting. Obesity related glomerulopathy is mediated by hyperfiltration, which might theoretically be reversible with gastric bypass.] (Source: Kidney Notes)

Gastric Bypass May Improve Renal Function in Obesity Related Glomeruopathy

Kidney Notes — Mon, 23 Jun 2008 23:00:00 +0100

Retained stent

UroStream — Mon, 16 Jun 2008 18:07:00 +0100

Seaspray's unfortunate close encounters with ureteral stents reminded me of the nightmare that is a retained stent. (not that you have that Seaspray, and I really hope you feel better soon!!!) If anything is guaranteed to shave years off the life of a urologist, it would be a retained stent.Ureteral stents, unlike vascular stents, are not meant to stay inside permanently. They need to be removed, or at least changed every few months (depending on the patient and the type of stent), otherwise the stent becomes calcified and it becomes virtually impossible to remove the stent. Anytime there is a foreign object in the urinary tract system, crystals form which lead to stone formation. Imagine having concrete poured directly within the ureter and letting it set inside, and you can understand wh...

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The rule of three

UroStream — Sat, 07 Jun 2008 17:17:00 +0100

There must be some cosmic rule that urological conditions come in groups of three. I have mentioned this on a previous post, but I have noticed that when I see a patient with a somewhat unusual medical condition, I am guaranteed to see two more patients within a short period of time with the same problem. I'm not talking about UTIs, stones or incontinence, but more like ureteral tumors, penile cancer and peri-urethral cysts. Nothing that is outrageously unusual, but not conditions we see daily.Recently, within a span of one single week, I have see three patients with acute urinary retention (over 3L) being admitted for elevated Cr (over 10) whose renal function improved markedly with catheter drainage but needed to stay inhouse for a few days because of post-obstructive diuresis (over 6L/d...

In a slump

UroStream — Fri, 06 Jun 2008 06:01:00 +0100

Sorry about the long break. It seems that within just a few days of returning from vacation, I felt like I never went away at all. Isn't that always so?In any case, I have been trying to keep afloat of my very hectic schedule. Besides my clinical duties, I've also had an unusual amount of administrative type meetings that are always scheduled at the convenient time of 7AM. Things have been so crazy busy at work that I have even cancelled one of the few treasured activities that I strive to attend bi-weekly: my Pilates class. Not only is it badly needed exercise, it is also a huge stress reliever and one of my therapeutic indulgences.I love Pilates. I discovered it a few years ago, when I was tired of hauling my protesting body (and mind) to the gym, to work on a treadmill or an elliptical...

Life Hacks for Doctors is the Slideshow of the Day on Slideshare

Kidney Notes — Mon, 02 Jun 2008 04:00:00 +0100

Just received this email:Your slideshow Life Hacks For Doctors has been selected as the 'Slideshow of the Day' on the SlideShare homepage.Our editorial team would like to thank you for this awesome creation. - The SlideShare teamNice start to the week. On the home page, Slideshare also highlights other slideshows on Doctors, Medicine, and Web 2.0. (Source: Kidney Notes)

Life Hacks for Doctors: An Introduction

Kidney Notes — Mon, 02 Jun 2008 04:00:00 +0100

| View | Upload your ownThe Efficient MD BlogThe Efficient MD Wiki (Source: Kidney Notes)

Life Hacks for Doctors is the Slideshow of the Day on Slideshare

Kidney Notes — Sun, 01 Jun 2008 23:00:00 +0100

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Life Hacks for Doctors: An Introduction

Kidney Notes — Sun, 01 Jun 2008 23:00:00 +0100

| View | Upload your ownThe Efficient MD BlogThe Efficient MD Wiki (Source: Kidney Notes)

Manhattan Solstice

Kidney Notes — Sun, 01 Jun 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; } Solar A Rays (aka Manhattan Solstice or Manhattanhenge), 5/28/08, originally uploaded by wlphoto. (Source: Kidney Notes)

Manhattan Solstice

Kidney Notes — Sat, 31 May 2008 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; } Solar A Rays (aka Manhattan Solstice or Manhattanhenge), 5/28/08, originally uploaded by wlphoto. (Source: Kidney Notes)

Fierce on fungus. Kinder to kidneys.

Kidney Notes — Thu, 29 May 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; } Fierce on fungus. Kinder to kidneys., originally uploaded by KidneyNotes. (Source: Kidney Notes)

Fierce on fungus. Kinder to kidneys.

Kidney Notes — Wed, 28 May 2008 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; } Fierce on fungus. Kinder to kidneys., originally uploaded by KidneyNotes. (Source: Kidney Notes)

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Nephrogenic Systemic Fibrosis

Kidney Notes — Sat, 24 May 2008 04:00:00 +0100

, originally uploaded by KidneyNotes. (Source: Kidney Notes)

Nephrogenic Systemic Fibrosis

Kidney Notes — Fri, 23 May 2008 23:00:00 +0100

, originally uploaded by KidneyNotes.Nephrogenic systemic fibrosis, a scleroderma-like condition, is related to the use of gadolinium in patients with severe renal failure. This dialysis patient developed nephrogenic systemic fibrosis just 3 months after being exposed to gadolinium for an MRA. (Source: Kidney Notes)

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 th...

Introducing The Efficient MD Wiki

Kidney Notes — Sun, 11 May 2008 23:00:00 +0100

Currently Reading: Little Brother

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

(Source: Kidney Notes)

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"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 ...

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 beha...

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 milestone...

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

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 previousl...

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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 ...

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 corre...

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)

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 so...

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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 ...

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 non...

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...

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 c...

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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 ...

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)

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 funct...

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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...

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 ...

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 creativ...

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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 revie...