Monday, April 30, 2012

Ear Infections, Broken Bones,

$7 128 Hz Tuning fork and $13 Stethoscope
With the tines vibrating, place the base on the bone 3-4 inches away from the pain center on a non-painful area. The vibrations will cause the ends of the bone to shift on each other which will cause pain. If the pain increases sharply, it is very likely there is a broken bone. If the pain does not increase, it is possible there is not a broken bone. For the long bones you can increase the sensitivity of the test by placing the stethoscope proximal to the suspected fracture and the tuning fork distal to the fracture. Decreased sound reaching the stethoscope (compared to the normal side) indicates the bone is broken. Sensitivity and specificity are both about 80% which means that if you test ten bones you suspect are broken, you will be wrong twice (whether you say it is broken and really isn't, or not broken when it really is.)

$30 Otoscope
Place the tip near the ear canal. You will find you need to lightly pull up and back on the ear to make a clean entry into the ear canal. The child will feel some pressure and may squirm so be careful not to puncture anything. You should be able to see the ear drum reflecting some of the light. If there is an ear infection the skin will appear red, the ear drum may appear to bulge out towards you causing some scattering of the reflected light.

I have no idea how good the $13 stethoscope you can get on actually is. For comparison, mine cost $150. My tuning fork cost about $7. My oto/ophthalmoscope set was almost $500, but you can easily diagnose an ear infection if you can visualize the area which you should be able to do with the inexpensive otoscope on

Sunday, April 22, 2012

Elitism and Throwing Stuff

There is something of an elitish, don't-mix-my-vernacular-with-your-plebian-tones attitude among medical professionals. To a point I understand this. An ear ache to a lay person is only an ear ache, but to a doctor it could be trauma, infectious, referred, or made up and differentiating between acute otitis media and ruptured tympanic membrane is important.
  • Ear pain/otalgia normal drum, Earache, Earaches after flying, External Ear Pain, Referred ear Pain Otalgia, Presentation/Tender swollen Pinna Nose Larynx, Ear trauma, Ear Pinna ulcer, Pain/temple area, Pain pre-auricular area, Painful submandibular gland, Pain/swelling Zygoma/arch area, Pain in lower jaw with exercise, Painful submaxillary salivary gland, Ear drum rupture/tear/laceration, acute
However, this has been carried to an extreme is some cases (in my lowly first-year opinion.) I was studying this week trying to memorize the mechanism of action of the 114th drug and ran across this confusing sentence. It was late and I was tired and spent longer than I should have trying to figure out what it was saying.

"Insulin/IGF-1 decreased signalling promotes increased stress resistance and lifespan."

Couldn't you have said it in a easier way? How about, "Less insulin and IGF-1 signalling leads to less stress and longer life?" I know the author probably has credentials and a reputation to manage, but he should know that the only person to ever read that sentence is going to be a very tired, very discouraged medical student near then end of a very long chapter.

Absence Seizure

This one really gets me for some reason. Most of you probably pronounce the word absence the way the dictionary directs - [ab-suhns] with the accent on the first syllable and a neutral vowel on the second. Doctors, however, talking about seizures don't want to sully their pronunciation with the peasant's. No, they pronounce it [ab-sahns] as in Renaissance. Perhaps there is more to the story of seizures. For all I know, the guy who classified them was French. 

Artery of Adamkiewicz

"We honor the generations of physicians who went before us by attaching their names to the contributions they made to medicine. How else would we be able to pimp medical students?" Names generally refers to function or position: posterior cerebral artery supplies the posterior portion of the cerebrum, anterior inferior cerebellar artery supplies the anterior inferior portion of the cerebellum, etc. 

To combat elitism, I propose a course called Throwing Stuff ought to be mandatory in medical school.

Wednesday, April 18, 2012

Make Your Inner Beauty Jealous

Some things are too good not to document. 

$3,250. Price negotiable. 

Clean Retail NADA value (w/current mileage): $4,825.

Well. The wait is over. The most ballingest car ever is finally on the market. This one-of-a-kind ZX2 coupe is to the limit. And it takes no prisoners.

Thats a double whammy.

Features? Yeah, its got em. Like how about it comes in sparkly, get-rich-or-die-tryin green. That means its camouflaged in the forest or lush fields of grass where you will undoubtedly be taking your lady (or ladies if youre driving this) for a picnic of skewered lamb and frosty beverages. Green = the new whatever color you want. Green = mother natures cloaking device.

Its got privacy glass so you can do whatever the eff you want as you blitz past zombies on the freeway. Plus, while everyone else is looking at each other picking their nose, youll be chillin in a darkened cocoon of comfort and maintaining the mystique and mystery that comes naturally when you own a ZX2.

30+ MPG? Uh-huh. Get out there and explore, Magellan.

Air Con? Check. Keep cool, my brother.

Cruise Control? Oh most definitely. Dont be like everyone else on the freeway with their stop-slow-and-go driving. Lock this baby in at 85 - Utah's real speed limit - and save on the MPGeezle.

Power windows? Power locks? Power steering? Thats a fatty mcfatty yes.

AM/FM, 6-Disc CD changing entertainment extravaganza? You know it.

Leather interior? Rare for ZX2s - but not this one. Because luxury is seats that feel smooth on your butt. 

Zippy 4-speed auto tranny? Indubitably.

And before you ask, no youre not dreaming - yes, that is a spoiler back there and yes. . . you want this car. Bad.

This well-maintained and fully restored beauty is a salvage title. It was bought out of an insurance pool after getting into a tiny fender bender (i.e. vicious car cock fight. . . which it won. . . with metal and brawn). 

The right front fender was dented, but then replaced by a cadre of men who were born in garages and bottle-fed Penzoil. Basically all that means is now this amazing piece of machinery has more character than your neighbors lame van.

Bottom line: if this car were any more advanced, it would stand up and say 'Autobots, roll out!'

Tuesday, April 10, 2012

Call the Elders

The second neuro test went okay. I was only 1 standard deviation above the mean which is still rather significant, but something of a letdown after doing so well on the first test. The average was only 74% and the standard deviation was 9 points.

This week our clinical course had something interesting prepared for us. Instead of a timed session to collect a history and physical and then compose a SOAP note we were given the opportunity to interact with difficult patients. The actors were instructed to yell, scream, cry, not speak English, demand, and anything else they can think of to see how we respond. Oddly enough, they scheduled it for the afternoon following our second neuro exam. My guess was that the actors were going to get as good as they gave.

One actor was a mom who was upset we proscribed her 14 year-old daughter birth control without notifying her. (Depending on the state laws, a minor can receive treatment for pregnancy, venereal diseases, and birth control without parental consent or awareness and it is illegal for the parents to find out from the doctor.)

One actor was a talkative fellow who blocked any attempt to have a productive appointment.

The last one I had was interesting. It was a Christian couple whose son had been taken to the emergency room by the preschool staff and was confirmed to have bacterial meningitis - a potentially fatal disease. The couple wanted to take the kid home without treatment so that the 'Elders' could pray for him as per James 5:14-15. (There has been a precedent for kids dying because of this attitude and the parents being charged with child neglect.)


I saw on my credit report a recent addition by a collection agency I didn't recognize so out of curiosity I called them up. (I left out my address and the institution that I "owe.")

Me: Hi, I'm calling about an unpaid bill that my credit report shows.

Them: Okay, first of all, let me make sure we have your information correct. (They get address numbers, city, state, and zip code right.) Do you live on 'TH' street?

Me: No.

Them: Oh, that must be why the bills we sent you keep coming back.

Me: Well, can you send me a bill of what you think I owe to the right address?

Them: No, we can't do that.

Me (surprised): Why not?

Them: We've already sent one out and we can only send out one at a time.

Me: Well, you've been sending it to the wrong address. Maybe if you send it to the right address I'll get it.

Them: Look, if you aren't getting your mail, you either need to talk to your wife who is throwing our bills away before you look at them or you need to talk to your mail carrier and ask him why he isn't delivering your mail. (I'm not making this up!)

Me (laughing): Yah, but you're sending it to an address that doesn't exist. 'TH' street? Don't you think a number might go in from of the 'TH?' Can we address that problem first?

Them: I know from personal experience that the institution that you owe has sent you bills. The fact that you have ignored them is your problem, not mine.

Me: I'll wait till I get a bill until I see a problem. Until then, thinking intelligently is your problem, not mine. Goodbye.

Actually all I said on my final salvo was just 'goodbye,' but now I'm wishing I had left them with a desire to grow some grey matter.

Sunday, April 1, 2012

30 Pizzas

I took the first neuro test on Tuesday night - the one that had a 71% average. There were two main advantages I had over the other people that took the test: 1.) I am a neuroscience major and 2.) I had all spring break to study. In that context, when I tell you that I scored 2.4 standard deviations higher than the mean, you should understand that that places me around the top 1% of students out of about 300 on that test. Sometimes the way the cookie crumbles is towards you.

Unfortunately, taking the test late puts me three days behind on lectures. That translates into ten lecture hours which might not sound like a lot, but let me use an analogy to describe how that makes me feel. Let's say you have to eat 10 pieces of pizza a day. You're a big guy and you are doing pretty well until something happens that sets you back three days. "That's okay," you think. "I'm a big guy and I'll just eat 30 pieces tomorrow." The problem is, if you can barely eat 10 pieces a day, what makes you think you can ever eat 30 pieces in a day? And what do you do when you are tired of eating all that pizza? It never stops coming.