Friday, December 25, 2009

Winery Refinery


As a long time drinker and new found wine connoisseur (which I think is French for "drinker"), I have recently figured out an algorithm for purchasing a quality wine.  

My first step is to peruse the aisles and try to choose a country's vineyard that I would like to try.  Generally I stick with Australians and French wines because those are the physically closest sections to the entrance. 

Next, I choose a grape.  Traditionally, red's go with more full meats and white's find the palate better with fish or chicken, but let me emphasize that a white needs to be chilled and isn't chilled at most wine distributors, whereas a red is ready to rock right out of the bag.  Among the reds, I'm a fan of the thicker, fuller, volumetrically larger bottles and tend to go with those.

The final step is, unfortunately, really more of an art than a science, and although I can describe the basic formula, some of the inputs require significant practice.  Essentially, I take a look at the name of the winery, and then of the particular label of that wine, I take the hilarity of either (or both, if it's a really good wine, like Benzinger's Moose Shoot) and multiply* that by the inverse of the price.  High score wins. 

*Note: There is no real math involved.  I mostly go, "Moose Shoot?  That's pretty funny.  11 bucks?  That's pretty cheap.  Donzos".



Wednesday, December 23, 2009

Excelling at psychiatry

The question we are taught to ask to assess depression and psychiatric risks is, "Have you ever thought about hurting yourself or others?"  But I don't think that is sensitive enough, there is a high potential for false positives.  To better screen for those who are truly in trouble, I think it should be reworded as follows: "Have you ever thought about hurting yourself or others, not including while driving in heavy traffic or when trying to format a document in Excel?"

Monday, December 21, 2009

ID thief

The guy at the liquor store rang me up and didn't ask for my ID.  He then asked, "debit or credit" and when I chose credit, asked to see my ID.  So despite my Ninja Turtles shirt and my purchasing of wine with names like, "Great Grapes" and "Smooth Operator", he took a look at me and thought, "this guy is more likely to be stealing someone's identity than to be under 21"?  What a dick.  I can't wait to steal his identity.

Saturday, December 19, 2009

Case of SOBs

I'm finishing up my preclinical book work and heading to the clinics in a month and things are so much fun.  Now we've done all the organ systems and so when we get these case presentations to work on, it's much more like having an actual patient.

23 y/o (year old) male presents with SOB (shortness of breath), fever, and cough.

PE (physical exam): Febrile (fever), dyspnic (pain on breathing), tachypnic (having really tacky pnics)
ABG (arterial blood gas): 7.48/55/98/22

"Now what's the differential diagnosis"  This is the most fun part.  Everyone knows what this is.  Everyone has seen a medical show of some kind and this is the part where they start to list diseases, each of the students saying a disease in turn at a fast clip, followed quickly by the head attending agreeing or another resident going, "Yes, but it's an acute presentation.  We must be missing something" (because they are always missing something, usually something they can find in 22 minutes plus commercials). The attending tells them to do something procedural sounding, the word, "stat" gets thrown around, a montage of hustling and needles begins, it's pretty special.  This is not at all how our sessions go.

We stare blankly for a solid 20 minutes until an MD/PhD who has done extensive research on ARDS raises her hand and says something really brilliant like, "asthma?"
"Great!"
We all congratulate her, exchange some high fives and start to pack up..."but the fever and blood gas don't really indicate asthma".
Ok now we are in a bind.  21 young doctors in training have a fake SOB with a fever, and if we don't do something fast this patient is going to die.  Or live.  Or whatever has already been written out for him in the rest of the case that none of us have read ahead of time.  Then someone looks at the title of the workshop, "Pneumonia".
"Could it be Pneumonia?"
"Brilliant!"  The doctor says something else, but he is drowned out by the thunderous sound of high fives.  When they die down, he follows up, "Now what do we want to do for the patient?".  Aww shit, it's one of those patients.  Fine. 

I got this one.  Earlier today, I was texting and rudely interrupted by the lecturer turning the lights out so we could see a CXR(Chest X-Ray), I'm gonna go with the recency effect:
"Chest X-Ray?"

"Exactly!"  My hand becomes inflamed and erythematous (hurts) from the high fives.  So we get a Chest X-Ray. Put in the order, take the patient to radiology, set the patient up, help the tech out, get the films on disk, bring them back to the doctor.  See?  I watch medical shows too.  I actually have no fucking clue how you get a CXR.  For our cases we just turn the page and there is a picture of lobar pneumonia from our patient, who according to the picture records, was lying about his age since the CXR was taken in the 80s and suddenly has breast tissue.  And this is how cases go.  Did I mention that in a month I'm supposed to be doing this with real people?

Friday, December 18, 2009

"Let's go bro, you got this!"

The deepest voice a male can make is the voice that is used to ask another male for a spot at the gym.

Thursday, December 17, 2009

Graphic

Surprisingly accurate

Damn dude, check out that abscissa!

Note: My friend pointed out that it looks like a woman giving birth.  I'm not sure what to make of that.  I think he's sexist since the head is null set.

Tuesday, December 15, 2009

Monday, December 14, 2009

Singing the Blues


When you say you like the blue M&Ms best, what you really mean is, you like blue best.

Thursday, December 10, 2009

Affective dial

On my speed dial (because I use a dial so much now) are my best friends, my family, my landlord and that one friend who really knows when to use "affect" and when to use "effect".  Messing that up could really effect my future.

Wednesday, December 9, 2009

Let's talk about H-P-V, let's talk about you and me.

We had a doctor tell us that you spend about 3 times the amount of time in a room explaining a finding of an abnormal pap smear than you do explaining a finding of full blown cervical cancer.  This is my response to a friend asking about HPV:

HPV, the kind you are referring to, is a virus that affects certain kinds of mucosa (internal goey tissue).  It can infect other kinds of tissue and give common hand warts and other stuff, but unfortunately for everyone, the kinds of HPV people care about basically just enjoy the genital mucosa and anal mucosa.  I mean, who doesn't. Anyway, there are a whole lot of different kinds (like 130) and there are 4 that people mostly care about.  2 that cause most of the genital warts (6 and 11).  By definition, they aren't really a problem. Ugly, but not really a problem.  By  the very fact that they are causing a wart, that means they are being harmless. 

The real problem is a few other strains that like to bury themselves into DNA (because it's soft and warm and there's candy in there) and hang out causing bad changes in genital and anal tissues, with types 16 and 18 causing most of the trouble.  They can, although seldom, cause cancer (cervical and anal). 

Now it's only certain strains, mostly 16 and 18, and they only bury themselves sometimes (in general, sexually active people have a 50% lifetime risk of exposure to the bad kinds, 75% lifetime risk of all kinds), and from there, only rarely do they actually cause cancer (1.3% lifetime risk of invasive cancer).  And, the great part for us is, they only ever do so in a very predictable fashion.  That is, they move from burying themselves, to a sort of abnormal, precancerous tissue, to full blown invasive, bad cancer.  Many cancers just pop in, full blown, no warning, totally uninvited.  Cervical and Anal at least have the decency to bring a bottle of wine.

So, a pap smear checks for the presence of these precancerous tissues, and a polyposcopy (or colposcopy) is an examination (scope) of the vaginal cavity and cervix (polyp and colpos respectively.  I'm kidding, not that medical terms are that far off from the ridiculous, but if the latin term for vagina were polyp, it would give a whole different meaning to certain nasal issues) looking for abnormal tissues and polyps to sample and evaluate to see what sort of stage they at in the progression of HPV, if any.  Basically it's the next step after an abnormal pap smear.

The beauty to all this is that, when caught early, it's super duper treatable.  That's why they do pap smears.  Death rates from cervical cancer have plummeted since the pap caught on (first tried as a follow up to the macarena, then realized to be a far more potent test than dance move, particularly because of the part in the dance when the vagina is swabbed.  Went fine in Europe, didn't catch on in the US.  Americans are prude). And with the guardasil vaccine, things are expected to really turn the corner.

Tuesday, December 8, 2009

my bike ride home(less)

Some student group was raising money for the homeless and as I rode by on my bike, this guy goes, "With each turn of your bike pedal, another person goes homeless, what are you going to do about that?"  I got off my bike and walked. Boom, eat that shit declining economy.

Sunday, December 6, 2009

Reboot and rally

Updates have finished installing. Would you like to restart your computer now, while you are working on important unsaved documents and you left to make a sandwich? Or later when you would naturally turn your computer off? You have 6 seconds.

Thursday, December 3, 2009

;)

If you are ever looking to make an email request turn passive aggressive, just remind me to do something and then end it with a smiley face.  When you get a chance, can you go fuck yourself :)

Bears and Futures


While texting someone a message to make them feel better about our group's performance, I accidentally typed "whatever, I think we'll do better in the bear future" instead of "near future", but decided not to fix it, because frankly, I hope we do fare better in the bear future, that shit is gonna be rough.