KOLAHUN

Cadillac Health - You Get What You Pay For

A friend of mine does executive health exams at the University and I decided to compare the services he provides with what we do for our patient at the County clinic.  Here's what I found...

The Healthcare Assessment at County Medical Center is a comprehensive medical exam that is tailored to your age, gender and health requirements. The entire examination and analysis of test results is completed in just one day.

The Basic Assessment includes the following services:

Review of past health records

Diagnostic tests such as:

Cholesterol screening

Complete blood count
Electrocardiogram

Liver and kidney function tests

Mammogram and gynecological exam, including Pap test, for women

Nutritional assessment

Prostate screening for men

Treadmill stress test

Urinalysis

Evaluation by a primary care physician

Guidelines for health improvement

Written report of your examination with results to follow

For a few more dollars...

The Executive Medical Assessment at University Medical Center is a comprehensive medical exam that is tailored to your age, gender and health requirements. The entire examination and analysis of test results is completed in just one day.

The Basic Assessment includes the following services:

Review of past health records

Diagnostic tests such as:

Cholesterol screening

Complete blood count
Electrocardiogram

Liver and kidney function tests

Mammogram and gynecological exam, including Pap test, for women

Nutritional assessment

Prostate screening for men

Treadmill stress test

Urinalysis

Evaluation by a primary care physician

Guidelines for health improvement

Written report of your examination with results to follow

Rate My Public School Lunch

 

Here's this month's school lunch quiz, America!

Can you find the whole grains?, the vegetable?, the milk/cheese?, the oil?, the fruit?, the meat?, the metabolic syndrome?

(Hint: the white packets are part of the fruit serving, because tomatoes are NOT vegetables)

Send your answers to:

The Ministry of Information

32 Whitehall

London SW1A 2HQ

Congratulations to last week's winner, Estelle Privy of Columbus, Ohio in the US, who correctly guessed "Chef's Choice" for the menu items and that school-based physical education programs are TOO costly to support, in these tough economic times. We need that money to combat diabetes and hypertension when they become adults in the future. Forward thinking, Estelle! Forward thinking.

"AMERICA'S PUBLIC SCHOOL LUNCHES - you are what to eat."

The Ministry of Information

“more power to the misinformed”

The Weather Underground

The Minister of Information, announced today that tomorrow's underground forecast calls for an 8.2 magnitude earthquake for the San Francisco area. Fires causing widespread devastation are expected. The sky should remain sunny and clear with little chance of rain.

"Today's Sumatra is tomorrow's San Francisco. Are you ready for the weather underground?", said the Minister.

This maps of “liquefaction” zones shows what the ground in different parts of the city is made of, and gives a clue to where the ground will shake the most and where damage from a quake is most likely to occur. On a map, San Francisco may appear to be a 7 mile x 7 mile square, but here we see that blue, green and yellow mark the "real" San Francisco and red denotes the part man added later.  Most of the city is landfill (red) and sand (yellow).

Dr. William Stewart Halsted (1852-1922)

This is the Physician and Surgeon's Alamanac for September 23, 2009.

Today is the birthday of Dr. William Stewart Halsted, born on this day in 1852 in New York City.

Halsted is considered to be one of the most influential surgeons in American history.

His mother was Mary Louisa Haines and his father was the successful businessman William Mills Halsted, Jr. Halsted grew up with considerable wealth.  The type wealth that allowed him to go to Yale in 1870 where he excelled in sports, scoring the first touchdown in the Yale-Eaton game, the first football game played with a field of 11 players on each side.

Despite being a poor student at Yale, he graduated at the top of his class at Columbia and went on to have a brilliant medical career.

Starfleet Medical Blog Entry : Stardate (Neg) 313359.58

   

  

  

  

  

  

  

  

  

  

  

  

  

Cmdr. Jubei Yagyu, Chief Medical Officer, USS Tallgeese, reporting.

We have just completed our five year mission cataloging cardiac anomalies amongst the major humanoid species of the Alpha Quadrant.  Tallgeese is now heading to Starbase 78 for debriefing.

Regretably, 12 of our 430 crewmembers were lost on away missions, in combat or went missing in action during this mission.  Oddly, a significant number were engineering, communications, security and yeomen officers or "red shirts", as they are commonly called, with very few casualties among the command, science and enlisted staff.

Noticing similar findings for other vessels in Galaxy Exploration Command, I reported my findings to Starfleet Medical, but have been advised by Public Relations Command that such finding have been vigorously studied in the past and were found to be purely coincidental. Millitary Intelligence Command has asked that I not pursue the matter further.

END TRANSMISSION

Always Remeber, "Empty Beds = Empty Heads"

When the inpatient case load was pleasantly light, we giddy, smiling residents would always hear our attending say, "Empty beds equals empty heads".

And now, I say it to my residents who think physicians-in-training are luck to have few patients to care for...that is, to learn from.

Medical aphorisms, or briefly stated truths conveying wisdom, still come in handy and are as old as the practice of medicine. Who hasn't been told that "all that wheezes is not asthma", "when you hear hoof beats look for horses, not zebras" or "WNL" means 'We never looked'?  Here's a list of some I often use and some more famous ones I found surfing the net.

Now if only I coud get them into these cookies!

How to be a Celebrity Physician

 

 

 

 

 

 

 

 

  

Let’s face it…like a star of stage or screen or TV, you are instantly recognizable to a small group of people, some you don’t know and others whose names you struggle to remember.   People will wait months and sit for hours, just to see you and sometimes – by appointment only.  Many may know your work and feel a personal connection to you, yet they know very little about you. They are used to seeing you in character and costume, but when they see you out on the street or in a restaurant– they “can’t believe it’s actually you!!!!”

You’re not just a doctor to your patients, but a celebrity to your public. Better get used to it.

Multiple Choice

Which country spends the greatest percentage of it's gross domestic product (GDP) on health care?

 

A) France
B) Marshall Islands
c) United States
D) Switzerland
E) Canada

 

  It's a trick question...

A drop at a time

It has been a while, but I founly re-found the magic calculation clinicians used to use before the invention of the automated 'drip' in administering intravenous liquids (fluids and medicine). 

1ml = 15 drops. 

So simple.  Guess I didn't google hard enough. 

Sri Lanka - a primer

As it happens, I'll be posted in Sri Lanka for the next three months.  I strongly suspect, that it'll be longer than three months because of the horrific conditions there.  Anyway, as a primer on the conditions in that country, I figured we'd start our journey together with the geography.  Needless to inform many of you, the conflict in Sri Lanka is between the native Sri Lankans' and the Tamils who immigrated from southern India.  Here are maps of both India (where you can see the proximity of Tamil Nadu to Sri Lanka) and Sri Lanka itself, an island a stone's throw away from India (and a walk/fly from India according to mythology).  Click on the images to enlargen them. 

My Favorite Martial Art Movies (so far...)

 

Achieving new heights in procrastination this weekend, I put together this list of my (16) favorite martial art movies for those of you looking to waste some time, too.
I've included a few comments, theatrical trailers (if you have time) and a few clips (if you don't). Almost all the full length versions are on YouTube, in divided parts, you kmow. Maybe I'll do my top ten movie list next time...
 
 
Seven Samurai 1954  Japan
Yojimbo 1961 Japan
As you can see, both perfect.
http://www.youtube.com/watch?v=YQMthIvFaOU
 
Fist of Fury (US Title: The Chinese Connection) 1972  Hong Kong
Bruce Lee's work speaks for itself...
http://www.youtube.com/watch?v=59J-IJwAVIw
http://www.youtube.com/watch?v=mjTmSvrCM2Q

Reduce Medicare Costs - Drink Soylent Green!

At 12% of the population, the over 65 age group accounts for 30% of aggregate health care spending in the United States. In 2004, the U.S. spent $1.85 trillion on health care, or $6,319 per person, but US per person personal health care spending for the 65 and older population was $14,797 in 2004, 5.6 times higher than spending per child ($2,650) and 3.3 times spending per working-age adults ($4,511).

Acute hospital care in the last two years of life accounts for over half (55%) of the spending for Medicare beneficiaries. Health care expenditures are expected to continue to increase as baby boomers begin qualifying for Medicare in the next decade. What's the solution?

Yawn

The involuntary opening of the mouth with respiration, breathing first inward, then outward.  Some people believe that it is a reflexive deep inhalation caused by decreased oxygen levels in the blood.  You take a deep breath and fill the largely unused portions of the lungs. That makes sense, cause when you’re tired and all, it’s probably because your oxygen levels are low. But it doesn’t clearly related to why certain medical conditions tend to be linked to yawning, excessive yawning in particular…

                                                                                                       

Neglected Diseases: Infectious Zombiism

Main navigation Home About WHO Countries Health topics Publications Data and statistics Programmes and projects EPR Home Alert & Response Operations Diseases Global Outbreak Alert & Response Network Biorisk Reduction

Epidemic and Pandemic Alert and Response (EPR) Country activities | Outbreak news | Resources | Media centre WHO> Programmes and projects> Epidemic and Pandemic Alert and Response (EPR)> Diseases covered by EPR> Infectious Zombiism   Main content Overview Infectious Zombiism is one of the many diseases of humans, which result in an animated corpse or mindless human being, both with the desire to eat human brains, flesh or both.   The first pandemic was believed to have started in 1968 in a Pennsylvania farm town on a budget of $114,000, it grossed $12 million domestically and $30 million internationally. 2.5 billion people live in areas where zombiism can be transmitted, mainly in developed countries. The geographical spread of both the zombie vectors and zombies themselves has led to the global resurgence of epidemic zombie outbreaks and emergence of zombie hemorrhagic fever (ZHF) in the past 25 years with the development of hyperendemicity in many urban centers of the United States.  In recent years, infectious zombiism has become a major international public health concern, surpassing other forms of zombiism such as voodoo zombiism (witch-doctor mind control), reanimation (scientifically proven), sittin’ in a cubicle making money for the Man! (Boooooo!) Infectious Zombiism is one of the most common undead-borne diseases of humans, exceded only by vampirism and neo-conservativism.   All three result in cannibalism.

Cotton-pickin' Primary Care: the growing reliance on a minority labor force.

    

Across the health care system, in for-profit, non-profit and government primary care centers, the pressure is on primary care providers to use the same limited time and resources that they've always had to deliver preventive care, chronic care, acute care, evidence-based care and charitable care to an increasing number of patients, who bring with them increasing demands and expectations for medical care.  As the US population ages and the prevalence of chronic diseases such as heart disease, diabetes and hypertension increasing, the burden of proving patients with comprehensive management solutions to their health problems will also be greater.

 

One of the leading thinkers of primary care reform, Dr. Thomas Bodenheimer, a professor at the Center for Excellence in Primary Care in the Department of Family and Community Medicine at the University of California, San Francisco, asked in his August 2006 New England Journal of Medicine Perspective editorial on the decline of primary care, "Who might support a national policy to rescue primary care?"  Well…we kinda already have a lower-cost policy solution: Let the minorities do it.

O Mundo Lusophone

Você sabe em quais paises se fala Português?  The list of countries follows the break...there are 9 countries where Portuguese is the official language.

O Re-iniciado com Cervical Cancer

Peço a descuple de todos, mas ninguém escreveu neste blog desde Janeiro 2009.  Não sei o que aconteceu com Jubei, mas para mi, tenho ficado nos últimos nove meses aqui em Moçambique..

...learning Portuguese and working on a PEPFAR funded rural HIV project.  Perhaps we'll deconstruct the process and experience as we go along.  There's a lot to praise and criticize, both within the PEPFAR world, the international NGO context and with the country of Moçambique itself. 

But for now, perhaps it's better to just jump into the world of 'articles-i'm-stunned-by'.  This week the New England Journal of Medicine published a Gates Foundation funded study of the best way to screen for cervical cancer in low-resource settings.  They followed about 130,000 women in villages in India and tried to find out which of three methods of screening would save lives.  In the end, they found that a one time screening for HPV, the causative virus of the vast majority of cervical cancers, after the age of 30 worked best amongst the three methods (the other two being normal pap smears and a simple staining method called VIA). 
 
A related editorial from two National Cancer Institute physicians argues that this study is so persuasive, the international community should 'now adapt HPV testing for widespread implementation.'  That seems premature.  This is still only one study.  And we're not sure what modifications or errors will soon be unearthed.

That being said, there's a few of impressive aspects to this study we should note while we await further confirmation and validation.  First, the study studied 131,746 women over 8 years in India.  That's stunning.  Over 130,000 women!  In India...in villages.  Most uneducated (70% without formal education) and most working at home (60%).  The logistic achievement of following, screening and treating 130,000 is almost incomprehensible. 

Sayonara, Japan...I'll be in my room.

The best word to describe the color green, is the word "blue".  The best Japanese word, that is.  Japanese word "Aoi" which translates to the English word "blue",  was orginally used to describe things in Japanese that were green.  For this reason, green apples are called "aoi ringo" in Japanese, which literally means "blue apple" when translated into English.

Interesting things like that come up in Japanese class, all the time. Like last week when I met a guy who had just spent 3 months in Japan working for the New Start Foundation, providing social services to "shut-ins".

"Shut-in", like "blue apple", doesn't really capture what the Japanese mean to say and what the non-speaker thinks they hear.  When this guy said "shut-in", I thought of elderly people who can't get around like they use to, so you have to knock on their door to check on them.  But he could tell, I wasn't getting it...I really had no idea.

Japan's shut-ins are not the elderly abandoned by others, they typically are the young people who have abandoned society.  The best word in Enlish I could think of was "loser"; but, as my new friend explained, it was more complicated than that and more serious than it sounds.

The Death Certifcate - getting the last write right

Sooner or later your gonna need one of these, too, and some of us have to fill them out; but few medical training programs formally review the correct way to document the certification of death.

Death certificates vary from state to state but most ask the certifier two main questions...

Qusetion 1: THE MANNER OF DEATH - The Easy Part
Was the death natural, accidental, intentional or worth investigating
Natural Causes - both a physican or medical examiner (coroner) can certify this type.
Only a coroner can certify...
Accidental deaths
Homicidal deaths
Suicidal deaths
Violent deaths 
Unknown or uncertain causes of death
Deaths related to surgery or anaesthetic
Deaths within 24 hours of admission to hospital

Question 2: THE CAUSE OF DEATH - The Hard Part (...or three parts, as it were)
1) Immediate Cause of Death:
The final disease or condition that resulted in death, usually the most recently developed (Myocardial Infarct/Pulmonary Embolism, for example).

2) Intermediate cause of death: 
The disease or condition that preceded and caused the immediate cause of death. (Coronary Artery Disease/Fat Embolism).

3) Underlying Cause of Death:
This is the original, fundamental etiologic disease or condition from which the remainder of the cuases of death originate; usually diagnosis of longest duration in clinical course leading directly to death (Hyerpertension and Dyslipidemi/Femur Fracture).

Once you've answered #1, it helps to think a bit before answering #2 and follow some guidlines....

the art of Yasuda Yukihiko

 

BIZARRO WORLD

 

With Obama’s victory, America has turned a page in its history of race relations.  For the first time, the voters put aside race to elect the best person to the highest office in the land, based on the content of his character and the strength of his ideas.  The public proved more comfortable with the idea of a brown face looking back at them as their leader. Young people, especially black kids, can now truly believe that they, too, can one day grow up to be president.  The world bears witness to a dream that is alive and well.                                                                                                               

 

In another universe, one that lies close to and moves parallel to ours, national history has not been made. In that universe, the bizarro universe…Obama looses. But they don’t envy us.  Living there is not so bad.  For it is like our universe was, not so long ago…  

 

Coffee Prince

    

Eun Chan doesn’t realize that Han Sung is into her. While listening to music at his place, he kisses her but doesn’t get the response he wants. Then Eun Chan is in Han Gyul’s car and they are fighting. At the coffee shop they ignore each other, sometimes Han Gyul picks on Eun Chan. She’s crying and it’s Han Sung who tries to comfort her.

I don’t know why Han Gyul gives her such a hard times, but after he yells at her and drives off in his car the flash back sequence explains it all…"how she cried in his car earlier that day… how he tied her apron… how she blew air in his face while he slept"…He turns around, races back, says something to Eun Chan in Chinese, moves in, stuns her with a kiss, and pauses long enough for Eun Chan to think...and she kisses him back.

Later on I figure out that Eun Chan is pretending to be a boy, but missed the episode where Han Gyul finds this out and realizes that he's not as gay as he was lead by his affections to believe.

Since it’s all dubbed in Chinese, it took me a while to find out the name of the show and even longer to find out the characters' names, not mention the finer details of their relationships (Han Sung and Han Gyul are cousins..) - but I race to be home by 8pm to see the next episode of my favorite Korean soap opera.

OBAMA DEFEATS MCCAIN*

*from our “You Heard It Here First” Department…

History will remember this as the headline photographed next to the smiling face of the triumphant US presidential candidate, Senator John McCain, following his surprise victory over his Democratic rival, Senator Barack Obama in November 2008.

Despite the latter’s seemingly insurmountable lead in the polls and in electoral vote estimates, even on Election Day, McCain was able to sweak out victory through a series of legal challenges and courtroom decisions that called into question and ultimately changed the results of the General Election that favored Obama.

Scores of newly registered Democratic voters proved to be no match for the team of newly hired Republican attorneys who met them at the polls.  Vote counting machines in key states and municipalities, used to avoid the vote counting errors of the 2000 election, failed to reflect votes in 2008 as they did in 2004. And in some places, Democrats, believing they had enough votes, stayed home denying their candidate a clear victory.

President McCain, thereafter presided over the great economic recovery of the 2010's, the histoic Israel-New Zealand Peace Accords, Samoa statehood and was later succeeded by his Vice Presidnet, Joe Leiberman.  Senator Obama later retired from the US Senate and won a Grammy for his voice recording of children’s books and, in 2010 the Nobel Peace Prize for his work on inspiring CHANGE.

The Ministry of Information

“more power to the misinformed”

from a poem by Sylvia Plath

Trailing its telltale tatters only at the outermost
Fringe of mundane vision, this ghost goes
Hand aloft, goodbye, goodbye, not down
Into the rocky gizzard of the earth,
But toward a region where our thick atmosphere

Diminishes, and God knows what is there.
A point of exclamation marks that sky
In ringing orange like a stellar carrot.
Its round period, displaced and green,
Suspends beside it the first point, the starting

Point of Eden, next the new moon's curve.

How to Wash Your Hands

Some people I know love putting that hand sanitizer on.  But not me! Give me that ole' fashioned soap n' water to kill the germs - and the Centers for Disease Control agrees. 

When hands are not-visibly soiled, a 60% or more alcohol-based hand sanitizer is recommended (by the FDA) with soap and water as an acceptable alternative.

"More questions than answers": With rising healthcare cost in mind, how much sense does it make to purchase hand sanitizer and install them in dispensers next to a sink with soap and water?

CDC Recommendations

A.When hands are visibly dirty or are visibly soiled wash hands with soap and water.
B. If hands are not visibly soiled, use an alcohol-based hand rub or an antimicrobial soap and water.

Do Nurses Eat Their Young?

   

I heard this for the first time, just recently, that being the new nurse on the floor often times means you’re persona non grata in the nurses' break room.  New nurses often find a hostile environment waiting for them in the world of healthcare – created by their fellow, more established nurses.

Some will mislead you, set you up to fail, offer little support or guidance or pooh-pooh all that new mumbo-jumbo about patient-centered care, health management teams and primary care homes you learned in school.  Some will just be mean, cause that's what happened to them, that's what's gonna happen to you, that's how you learn, that's just the way it is. How’s a new nurse to survive?

In our home: God, Jesus and Jimmy Carter

       

"A strong nation, like a strong person, can afford to be gentle, firm, thoughtful, and restrained. It can afford to extend a helping hand to others.
It's a weak nation, like a weak person, that must behave with bluster and boasting and rashness and other signs of insecurity."

Georgia Governor Jimmy Carter, New York City, October 14, 1976
39th President of the United States of America (1977-1981)
Born on this day in 1924.

The Fed to Americans: Don't Buy Stuff You Can't Afford

   

The US Federal Reserve Bank, responding to news that federal government will soon be unable to afford any more corporate bailouts or Central Asian wars or bridges in Alaska without significantly raising taxes and/or increasing foreign debt, has stepped in, for the first time, in asking the government and private citizens to stop buying stuff they cannot afford.

Citizenship, is it in you?

   

A friend of mine teaches a citizenship course at City College and he tells me people are freaking out because a new version of the citizenship comes out on October 1, 2008.

The old test was 10 questions taken from a bank of 100, found here..

http://usgovinfo.about.com/blinstst.htm

I took a sample test on the MSNBC website...

http://www.msnbc.msn.com/id/13442226/

I got one wrong. F****** Supreme Court questions!

Just for kicks, I took online sample tests for citizenship for some other countries...

Perseus and Andromeda, by Paolo Veronese, 1584.

         

Here we see Perseus flying to the rescue of Andromeda, with what apears to be... downtown Cincinnati, in the background.

Before the 2010 remake comes out, I suggest you see the original "Clash of the Titan" (MGM-1981).

Some might complain that a CGI remake of the live-action, stop-motion-animation classic retelling of Greek legend is in poor form, but even the original movie was a "reimagining" of a Greek myth, that has been revised and retooled several times over the centuries.

In the 1981 movie, for example, Perseus (not Bellerophon) flies on Pegasus (not winged shoes) slays Medusa (from who's neck (or blood) Pegasus was born) and then uses the head of Medusa (not his sword) to save Princess Andromeda from (not Ceto, but) the Kraken (a sea creature from NORSE(!) mythology).  The movie doesn't go into how Perseus then goes on to use Medusa's head to turn anyone who gets into his way to stone, until Versace comes along and restores her to beauty just in time to use her head as his corporate logo. And so, the legend continues.

   

The new movie will probably take more liberties, but hopefully it will continue interest in Greek mythology in 2010 as it did in 1981.  As long Perseus never exclaims, “By the power of Greyskull!”, I think a remake should be OK.

But see the ’81 version…Lawrence Olivier, Maggie Smith, Burgess Meredith, Harry Hamlin…it’s a classic!