September, 2008 Archive

September 23, 2008, 10:00 am

And One More For the Road

Man, you know you are an American icon when your face is painted on the side of a Las Vegas hotel!

Checked to see what the tickets would be…


Um, while I’ve seen Barry Manilow at least 8 times between 1976 and 1979, no way was I going to pay that much money.

I would have paid it, however, for Tony Bennett. I’d have paid even more.

I would have taken out a second mortgage, if I’d have had to.

But he was only there on Friday and Saturday.

I missed it.


This was totally cool!

It’s just a bar in the Vegas airport, but it’s a Budweiser bar!

Meaning lots of Kasey Kahne all over the place!

No, I didn’t stop for a drink.

But…what a great place to watch a race (next to the NASCAR cafe, of course!).


Tomorrow at 0600, my nursing cap goes back on as I travel to the ENA conference in Minneapolis, Minnesota.

Actually, I’m going as “media”, because I’m a blogger.

I better put on my “journalist” hat, too!

Just as being around a group of bloggers is inspiring, it is no different when a thousand ER nurses get together.

It’s electric!

I expect I’ll have plenty to blog about for quite awhile after this trip!

As for now, I have, literally, hours of homework and reading to catch up on!

Must. Turn. Off. Computer.

In a minute…..

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5:51 am

Grand Rounds 5:1 – In Your Own Words


Didn’t expect to see Grand Rounds here?

Let’s just say I’m having a friend over to celebrate an anniversary!

Welcome to the party; I’m sure you know my friend.


Grand Rounds 5:1 – In Your Own Words

Welcome to the historic, 5th year anniversary of Grand Rounds, the weekly summary of the best of the medical blogosphere. As the proud new co-leader of Grand Rounds, I am committed to expanding its reach, promoting the Grand Rounds “brand”, and making sure contributors’ voices are heard by healthcare’s movers and shakers.

This day happens to be historic for me as well, since I have just taken the leap into blogging independence. I am excited that “Dr. Val and the Voice of Reason” lives on at the Getting Better Blog. I am committed to integrity, transparency, and medical accuracy – presented in a warm, and down-to-earth manner. Unfortunately, my new site is not live yet, so KevinMD and Kim from Emergiblog have graciously allowed me to crash guest blog at their sites for this edition of Grand Rounds.

I’ve chosen to present the submissions in their authors’ own words – the purest form of expression. I selected my favorite quote from each blog post, and organized them topically with an introductory cartoon of my own. The order in which they appear reflects the order in which they were submitted. Asterisks denote exceptional story-writing (IMHO).

Thank you for reading – and please consider supporting Grand Rounds by featuring its new button on your blog or website. Health bloggers have a collective voice – it is Grand Rounds


The Healthcare “System”

Dr. Wes, Our Healthcare Hindenberg: I wonder how any health care system, much like the foregone housing market, can sustain itself with our current similar mindset of universal, limitless healthcare for all…Like the 12-step program for Gambler’s Anonymous, we must first acknowledge we have a problem and are addicted to shiny objects, the opulent, and the whizbang. Only then can we start to recover from our healthcare spending orgy.

Dr. Rob, Holes In The Bottom Of The Boat: Simply put: any system put in place must have a means of cost-containment – something that is missing from most plans. It is as if we are talking about getting a bigger bucket to bail the boat rather than patching the holes in the bottom of the boat that are spewing money. Any system in place that does not contain cost somehow will fail.

Doc Childneuro, Those People, Insurance companies have a motive to charge or exclude the smokers and the obese. It turns out they have the same motive to exclude those with Cerebral Palsy and Multiple Sclerosis. This motive applies to any family with cystic fibrosis or sickle cell disease, or an entire host of genetic disorders.

Louise, Domestic Medical Tourism, Large employers are increasingly interested in networks that allow their employees access to hospitals all across the country, providing a much wider range of cost and quality of health care options for their employees. Large employers have bargaining power, and some have already struck deals with foreign hospitals, which they’re able to use as leverage to bargain down the prices at domestic hospitals

Allen Roberts, Transfers: And, the hard and ugly truth: transfers have allowed a lot of very dysfunctional hospitals to stay open, IMHO. A hospital cannot get Ortho coverage for the myriad reasons specific to that specialty? Well, just transfer them to a hospital that does. In this way, bad hospitals (administrators and medical staffs alike) aren’t confronted with their failures, their failures are transferred. The inadequate hospital now doesn’t have to face angry patients and their families for their inability to manage their medical staffs, they just defer their responsibility to those who are just that: responsible.

Bob Coffield, HIPAA: Can you release medical information to family and friends? The Office for Civil Rights has issued new guidance for providers to follow when assessing whether or not they should provide protected health information (PHI) to the friends or family of a patient under HIPAA Privacy Rule 164.510(b).

Kim, Wheels Are Turnin’ – Blog World Expo, 2009: It’s not “maybe” anymore. We’re on. Put in your vacation requests. Get a passport if you need one. Sign up for those extra shifts. Arrange for coverage while you’re gone. October 15 – 17, 2009, Las Vegas, Nevada. The medical/health blogosphere will have a full track of presentations at BlogWorldExpo09. The missing ingredient is you.



David Williams, Obama v. McCain on health care. Part 4: Premium subsidies and tax changes: Obama’s plan would be better than McCain’s if enacted as described, because it would reduce the number of uninsured while McCain’s plan would have the opposite effect. However if McCain’s proposal led to a cap on employer deductibility as a compromise – which seems likely – I’d favor it.

Hank Stern, Mo Money: The government doesn’t have any money of their own. Businesses do not pay taxes (or civic rent).The government derives income from taxpayers. Businesses derive income from customers. Bottom line is, we all pay.


Being A Doctor

PalMD, So Would You Do It Again? : The financial stresses of being a young doctor (including starting a practice, having a family, caring for patients, etc.) are tremendous, and our system pushes the talent away. Still, for people who love medicine, love other people, love to wake up every morning knowing that you are making a concrete difference, the sacrifice in time and money is worth it.

Vitum Medicinus, Join me on my first on-call shift, and find out why I slept so little:

5:21 pm ::: Fell asleep on the toilet while eating a granola bar.
5:36 pm ::: Woken up by a patient who claimed I was sleeping in
his bathroom

Bongi, Sign: He swung his hand back with the index finger extended briskly in the sign demanding the scalpel. The prof threw his hand onto the scalpel’s point. I imagined an old Japanese warrior throwing himself on his sword.

Bruce Campbell, Uncertainty: My vacation had ended up delaying his surgery by several days. I could not deny that.ËœOh, Doctor, I was so certain that the cancer would have grown too large for surgery by the time you got back into town! I was certain that he would die!

Dr. Shock, Emotional Intelligence and Medical Education: The nurse-rated patient doctor relationship (PDR) and the Emotional Intelligence (EI) score for the doctor were positively associated with patient trust at a significant level. A doctor’s self reported Emotional Intelligence did not correlate with patient-rated trust, or the patient rated quality of the Patient Doctor Relationship.

Dr Skakhi, You’re Not A Real Saffa [South African] Doctor Until You Have: Seen worms exiting the human body via anus, nose, mouth & laparotomy; cauterised warts the size of cauliflowers; stopped wearing a mask around TB patients (pregrad).

Joshua Schwimmer, The Medicine 2.0 Congress: The first “Medicine 2.0” Congress happened on September 4 – 5 in Toronto, Canada. You’re justified in being confused by –or even skeptical of — any concept released under the version number “2.0” (or, even God help us, “3.0”). But the people who gathered under the flag of Medicine 2.0 early this month are actually doing interesting work.

Jeffrey Leow, House 106: The Socratic Method: Why are specialists doing this U/S and interpreting them? What was the radiologist/US technician doing?

Dr. Cason, The Ugly Side of Being a Doctor: I’ve resuscitated babies in a Walmart and a pizza joint. I’ve run to multiple car accidents and performed the Heimlich in restaurants. I answer questions daily for readers, friends, neighbors and strangers. I keep an otoscope charged in my kitchen. I make house calls and advise friends. I have two websites. I make no money but dream of funding humanitarian missions. Because I have time and medical knowledge, I hope to use it well.


Diagnostic Conundrums

Allergy Notes, Allergy to Wine? Correct Diagnosis May be Wine-Induced Anaphylaxis and Sensitization to Hymenoptera Venom: Wine contains many contaminants. Some of them come from Hymenoptera insects that fall into the wine when grapes are collected and pressed. We have found patients with allergic symptoms related to wine consumption who are sensitized to Hymenoptera venom without previous stings.

Laika Spoetnik, Nursing Myths (1): Post-operative Temperature Measurements. Routine temperature measurements in post-operative patients have a very low sensitivity, a low positive predictive value and meaningless likelihood ratios.

Robin S, Fiona Apple may just have it right…: Pituitary tumors have a large spectrum pathology. These “little buggers”may cause large problems, also.

Patient Education & Perspectives

Sudeep Bansal, MD, Gray’s Anatomy Vs Real Doctors: There is a lot of inaccurate information on television. According to this survey people remember health information imparted on TV, probably more so than given to them in their doctor’s office.

Rachel Baumgartel, Heroic Diabetes: Jay Cutler hasn’t seen too many negative comments around Denver media – if anything, it is portraying him as the heroic diabetic (if any mention of his new condition is made at all). His health was starting to decline last season, but could that really be the only reason the Broncos declined as well?

Clinical Cases, Google founder Sergey Brin starts a blog, shares he’s at risk for Parkinson’s disease: Sergey shares that he has a mutation in the gene LRRK2 which carries markedly higher chance (in the range of 20-80%) of developing Parkinson’s disease. He says, ‘This leaves me in a rather unique position. I know early in my life something I am substantially predisposed to. I now have the opportunity to adjust my life to reduce those odds (e.g. there is evidence that exercise may be protective against Parkinson’s). I also have the opportunity to perform and support research into this disease long before it may affect me.

Amy Tenderich, Five Things I Learned About HealthDesign: There are so many people with diabetes (and other burdensome conditions) out there struggling just to make ends meet. Fancy new technology is not helpful for people who have no access to it.

Julia, Nomenclature: Why isn’t there a better nomenclature for something as life-altering as fatigue? Ideas, anyone? I’ll start:

  1. Phylum: ‘lying-on-the-couch-like-a-giganticus-slugiae’
  2. Class: stinkus-maximus-no-shower-for-two-daysium.’

*Kerri Morrone Sparling, Twenty-Nine: Some people will say that being diagnosed as a kid is easier because you grow up with this disease [diabetes] and it becomes your “normal” without much effort. Others say that an adult diagnosis is easier because you have decades without the disease, thus maybe lowering changes of complications. From my perspective, I can’t even wrap my head around an adult diagnosis. I only know what I know.

Laurie Edwards, The Words We Use: Language and the Patient Experience: For patients who have struggled with diagnosis for years, finally having a name for their symptoms can be incredibly validating. It also confers membership in a community of patients with the same symptoms and struggles, which, given the isolating nature of some chronic illnesses, is important.

Dr. R, The Sandwich Generation: I already knew that I was in The Sandwich Generation; where I have to care for both my aging parents and my own children. But I did not know that I was in The Sandwich Profession; where a primary care physician could be sandwiched into the smallest possible space in a humongous building.

*Barbara Kivowitz, Putting Illness in its Place: Betty & Peter’s Story of Pancreatic Cancer: Couples dealing with illness understand too well how illness turns a relationship of equals into one of patient and caretaker. Autonomy slides into dependency; activity is regulated not by interest but by stamina, and time gets measured by intervals between medication doses.


Health Tips

Ramona Bates, Graduated Compression Stockings: Graduated compression stockings are useful in preventing deep venous thrombosis (DVT). Like many things, they only help if used and if used properly. A recent study showed that up to 26% of patients had the wrong size stockings.

Jolie Bookspan, Getting The Right Yoga Medicine: In modern life, it is common to sit too much. The answer is not more sitting, but to get up and stretch the other way. The concept is not just mystic yoga, but common sense.

Paul Auerbach, Farewell To Outdoor Falls: Mountaineers fall from precarious ledges, youths fall from slippery rocks near the edges of waterfalls, rock climbers fall off boulders, and hikers get dangerously close to the edge of poorly maintained trails, from which they plunge into canyons.

Dean Moyer, Back Pain And Anger: Over 60% of the people surveyed were feeling somewhere between irritable and downright hostile just prior to the bonehead move that earned them a ride to the ER.

FreshMD, Wet Nurses: A wet nurse is a woman hired to breastfeed another woman’s baby. Having fallen out of favour in the Western world around the end of the nineteenth century, wet nursing has recently been making a small resurgence. Women who want their child to benefit from breast milk, but want to return to work full-time and don’t want to pump, for example, outsource the nursing to the hired help.

Nancy Brown, The Importance of Family Dinners: If you could reduce the chances that your child would smoke, drink, use illegal drugs, misuse prescription drugs, and have friends that did those risky things – all in less than an hour a day – would you do it? Of course you would but the research suggests that less than 60% of families are doing it – and you actually only have to do it five times a week to enjoy the benefits. I am talking about family dinners – at least five times a week – how easy is that?


Next week Grand Rounds will be hosted by Monash Medical Student. Be sure to submit your best posts to him this week! If you’d like to be sent more information about Grand Rounds, please email me at “valjonesmd at gmail dot com”.

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September 21, 2008, 10:47 pm

Wheels Are Turnin’ – BlogWorldExpo 09

It’s not “maybe” anymore.

We’re on.

Put in your vacation requests.

Get a passport if you need one.

Sign up for those extra shifts.

Arrange for coverage while you’re gone.

October 15 – 17, 2009, Las Vegas, Nevada.

The medical/health blogosphere will have a full track of presentations at BlogWorldExpo09.

The missing ingredient is you.


The luncheon was great – ten of us were present, they put out enough food for fifty!

But we did more than eat. We talked. And brainstormed. And realized that we had more than enough topics to cover eight sessions over two days.

We tried to think of as many areas of the health blogosphere as possible. We looked at the suggestions made on Doctor Anonymous’ BlogTalkRadio show.

We tried to provide unique content and not duplicate what is already offered at the Expo: basic monitization, basic blogging, traffic, SEO optimization, dealing with spam and trolls, etc.


And so….drum roll, please…here is the very first, hot off the press list of topics that our group was able to debate, discuss and deliver for your perusal. Remember, this is a tentative look at what the med/health blogging track could look like in ’09.

We tried to include patients, health bloggers in general, doctors, nurses, med and nursing students, medics, administrators, and corporate health care bloggers.

(PS – the descriptions are mine at the moment so if it sounds goofy, consider the source!)

  • The Danger Zone – How to Stay on the Good Side of HIPAA (possibly including debate on transparency vs. anonymous blogging, pearls and pitfalls of blogging about work or your life as a patient, how much information is too much information) – possibly a panel?
  • Blogging on Drugs – Legal and Regulatory Issues Pertaining to Pharmaceutical Companies and medical bloggers
  • Blogger’s Block – How to Keep the Passion in Your Posting (I’m am SO into this one! Not that I’m trying to influence anyone. Or anything.) For ALL health-related blogs.
  • Bloggin for a Livin’ – How to Leverage Your Expertise (For ALL health bloggers)
  • Corporate Social Media in Healthcare – The big companies and hospitals are blogging; what issues do they face and how do they get their information out there?
  • Health Policy Issues – need I say anything more than this is two weeks before the election? This one affects ALL health bloggers. It literally BEGS for a panel discussion. I suspect lively interactions here!
  • Walk Right In, Sit Right Down – Networking Inside/Outside the Health Blogosphere (what’s out there for us, probably good for newer individual health bloggers who aren’t familiar with GR or CoS and for established bloggers who haven’t taken advantage of what the social media “outside” the medical blogosphere can do for them)
  • Let’s See How Far We’ve Come – a look at the state of the medical/health blogosphere; Where we’ve been and where we are going; who were the pioneers of the genre?
  • Skeptics Circle – a great idea by Dr. Val to include our fellow bloggers on the platform; we did not get a chance to flesh this one out, but I’ve been looking at their carnival and there are very interesting posts there! Perhaps a panel, a talk on what makes a “skeptic” blogger and are we all “skeptic” bloggers at heart < — just brainstorming online here.
  • Blogging for Change – no, Obama won’t be speaking (unless he would! Hey, I’m thinking big.) Actually, I found this one deep in my notes. How to use the blogging platform as a vehicle for activism/change/revolution in health care.

Okay, so there it is!


How’d we do? Did we hit the jackpot or do we need to go back to the ATM (you can tell I’m still in Vegas)?

Obviously we have eleven topics and eight slots (no pun intended), so there will be a poll placed shortly where you can vote for your favorite eight.


The logistics are still being worked out as I’m writing. As I get more info I will post it.

I can’t stress enough how grateful we are for the support of Rob Halper at Johnson & Johnson for helping us make this a reality (and derailing my weight loss efforts at the same time!) Thanks again, Rob!


We need to get the word out! I’ll be compiling an email list and I’ll be working on contacting as many patient bloggers as I can – we need their input.

Word of mouth is good, word of post is even better.

This has the potential to be HUGE.

I can’t believe it’s really happening!


You never know where you will find a med blogger.

One of our guests, Leslie, was a health blogger whom we met at the conference. Shellee and Laurie are cath lab nurses who run a woman’s site that often deals with health related issues. Shellee reads Emergiblog and found out about the luncheon. All three were a great asset to the meeting and we were happy to meet them!

The networking possibilities here are amazing!

You won’t be disappointed!

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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