MDOD

Stupid Woman Faked Attack

No, she wasn’t assaulted by an irate Obama supporter. Good. Bad for McCain, good for the poor schlub who might have been dragged in for questioning. Idiot woman. She should go to jail.And from a physician’s perspective here’s something I missed, perhaps in my desire to think the worst of the other side which is, according to my beliefs, a sin, and for that I am sorry.

Take a look again at her picture. Imagine being her assailant. Imagine you are being assaulted. Hard to carve a letter in someone’s face with them screaming and fighting. Especially hard to do it without breaking the skin. Shit. Stupid of me. My sincere apologies.

With my apology out there I will add this… We do sexual assault exams in the ER for cases of alleged rape etc… If you are an ER doc and you have a different experience than this then please chime in… I estimate that about one in ten of these exams goes to trial. Why? because the other nine are just like the above story, or go something like this…

Me: So, tell me what happened so we can make sure you are okay.

Patient: Well, I went dancing with my friends and drank a gallon of vodka. Today I woke up and my head hurt and my pants were on backwards… I think I may have been raped.

Peryorbital Ecchymosis and Traumatic Tattooing (on the campaign trail)

The victim of this assault will probably recover fully and without scarring. If there is a persistent scar there is hope that with proper treatment that it can be faded or altered in such a way as to make it almost unnoticeable. Luckily no one was hurt in Minnesota, just some property damage is all. And really, this thing up in NYC is just a lark… nothing but a lark.

Traumatic tattooing is hardest to fix properly in motorcyclists who are not adequately protected against road grit and grime (full leathers for instance and a helmet). The challenge, and the pain, comes from properly cleaning these wounds, and, in the case of ground in road matter conscious sedation is often needed. Conscious sedation can be read about in another case here.When one has to remove ground-in road grit a plastic bristled sponge is used along with wound irrigation under pressure. Meticulous wound care is also needed to insure infection prophylaxis.

Periorbital ecchymosis is doctor-speak for a ‘black eye’. It both eyes are involved it raises the possibility of a basilar skull fracture which complicates management and can be life threatening.

Traumatic iritis is probable here, and there may or may not be an orbital blow-out fracture. On exam traumatic iritis and accompanying corneal abrasion would be picked up by flourescein uptake on wood’s lamp exam, and a constricted pupil on the injured side.

A “blowout fracture” would be picked up on physical exam by a lateral gaze palsy and would likely be seen on plain Xrays and almost certainly by CT Scan. These often require surgical correction with plating of the fractured orbit to allow conjugate gaze.

Now it may well be this alleged assault is a fraud of the Tawana Brawley type, the point has been made that it may have been self-inflicted. Such self inflicted wounds would indeed be possible and the backwards “B” either indicates it was done in a mirror, OR that the perpetrator was smart enough to do it backwards, or that he was cutting her whilst standing over her (after he punched her lights out), or that he was simply not very good with his ABCs. So far I have not seen N.O.W. demanding the perpetrator’s immediate castration, but there’s still tomorrow.

It is also possible to give yourself a black eye as demonstrated by one of the Naval NFOs shot down in Gulf War I who beat himself up pretty damned bad before capture, evidently, to prevent being used as a television propaganda dummy.

If this is a fraud it is a despicable fraud, and one that will increase the flame under the boiler. If it is a fraud then a million dollars says the MSM ties it immediately to McCain’s campaign sans evidence. If it is not a fraud, the MSM will let it quietly pass and focus on how Brave “O” is to take a tough stand against the perp and not even consider the possibility that it could be somehow tied to “O” (and I do am not suggesting it is, I’m merely pointing out the double standard).

Both candidates response’s are heartening. If Obama wins it will be interesting to see what happens to the perpetrator and if he will indeed be “swiftly apprehended and brought to justice.”

The ATM tapes would be interesting to see. If they show the guy doing it they will not be released. If they don’t they will be. If she is a fraud you will hear about it here as soon as it is proven. This story is already in the MSM as you can see from the link and I’m stunned. If some pissed-off “O” supporter really did this however, you will have to look for the story on page 43 of the NYT right behind the pig manure sales ad. Forget that, they won’t print it.

Mystery Solved

Well, we figured it out. The dog went missing for two days. Turns out she was spotted on a bus coming from a McCain rally. (see picture of her with goodie bag she got at the rally) We had a long talk with her, and now she knows not to leave the house without telling us where she is going. All this time she was doing that defecating and urinating on left wing propaganda on purpose. She actually has been following the campaign and knows the issues ( and even knows the candidates-unlike many BHO supporters -see previous Howard Stern post ). She now realizes there are better ways to express her political views and disappointment with the mainstream media, but we have come to a compromise. When she needs to go potty we say “Do you need to Garafalo, do you need to Rosie?” and she loves it. Then in the yard there is a great big cardboard cutout of Bill Maher reading the NY Times that we wash off every couple of days when it gets covered. Everybody wins.

A Great Editorial from ACEP News

October 2008
ACEP News
By David F. Baehren, MD

The United States has enjoyed the most successful and enduring form of elected government in the history of mankind. In spite of our political class being populated by some of the most unworthy scoundrels ever to run for office, our system of checks and balances has served our nation well, and we have prospered.

The genius of our founding fathers is evident in their deliberations over the writing of our Declaration of Independence and the Articles of the Constitution.

The signers of the Declaration were accomplished and serious men. Almost all were wealthy, and each had much to lose by signing his name. At the end of the document, they wrote, “We mutually pledge to each other our lives, our fortunes, and our sacred honor.” They knew the dangers they faced. Many were hounded by the British and eventually lost family, fortune, and their lives. They died, however, with the thing they cherished most still intact: their sacred honor.

Fast forward to present day, when our politicians and candidates spend more time trying to get and stay elected than they do thinking about the preservation of the republic–a republic for which so many have risked and given their lives. Our current crop of public servants couldn’t shine the boots of the likes of John Adams, Samuel Adams, Thomas Jefferson, and Ben Franklin.

An election year seems to bring out the worst in them. The dishonorable pandering that goes on is most vexing. There seems to be little talk about what’s best for the country as a whole, and lots of talk about what can be done to please this or that interest group. The latest redistribution-of-wealth scheme disguised as a stimulus package is a very good example of this kind of nonsense.

The biggest prize of all in the pandering game is health care. Some are ready to give it away to all at the expense of the taxpayers. Assuming one believes that expanding the federal health care system would actually help people, it’s easy to appeal to voters based on stories of individual hardship. How could anyone deny health care insurance to a working mother of three?

When the poster child approach is used, it becomes difficult to make an argument against a national health plan without sounding heartless. And those who are pushing for national health care are counting on this. A rational person might first ask what kind of coverage would be provided. Would it be like Medicaid, where access to care (except emergency care, of course) is quite limited, and the only guarantee is that nobody will try to collect money after the government pays 30 cents on the dollar?

Would everyone have Medicare, where money gushes like Niagara Falls? (Some of that money actually splashes at the feet of doctors on occasion.) Medicare pays for people who don’t recognize a soul or know the year to get dialysis. Ambulances shuttle patients all over creation at $500 a ride–but Medicare won’t pay a doctor a reasonable fee to make a house call. Amplify this kind of waste five times, and the budget deficit will soar. The money will dry up quickly, and then the rationing will begin. At first, it will be relatively easy, and we won’t dialyze people who don’t know what planet they inhabit. Later, choices will become more difficult, and people will wait months for bypass surgery or will be disapproved for hip replacements.

Will we allow people to purchase supplemental insurance and maintain a two-tiered system, or will everyone be forced to live under the same cash-strapped federal system? That’s the way it is in Canada. Those with means choose to come to the United States and pay out of pocket when they are put on the waiting list for surgery or chemotherapy, because they are prohibited from buying private insurance.

Americans will demand choice in their health care coverage. Just as people with money abandoned city schools 40 years ago, people will flee the federal health care system. Access to good care will be diminished for those who are stuck in the federal system and will improve for those who can afford the private system. Our elected officials may feel better for having done something to “help” people, but everyone else will be the worse for their efforts. And the very people they set out to help will suffer the most. Just look at the failed public school system of every large city in the country to get a look into the future of health care.

There is more to this than guaranteeing health insurance for a mother of three. The larger debate should surround what’s best for the survival of our republic. This is what our founding fathers pledged their honor to. They put the good of the nation ahead of their parochial interests.This is a rare discussion in Washington anymore. Remember, it is our elected representatives who have created the Social Security system but failed to put money aside to pay the tens of millions of people who are about to start collecting from it. These are the numbskulls who gave us EMTALA and demand our servitude (under threat of stiff penalty) without any promise of compensation for our efforts. This is the fiscally irresponsible lot that spends money on useless earmarks while our collective debt soars. I don’t have high hopes that any of our candidates or elected representatives will look at the big picture and realize that our Constitution does not guarantee happiness. We have no right to it. We are free only to pursue it.

Our founding fathers did not believe that pursuing happiness involves sitting on the couch waiting for your federal insurance card. Thomas Jefferson said, “The democracy will cease to exist when you take away from those who are willing to work and give to those who would not.” He would not be pleased with our current entitlement state and our punitive tax code. He might even look at our current government in the same way he saw his British oppressors and say that it is his right–it is his duty–to throw off such government, and to provide new guards for our future security. No doubt, today he would be branded as a crazy extremist. Every election provides our nation with a crossroads. For physicians, this is a particularly important one. I fear that the implementation of a national health care system will propel us further down the slippery slope we travel already.

When the majority sees fit to tax the wealthy minority to pay for something not promised in the Constitution, our republic creeps closer to collapsing into socialism. And then we will be a mere shadow of the great republic forged over 2 centuries past.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo Medical Center. Your feedback is welcomed at David.Baehren@utoledo.edu

Ask the Vet…

If there are any veterinarian readers out there I need some help. My wife’s Yorkie is having potty training problems. She will only s**t on the New York Times editorial page, or occasionally the front page. We got her to go on the S.F. Chronicle once, but then was acting “funny” for days. She did urinate on a copy of The Audacity of Hope at a liberal co-workers house, but we want her to start going outside. Do you think she is doing this on purpose? She seems to enjoy the experience more than a normal dog. We have tried training and books, but nothing works. Please help.

Signed

Frustrated in what used to be America

EMS Saves… Another Universal Healthcare Plan Fails

That’s Jim Craig, I believe, circa 1980.

Hawaii’s universal child health care initiative failed within the first year because, unbelievably, people who formerly paid for their insurance quickly dropped it to get the ‘free’ insurance. Check it out here.

Back to medicine. For some reason there are a lot of docs and nurses out there who look down their noses at EMS.

You are twenty-two and healthy. You get stung by a bee. You go into anaphylactic shock and are dead when EMS arrives. They transport you 45 minutes to me, all the while doing CPR, intubating you, and pumping you full of epinephrine. As you hit the door your heart starts up again and I get to bless you as you go up to the unit. Your family wants to thank me but I point them straight to you. You did it and did it well.

I love paramedics, and for you future users of EMS, these guys and gals are EXACTLY who you want on the scene of your heart attack or car crash. You don’t want House, MD, nor do you want Marcus Welby. You want the people who are trained to get you out of your car, revive you, and get you to me alive.

God bless the intrepid medics. I know your pay sucks and people hit you and spit on you, but without you there would be lots more dead people.

The Elusive Rat

I know this is a medical blog…..but a little non-medical levity now and then is a good thing.

For about 5 years, I’ve been trying to get my wife to clean out her side of the closet. I’ve done it myself several times which pissed her off so badly that she yelled at me for days, then promptly trashed out her side of the closet again. I knew that the only way she’d keep it clean was if she actually exerted the effort herself. (I could make a political corollary here, but I won’t). The trick was getting her to do it. I tried every incentive, but to no avail. So, I got creative……..

A couple of months ago, I purchased a toilet flapper valve at WalMart and cut little “rat turds” from the rubber.

Then each night after she went to bed, I left a few of these “turds” in the closet and bathroom floor outside of the closet. The following day, the “turds” were gone so I knew she had seen them. After a few days, I confronted her about the fact that her side of the closet was so trashed out that a rat was living in there! Still, she ignored the “problem”. I kept making “turds” and she kept picking them up.

So, I knew that I needed to ratchet up the performance. I thought about it and realized that what was missing from my presentation was that lovely urine smell associated with rodent infestations. So, I went to a local hunting store and purchased some doe urine.

Each night when I sprinkled the “turds”, I also fragged her closet crap with the deer pee. I had to endure about a week of horrific odor, but she finally cleaned out the closet!

She was very puzzled (and probably relieved) that she couldn’t find the rat’s nest. And BTW, she’s kept it clean.

Its so Hard

It’s so hard to find evidence that McCain saw the meltdown coming, tried to stop it, and that the democrats resisted to all of our detriment. After five seconds on the web, however, I was able to find this.It’s also really hard to believe (since we all know that G. Bush and the evil emperor stole the 2000 election), but the democrats seem to have a whole bunch of voters registered illegally. Stunning!

Tough as well to find evidence of the left cheering against our troops in Iraq or Obama taking meetings that would be loudly decried by the MSM as treasonous if he were simply Republican.

I know the sources I’m using are conservative, but see, we are conservative here and it’s our blog, and since we are obviously racist homophobes it should be very easy to factually refute these charges.

As a newly minted Obama supporter I can not wait for my early retirement and disability checks and Mark Steyn can go to the currently politically acceptable equivalent for that old outdated concept of ‘hell’. Thank you all for your support. Oh, and the normally correct SNL troupe can go to Mark Steyn’s place too, but since their skit was pulled and can’t be found anymore maybe they don’t have to go there, maybe they should go to a NASCAR race?

‘m going to leave Rush up here just to piss of the left.

Healthcare is a Right (and free puppies)

Sarah Palin, God bless you. John McCain, get off your ass.Physicians suspected when EMTALA was passed that it was a set-up for a government takeover of health care in America.

The sub-prime meltdown is EMTALA writ large on our economy and the answer, after the government forced banks to provide mortgages to people that would not otherwise have qualified (here for example or simply click below) is, genius move, to get the government more involved.

Since Obama has declared health care a ‘right’ let me explain to those of you outside of health care what will follow if it is given a firmer foundation than it already has in EMTALA.

1. Care will be rationed. It’s just that simple, all the other consequences are obvious, but this is the most important one for you.
2. Physicians will quit, retire early, cut their hours, or otherwise opt out.
3. The rich will still get excellent care either legally or illegally, but it will be unavailable for ordinary folks (see #1).

With a ‘right’ comes a ‘responsibility‘. If health care is a ‘right’ then who is responsible for it?

For the last twenty five years the answer has been the taxpayer, physicians, hospitals, and insurance companies (and the system has nearly broken under it’s weight). When the ‘right to health care’ is enshrined along with ‘life, liberty, and the pursuit of happiness’ then, and this is not a bad thing at all for doctors (in theory, all the care we deliver will be compensated but at rates set by the government), ‘the rich’ will pay for it, and, ‘the rich’ will be defined by your government. The magic number for being rich, depending on who you listen to, is either an aggregate income of $250,000, or, according to the conservative media, folks making more than $45,000 a year.

I will make more money, initially, with an Obama-like plan, and I will not work as hard. It is idiocy. For many of you who are fairly healthy it will be great. When you get really sick, however, you will wait. Depending on where you live you may wait till after you die because there will be no incentive for hospitals or physicians to see more patients or to expedite treatment. In fact, if tort reform is not enacted with Obama-care, it will be a really bad idea to see more patients than your banker’s hours allow, and a disincentive to take on difficult cases.

Welcome to the world stood on it’s head. See you in line for free food. Farmers and grocers, you’re next.

Grandly Rounding, MDOD Style…

”Outta the way, fancy boy! I’m a-commandeering this here clown car!”

Thanks everyone for visiting for MDOD’s first hosting of internet medblog Grand Rounds. Folks have asked if there is a theme for this week and since I’m new to this the answer is… well, maybe. I am going to post everything that was sent to me and some stuff we found. I hope you enjoy it.

We have a bit of a reputation amongst our twenty or so regular readers for being hard right smart assess and we confess, it’s true. But since you can’t turn anywhere today without being bombarded with politics, financial armageddon talk, nor can you dine at home without getting phone calls hustling you for money for candidate X, Y, or Z, we will steer clear of all that as much as possible. If a theme emerges here it is merely due to synchronicity and alcohol. So, without further ado, let’s take a trip through medical cyberspace…

White Coat Rants makes a tear well in our eye with his post detailing the idiocy produced when committees morph into bureaucracies and then into government oversight entities. And this all for the sake of money shuffling and vote buying. Outside of the academy, Medicine is dying, patients are dying, and doctors are the whipping boys of the moment. Check this one out too.

Those of you in Emergency Medicine will recognize the name Paul. S. Auerbach, MD. Dr. Auerbach is one of the fathers of a relatively new offshoot of Emergency Medicine- Wilderness Medicine, and is currently on the faculty at Stanford University. As an instructor I can tell you that this discipline is low on theory and high on practicality (and that’s just my style). I think you will find his post, a part of a series on Desert Survival techniques, very interesting. Dr. Auerbach, if you need anything just give a shout-out, you know, expedition doc for the Pussycat Doll’s tour of the South Pacific, or for the Swedish Bikini team’s naked ascent of the world’s tallest peaks (bad pun intended)?

Benjamin Disraeli (and Mark Twain following) made famous the quip that there are three kinds of lies… “Lies, damned lies, and statistics.” David Harlow fleshes this out in an interview with the general counsel for UMass Memorial Health Care System in the kind of depth that is far beyond the immediate comprehension of a simple car-crash physician like myself. Shutting down all CABG procedures at his facility may seem a bit drastic based on these statistics, but decide for yourself.

We empathize with the post from The Dragonfly Initiative which gets to the gritty reality of practicing Emergency Medicine as seen from the provider side. We wish we had written this.

Over at Mother’s in Medicine FreshMD explores an interesting problem… how should a female physician respond to patient’s compliments about her looks? The post was inspired by Pakistan’s President Zardari’s comment to Governor Palin that she was, in a word, ‘hot’. We agree. We too would like to ‘hug’ her.

Bongi, over at Other Things Amanzi, gives a detailed account of a poor outcome (in spite of his best efforts late in the ninth inning) in a case of pseudoaneurysm presenting to a makeshift medical facility in South Africa. Want to know what a pseudoaneurysm is and why this particular patient ended up losing a limb? Check this one out.

How does the mainstream media do with its reporting on complex medical topics like genetics? Not very well according to Walter Jessen.

Dr. Jolie Bookspan sent me a nice post about living under the sea. Really. During her studies in extreme human physiology she actually worked in a lab tethered to the bottom of the sea. I always wanted one of these… it rated much higher than having a tree house when I was a kid. Never did get to do it though. Lots of good links here regarding how the human body responds at extremes and even some fun stuff to do with your kids to introduce them to scientific concepts and the scientific method.

A doppelganger from South Africa lays in on the line at Just Up the Dose about choosing medicine as a career. Sounds like our South African brethren have a model for training physicians which might just make its way here soon. Great.

Dr. Bruce Campbell, an accomplished head and neck surgeon draws an interesting analogy between learning to drive a car and learning how to perform surgery. This hits particularly close to home as, in my years in the military I was involved with an aviation training squadron. I came away from that experience thinking that surgeons and pilots were cut from the same cloth and were trained in very similar fashion. Thanks Dr. Campbell.

A medical student at Twenty-four Hour People posts about his ’sub-I’, or, ’sub-internship’ recounting some very interesting patients with a bit of sarcasm and sharp wit here.

Dr. Carty at Hot Medical News scratches us on the back a bit (ahhhh, nice…) with his post regarding the rise of the new medical power-players… the ‘people with clipboards’.

Captain Atopic from Australia enters a post about medication errors and how Murphy’s Law tends to rule in the land of medicine.

Could we really make it through an entire Grand Rounds without mention of the election and it’s impact on health care? No, here are some common sense tips (from the Poked and Prodded blog) for all on how to save on health care in spite of whether we spin left or middle come November.

Can you imagine that the government might be very inefficient and silly at administering one of it’s multi billion dollar programs (Medicare/Medicaid)? Neither can I, but evidently it does happen as explained here at InsureBlog.

Over at Nurse Ratched’s place you will find a post detailing the life of one of the first “tough women of Alaska”, a nurse known as the “Angel of the Yukon.” Very interesting.

An humorous slap-fight is underway at the Clinical Cases and Images Blog. I must admit that I’m on the side of the radiologist in this one… we scan because we would rather defend a malpractice action with a radiology read under our belts than try to convince the jury that our physical exam skills are ‘better than a CT’. I’m not saying a neurologist is not ‘better than a CT’, I just don’t ever have one around when I need one.

The horrors of first year Medical School lecture are detailed here right down to the penny. Thanks to our friends over at The Week or Some Derivative of Said Length of Time. Memories.

The Law of Conversation of Mass is given a humorous twist by Val Jones here and don’t tell me this doesn’t make sense!

Do you all remember your surprise at learning that maggots and leaches had made their way back into modern medicine? Another ancient technique aimed at allergy and sinus infection sufferers is detailed here. Honestly, this cut my sinus infection rates almost to zero (though it’s a bit uncomfortable).

Barbara, at In Sickness and in Health, writes with admiration about the great love demonstrated every day by ordinary people taking care of terminally or chronically ill partners. Barbara, thank you for this.

At Laika’s Medliblog you may learn about an enterprising new genetics company offering, for a fee of course, to analyze your DNA and determine whether you may be at risk for certain diseases. This raises a host of ethical issues which Laika explores with a raised eyebrow.

Laurie Edwards at A Chronic Dose speculates about the impact of the financial crisis on the already extant crisis in managing chronic illness.

Is there gender bias in medical texts? In the classroom? Personally I don’t care as long as the women who go into medicine are hot and speak only when spoken to, but check this out…

Concerned about the supply of ‘organic food’ and the prices thereof? Can’t find a good organic apple at a good price? My solution is to buy the inorganic apple and poke fun at those buying the organic kind (if you are right then you will have your revenge), but here you go. Going to polish off a few inorganic beers… back in a minute.

I think if the good Doctor (a psychiatrist) over at How to Cope With Pain were a regular reader that she would have been scared away, I mean erdoc85 just posted on ‘fibro’, but… All I can say is God Love ‘ya doc, I could not do what you do, and, while I’m thinking about it, what percentage of your patients are ‘cures’.

Yet another submission from someone who does not follow this blog, but, since I’m posting all that are sent I will let you decide about whether fibromyalgia should limit one’s ability to purchase long term health insurance. Now being schooled in basic economics it seems to me that insurance companies should be allowed to manage their risk as they see fit, for the alternative is to do away with insurance as we have known it. I do not say this as someone without any ‘disqualifying conditions’, but, even being only partially insured, I understand why insurance companies do not want to cover me for an ailment which is likely to make me a losing proposition.

MDOD Grand Rounds comedy award winners for the week…

First, a wonderful bit of satire from Canadian Medicine lamenting the lack of ‘journalistic ethics’ in the medical blogosphere. We hope this wry bit of humor will lead to the establishment of at least a baseline of what might be termed ‘ethics’ in journalism.

Second, and again on the satire front, Colorado Health Insurance Insider takes a poke at a scary development in the American mindset, one that elevates access to health care to the level of life, liberty, and the pursuit of happiness. They almost had me with this bit of cheek until I realized that with a little bit of reading between the lines the operating mantra here is “from each according to his ability, to each according to his need“. Great one guys. Really funny!

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