1960's stereoscope anatomy

Remember the View Master? I remember it fondly, although I never had more than a few story lines to look at. Apparently, some researchers used the technology to make a library of 3-D anatomical imagery. These images are now going to be available online (for a price!). More:
'It was Bassett’s genius for dissection that attracted the attention of William Gruber, the photographer who invented the View-Master, a stereoscopic viewing device familiar to most children. A 17-year collaboration between the two resulted in the production of the Stereoscopic Atlas of Human Anatomy begun in 1948 and not completed until 1962. It consisted of 221 View-Master reels with 1,554 color stereo views of dissections of every body region. Each stereo view was accompanied by a black-and-white, labeled drawing and explanatory text.

'“It was very popular nationally,” (curator Dr. Robert) Chase said. “When Bassett first showed the images, lines formed around the block to see them.”

'“Although they’re 50 years old, the pictures were taken with high-resolution Kodak film,” said (anatomy professor Paul) Brown, explaining why the images have held up over the decades. “This is what they looked like before we got them,” he said holding up the original View-Master reels. “One can see how the nerve enters the jaw. It is possible to see inside of the sinus cavity. Look at the quality. It’s just fabulous.”'
via BoingBoing and also see BoingBoing

I wonder if the release of these photos was met with any of the denunciation that accompanied the BodyWorld exhibition. I doubt it. The 1950s-1960s were a time of much greater faith and generalized interest in science--it wasn't nauseatingly ubiquitous the way it is now. Also, there is something about the BodyWorld exhibition that fails to satisfy inquisitiveness yet does not rise to the level of art. BodyWorld doesn't actually invite us to investigate closely, nor does it impress aesthetically. It seems to be an interest born out of interest in death. The point of the exhibition seems not to be to generalize from the plasticized corpses, but to constantly have in the back of one's mind this is an actual dead person. I can understand the criticisms.

hi Kcal diet = more boys

Maybe part of the problem for those Hebrews was the increased nutritional support the mothers were getting in Egypt. According to an article from the BBC, higher calorie diets may lead to an increase in the chances a mother will carry a boy rather than a girl. The converse makes sense from an evolutionary perspective. If you want to make sure your genes get passed on, would you choose to have a boy or a girl? A girl obviously.

Journal of Midwifery and Women's Health

noted: Journal of Midwifery and Women's Health , an Elsevier publication, I believe.

The current issue has a free review of Tina Cassidy's Birth: The Surprising History of How We Are Born.

Nur360 clinicals day 3

I spent the day in Lake Champlain OB-GYN and Midwifery Services today. All in all, quite boring. The midwife I was supposed to follow ended up having the day off. So, first I spent 30-45 minutes sitting in her office. (They gave me a stack of charts to look at--woohoo!) Then I was ushered over to the office of a general family NP, who I thought I would be following. But, although nice enough, for some reason she didn't seem to want me shadowing her. So, after talking with the NP for 10-15 minutes, I was shuffled over to an OB-GYN doctor with whom I saw about 8 ob patients (I wasn't invited to observe the colposcopy). He was very efficient, almost machine-like. This makes for good business, but isn't so interesting to observe.

The most personally significant event was one visit with a mother who was, well... a babe, in modern bachelor parlance. This cinched my belief not only that I am completely wrong for maternity nursing but also that men are in general. In pediatrics last semester, I took care of one 17-year-11-month-old patient who was pretty but it was my first clinical rotation, and I think I was keyed into wondering about this issue. I haven't had a younger patient in med-surg, but with older med-surg patients I am able to turn off that switch in my brain. Not so in obstetrics. With all the femininity, babies-talk, vaginas, etc, everything about the situation says "reproduce!" so that on meeting attractive women it is not so easy to turn off that switch. Even if there are some guys who could function in this environment, I don't think it's fair to women to have to wonder.

I was supposed to go home at noon, but I went back to the office after lunch so I could meet a C.N.M. I was able to take in two visits with her, both with patients who had complicating medical problems and one of whom I knew, so I felt this was a good use of time. Plus, it turns out the C.N.M. ran the Lamaze class my mother took when I was born! She seemed like a highly competent person, but I was really hoping to see the midwife who ran the delivery I saw last week. They share an office, and I note that her bookshelf had a few too many books of too old a vintage for there not to be some sort of antiquarian-scholarly-nerdy-collector interest there (id est cool and intriguing to me).

The office (which is shared with a third midwife as well) also has a print hanging on the wall above aforementioned bookcase with the inscription "And the midwives feared God and did not as the king commanded them, but saved the children alive." In case you don't recognize it, this is derived from a passage from the first chapter of Exodus--
ותיראן המילדת את־האלהים ולא עשו כאשר דבר אליהן מלך מצרים ותחיין את־הילדים׃

I find this a very odd print to have in the office since, as I discovered using the UPIN registry, cool midwife also seems to be registered at Planned Parenthood. The print differs from the usual translation of the Exodus text on two important points: it removes "of Egypt" from the mention of the king and the modifier "male" from from before "children." These changes de-contextualize and universalize the text. I think that they're supposed to be liberalizing--midwives fight the power ("the king") on behalf of the women (not those boys!)--and that this is the spirit in which the print was hung. However, the changes really serve to highlight the point of this passage--"...the midwives feared God and... saved the children alive." The meaning still cannot be changed if universalized to a secular context--the midwives' emotional and ethical response led them to save the children. In a pediatric office, this print could have a different meaning, but in an obstetric office, there can be only one. How could someone miss it?
And the king of Egypt spake to the Hebrew midwives... And he said, When ye do the office of a midwife to the Hebrew women, and see them upon the stools; if it be a son, then ye shall kill him: but if it be a daughter, then she shall live. But the midwives feared God, and did not as the king of Egypt commanded them, but saved the men children alive. And the king of Egypt called for the midwives, and said unto them, Why have ye done this thing, and have saved the men children alive? And the midwives said unto Pharaoh, Because the Hebrew women are not as the Egyptian women; for they are lively, and are delivered ere the midwives come in unto them. Therefore God dealt well with the midwives: and the people multiplied, and waxed very mighty. And it came to pass, because the midwives feared God, that he made them houses.

brain cake

instructions at wikiHow:via MindHacks.com

Oprah abused me

After the posting of the following postcard on PostSecret.com, I feel I can now come out about a type of abuse I received at the hands of Oprah Winfrey and my pediatric clinical instructor. On my first day of pediatric rotation last semester, my clinical instructor forced us to watch an (early) Oprah Winfrey episode about child sexual abuse. The show included interviews with victims of child sexual abuse as well as the relatives (mostly men) who abused them. The main points of this show were two-fold: (1) anyone you know (but especially any man you know) could be a child sexual abuser, and (2) child sexual abuse is propagated from victim to victim to victim. The video was extremely unpleasant to experience, made me wonder if the other students were looking at me as a potential abuser, and made me feel fearful and powerless vis-a-vis the instructor since the video implied that, if I spoke out, it was potentially a sign that I was covering for abuse. In short, being forced to watch the video made me into a victim myself.

Now, of course, you are going to say that it was so very important for me to know about child sexual abuse in a peds rotation. And I agree with you, but this is just the point: the conceptual content of the video could have been communicated adequately in about 5 minutes. Being forced to sit through 40 minutes of emotional turmoil was just value added abuse. People who propagate this video and this type of instruction are, I contend, themselves part of a victim chain in which fear and paranoia is spread as surely as sexual abuse is spread in that victim chain. Attempts to stop child sexual abuse by forcing students to watch videos like this are really attempts to inoculate by giving everyone a little seed of emotional hell to carry around. The implication is that I'm such a bad person that I would ignore abuse if I weren't exposed to it myself.

Well, Oprah, you may have had a tough life, but I reject you and your self-indulgent and useless video. And, clinical instructor, you should know that although I am friendly to your face, every time I see you I feel resentment at having been forced to watch Oprah's trash.


-----Email Message-----
Sent: Sunday, April 20, 2008 6:00 PM
Subject: "Father Molestation on TV" Secret

I read a book when I was very young that dealt with father molestation. From that point on, I was so terrified of the idea that my dad could do that. It ended up controlling my relationship with him.

He died 8 years ago and the guilt still haunts me to this day. I wish I could have been closer to him.

I cried for the first time in years when I saw this postcard. I want to thank the person who sent it...it is my secret, too. I have never been strong enough to tell anyone about it.

Nur360 clinicals days 1-2

I am finished with the first two of six days of maternity clinicals at the Alice T. Miner Center for Women and Children.

Thursday, Day 1:

Arrived 0800 and changed into green-colored, provided, clean, OR-CWC-ICU scrubs. Then received tour of maternity unit. Then did scavenger hunt. Then watched NYS mandated shaken baby video. Short day.

Friday, Day 2:

Arrived 0630, ate breakfast, changed into green scrubs, and in L&D by 0700 with fellow nursing student Glen to receive report. As it turned out, there were only two labors going on today--one was a very fast labor, which resulted in a delivery I got to see, and the other was an induced labor that was going on when I got there and still going on when I left.

What can I say? I saw a delivery. Babies are wonderful. Seeing them pass through the vagina is humiliating.

Actually, come to think of it, my main impression of the day is of the midwife who managed the delivery. She was great. Anecdote: When inserting the foley catheter post-delivery, she saved the unused specimen container so her daughter could collect insects in it. Visual impression: A little more aggressive and modern looking than this photo from the CVPH website would suggest. Did I get a little crush? And so what?

Anyhow, I'll post here my academic journal entry for the day, hopefully sans HIPAA-violating info:

I woke up early Friday morning to trim my hair before clinicals only to discover what appeared to be the first gray hairs I've noticed. In clinicals, I was treated with complete indifference by the primary nurse to the extent that Glenn and I were addressed as "Glenn" throughout, as in "Glenn, come in here," or the following dialogue:
Glenn: "So I guess we're taking off. Thanks, Nurse#1."
Chris: "Bye, Nurse#1. Nice to meet you."
Nurse#1: "Bye, Glenn."
I've never been so invisible before... And I learned later in the day that Nurse#1 is carrying on with a doctor who lives with his wife and small children... Considering these blows to my ego and sense of community, I'm just glad to have finished the week without precipitating a mid-life crisis. But what about the learning?
Unfortunately, no Cesarean sections were performed this Friday, although a vaginal delivery was observed about 0800 ... This was my first exposure to labor and birthing, and, all dark humor aside, the situation with the nurse was not helpful as I was very unsure how to approach the mother and family… and was trying to follow the nurse's lead. As a result, I did not get involved in vital sign collecting beyond putting a BP cuff on the patient…. I was also not involved in analyzing the fetal monitoring strip, although it was reviewed after the birth.
Perhaps if we had been present during the latent or active stages of labor, there would have been more time to get used to the newness of the situation and develop rapport with the patient and family. Then, I might have been able to provide more comfort and support to the patient and father. These might have included assisting SM into a comfortable position, getting her ice chips and fluids, and encouraging her to focus, breath, and relax. As it was, Glenn and I mostly assisted by holding the patient's legs up and back during the birthing at the instruction of the midwife…

In the immediate post-delivery period, the situation was much the same. I did get… some water, and helped to change her soiled linens to the extent possible. However, most of the post-delivery period was devoted to.... After the midwife determined that she required the assistance of the doctor, the patient was covered with a sheet and left to relax. Any progress towards the post-partum unit was "put on hold," and… The primary nurse also hung a fluid bag in the post-delivery period with Pitocin, the exogenous oxytocin analogue used to promote uterine contractions that decrease the risk of post-partum hemorrhage. Carboprost might be ordered for this same purpose.
...

keep up on avian influenza...

http://www.medicalnewstoday.com/sections/birdflu/

alligator blood fights Staph. aureus

...so of course scientists are trying to find ways to utilize this for medicine. Go scientists!

via BoingBoing

haven't failed Nur360 yet...

I haven't been posting much lately because I haven't been doing too well in school--specifically, in maternity. My test average was 0.5 points below passing until our last exam Wednesday, when I got an 84. I'm not out of the forest yet, but this is better than still failing.

The whole business is very frustrating. I had a 4.0 in all my pre-nursing coursework and received so far a lowest grade of B+, and that was due to work being handed in late. This is so backwards that I can't get any of this maternity to stick in my memory!!

freedom from brain scans

Sigh... I suppose this will be an ethical issue in nursing at some point, and some brainiac nursing theorist will say we should scan people's brains to extract 'total information' for 'total treatment'...

We think of our brains as the ultimate private sanctuary, a zone where other people can't intrude without our knowledge or permission. But its boundaries are gradually eroding. Hypersonic sound is just a portent of what's coming, one of a host of emerging technologies aimed at tapping into our heads. These tools raise a fascinating, and queasy, new ethical question: Do we have a right to "mental privacy"?

"We're going to be facing this question more and more, and nobody is really ready for it," says Paul Root Wolpe, a bioethicist and board member of the nonprofit Center for Cognitive Liberty and Ethics. "If the skull is not an absolute domain of privacy, there are no privacy domains left." He argues that the big personal liberty issues of the 21st century will all be in our heads — the "civil rights of the mind," he calls it.

But this isn't just about reading minds; it's also about bombarding them with messages or tweaking their chemistry. Transcranial magnetic stimulation — now used to treat epilepsy — has shown that it can artificially generate states of empathy and euphoria. And you've probably heard of propranolol, a drug that can help erase traumatic memories.

Let's say you've been assaulted and you want to take propranolol to delete the memory. The state needs that memory to prosecute the assailant. Can it prevent you from taking the drug? "To a certain extent, memories are societal properties," says Adam Kolber, a visiting professor at Princeton. "Society has always made claims on your memory, such as subpoenaing you." Or what if you use transcranial stimulation to increase your empathy. Would you be required to disclose that? Could a judge throw you off a jury? Could the Army turn you away?

men and miscarriage

For a paper last semester, I had to look at the evidence for how to deal with men who partners had mastectomies. There is essentially no nursing literature on this point. The Times has an article on how men deal with miscarriages... also, no real info...

4/7 SciAm roundup

Fasting May Bolster Healthy Cells' resistance to chemotoxins
why some smokers get lung cancer and some don't
Could microbes cause mental illness
buried prejudice (even effects doctor's decisions...)

what do you say... schizophrenic... mother...

Furious Seasons has a somewhat interesting post entitled what do you say to a paranoid schizophrenic whose mother just died? I'm supposed to have my psych rotation next semester, assuming I pass maternity, which... who knows?

water myths on NPR

An interview with scientists on NPR regarding myths about drinking water:

Myth No. 1: Drink Eight Glasses Each Day
Myth No. 2: Drinking Lots of Water Helps Clear Out Toxins
Myth No. 3: Lots of Water Equals Healthier Skin
Myth No. 4: Drinking Extra Water Leads to Weight Loss
Myth No. 5: It's Easy to Get Dehydrated During a Workout

http://www.npr.org/templates/story/story.php?storyId=89323934

teen suicide stats

The blogger at Agoraphilia has posted an interesting graph showing that suicide is a must higher problem amongst older people than amongst teens, with the rate rising steadily through life. This doesn't really surprise me...

women over-report empathy

Frankly, I am not surprised to read at MindHacks that when gender differences in empathy are measured by self-report, women are more empathetic, whereas there is also most gender difference when empathy is measured more objectively... 'nough said.

brain lamp



via MindHacks

early Dx with PET-MRI scanner


Researchers this week announced a new, faster way of imaging inside the body that could detect tumors more quickly and lead to earlier treatment. Scientists from the University of Tübingen in Germany report in this week's Nature Medicine that they were able to locate and monitor tumor growth in mice with a scanner they developed that combines positron emission tomography (PET) and magnetic resonance imaging (MRI)—and said they were optimistic it could be ready to use in humans within three years.

papercraft anatomy head



Artist Bert Simmons creates papercraft anatomical structures...

via BoingBoing

nursing in the news roundup

A nursing in Canberra, Australia, will be designed specifically for dementia patients, although the article does not say how...

A Canadian LPN who protested Planned Parenthood is fighting the suspension of his license.

Shift work results in decreased health:

They ate fewer hot meals each day, but were more likely to snack, with a preference for fattier and sweeter foods, and drank more tea and coffee.

One study showed 69 per cent got no exercise at all, while another showed they were more likely to smoke, and smoke heavily, than other workers.

And more nurses are turning to travel nursing...

the signature incident

I had a small conflict with one of my nursing instructors a while back, and I've been obsessing over it ever since. I don't why I didn't think to just blog about it!

A Monday or two back, I went in to see my Nur356 Professional Concepts instructor about a test we had taken recently. My grade was, I thought, quite low considering that she had said she would give us bonus points for attending a certain out-of-class lecture. When she was looking at my grade, she said, "Oh, I know. You must be the signature I couldn't read [on the sign-in sheet for the lecture]." She proceeded to produce the sign-in sheet and said something along the lines of "really, that signature isn't legible," in the tone of "your signature isn't acceptable."

Now, you have to understand that we have a daily class sign-in sheet that has all of our names printed next to the place where we sign our signatures. So, all that was required was for her to look at a sign-in sheet and match my signature on it to the one on the sign-in. And that's assuming that my signature really is illegible, which is an exaggeration. So, in essence, she chose not to read my signature, even though she had promised points on a test.

Why? Although not illegible, it is not an exaggeration to say that my signature is large and distinctive. Essentially, she decided that my signature did not represent the type of cowed and broken student she prefers to have in her classes.

Aside from the bold-facedly unethical removal of points from my test, I am aghast at the attitude completely inappropriate for a university setting. The type of person she wants for her program is completely opposite the type of person that instructors should be trying to cultivate, and you don't critique someone's signature anyhow. Honestly! If she wants to teach elementary school, she should leave academia!

gallbladder for real?

I thought this photo from Wikipedia was of a sculpture that incorporated gallstones, until I looked at it closer. Is that a gallbladder in an emesis basin??!! I didn't realize so many gallstones could fit in the gallbladder...

protein map of spit may mean easier testing

By Julie Steenhuysen

CHICAGO (Reuters) - U.S. researchers have identified all 1,116 unique proteins found in human saliva glands, a discovery they said on Tuesday could usher in a wave of convenient, spit-based diagnostic tests that could be done without the need for a single drop of blood.

As many as 20 percent of the proteins that are found in saliva are also found in blood, said Fred Hagen, a researcher at the University of Rochester Medical Center in New York who worked on the study.

The researchers hope saliva-based tests could be used to diagnose cancer, heart disease, diabetes and a number of other conditions.


Already there are saliva-based antibody tests to detect human immunodeficiency virus, or HIV, and hepatitis infections, Hagen said. He said this protein map will provide new targets.

Other groups are working on a saliva-based test for breast cancer that would detect a protein fragment from the HER2 protein. Hagen said such tests could eventually replace uncomfortable and costly mammograms.

"We envision in the future spitting in a tube and looking for a marker like this breast cancer marker. It would be much easier to do, potentially at home," he said.

(edited)

Men in Nursing book


Men in Nursing: History, Challenges, and Opportunities (edited by Chad E. O'Lynn and Russell E. Tranbarger) is an academic book of some interest that contains a few interesting articles on the challenges of male students in nursing programs. I think I have definitely experienced some challenges, from the lack of actual teaching about "nursing fundamentals" such as touch and caring, which is mentioned in this book, to the almost total lack of visual aides in nursing lectures.



Medtronic: bad stents & hackable pacer device

The biomed company Medtronic seems to be taking a hit in the news recently, with a high death rate from a stent graft system and an automatic defibrillator monitor that sends un-encrypted medical data:
New data point to greater deaths in patients receiving Medtronic Inc's AneuRx stent graft system, which treats artery bulges in the abdomen, the U.S. Food and Drug Administration said on Tuesday.

AneuRx is used to treat abdominal aortic aneurysm or AAA, a life threatening condition in which the aortic artery bulges and can burst -- often without prior symptoms.

About 1.2 million Americans have such a bulge, according to Medtronic, but only 15 percent are diagnosed and half are never treated.

and:
A common new technology for monitoring defibrillators is vulnerable to hacking and even to reprogramming that could stop the devices from delivering a lifesaving shock, according to research to be released Wednesday.

In the model researchers studied, transmissions from the defibrillator to the bedside monitor are not encrypted, which means that someone intercepting the transmissions could retrieve such data as the patient's birth date, medical ID number and, in some cases, Social Security number.

Alistair Cooke and penis enlargement

Following up on a recent post, I direct your attention to a Reason magazine article on crime and tissue harvesting:
Alistair Cooke's body lay cold in the embalming room of an East Harlem funeral home, suspended in the brief limbo between death and cremation. A "cutter" soon arrived to make a collection. He sliced open Cooke's legs, sawed the bones from the hip, and took them away. The quintessentially British presenter of Masterpiece Theatre and Alistair Cooke's America—the face of genteel, urbane Albion to millions of Americans—was being carved up for parts..
Alistair Cooke's remains were only the most famous of more than a thousand bodies plundered by Michael Mastromarino, owner of Biomedical Tissue Services (BTS). He had a simple business model: Pay funeral directors for access to bodies and resell bones, heart valves, spines, and other tissues to biotech firms in need of spare parts.
The history of transplantation has been one of overcoming visceral opposition-of rejecting what the prominent bioethicist Leon Kass calls "the wisdom of repugnance."

gastroparesis, Lipitor & Benicar

Last Wednesday, I went to my PA and discovered that my cholesterol, triglycerides, and blood pressure are all sky high. So, I got prescriptions for atorvastatin and olmesartan. Interesting changes occurred:

For some time, I have been having premature satiety, bloating, and also bowel movements of undesirable consistency (back and forth between constipation and diarrhea). Although I don't think the symptoms were quite strong enough to constitute gastroparesis, with my weight, age, and family history, I was wondering if I was experiencing some pre-diabetic problems.

Then, after taking the prescriptions for a few days, my bowel movements became well-formed and easily voided and I seem to be able to eat more now at one sitting and don't experience as much GI discomfort.

So, is gastroparesis treatable with statins and ARBs? I did a search on Google and in CINAHL Plus, and I couldn't find anything. In PubMed, I found two very sketchy sources:

Understanding the pharmacokinetic and pharmacodynamic characteristics of antihypertensive drugs will be of clinical importance in diabetic patients with advanced nephropathy (glomerular filtration rate of less than 30 ml/min) and/or other complications, such as impaired gastric motility or gastroparesis, and will thereby lead to a more rational management of hypertension in those patients. (1992)
...

Eight patients with postprandial hypotension and orthostatic hypotension were treated with the somatostatin analogue SMS-201-995. Low doses of this drug (0.2-0.4 microgram/kg) raised the blood pressure... Treatment was followed by abdominal cramps and nausea in two patients with gastroparesis diabeticorum...

Big Brother contaminates feeding tube

The TSA (Transportation Security Administration), which is the branch of government charged with taking away Americans' nail clippers, recently forced an adolescent with a feeding tube to open his sterile backup tube for inspection:

James Hoyne, 14, has a feeding tube in his stomach and carries a back-up in a sealed clear plastic bag. Hoyne said two weeks ago a TSA officer insisted on opening the sterile equipment, contaminating his back-up feeding up tube which he later needed."

I said 'Please don't open it' and she said 'I have to open it whether you like it or not. If I can't open it, I can't let you on the plane,'" Hoyne said of his conversation with the TSA screener.

Your tax dollars at work!!

via BoingBoing

oncology & blood xfusion... patient experience

The Cheerful Oncologist is a blog that has ended, and too bad. From the comments:
I hated the blood. Of everything, it is still the thing that I shudder most at when I remember. I hated that I felt bad and that I needed it. I hated to take it in the summer when the supply was low, and there might be someone who was otherwise healthy but needed it because of an accident. I hated that I could taste it for days and days afterward when it flowed through my port. I hated the feeling of having someone else's cells flowing through the center of me, as if it were some sort of violation of the core of my being. --emmy

Viagra: ten years & herbals bad

Apparently, Viagra is soon to be, or recently became, ten years old. PLoS publishes an essay on how Pfizer markets Viagra to healthy men:
Ultimately, there must be a debate about how limited resources for health care should be spent and who should make those decisions. Are men who seek to enhance their normal sexual function “worthy” enough to have their treatment paid for? If we pay for drugs and other procedures that enhance lifestyles, then other treatments either may not get funded at all or may become inadequately funded. Who will get the lifestyle drugs? Everybody who wants them? And do they get an unlimited supply? As the number of enhancement treatments grows, the scenario surrounding Viagra will become all too familiar with other drugs.

via Dr. Petra Boynton

Also, WIRED warns us against using herbal Viagra substitutes, which can have harmful effects:
In a report to Forensic Science International, which became available on Feb. 21, Dries de Kaste and his team explained that each of the shady products includes unnatural chemicals that are not listed on their labels. Since none of those molecules have been tested in rigorous safety studies, and each can affect the cardiovascular system or interact with other drugs, they are quite dangerous.

via BoingBoing

gastric bypass... on Konishiki

Famous Hawaiian-born sumo wrestler Konishiki has had gastric bypass surgery. The laparoscopic surgery I saw recently was on a fat man and some very deep wounds were created. I can't imagine operating on Konishiki.


via F-cked Gaijin


Nur363 endocrine, renal test sucked

We had an exam today on endocrine, urinary tract, and renal disorders. And I did very badly. It seems like no matter how much I study, there are details that I completely miss. And I don't just mean forget, I mean completely miss as in looked, didn't register, don't remember even seeing that before. We had a question on ABG's and DKA coma, which you were supposed to associate with metabolic acidosis, which seems like a no-brainer as long as you already know that's the answer. Here are the answers I was trying to choose between...

pH 7.1, pCO2 16, HCO3 [low]
pH 7.2, pCO2 46, HCO3 [high]

But what if diabetic ketoacidosis is a special case of pH imbalance--the pathophysiology is unique after all? (And why would you ask an ABG question if it's just supposed to get you to regurgitate a standard metabolic acidosis profile?) I was thinking... metabolic acidosis is related to failure of the kidneys to buffer adequately... so in a DKA patient the kidneys are working correctly... resulting in a higher circulating bicarb than in metabolic acidosis... possibly resulting in a different ABG profile... Plus... I don't really know how the diagnostic ABG test works and since acids and bases exist in dynamic equilibrium and not in a static state, it's possible that higher circulating bicarb is reflected in the ABG...

Well, obviously one problem is that I didn't really understand the underlying concept of metabolic acidosis, thinking it was related to an inadequacy of kidney function rather than an inadequacy of the kidney's function, you see. That's not entirely my fault as this was the message I took away from Nur362, in which I got the ABG questions right on the exams. But it does point to the problem that I'm not really learning physiology in nursing school. In order to keep myself from getting mixed up, I have to dig deeper than we are going.

Anyhow, the problem that really grates on me is that I reviewed the notes after the test and, sure enough, right there under the diabetic ketoacidosis heading it says metabolic acidosis. I had gone over these notes maybe five times last night, and I don't even remember seeing these words on the paper. They're so meaningless in that context that my eye glossed right over them. This happens to me all the time, and I don't know how to prevent it without, as I said above, taking every word in the notes and systematically reviewing it more thoroughly. I just don't have time for that.

And then there's The Big Number Issue. At work, I can't remember doctors' pager numbers even though I've been working as a ward clerk for 3 years--they just don't have meaning to me, and they don't stick. If I could have remembered the reference values for the ABGs, I probably could have figured out the correct answer. But I didn't remember the pCO2 value, and I assumed, of the two answers I was trying to choose between, that one represented a high value and one a low value. If you know your ABGs, you know that they actually represent a low-high value and high-high value. But what if the low-high value really was low? That would represent decreased ventilation, and wouldn't a patient in a coma have reduced respiratory status?

Well, it sounded good at the time. Wikipedia says that Kussmaul first defined Kussmaul breathing as a "sign of coma and imminent death," but the article on diabetic coma says "In the early to middle stages of ketoacidosis, patients are typically flushed and breathing rapidly and deeply, but visible dehydration, pallor from diminished perfusion, shallower breathing, and rapid heart rate are often present when coma is reached." So, depending on which article is right I was either wrong and wrong or wrong and right...

This whole nursing school situation is very frustrating. Since returning to school to do nursing, I had maintained a 4.0 average, including a 4.0 in the A&P crash summer course, which I took while working full time (40 hours per week). And it looks right now like I will be repeating at least Nur360 maternity and maybe this whole semester if I'm not kicked out of the program. This is really crappy.

Knome's commercial gene sequencing

I was alerted to the following because I am on Knome's e-mail list. Not that I will ever be able to afford to use their service...

The New York Times
reports on Dan Stoicescu, a millionaire who paid to have his genes sequenced by Knome, Inc:

Mr. Stoicescu is the first customer of Knome, a Cambridge-based company that has promised to parse his genetic blueprint by spring. A Chinese executive has signed on for the same service with Knome’s partner, the Beijing Genomics Institute, the company said.

Scientists have so far unraveled only a handful of complete human genomes, all financed by governments, foundations and corporations in the name of medical research. But as the cost of genome sequencing goes from stratospheric to merely very expensive, it is piquing the interest of a new clientele.

“I’d rather spend my money on my genome than a Bentley or an airplane,” said Mr. Stoicescu, 56, a biotechnology entrepreneur who retired two years ago after selling his company. He says he will check discoveries about genetic disease risk against his genome sequence daily, “like a stock portfolio.”

Knome is not the only firm in the private genome business. Illumina, a sequencing firm in San Diego, plans to sell whole genome sequencing to the “rich and famous market” this year, said its chief executive, Jay Flatley. If competition drives prices down, the personal genome may quickly lose its exclusivity. The nonprofit
X Prize Foundation is offering $10 million to the first group to sequence 100 human genomes in 10 days, for $10,000 or less per genome. The federal government is supporting technology development with an eye to a $1,000 genome in the next decade.

But for now, Knome’s prospective customers are decidedly high-end. The company has been approached by hedge fund managers, Hollywood executives and an individual from the Middle East who could be contacted only through a third party, said Jorge Conde, Knome’s chief executive.

Verein zur Förderung Freier Informationen für die Pflege e.V.

I just discovered that NursingWiki, which I just blogged earlier today, is run by a German organization called Association for the Promotion of Unrestricted Information on Nursing. I think that in fact this organization only runs NursingWiki. However, it is nice to know it exists, which it does at:
Verein zur Förderung Freier Informationen für die Pflege e.V.
Bismarckstrasse 78
D-45888 Gelsenkirchen
Germany
verein@pflegewiki.de

Benner vs. Ericsson on experience

Mindhacks reports on a recent Time magazine article that highlights work by Dr. K. Anders Ericsson, who has shown that experience is not a good measure of expertise. Rather, it is challenge and exertion that produces expert performance. This seems to be at odds with the Patricia Benner idea of novice to expert nursing, in which inexperienced nurses just follow rules, while experienced ones perform intuitively.

Actually, I don't have any idea if Benner and Ericsson are at odds, because I don't know enough about either theory. However, Ericsson-as-presented-in-blog-post is at odds with Benner-as-presented-in-nursing-concepts-course. I have the feeling that part of the point of promoting Benner to nursing students is social control--that is, get students to internalize the idea they are novices so you can tell them "hey, just the follow the rules."

Nursing programs as I have witness them are two-faced in promoting "critical thinking" and "evidence-based practice" on the one hand and hierarchy and the authority of elders on the other. It would be nice to say that this is the difference between newer and older nurses, trained under different systems, but it doesn't seem to be.

In fact, just today, just an hour ago, I had one of the Dean Vaughn system medical terminology labs in which the instructor told us before class that, in her PhD program, they had been learning about the importance of learning styles and that we each had to develop our own ways to study and learn, and told me during class that I should stop studying the terminology by myself (quietly) and follow the video with the rest of class.

NursingWiki & Wikipedia nursing portal


http://en.wikipedia.org/wiki/Portal:Nursing



http://en.nursingwiki.org/wiki/Main_Page


Here are two wiki resources for nurses. The NursingWiki is a nice idea, but there aren't many articles, the articles aren't very in depth, and it seems sort of redundant when you have Wikipedia, which covers pretty much everything in the world. Additionally, the NursingWiki suffers from a certain lack of vision for the site. For example, under the article "nurse," there is a portrait of a smiling woman woman in white scrubs. Why? Is that what a nurse is--a "smiling woman in white scrubs"? Likewise, the article "nursing language" contains no discussion of medical terminology or the incorporation of extra-medical terminology into nursing but does have a list of random medical terms and their German translations--huh?

Nurses interested in contributing to open access, open source knowledge databases about nursing should stick with contributing to Wikipedia, since there is no need to duplicate that service. However, NursingWiki could fill a niche by providing articles for nurses. For example, a Wikipedia article on colecystectomy should not include information about nursing interventions as that is too narrow a focus (i.e., not of interest to the general reader) for an encyclopedia. However, a NursingWiki article on colecystectomy that describes nursing interventions with research citations would be a great resource.

(But shhhhh: it would also be step on the path to open access and open source textbooks!!)

HIV not a modern virus

PLoS Pathogens publishes a case of convergent evolution that suggests that ancient primates may have dealt with viruses similar to HIV (or SIV, I guess...).

via Monkey Day News

  1. Newman RM, Hall L, Kirmaier A, Pozzi L-A, Pery E, et al. (2008) Evolution of a TRIM5-CypA Splice Isoform in Old World Monkeys. PLoS Pathog 4(2): e1000003. doi:10.1371/journal.ppat.1000003

skin graft vs. penis enlargement

Moulitsas, founder of DailyKos, claims that some congressional candidate is funneling skin graft material away from burn victims toward penis enlargement patients. This is a little hard for me to swallow since the amount of skin needed for penis enlargement must be infinitesimal (since penis enlargement surgery doesn't really do much).

via BoingBoing

Let Britannia Rise blog

http://letbritanniarise.blogspot.com

Following on previous posts about my extra-nursing-self, I share with you a blog I like to visit that is today promoting a bit of Handel. Now if, as some theorists like Virginia Henderson suggest, becoming a good nurse means becoming a well-rounded and well-educated person, this clip should improve your nursing ability as well...



Chinese food cures psychosis?

Mindhacks reports on recent interest in using glutamate-related pharmacologics as antipsychotic medications. Users of PCP, which acts as a glutamate-receptor antagonist, often show symptoms similar to schizophrenics, suggesting that glutamate may play a role in both conditions.

Now, in case you're wondering, yes, glutamate is
that glutamate, as in mono-sodium-glutamate (MSG). The glutamate that you don't put in food is called glutamic acid, but really MSG is just one form of glutamic acid. As you can see from the chemical structures, the only "difference" between MSG and glutamic acid is that MSG has an Na ion instead of an H ion. But as all good nursing students know from Chem271 Organic and Biochemistry, the Na or H come off in solution, meaning they provide same anion in the body.

Now, apparently this whole business about the "brain," or whatever, must be complicated stuff, otherwise they would have figured out a long time ago that Chinese food could cure psychosis. But they didn't. What I really found interesting reading about all this is that MSG really is excitotoxic and that the FDA has identified a grouping of symptoms that some people display after consuming glutamic acid... and I have some of them! Whenever I have eaten food from some unnamed restaurants in my town that advertise no MSG, I get extremely drowsy and weak (like falling asleep at my desk at work while I'm entering MD orders drowsy!), I sweat profusely, I get a warm, swollen face with a headache, and I seem to have palpitations. Lo and behold, here are the symptoms from Glutamate Symptom Complex (GSC):
  • Burning sensation in the back of the neck, forearms and chest
  • Numbness in the back of the neck, radiating to the arms and back
  • Tingling, warmth and weakness in the face, temples, upper back, neck and arms
  • Facial pressure or tightness
  • Chest pain
  • Headache
  • Nausea
  • Rapid heartbeat
  • Bronchospasm
  • Drowsiness
  • Weakness
  • Sweating
So, next time somebody like a patient complains of problems after eating some places, don't shrug it off, they may be experiencing GSC excitotoxicity.

WIRED MAR.2008 INFOPORN


The latest issue of WIRED magazine has an infopr0n column that shows the relative strength of bacteria at different anatomic locations.

In med-surg we are studying urinary tract right now. Want to know why foley caths get infected so easily? See orange at right [click for larger image]. Also, notice that the numbers being used here are phylotypes, not species. The intestinal tract has something like 400-500 species of bacteria, most of which haven't been definitely ID'd yet. Pretty amazing.

An antiquarian, not a nurse... sorry instructors

For a short-cut of this post, click here.

Today, for the last few weeks, in recent months, and for a few years, I have been feeling pretty down, but today in particular. I definitely don't have the same burning desire to be a nurse that some of my classmates seem to have, and, by getting absorbed into the field, I often feel that I am losing myself. I think I am pretty much immune to the "professional socialization" process that we are supposed to be going through, but I can become branded (in the western sense). Part of the reason I didn't pursue the medical field from the start is that I see it as a type of labor, like "hyper-plumbers." Nursing is even worse in that in addition to being defined by your labor, there are extremely strong societal associations and pressure for conformity. Although I'm sure most nursing instructors and organizers don't see it, their desire to create a highly defined professional profile actually puts a ceiling on the amount of respect they can garner as a profession from other professionals. Several of my nursing instructors like to repeat the fact that nursing is the public's "most trusted" profession. The connection they don't make is that people trust nurses because they think of nurses as robotic dispensers of safe medical care. The public doesn't trust uncertainty, ambiguity, and experimentation. They do trust nurses because when nurses tell them to eat a certain way, they never qualify their statements by discussing the state of nutritional science. For biologists, anthropologists, or philosophers, the qualification would be more true and useful.

Anyhow, I was looking at Manolo's Shoeblog today, and he linked to this CD by one Philippe Jaroussky. As soon as I started listening to the samples, I was immediately transported back to myself. Yes, our lives are lived in the dirty, selective, unjust world of nature, but there is also a higher identity that comes from our internal lives. I may have to work in this uniformed, institutionalized, modern, conformist profession to make a living, but it is not who I am.

NursingCarePlan blog

nursingcareplan.blogspot.com

This is an interesting idea for a blog. The person puts up careplan ideas. I suspect it is mostly for advertising revenue, though. Also, no posts since November 2007...

1949, Fluid Balance from the Nurses' point of view

Here's an article I came across by accident from 1949. Enjoy this little blast from the past...
Understanding the important role of water, salt, and glucose in the body, the nurse can do her part to help restore the patient to health.

Revised 2-26-08 12:45...


Actually, revisiting that article, I found the graphical presentation of fluid balance pretty interesting. It is too inadequate, unfortunately, for teaching, but it is interesting to look at. Also, looking over the Nurse's Daily Worksheet for 1949, it was interesting to see what has and has not changed. You get the idea from studying the history of nursing in school that nurses didn't do anything in the past, but this I+O balance sheet looks pretty familiar...

AndSicker blog

andsicker.blogspot.com

This is a student nursing blog that is more like what I had envisioned for my own blog here. It's much better than mine is, though. The author is probably just a lot smarter than I am.

One thing I'm struck by in perusing this blog is that it doesn't get very absorbed in the theoretical aspects of caring, holism, "health", etc. Although I am resistant and skeptical naturally in those areas, I get dinged so much and so uniquely on my clinical paperwork and care plans on not "knowing" patients better that I have started to wonder if it is really me and not an innate voyeuristic desire to peer into people's lives on the part of the instructors (which is what it seems like to me). Maybe it is because this is a male nuring student, or maybe it's the difference between an ADN and BSN program... although I have to say that we were never even exposed to the term "metrology," which I find embarassing...

Nur363 clinicals day 6 (operative)

Once or twice a semester, we take a day of clinicals to do an OR rotation. Today was my day. I had really wanted to see an open heart operation, but there were no open heart cases on Fridays unless they were emergent, so...

I started off with a laparoscopic colecystectomy that I was told was going to be a laparotomy. From there, I went to get another case and was told that they didn't really have anything interesting and I should just wait around the nurses' station. So, I pushed until they let me go see a temporal artery biopsy. I think the surgeon didn't realize I was a student, because I ended up assisting by running the Doppler they were using.

After that I got a tour of the open heart operating room even though there weren't any procedures.

After lunch, the only things they had for me to see were a removal of a portacath and a haemorrhoid repair. During the repair, in which I assisted in a few very minor ways, the circulating RN said I was a lot more free than the other students who usually stand off to the side afraid. What can I say? I think growing up in a church and social circle that included doctors has made me a lot less intimidated by them than most nurses seem to be.

Anyhow, it wasn't the best day it could have been. The OR educator said I could come back on my own time to see an open heart procedure if I wanted, so I'm going to wait until this clinical rotation is over and then go back...

Nur363 clinicals day 5

My day was pretty much spent observing an aortogram with runoff, which looks pretty much like the image at right when viewed through fluoroscopy, then talking with the patient in PACU, and performing post-procedure groin site and vital checks back on our med-surg floor.

Since the aortogram set-up was similar to our cardiac cath lab, and since my work as a ward clerk involves managing MD orders for post-angioplasty cardiac patients, today was very satisfying. More work to be done on the nursing, though. It is very easy for me to see the patient as a piece of meat with a puzzle inside. A long talk in PACU was nice but not smooth by any means. It didn't help that I was starting to get quite hungry by the time were ready to leave.

Timberland Fells Trainer shoe

Our Plattsburgh State Nursing student handbook has very strict guidelines for clothing. It includes "all-white shoes."

Now, it is a fact that most all-white shoes that are a possibility for wearing into a patient care setting are ugly as hell. See if you don't agree:


Exhibit#1These New Balance MW576 are a horrifying study in banality. With their thick soles, stubby toes, over-padded ankle support, and perforations placed without consideration, they conjure the phrase "comfort care" from the very ether.


Exhibit#2If you don't know yet, the Dansko stapled clog is supposed to be the gold standard in nursing footwear. For this reason they are included at AllHeart.com. And if you go to buy some there, you will notice that women's and men's Dansko clogs are sized on the same scale. Why? Because women's and men's Dansko clogs are the same shoe. The Dansko has made it onto shoe guru Manolo's Gallery of Horrors for good reason. It is as clunky and formless as a shoe can get. On women, it is slightly too masculine looking. On men, slightly too fem.


Exhibit#3You knew they had to be here, right? Another freak from Manolo's Gallery. He sums them up best:
These they are indeed the shoes of a hypothetical distopian future, one in which the inmates they must be dressed in the footwear least likely to be useful in the popular uprising against the regime.

That pretty much describes a hospital. Anyhow, if a man is going to own crocs, it should be a pair of, maybe, these...

Exhibit#4
...but these are not a possibility for wearing into a patient care area.



So, what is one to do about this situation? My answer was the Timberland Fells Trainer:
The Fells Trainer has a number of advantages in the situation I've laid out:
  1. It is white enough not to be offensive with a white nursing uniform, but...
  2. it is not white enough to conform to the "handbook," while...
  3. one could plead ignorance about the silver stripes when ordering off the Internet...
  4. and the red lining matches our school colors, and, hence, our uniform patches, etc.

Is the Fells Trainer a comfortable shoe for shift work? Well, for some it might be. For me, not so much, but I weigh a lot. That's why I replaced the standard insole with a Moszkito.

The point of course is not to get you to buy the Fells Trainer (which isn't sold in white now anyway), but to think outside the box a little. There will be plenty of time for conformity when our RN licenses are on the line. For now, it is nice to tweak the nursing instructors a bit.