By Greg Laub
Dr. Allen Laub is a retired pediatrician who is making his foray into the blogging world — and yes, the two are entirely related. He claims he is not bored, but he didn’t blog before retirement. After all, no one can read his handwriting …

By Charles Bankhead

At the recent Genitourinary Cancers Symposium (GuCS), a spontaneous outburst of levity reminded me that the conferences MedPage Today covers aren’t entirely serious events. In fact, a lot of downright hilarious incidents occur at these meetings — some intended, some not. During a presentation at the aforementioned GuCS, a comment from the audience — an unintentional double entendre with sexual overtones — left the presenter struggling to regain his composure, much to the amusement of the attendees. I won’t go into specifics because this is family-oriented entertainment.

These funny moments occur with regularity, and some of them will remain fixed in my memory until my memory is no longer fixed.

The humor often matches the topic of discussion. During a presentation at a diabetes meeting, a speaker described a patient as having Dunlop Syndrome. The speaker continued for a few moments before pausing for effect. “I assume all of you are familiar with Dunlop Syndrome. That means his belly done lop over his belt.”

If you’ve ever had to suffer through a friend or family member’s slides of a vacation or some other event, you can sympathize with audiences at medical conferences. You can also understand how attendees appreciate a bit of levity to break up the monotony of one slide presentation after another in a darkened room.

Some years ago, before the arrival of the digital age, a speaker was clicking through film slides, and paused to stare at the screen. He removed his glasses and wiped the lenses, then put the glasses back on, only to continue staring at the screen. Finally, he turned to the audience and asked, “Is that slide out of focus, or am I having a stroke?”

Even with digital wizardry, technology doesn’t always work as planned. At one meeting I attended, the slides stopped advancing. After several attempts to move things along on his own, the speaker cued the A/V technician with the familiar refrain: “Next slide, please.”

Nothing happened, so the speaker repeated, “Next slide, please.” Still nothing.

Heads began to turn in the direction of the A/V console, where the technician was engaged in catching flies: Head tilted back, eyes closed, mouth wide open.

When a bit of low-level laughter failed to awaken the A/V technician, one of the session moderators stood up, walked to the A/V console, cupped his hands around his mouth, bent over near the technician, and yelled, “NEXT SLIDE, PLEASE!”

The poor A/V tech nearly fell out of his chair. Suffice it to say, fly-catching activities ceased. At least for that session.

Medical organizations take financial disclosures seriously, but the same can’t be said of some the speakers at conferences. After displaying a lengthy list of financial relationships, one presenter said, “Basically, I take money from anyone who will give it to me.”

The British are known for their wry and witty observations at medical conferences, particularly when critiquing their colleagues’ work. During one recent meeting, a Brit expressed his disdain for the design of a clinical trial: “You set the bar so low you were in danger of tripping over it.”

Smaller meetings tend to have a disproportionate share of humor, probably because members are well acquainted with one another. So it was at one smaller meeting I attended several years ago. A resident had just completed a rather light-weight presentation, designed to give the young physician experience with scientific meetings.

When the moderator opened the floor to questions and comments, a large body arose from the back of the auditorium, and the owner began a deliberate stroll to the front. He had an unruly mop of snow-white hair and a thick bushy mustache of the same color. To describe him as portly was like saying the Empire State Building is tall. He resembled a walrus on his way to crush a penguin or baby seal.

This particular character had a reputation for ruthless questioning and the snidest of snide remarks, especially when an intern or resident was involved.

As the walrus made his way to the front, I witnessed a phenomenon unlike any I had ever seen and have not seen since that day. Initially, it was barely audible, but in short order, a cascade of booing and hissing followed the walrus to the front of the room and did not stop until he was recognized by the session moderator, as if any introduction were necessary.

And so the inquisition began. Each question and snarky comment prompted more boos and hisses, but the inquisitor paid it no mind as he bore into the defenseless resident.

When he had done as much damage as possible, the inquisitor stepped back from the microphone, eyed the young physician at the lectern, and said, “This is all very interesting. I look forward to reading about it in the Journal of Irrelevant Research.”

The walrus wheeled and started the slow, deliberate walk back to his seat, surrounded by a cacophony of boos, hisses, and catcalls. He acknowledged his detractors with a curt, semi-salute from the side of his head, looking every bit the part of the victorious villain in a professional wrestling match. He loved every minute of it.

The next time you read MedPage Today‘s coverage from a conference, keep in mind what news commentator Paul Harvey so often said when signing off: “And so that’s the rest of the story.”

By Liz O’Brien

The book had been on the shelf above my desk for so long it had become invisible — a nondescript, faded little paperback, pressed between two other homely, undistinguished volumes.

I only noticed it as I was leaning back in my chair, scanning the office for inspiration for something to write about since it was my turn to blog.

It was the “Mothers’ Medical Encyclopedia,” nearly 40 years old now, shabby, dog-eared and well-thumbed-through, a good and loyal retainer who had kept vigil with me through many a sleepless and scary night tending feverish and crying babies.

It lists 14,000 topics in alphabetical order from abdomen to zoonoses. I remember how I would delve through its pages, desperately searching for what was the matter with my child and alternating between relief and fear at the possible diagnoses I found.

For example, here’s the entry for night terrors:

This is something completely different from a nightmare (see above). The youngster will wake up screaming, and he is indeed in genuine terror, even though he has not had a bad dream that he can remember or recount. When you run to comfort him, you may find he is very disoriented, he may behave very strangely, he may not recognize you.

Do not panic . . .

I tried not to.

But not only did my kid not recognize me, he didn’t even know I was there!

My 5-year-old son stood ramrod stiff on the edge of the bed, his eyes bulging out of their sockets in terror, a trembling finger pointing to the corner of the bedroom as he declaimed in a horrible, monotone voice, an octave below normal:  “IT’S . . . OVER . . . THERE.”

I squinted closely at the page under the little Winnie the Pooh night light.

The book went on to say that he would eventually come out of it (oh, please, please . . .) and that such behavior is not uncommon but is a sign of emotional disturbance (uh-oh). However, it’s usually temporary (whew), but if it persists it could be serious and will need professional help (oh no!).

I re-read this entry for reassurance each time it happened. With the help of a wet washcloth stroking his face, my son would eventually return to me from the land of his terrors, drop back to sleep, and in the morning, except for sometimes asking, “Mommy, did I have one of those dreams last night?” he seemed fine.

I kept an eye peeled for “emotional disturbance,” but he appeared to be his generally sunny little self. When I mentioned these episodes to the pediatrician, he confirmed what the medical manual said. They continued intermittently over the next year or so, and then disappeared altogether.

But while they were going on, it was good to have my “Mothers’ Medical Encyclopedia” at my side. Thus armed, I took my stand against night terrors and nightmares, and all things that stalk the nursery by night: upset stomachs and belly aches, fevers and coughs — all the things that seem so much worse in the dark. It whispered “do not panic” and gave me sensible advice while we waited for morning to come.

By Chris Kaiser

This is a story about a man who actually died doing what he loved.  

John Alleman was 52 and for the last year or so, he pounded the
pavement in front of Las Vegas’s Heart Attack Grill, encouraging tourists to
step inside the decadence and enjoy a 9,000-plus calorie burger.  

Well, as life often deals ironic cards, Alleman died on Feb. 12 of  –  a heart attack, according to a report in the Las Vegas Sun.

Alleman became known as the unofficial spokesman for the
Heart Attack Grill, receiving no money for his efforts, but occasionally being
given free food.   

According to the Las
Vegas Sun, owner Jon Basso warned Alleman that his eating would end tragically. But Basso’s tongue is firmly in his cheek on his web site, so who knows how he delivered his cautionary tale to Alleman.

Waitresses at the Grill dress in white nurses’ outfits, but
I’m pretty sure none of them could have been of much help to Alleman at his
most dire time of need. 

The menu sports items such as the “Single Bypass Burger,” “Flatliner Fries” (boldly proclaimed to be fried in pure lard), and Double,Triple and Quadruple “Bypass Burgers,” the last being 2 pounds of ground beef for
$13. Bypass burgers come replete with bacon, cheese, raw onions and tomatoes.
The tomatoes almost seem like an afterthought.

The folks who at Guiness who dole out World Records gave an award to the “Quadruple Bypass Burger” for being the “most calorific burger … in Las Vegas … packing 9,982 calories.”

And the Physicians Committee for Responsible Medicine also got involved. It called for the restaurant to lose its license and not be able to capitalize on “obesity, clogged arteries, and now serial casualties” in a letter to the Las Vegas Department of Planning.

“Serial casualties” refers to the death-by-heart-attack in 2011 of Blair River, 29, who clocked in at over 500 pounds and was also considered an unofficial spokesman for the Grill.

The Physicians Committee for Responsible Medicine suggested the Heart Attack Grill focus on healthy vegan food, with such menu items as “Better for You Burger” and “Feeling Fit Baked Fries.”

The American Heart Association has outlined seven behaviors people can adopt that will ensure them a longer and healthier life than if they didn’t adopt them. They include four core behaviors:

• no smoking
• normal BMI
• lots of physical activity
• eat healthy

And then there are three criteria to meet:

• cholesterol below 200 mg/dL
• blood pressure lower than 120/80 mmHg
• not having diabetes

The European Society of Cardiology unveiled new guidelines last May at the EuroPRevent meeting that called for everyone to have at least one cardiovascular risk assessment in their lives: men after age 40, women after age 50.

The new guidelines also stress the use of a risk/age assessment as a means of communicating one’s risk of heart disease. In other words, a  35-year-old can have the arteries of a 35-year-old, or theirs may resemble those of someone in their 60s.

In a statement on the Heart Attack Grill’s web site, the owner says: “The medical industry, fitness professionals, the entire world has failed the American public. I can say this with confidence. I’m going to tell you something different than other doctors and fitness professionals. I’m going to prescribe a diet that actually works.”

The diet, which consists of foods on his menu, as well as beer and cigarettes, works because you stay on it, Basso says. No more yo-yo effect. I could think of worse marketing ploys.

And Basso throws some added incentive: Anyone who weighs over 350 pounds eats for free.

“Imagine the joy of knowing you’ve finally achieved something,” he concludes.

By Gary Schwitzer
The cover story of the March edition of Consumer Reports is “The cancer tests you need – and those you don’t.“  You need a subscription to access the full content, but here’s a glimpse of what’…

By Gary Schwitzer
A paper in the New England Journal of Medicine, “Myths, Presumptions, and Facts about Obesity,” drew lots of news attention.
The authors reported:
We identified seven obesity-related myths concerning the
effects of smal…

By Todd Neale

Typically, if you wanted to investigate disease outbreaks for the CDC, you’d complete the 2-year Epidemic Intelligence Service (EIS) program, But before you even got to that point, you’d have to be some type of healthcare professional — a physician with at least a year of clinical training, a doctorate-level scientist, or some other type of professional with an MPH. That takes time.

Well, put away the books, because I’ve got good news for you. Apparently your iPad can give you all the disease-fighting thrills you need — the CDC has released an app called “Solve the Outbreak.” In it, the user becomes an investigator for the EIS, trying to get to the bottom of three fictional disease outbreaks based on real-life cases (with more to be added). The app provides clues and data and allows users to make decisions about how to proceed with the investigation, learning about epidemiology and earning points as they go. The results can be shared on Facebook and Twitter, of course.

“The goal is to use new technology to provide an engaging, interactive way for users to learn how CDC solves outbreaks, thereby increasing general knowledge about real-life public health issues,” CDC director Tom Frieden, MD, MPH, said in a press release. “The public no longer have to experience an outbreak investigation through fictional Hollywood films like Contagion.”

This is an interesting idea, and, for some of us, the closest we’ll get to the front lines of a disease outbreak. And that’s probably for the best.

By Celebrity Diagnosis

Five months to the day after her bone marrow transplant, Robin Roberts was back at the anchor desk on Good Morning America.
Roberts, 52, underwent the bone marrow transplant on September 20 to treat Myelodysplastic Syndrome (MDS), which was a complication of the treatment she received for breast cancer in 2007. Her sister Sally Ann Roberts, an anchor for WWL-TV in New Orleans, was an excellent match, and became the bone marrow donor.
Before the actual procedure, Roberts had to undergo 10 days of
intense chemotherapy remove any abnormal cells from
her body before the new immune cells were introduced. This came with all
the typical side effects of chemotherapy — raw throat, achiness, weakness and headaches.
Of the day of the actual transplant, Roberts told People magazine she remembers very little — although she does recall seeing her transplant specialist, Dr. Sergio Giralt , at
Memorial Sloan Kettering Cancer Center, say a prayer as he injected the
stem cells into her chest catheter. “I loved that he prayed,” she said.
Afterwards, Roberts came to a near breaking point:

“I was in a pain that I had never experienced before,
physically and mentally. I was in a coma-like state. I truly felt I was
slipping away.”

Fortunately, this period ended, and she slowly began to see
improvement, measured in how many laps she could walk around the nurses’
station.
When she finally went home on October 11, Roberts was excited to be
home, but worried about leaving the “safety” of the hospital
environment. She had to wear a surgical mask everywhere (even in her
apartment) to protect her new immune system from infection. Her anemia made her weak. Her muscles had
atrophied and her appetite was almost nonexistent.
In November, she contracted CMV (cytomegalovirus),
which put her back in the hospital. It took 6 weeks to clear the virus.
Although things have shown continued improvement, her oncologist, Dr. Gail J. Roboz, says, “We’re not out of the woods yet. Robin’s immune system is like a 5-month-old baby’s. She’s very vulnerable.”
Over the past few weeks, Roberts has been “in training” to get her body ready to return to GMA.
She’s had to become re-accustomed to getting up at 3:45 am. She’s gone
through a few “trial runs” at the office, and she will probably only
work a few days a week for a while.
It was nice to see Roberts back on GMA, her smile raising the
spirits of all those who have been inspired by her journey. As she told People:

“I want to give people hope. I want to let them know there is another day. I can be fearful or fearless. I choose to be fearless.”

Guidelines for Monitoring Bone Marrow (or Stem Cell) Transplant Patients

As Roberts’ story illustrates, the road to recovery after bone
marrow (or stem cell) transplantation is long and fraught with danger.
There are three main things that must be carefully watched:

1. Prevention of infection and reimmunization
2. Monitoring for Graft-Versus-Host Disease (GVHD)
3. Nutrition

The following are excerpts from the The National Marrow Donor Program^® (NMDP) guidelines to assist physician care for post-transplant patients after they return home.

Post-Transplant Complications

Infection Prevention

To reduce the incidence of infectious complications, immunosuppressed patients must restrict their activities.

Post-discharge restrictions: Day 0-100:

•  
  Avoid crowds, use mask when in public places
•   Visit doctor 1-3 times a week for the first 4 weeks with blood tests to check blood counts, renal function, liver function, cyclosporin A (CsA) level
•   Adhere to catheter care requirements
•   Use caregiver for transportation, shopping, cooking
•   Avoid contact with small children and pets

Post-discharge restrictions: 3-6 months

•   No longer needs mask
•   Doctor visit once a month, more frequent if patients have GVHD
•   Monitor for chronic GVHD
•   Continue prophylactic CsA, tacrolimus, or other immunosuppressive drug

Post-discharge restrictions: 6-12 months

•   Stop immunosuppressive drugs if there is no GVHD
•   May be able to return to work
•   Monitor for chronic GVHD
•   Still at risk for infection
•   Monitor for disease status
•   Some may still be taking prophylactic antibiotics

Transplant recipients may remain immunocompromised far beyond 2 years
post-transplant, especially individuals with chronic GVHD. Therefore,
post-transplant patients should be routinely re-vaccinated after
transplant until they regain immune competence.
The re-immunization schedule is as follows:

Graft-Versus-Host Disease (GVHD)

Chronic GVHD, an immune response of the donor-derived T cells against recipient tissues, occurs in approximately 30-70% of patients receiving an allogeneic transplant. It is a serious, potentially life-threatening post-transplant complication.

Early detection of chronic GVHD can help
prevent irreversible organ damage, improve survival, and increase the
quality of life of transplant recipients.
There is an excellent photo library for physicians of signs of chronic GVHD. You can access it by clicking here.

There are also a number of free mobile apps to help physicians monitor transplant patients. You can learn more about them here.

Research might one day lead to better treatments for disorders such as ADHD, autism, scientists say
WEDNESDAY, Feb. 20 (HealthDay News) — Using real-time images of brain connections developing in late-stage fetuses, scientists say they’ve been able fo…

By Kevin, M.D.

Hospitalist programs are becoming the norm nationwide. 

What makes a great program?  To me, communication is key.  With hospitalists, patients are cared for by more doctors than ever.  The transition from primary care to hospitalist, and from the “day” hospitalist to “night” hospitalist, can introduce sources of medical error.

Janice Boughton is a hospitalist herself, and she describes what her ideal program would look like: “All you need is great doctors, a simple and user friendly EMR (electronic medical record), moderate work loads and face-to-face signouts.”

In many hospitals, attaining all these goals is difficult, so it’s easy to see why many hospitalist programs fail.

***

Falls are a problem that hospitals strive to prevent.  One way of doing so is installing so-called bed alarms.

But do they really work? 

Geriatrician Ken Covinsky examines the evidence in a study:

On the bed alarm units, there were 5.76 falls per 1000 patient days. About 1/4 resulted in injury
On the usual care unit, there were 4.56 falls per 1000 patient days.  About 1/4 resulted in injury

Although not statistically significant, there is a trend towards bed alarm units being associated with a higher frequency of falls.  Certainly it doesn’t lessen the incidence.

One reason could be that bed alarms are activity-restricting.  Older patients are encouraged to get out of bed and ambulate with assistance.

When you consider how expensive bed alarms can be, it’s time to re-think the approach to preventing falls.