head nurse 

Photos from clinic party 

Photo of stained glass window recognizes heritage and history
Posted by Hello

last mass...patients and friends
Posted by Hello

Tourists funding terrorists

Most people don't know that there is a Marxist group trying to overthrow the Nepal government.

I could probably sympathize with any group trying to replace a medieval government with a modern one, but after seeing the "fruits" of similar revolutions, one has to wonder...

However, the tourist dollars keep the Nepal government afloat, so probably they look the other way when the Marxist ask for donations in return for not attacking tourists...

However, the real danger is that tourists are infecting the Nepali guides...with HIV...Young tourists are, of course, YOUNG, and full of hormones, away from home, in close contact with other tourists, and so one presumes there are a lot of opportunities to spread various STD's to one another...but there is a mention in the article about condoms being taboo in Nepal's culture--so this article worries about tourist STD spread to locals. Not one mention if the HIV is due to hetero or homosexual spread of HIV...(a taboo subject on the BBC, I guess)...The BBC mentions that condom use is taboo in Nepal cuture..but the Big question: is homosexuality taboo in Nepal, or are they like many Asian cultures, where homosexual contact by men where there are few women is "just sex", frowned upon but considered something humans do? And if the guides are getting HIV from tourists, is it because they are being sexually exploited?

One of the dirty little secrets of tourism is the sexual exploitation of poor local people by tourists...usually it is young girls, but young boys are also at risk.

The reason this is important is because if the guides contract HIV from tourists (often through homosexual contact) they will go home and give it to their wives and children, a spread that could terribly affect the economy of that small country, since those infected will soon become too sick to work, and their families will also die...


Dr Ehrlich, call your office..

superbowl Sunday

Superbowl Sunday...the world shuts down for 24 hours as men gather around the TV...

Michelle Malkin has a perfect recipe for today: Superbowl Lumpia....(Lumpia are Filippino eggrolls)...

Bon appetit!!

Pump pump pump

This is heart disease week, so Parade magazine has articles on the heart.

Here is an animation on how the heart pumps...

And here is a link to the Pump song...

I didn't know that it originally came from Happy Days...or that Potsie Williams was the nephew of Dr. Heimlich, of the Heimlich maneuver...

.

The American Heart Association has a "live and Learn" quiz for you to take...and if you finish it, they claim they will send you a free recipe book. I don't know if the books any good, but hey, what else do you have to do on a Saturday morning?

Art on stone

the NYTimes has an article on bushman art.

In Southern Africa, you often will see huge boulders that have either "caves" or protected cracks between them, and if you go in, you see art made by the San people, who predated the present day tribes of South Africa by thousands of years.

Many of them have never been discoverd, but hopefully now people in that multi racial country will learn the heritage of those who were there before the Boer, the English, the Malasian, the Indian, and the various Bantu tribes arrived there (most people don't know that the Zulu and other Bantu tribes only arrived in South Africa less than 1000 years ago).

retirement party

Carnival of the recipes take 25

The Glittering Eye is hosting the Carnival of the recipes this week.

I usually posted recipes on my blog, but we are so busy packing that I merely defrosted lasagna for supper...

Recipe: Take out of box. Microwave until hot.

Bon appetit!

I am retiring from Oklahoma, and will move to the Philippines with my Filippino husband next week. So if posting is light, it's because not all airports have hotspots, and because I am busy packing.

I was going to post "going away" party stuff on the blog, but two problems.

One, the photos I took are fuzzy.

Two, the photos keep posting to my private blog instead of this one.

Oh well...

Lace

On line books page has a whole set of links to lacemaking...

No, I don't make lace, except for crochet doilies. But like every other cultural thing, it is interesting how people do "ordinary" things and make beauty.

In a history of textiles, it was noted that the earlist textile were cords and net bags to carry things...which evolved into grass skirts, bands (i.e. belts) and then cloth.

And even the Neanderthals made jewelry...

Twinkie alert

Those familiar with Fox's acid tongued Bill O'Reilley know his latest crusade is against a left wing nut case who is a professor who calls those killed on 911 as little Eichmans....

If we fired every A**H*** at American colleges, we would be in big trouble...

However, the real scandal is not that he is an idiot, but that he was hired as an American Indian ...and he cannot prove he is an American Indian. You see, most Indians are enrolled on tribal rolls, and know their ancestors and geneology. And to be recognized, one must have a CDIB card, proving percetage of Indian blood and in which tribe or tribes....Here in Oklahoma, there ARE a lot of part Indians, often belonging to non recognized tribes, but they often can trace their "indian" ancestor. And then, there are "twinkies", the wannabees.

Big deal, you say?

Actually, it is, ...at least here in Indian country.

And this editorial defends his right to speech, but notes:

Churchill's statements are obviously devoid of even the most basic humanity that American Indian peoples hold dear. In no way does his insult reflect the views of Indian country. To know the response of Indian country to the 9/11 tragedies is to reflect on the humanitarianism shown by Eastern Native communities: from the Mohawk to the Oneida, the Pequot, Mohegan and many others who immediately put their people - ironworkers, ferry-boat crews and medical personnel - into the rescue and recovery operations, to the California Indian nations that expressed their solidarity with America and donated generously to the rescue efforts, to the Lakota families who brought their Sacred Pipe to pray at the site, leaving their quiet offerings early one dawn. This is always the preferred way of human beings - to understand the kind of empathy required to belong to the human race is essential in all political and economic discourse. To call the people who were murdered on Sept. 11 ''little Eichmanns'' is a hideous expression that when combined to Churchill's mistaken Native identity can only poison the public discourse concerning American Indians.

General Watie, call your office....

Apples and oranges.

A new British report says a person can take daily heroin and lead a normal life...duh...

This will, of course, be distorted to prove the Brits should legalize heroin and tell those using it that they can use it safely, which of course is nonsense.

Doctors know that those "addicted" for pain control lead normal lives, because they take enough to control pain, but not to get high. If they enter hospital, they might get a physical "withdrawal" but if you relieve their pain, they will not stay addicted. Examples are many cancer patients, or people with fractures and injuries after car wrecks.

And if you read the report, most of the working addicts interviewed for the report didn't inject, and many denied it bothered their families or jobs...ah, but how many times in our offices do we hear people claiming that their drinking doesn't affect their health, when their Liver enzymes are high, they have ulcers, and their third wives are divorcing them?

Latin quiz

BBC has a quiz on Latin words used in English...

Latin used to be taught in schools....now we only teach "modern" languages. However, Latin teaches us roots, both historical and linguistic.

If you learn Spanish, you learn Spanish culture.

If you learn Latin, you learn the roots of Spanish and French culture, the roots of Medicine, the roots of many English words (via Norman French) and the roots of western Civilization.

I am not an expert at language, but I speak several poorly, and am fascinated by how languages express things differently.

And on reading one book on Tolkien by one of his fellow professors of Linguistics made me realize not merely the linguistic roots of LOTR, but of how linguistic roots of towns and roads tell us history.

In the USA of course, most of us know where our town names come from, but rarely think of it.

When I grew up in Philadelphia, a nearby street was Limekiln pike which had street signs saying TPK...but tpk, i.e. turnpike? Yes, it was once a turnpike, and there were once limekilns nearby...This portion of Limekiln Pike was an extension of the original segment established in 1693 to provide a thoroughfare between Old York Road and the limekilns of Thomas Fitzwater in Upper Dublin Township.Alas, I never got to dig into history much more than that...

Similarly, in medicine, we incorporate names into our craft...for example, Legioneer's disease comes of course from the American Legion convention in Philadelphia...but daily we use names of organs and illnesses which have history, but alas how many of us know where such names come from...

Jacob Grimm, call your office...

Politics

Bush's speech only put me to sleep twice, so it was good.

Before the speech, Brit Hume said: One thing different about this president is that when he says something, he means it...

If I were a middle Eastern Despot, I'd be trembling in my shoes...but not because of the threat of war (at least I hope the cowboy doesn't spread the war) but because of what Thomas Friedman notes: that it is the Iraqi people who voted and showed the self styled fascists that democracy can work...

MIscellaneous

Want to invest? I'll tell you in one word...

Stem cells...

Yup. Bone marrow stem cells...so they will have the same DNA, easy to get (there are a lot more in bone marrow than in an embryo)

Another good investment:

Starbucks. Not only is it one of the most widely recognized brands, but professors are writing about how Starbucks changes cultures.

Ironically, in Oklahoma the nearest Starbucks is 50 miles away (we have an independent coffee shop with gormet coffee downtown, not a starbucks)...but in the Philippines, there is a Starbucks on the main road to Manila, maybe 30 miles form our village.

And, of course, Baywatch is one of the most widely watched TV shows in Asia...

David Hasselhack, call your office.

Medical bankrupcy

Medical bills among the insured are a major reason for bankrupcy...

but if you scroll down, you see the article mentions has some holes.

First, it was done by a doctor who supports "universal health care"...and from Harvard, where socializing medicine is considered the holy grail...

and then we see this:

"Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness."

You went bankrupt for $11,000? Most people's cars cost more than that. I often advise patients to pay so much a month until it's paid...and if hospitals and offices were more cooperative, they would encourage such payments. Instead they send these complicated bills implying pay now or we won't see you. So the patients panic.

But the real reason for bankrupcy is not the bills, but the loss of the salary of the sick person, or of the sick person's spouse/daughter etc.

And if you go bankrupt, you don't lose the house/car/farm.

When I was in private practice, a lot of people who had no insurance and Caesarian sections went bankrupt to save their small farms and equipment. Probably the entire bill was abou $12,000, but that was in 1980 dollars, and would be three or four times that amount now.

But when the wife worked, it meant that they lost her income which was needed to pay extra bills.

Answer? Universal catastrophic care, i.e. where bills go over $20000 a year.

But in a world where Medicare covers Viagra, and it is the yuppies, not the hardworking oil workers, who come into my office and demand instant MRI's of their bad backs and arthroscopic surgery of their knees, I don't really support universal care.

Subsidizing insurance for workers, however, and catastrophic coverage is badly needed...

So it's come to this, has it?

The big news on the blogosphere this evening is that "special ops Cody" has been taken hostage, and may be beheaded if Iraqi prisoners are not released...

Presumably, GI Joe and Barbie Army will have to go in and rescue him.

Like memogate, the fraud was picked up ten minutes after the photo was posted on the right wing site Free Republic ...but since I don't surf during working hours, perhaps Drudge picked up the fraud first...

The Islamoterrorists haven't looked so stupid since Osama's photo was posted all over without noticing that evil Burt was in the photo...

Miss Piggy call your office...

Patients or paperwork, take two

The fine line on documenting is helped by dictating (paying a secretary to type it out)...however, there is a two day average delay in getting it down...

So you have to write everything on the chart, and THEN dictate--double duty. IN the past, I always summarized what was important, and dictated the chaff...

Another way to summarize is to list the problems, then summarize what you saw to emphasize why that diagnosis or problem was on the list.

Then we have the nursing type records: Three pages of checkmarks, originally for nursing diagnoses, but I've used them in ER's...again, the problem is that the vital stuff is lost in the checkmarks.

Maybe computerized records are the answer: You put the vital stuff in the main part, and the chaff/normal/unimportant (like a false eye in a stroke patient) in a pop up window. But again, that takes time...and maybe using Dragon or similar voice dictation programs will work faster than hiring a secretary (and now some secretaries are outsourced to other countries).

In the meanwhile, until we have computerized records, (coming next year) I will continue scribbling my summaries and not getting paid for my time due to lack of "documentation" of all the different systems needed for medicaid/insurance billling....

Dr. Casey, call your office.