More EXTREME Body Parts: Part 2

Diversity in the human body and other living things is a fascinating topic. Last month, the most popular blog entry was on extreme body features. Due to the popularity of that entry, I decided to do some more research and bring you some more amazing extreme body parts. So…here we go again (all Guinness World Record holders).

1. WIDEST MOUTH: This is Francisco Domingo Joaquim "Chiquinho" from Angola. His mouth is 17 inches wide. By the way I am a Pepsi fan so this picture should not be seen as an endorsement for Coca Cola.

2. LARGEST BREASTS: This is Annie Hawkins-Turner (aka Norma Stitz). The around chest-over nipple measurement is 70-inches. I’ve spared you some other pictures but if you dare, you can search on-line for more.
3. LONGEST NOSE:

This record belongs to Mehmet Ozyurek from Turkey. This schnozz measures 3.46 inches long. I’d hate to be near one of this guy’s sneezes. 

4. LONGEST FEMALE LEGS: This record belongs to Svetlana Pankratova of Russia which are 5.9 inches. ZZ Top sure would have loved to have her for their Legs music video.

5. SMALLEST WAIST: This waist belongs to Cathie Jung, coming in at 15 inches. It almost looks unreal, which is what makes it all the more amazing.

6 & 7. LONGEST MALE AND FEMALE FINGERNAILS (EVER): These belong to Melvin Boothe (now deceased) which were 32 feet and 3.8 inches. To the right is Lee Redmond whose nails measured 28 feet and 4.5 inches.  I’m guessing they don’t use computers.

8. TALLEST LIVING MAN: This is Sultan Kosey from Turkey. He is 8 feet, 3 inches tall. Here he is with…Al Roker! Guaranteed Al asked him how the weather was up there.

9. TALLEST LIVING WOMAN: This is Yao Defen from China. She is 7 feet, 7 inches tall. I’d like to see her take on Yao Ming in a game of one on one.

10. WIDEST TONGUE: This is Jay Sloot from Australia, who has a 3.1 inch tongue width. One wonders if Gene Simmons is jealous.

Want more? Click for even more and more extreme body parts.

When Patient Advocacy Becomes Patient Enabling

Physicians, nurse practitioners, nurses, psychologists, physical therapists, and a whole host of other health care professionals entered their respective professions to help people. One part of being an effective health care provider is to advocate for your patient when they need it. If your patient (who is a mechanic) broke his arm and needs a note for the employer for a few weeks off, you provide it. If your pediatric patient (who suffered a severe traumatic brain injury) needs you to write a note regarding academic accommodations, your write it. If your stroke patient needs you to write a letter of medical necessity to the insurance company for why they need extra physical therapy for rehabilitation of a weak limb, you write that too. This is just common sense and while it can be seen as advocacy it is also sound practice.

Where patient advocacy starts to become problematic and can lead into patient enabling, is when there is: a) a lack of objective biomarkers to indicate the presence of a pathological physical condition and/or b) the patient is pursuing some form of compensation (e.g., disability application, workers compensation claim, no-fault insurance claim, and/or litigation). By objective biomarkers, this means that there are no significant abnormalities on blood tests, x-rays, MRI scans, physical exam, or other objective measures. When a and b are both present, the risk of patient enabling increases significantly.

In such cases, the health care provider is often left to diagnose, treat, and manage the patient based purely on subjective symptoms. The provider may also be asked to fill out disability paperwork (even on the first visit), fight insurance company denials for expensive tests, and be asked to refill pain medication prescriptions. While it may be easier to go along with these requests, if you are a healthcare provider how do you know that the patient is not exaggerating their presentation, that you are actually treating the true source of the problem, that you are not causing more harm than good in the process, that you are not enabling abnormal illness behavior, and that you are not enabling someone’s financial goals as opposed to medical treatment goals?  

This is a topic that rarely commented on in clinical notes or discussed with the patient. There are several reasons why this is the case, including but not limited to: a) an automatic proclivity among some providers to believe subjective symptom reporting is accurate based on a belief in the inherent truthfulness of others, b) a belief that reinforcing and “validating” symptoms helps the patient feel like someone cares and is thus more important than questioning if the symptoms are accurate, c) helping patients is equated to prescribing and ordering diagnostic tests targeted to each specific symptom, d) not realizing that the presentation may be exaggerated by failing to integrate evidence-based research findings into case conceptualization, e) not utilizing objective measures of treatment progress (or lack thereof), f) fear of complaints and litigation, g) it takes too much time to address, and h) not realizing that there are ways to more objectively and comprehensively evaluate exaggeration.  

As a caveat to this discussion, I want to be clear that there are patients with only subjective symptoms who may have a genuine medical problem that objective tests did not detect. A famous quote about this drives the point home “absence of evidence is not evidence of absence.” To be more accurate, however, the phrase should read, “absence of evidence is not always evidence of absence.” This is because many times a medical test is negative because there really is nothing medically wrong. In other words, many times, “absence of evidence actually is evidence of absence.”

This post should not be read to imply that patients with subjective symptoms, negative objective test results, and who are pursuing compensation should not be treated and advocated for. These types of decisions will always depend on the specifics of the particular case. However, in general, health care providers need to exercise much greater caution in such cases than in the ones described in the first paragraph.

A few tips are as follows.

1)      Use objective measures of treatment progress and require/request this of others who you refer the patient to for treatment. If the patient is not improving with a certain plan of care, it is time to change direction rather than continuing the same treatment for months to years. You may be surprised to find when doing this that the patient is actually reporting worse symptoms over time. If so, it is time to consider why and change course.

2)      Consider if the patient’s presentation significantly exceeds what would be expected based on scientific knowledge of the condition. If the presentation is not biologically plausible, it is time to consider a psychological explanation for the presentation, reexamine the diagnostic impressions, treatment, and advocacy efforts.

3)      Do not feel compelled to immediately fill out disability paperwork or other paperwork supportive of compensation requests without having some data to support your position. If a physical limitation is described as disabling, refer the patient for a functional capacity evaluation. If the patient claims cognitive impairment, send the patient for a neuropsychological evaluation so the role of psychological factors can be explored. These types of evaluations can provide very useful information about the reliability and validity of the patient’s symptoms that is based on objective data and supported by peer-reviewed research.

4)      Use data from the above evaluations to help guide decision making. For example if you find out the there is overwhelming evidence that the patient’s presentation is exaggerated, malingered, and/or caused by psychiatric as opposed to neurological problems, it is time shift the care to a psychiatric focus and only treat physical symptoms that can be objectively verified.

5)      Consider the possible harmful effects of continued treatment without employing reliability and validity checks. For example, if you are treating a non-existent attention problem with a neurostimulant you can be raising the patient’s blood pressure to dangerous levels. If you are keeping patients in physical therapy for gait imbalance who are not improving and who have a non-physiological gait pattern, you are restricting access to care for patients with genuine medical problems who need the service. The same applies for ordering diagnostic tests (e.g., CT scans which expose patients to radiation) that have very little chance of yielding any new information given what is already known about the case.

In sum, health care providers best help patients by using objective data to guide case conceptualization, treatment, and advocacy efforts. Sometimes, you need to be skeptical, sometimes you need to say no, sometimes you need to say something the patient may not want to hear, and sometimes you need to decide and communicate that there is nothing else you can do. This can all be done in a polite, caring, and respectful way. It does not mean that you have failed if all of your patients do not get better. Some will never get better and some do not want to. It’s just the reality of working in the modern day medical system.

Guest Blog Entry: Are You a Helicopter Parent?

Today's guest blog entry is written by Dr. Tanya Gesek.  Dr. Gesek is currently a Visiting Assistant Professor at Syracuse University. She has worked as a middle school psychologist, in residential care for children, in county mental health, and has always maintained a private practice in some form or fashion. She is also the current President of the Central New York Psychological Association. Her guest blog entry discusses parenting, teaching responsibility to children, and helicopter parents (parents who hover like a helicopter over their children whether it is needed or not).

Are helicopter parents becoming a thing of the past?  I sure hope so.  Last spring I received an email from a parent asking about their child’s grade on a test.  The parent wanted to know what their child could do to improve their grade.  Right now you may be thinking, “That is not so bad.”  Well what if I told you that I teach at a major university?  Yeah, now you are with me.

The trend has likely predated my professional career, but I have been amazed in my work with both college students and younger children in my private practice, at how much parents do for their children.  For some reason, we parents have come to think that our job is to make our children happy, all the time.  Whatever happened to facing the challenge?  Do we even use the term “buck up” anymore?

Yes, it is much easier to tie their shoelaces for them.  Homework goes a lot smoother when you hold the pencil.  Your child will be more content if they never hear the word “no”.  There are less tears when everyone gets the first place ribbon.  Your house will be much cleaner if you just do the chores in the first place. 

But what you will also have is a grown up that does not know how to deal with frustration, a college student that cannot troubleshoot a really busy week, and a future employee that falls apart if they get critical feedback from their boss.

I have never heard of a child dying from disappointment and rarely hear my adult friends complain that they had to problem-solve for themselves as children.  Being a resilient adult includes facing challenges, dealing with disappointment and “bucking up”. 

And the Top 5 MedFriendly Blog Entries in September Were...

Below are the top 5 most popular blog entries for the month of September. This will be a monthly feature of the MedFriendly Blog and gives readers a chance to catch up on the most popular blog entries they may have missed. Overall, a good month for the MedFriendly Blog. As the blog becomes more popular, page views will increase. Please post a comment if you have blog entry suggestions. Here is the Top 5 list:

1. Amazing Images of Extreme Bodies and Body Parts: This is the clear winner with 76 page views. People love the visuals. I’ll try to put up more images next month.

2. Guest Blog Entry: Chakras 101: This was the first guest blog entry since the MedFriendly Blog relaunched. It came in a close second with 57 views. Will a follow-up to this entry be in the works? Stay tuned.

3. White blood cells promote cancer: Cancer will always be an interesting topic for readers. But hearing that white blood cells many play a role in the disease? Definitely of interest. Comes in at 43 views.

4. Abandoning Alzheimer’s Disease: My Response to Pat Robertson. This was my response to Pat Robertson’s advice that a husband of an Alzheimer’s patient should divorce her after putting her in custodial care. It was featured on the popular medical blogging site, KevinMD. Comes in at 42 page views.

5. What to do if You Can’t Afford Medications: A helpful primer for patients on this topic. Comes in at 41 page views.

Is Asbestos in Your Children's Crayons?

Is asbestos is your children’s crayons? Can asbestos cause cancer and other serious illnesses? How much asbestos was released into the air on 9/11/01? What is asbestos anyway?

You’ve all heard of asbestos, know to stay away from it, but do you really know what it is and why it so dangerous and deadly? Do you know what to do if it is found in your home and who to contact for inspections and possible removal?

Find out the answer to these questions and more on the brand new asbestos entry on MedFriendly.com. This entry was created after months of research and represents the most detailed and comprehensive article on asbestos on the internet today. The entry was created to commemorate the 10 year anniversary of MedFriendly – where medical information is easy to understand.

The 10 Year Anniversary of MedFriendly.com

October 2011 is the 10 year anniversary of MedFriendly.com. I’ll be going out to celebrate with my family and reflect on how much hard work has gone into this lifelong project of mine. I figured I would reflect a little here on the past 10 years, how it all started, and where things go from here.

I remember the beginnings of the website idea like it was yesterday. I was driving with a friend in Ft.Lauderdale, Florida, where I was attending graduate school. The person I was driving with told me that his girlfriend had a website that she made about psychology.

“Really?” I asked, “How did she do that? She must know a lot about computers.”

“Nope,” the person replied. “She just bought some books and taught herself.”

Immediately, I thought to myself that it would be fun to have a website about something. I had no idea how to make one, but if someone else could pick up a book and figure out how to do this, I figured that I can too. I won’t repeat how I decided to create a medical website where medical information is easy to understand, because that is all described here.

Upon reflection, a few embarrassing admissions are in order. First, I initially avoided computers when they first became popular. To understand how much I avoided them, I was still using a Brother Word Processor in 1998 to write reports in college. That year, I met my future wife and she introduced me to programs such as Microsoft Word and AOL.com (the 3.0 version!). Man, do I feel old writing this. Fortunately, I was a quick learner and within a few years, she was coming to me for computer questions. Within three years, in October 2001, I had taught myself HTML (hypertext markup language) which is the code you write to make a website. MedFriendly.com was born.

Learning can sometimes be a painful process, especially when technology is in its infancy. If you were ever to see what a MedFriendly website page looked like when it first began compared to what it looks like now, it is like the difference between night and day in terms of design and functionality. Changing all of the pages to modify the format took an intense amount of work since each page is uniquely customized. Back then, you were also forced to work at a desk because there was no wireless internet. Nowadays, it is so much easier to be able to have mobility and work on the website from anywhere in the house.   

Initially, there was never any intent to make money with MedFriendly. It was a fun interested way for me to learn, share knowledge, and teach others along the way. It still is. But over time, advertising opportunities arose that would have been foolish not to take advantage of. I experimented with various options. Initially, most pages on MedFriendly had links to books to books on Barnes and Noble.com but sometimes the links would change and instead of having a picture of a medical book on the page, I was left with a big red X in it’s place. I also could not always find a book to match the page content. In addition, not many people were buying the books and eventually, it just was not worth the hassle. I tried a similar arrangement with Amazon.com and with another company I cannot remember that sold medical supplies. For similar reasons, these arrangements did not work out.

Then Goodle AdSense came out and revolutionized the online advertising industry. Now, all I needed to do is place the same ad code on all my pages, and Google targets advertisers to the specific content on my page. Quick, easy, and profitable. That relationship has endured, has grown to this day, and will continue to evolve.

Over the years, I’ve been fascinated to see which of the thousands of entries on MedFriendly that people gravitate towards. For some reason, no matter what medical condition I write about, the term feces has been the #1 term on for over five years. I think this may because the entry is somewhat humorous, but is mostly because it covers a topic that people have healthcare questions about but may be embarrassed to talk to their doctor about. Solution: search the internet. The second most popular type of entry is anything that has to do with blood test results, which makes sense given that people are curious about what their blood test results mean. And, people really like detailed content. Long entries, with a lot of detail, are far more popular than brief entries that provide definitions of descriptive medical terms.

In that vein, there will be a focus in the future on adding more entries with detailed content. The goal is to continue to provide information that laypeople and medical professionals find useful, is easy to understand, covers interesting topics, and does so in a way that sets it apart from any other website on the internet.

Tomorrow, to commemorate the 10 year anniversary of MedFriendly, I will unveil a major new detailed entry that has been months in the making on a topic that is medically, legally, and historically fascinating. Come back tomorrow to see what it is. Thanks to the readers and fans of MedFriendly for helping make it a popular healthcare website! Here’s to another 10 years!

Waking Up with a Live Grenade in Your Face

This is an amazing story. Imagine selling some food on a street corner, minding your own business. All of a sudden, you hear an explosion. Stunned, you turn around to see what it was and an object hits you in the face. You get knocked down. Your face is burning. You touch it. You check your hands. Blood.

The next thing you know, you wake up in an ambulance. There is something in the right side of your face. You figure it’s a rock. The doctor examines you. It’s a live grenade fragment that was supposed to explode when it hit you but it did not. You need it removed. But there’s a problem. If people try to remove it and it explodes, everyone within a 32 mile radius will be blown to smithereens.  

This sounds like something from a Hollywood movie or the TV show, 24. But it is exactly what happened to 32-year-old, Karla Flores, from Mexico. Fortunately for her, a brave team of medical professionals saved her. They moved her away from the other patients and medical volunteers were sought to treat her. Four brave people volunteered: three doctors and a nurse. Two explosives experts also consulted.

Only local anesthesia could be used to cut a hole into her trachea (windpipe) to help her breathe during the surgery, as she could barely breathe before the surgery or swallow her own bodily fluids.  The military doctors guided the doctor and the grenade fragment was removed. She is left with a massive facial scar and half of her teeth missing, but at least she is alive. The medical staff should receive some type of award and recognition for incredible bravery.

My Take on Michael Jackson's Death, Propofol, and His Doctor

Propofol…also known as Diprivan. Many people reading this may not have heard of the drug that played a major role Michael Jackson’s death on 6/25/09, but now that has all changed. His doctor, Conrad Murray (a cardiologist), who ordered the drug for Michael Jackson, and who is now on trial for involuntary manslaughter (causing the unintentional death of another, in this case due to negligence), ordered the drug for Michael Jackson and made it available to him.

What people need to understand about propofol is that this is not a pill you get from your pharmacist or buy off the street. This is a very powerful medication you get in a surgery room to render you unconscious. It is a white, milky liquid that looks like Milk of Magnesia. It is so mind altering that it is referred to by doctors as Milk of Amnesia. In fact, Jackson reportedly referred to it as his “milk.”  I’ve been given this medication many times when I was younger for various surgical procedures. I remember watching the doctor push the medication in and telling myself that I would see how long I could mentally resist its effect. Within 10 seconds, I was out cold…every time.

Now, the trial needs to play out of course and people are innocent until proven guilty, but there is no getting around the fact that people simply should not be administering this medication outside of a surgical setting, where anesthesiologists (not cardiologists) are on hand to closely monitor the patient. Why? The drug is so powerful that it slows the heart rate down and can make it impossible to breathe without use of a respirator. Keep in mind that Michael Jackson was found in full cardiac arrest by paramedics.

On top of using propofol, Michael Jackson was also using several other sedating medications (lorazepam, diazepam, and midazolam). You are probably familiar with lorazepam and diazepam since they are usually marketed under the name, Ativan and Valium, respectively. Both are typically prescribed in pill form to treat acute anxiety but have other uses that cause sedation (e.g., insomnia treatment). Midazolam is sometimes marketing as Versed. It is a very powerful medication that is sometimes also used in surgical centers for sedation. He also had lidocaine in his system, which is a local anesthetic medication commonly used in dental offices. Lastly, he was using ephedrine, which is a stimulant medication.

All of these medications were found in Michael Jackson’s system when he died, with propofol and lorazepam in the greatest amounts. Just taking one of these medications has a powerful effect on the body. Imagine the effect of combining all of them. Also, Michael Jackson had a history of taking many other powerful prescription medications, most of which were again sedating and mind altering in other ways. 

If you want to get a sense of exactly how Michael Jackson sounded with these medications in his system, just listen to how he sounded on Dr. Murray’s cell phone recording. You do not need to be a doctor to understand that something was wrong here.

So, would anyone reading this then order forty more bottles of propofol for Michael Jackson? Well, that is what Dr. Murray is said to have done. He also used non-standard CPR by not doing this on a hard surface and not using both hands for compression. According to testimony today from a bodyguard who was present at the time of Jackson’s death, Dr. Murray asked if anyone knew CPR. How a cardiologist administering propofol does not know CPR has go to be one of the most ridiculous things I have ever heard.

Testimony today was also that Dr. Murray did not call 911 right away but called Jackson’s personal assistant instead, saying he had “a bad reaction.” That may be the understatement of the year. He also tried to get the assistant to remove the propofol from the room, according to testimony today. Thankfully, Dr. Murray’s license to practice medicine has already been suspended in California. However, Dr. Murray has more to worry about now than the judgment of a state licensing board.

Waking Up Alive in a Morgue

Everyone has different fears but one fear that is probably universal is being buried alive. The next closest thing would be finding yourself locked in a morgue refrigerator, wrapped in a plastic body bag…while you are still alive. I first read about a story like this earlier in July 2011, when an 80-year-old man awoke in a morgue refrigerator in South Africa after being sent there due to a presumed death from an asthma attack. Twenty-one hours later, when the man awoke and realized something was wrong, he began screaming and morgue workers thought that the noise was a ghost. The man was rescued after it was realized the voice came from a real person. He was then taken to a hospital and discharged in stable condition. Needless to say, the man was traumatized, had difficulty sleeping, and had nightmares.

Well, now it has happened again…this time to a woman in her 60s in Brazil, who was pronounced dead from pneumonia after suffering two strokes. In this case, the woman’s daughter came to see her mother in the morgue and gave her one final hug. When doing so, she realized her mother was still breathing. The hospital was notified but this was after the poor woman had spent two hours in a plastic bag. The patient was immediately put back on life support. The nurse who first checked her vital signs was fired.

It is reassuring that this has not happened in the United States yet but it may just be a matter of time. My concern is that there may be too casual of an attitude towards death and that the evaluations of these patients were not done as carefully as they should be. In many cases, where people have advanced directives to keep them alive at any circumstances, there would usually be an objective way to test to see if the person was truly dead – an absence of electrical activity of the heart as measured by an electrocardiogram.

However, some people have advanced directives that they should not be resuscitated and so they may not be hooked up to such electrical tests. This often happens in nursing homes, for example. In such cases, a nurse usually checks the pulse and respiration (breathing). This should be double checked by another nurse. In hospitals, a doctor usually does this. It is very hard to imagine, if the nurse or doctor took their time doing this assessment, how a person can be declared dead when they are alive because they would be breathing and have a pulse, even if both were decreased. These issues need to be taken more seriously because what happened in these two cases should never happen anywhere.

Medical Blogging and Patient Privacy

Running a medical blog has become much more challenging over the years. It has always been understood by medical and health care bloggers that you should never post information that violates a patient’s privacy. In other words, do not post patient’s names, photographs of patients, or any other information that can specifically be used to identify them. However, changing patient demographics (e.g., gender, age) and limiting the information discussed such that the patient would not be directly identifiable by others was a way to still discuss important lessons learned from specific cases via social media.

But recently, things have changed. For example, I am aware of specific recent policy implemented by some health care organizations that any employee who has a social media account (e.g., Facebook, Twitter) or a blog cannot post information related to a specific patient case even if the patient is the only person who may be able to identify him/herself based on the information posted. One way around this is getting consent from the patient, but sometimes you may not think to write about a specific situation months of years later after reflecting on it.

In those cases, retrospectively obtaining consent is unrealistic and can seem unprofessional to the atient. For example, imagine making this kind of phone call:

“Hi, Mr. Jones, this is Dr. Smith. I saw you at General Hospital a few years ago. Yes, yes, I’m doing good. How about you? Good. So anyway, I was wondering if you could give me permission to write about your case on a blog I run.” 

One of the medical blogs I like to follow is KevinMD. One of the main features is that it shows a collection of the top medical and healthcare blog postings from the internet each day. I was perusing some of these entries last night and I was interested to see that there are still many doctors posting about specific patient cases. These are good posts. Excellent posts. Posts to learn from.

But I fear we are increasingly going to reach a point where these types of posts decline in frequency, either for fear of litigation for arguably violating patient privacy (even if the patient is the only person who can identify him/herself) or for fear of termination by an employer. Personally, I’ve decided to take the safe route and not report on any specific patient cases from my current place of employment. But I am curious what other medical and healthcare bloggers think about this and how they are handling (or plan to handle) this potential limitation in blog posting at present or in the near future.

When considering these recent restrictions, I think back with a smile to the days where you could open an old medical text and see pictures documenting specific medical conditions in patients, full face and all.

How I defeated low back pain

Anyone who has suffered from low back pain knows how debilitating it can be. I have had low back pain in the past but several months ago I had the worst low back pain of my life. It was impossible to sit anywhere without being in significant pain and when it was at its worst, I could not find a comfortable position to sleep in.

I could literally not lift my left foot up to move it into the car or to put on my socks. Sometimes, I was stuck on the ground and could not get up. It was terrible and demoralizing.

I tried all of the common remedies: back bend stretching exercises, pain medication, yoga exercises, lumbar rolls, use of a back brace, etc. Some of these remedies had worked in the past, but this time, they only provided very mild relief or none at all. I knew that the cause was most likely my posture. Being 6 foot 6 and 250 pounds and having a job that requires constant sitting, there is constant pressure exerted upon my back all day. Although that was a problem, the bigger issue was that I had a leather sofa that I would sink into at night and sometimes fall asleep in. This was throwing my back out of alignment eventually causing the disc to slip out and press upon the nerve.

The only place I could find at home that gave me any type of relief was sitting in a reclining chair and leaning backwards. It was terrific because it allowed me to sit while taking the pressure completely off my lower back. I could even fall asleep in it without aggravating my back. I immediately realized that I had to move this chair into my living room and use this as my new seat at night. For a few days, it was also my new bed. No more sinking into leather couches.

By making this change, it helped put my back into alignment. I also bought a new Shiatsu massager for my work chair and I was able to check out both orthotics and braces from an As Seen On TV store. The massager is helpful when a flare up occurs but I have not needed to use it since using the recliner chair. Nevertheless, I still keep the massager over the chair because the knobs press into the lower part of my back and force me into an upright position during the day. Another thing I did to help was to get up out of my chair and take a walk around the hall several times a day, making sure I was standing as straight as I could.

The point is that posture plays a huge role in low back pain and you can get into bad habits that cause this problem. One way to relieve and rid yourself of the pain is making major changes to your posture by getting rid of bad habits. Now, I can play basketball again with my kids, paint for a few days without back pain, and sleep in my regular bed without pain.
The interesting thing is that no one I had ever spoken to, including a physician, had ever mentioned trying to relieve back pain by using a recliner chair. It was such a simple solution but one that I discovered myself and wanted to share with you. Please pass it on to anyone you know with low back pain.

Spontaneous human combustion

If you have never heard of spontaneous human combustion, it refers to cases in which a person is found burned to death (usually in bed) with no apparent external cause. The furniture around them is typically intact and not burned. Some theorize that there are people whose bodies suddenly catch fire due to some mysterious factor unique to them (such as abnormal levels of concentrated gas or alcohol) or paranormal explanations such as ghosts. While paranormal explanation may sound very mysterious, they do not withstand scientific scrutiny. Importantly, while many cases may have appeared to have no external cause, an actual external cause of ignition has later been found.

I remember watching a TV show about this a few years ago and the best explanation was the wick effect. That is, a source of flame (such as a burning cigarette), burns the clothing of the victim in one area, splitting the skin and releasing fat from under the skin. The fat is then absorbed into the burned clothing, and acts like a candle wick. The burning can continue for as long as the fuel is available. This hypothesis was successfully demonstrated on the show with a pig. With that being said, some debate whether this process can occur in humans and cases continue to pop up now and then.

If you have not heard of a specific case, below is a report of a case of spontaneous human combustion reported several days ago by Nick Collins at The Telgraph.

Man 'spontaneously combusts'
Spontaneous human combustion has long been the stuff of fiction, endorsed by eccentric scientists and employed by novelists including Charles Dickens as a convenient plot twist.

But yesterday the most unlikely cause of death, in which people burst into flames without any external source of ignition, was given official sanction when Irish coroner found a pensioner had burned to death for no apparent reason.

Michael Flaherty, 76, was found dead at his home in Galway last December after a neighbour heard the smoke alarm in his house go off in the middle of the night.

But while his body had been burned to cinders, fire officers who attended the scene were astonished to find nothing else had been damaged apart from the floor below him and a patch of ceiling above.

There were no signs of any devices which could have ignited the body, and no indication of foul play, officials said – Mr Flaherty's body appeared to have simply cremated itself.

Officers who attended the scene claimed they had never seen anything like the extraordinary case, and the inquest heard fire officers were unable to give any explanation for what sparked the blaze.

Recording his verdict, west Galway coroner Dr Kieran McLoughlin was left with little option but to become the first coroner in the country's history to record the unusual verdict.

He said: "This fire was thoroughly investigated and I'm left with the conclusion that this fits into the category of spontaneous human combustion, for which there is no adequate explanation."

Spontaneous human combustion was a phenomenon first described by Victorian doctors, who suggested the body could suddenly go up in flames as a divine punishment for alcoholism.

Other explanations for the unexplained combustion of the body include the influence of ghosts or other paranormal entities, the production of unusual concentrations of gas, or external factors like cigarette sparks.

In the 1850s Charles Dickens, the novelist, attracted controversy after Krook, a rag and bottle merchant, spontaneously combusted in Bleak House.

The mystique of the theory is heightened by the striking similarities between documented cases. In many instances the body is found reduced to ash while the arms, hands and legs remain, and in several others the victim is completely consumed while nearby objects such as furniture remain untouched.

In one example, a Welsh policeman who found the victim's body noted that the fire appeared to have come from within her abdomen.

The latest case bore many of the hallmarks of the classic case – the victim was found on his back by the fireplace, with his head intact but the rest of his body entirely consumed.

Fire experts said the evidence suggested the fire had not been the source of ignition.

Bob Rickard, of the paranormal magazine the Fortean Times, told the Telegraph: "It has become rare now, I have not heard of a case for a couple of decades. But what is even more interesting to me in this case is it is the first time I can remember that a coroner has come out and announced a verdict of spontaneous human combustion.

"Normally they try to leave an open verdict or try to express it in some other way."

Mr Flaherty's family said they were satisfied with the investigation, the Irish Independent reported.

Top 10 Ways to Tell if You Need To See a New Doctor

As a patient care provider and someone who is occasionally a patient myself, I am going provide some suggestions on ways to know when it is time to consider seeking a second opinion or time to seek a new health care provider. This top 10 list is taken from personal experience.

1. The number one reason to seek a new healthcare provider is when the treatment you are receiving is not working. This may seem obvious but sometimes, people continue to remain with the first treatment provider they come into contact with because they “feel bad” that the provider may be offended and sometimes just fall into a pattern where they are going for “treatment” without realizing that their symptoms have remained the same or worse for years. The patient needs to care about him/herself first. With modern healthcare being as busy as it is today, the provider will likely be too busy to get upset about some patient attrition now and then.

2. The healthcare provider is more concerned about discussing himself that talking about you. I will never forget going to see an ear, nose, and throat (ENT) doctor once who literally would not stop talking about himself and his own accomplishments for the first 10-minutes of our interaction. It is a bad sign that the provider will not be sufficiently focused on the patient to provide proper evaluation and management.

3. The healthcare provider does not want to order tests that can aide in better diagnostic decision making (such as magnetic resonance imaging) because they “don’t want to fill out all of the forms.” This is different from not wanting to order tests that would not be helpful. If a surgeon did not want to fill out forms to order a test that can clarify the diagnosis, for example, would you feel confident that this person would take the time to take put the sutures in properly, or would they possibly, leave a scalpel inside of you? I would not want to take the chance.

4. You are rarely being seen by the doctor but are almost constantly being seen by a physicians assistant or nurse. Not that there is anything wrong with physicians assistants or nurses because they do play a very important role in health care, but if you are seeking the care of a specific healthcare provider and are rarely ever getting to see that individual (and you are not getting the care you believe you need as a result) this is a good sign that it may be time to make a switch.

5. The provider becomes defensive and angry when asked polite but challenging questions. No health care provider is always correct with diagnostic decision making or managing treatment. Patients should feel like they can have an open and honest discussion with the provider which includes asking questions about possible alternative diagnoses, treatments, or inquiring about information gathered from popular news sources. Provided that the questions are asked politely and without the intention of being antagonistic, there is no need for the provider to become upset. There is no need for a patient to feel scared to ask questions of their physician, nurse, psychologist, etc.

6. Feeling rushed. Healthcare is best when the provider is able to take the time to listen and understand the patient’s problems. When the provider gives off signals (e.g., frequently checking the clock or a watch, sighing when questions are asked, walking towards the door, cutting off questions) that he/she cannot spend much time with you, it may be time to consider seeking the care of someone who can.

7. When the provider makes decisions that turn out to be harmful. An example of this would be going to a pediatrician for a child with respiratory problems and constantly being told it is probably due to allergies despite the fact that the child has no known allergies and has not improved with allergy medications or a nebulizer. Due to the delay in taking the parental report seriously that the problem is likely more than allergies, the child develops pneumonia and is hospitalized. Situations like these are reasons switch providers. While no health care provider is free from making mistakes, this does not mean you have to stay under that provider’s care.

8. The provider has decided upon your course of care before evaluating you. This one sounds hard to believe but it happens sometimes. I had a situation once when I went to a doctor, he saw my chief complaint, and filled out two medical scripts before talking to me or evaluating me. Medication and other treatments should be based on a discussion with the patient and an evaluation.

9. The provider is not really listening to you. If you go to see a health care provider and he/she is too busy doing other things while you are trying to explain what is wrong with you, it is a bad sign that the provider is not paying sufficient attention to detail to provide optimal care. Examples include writing out another patient’s medical notes or prescriptions, typing text messages, or sending emails when the patient is trying to explain the reason they are there. While some people are good at multi-tasking, attention to detail decreases and errors increase when multi-tasking occurs. The provider should be focused on you, and only you, when you are in the evaluation room together.

10. Lastly, research your healthcare provider on your state’s online licensing board’s website. You would be surprised how many are still practicing despite being the focus of serious investigations, reprimands, and recipients of prior disciplinary charges for actions that violated standards of the licensing board (e.g., improper note keeping, fraudulent billing, poor medical care). An internet search on popular search engines can also be helpful as some physicians move to another state if a license to practice has been removed from a prior state of residence. Online searches can also reveal prior criminal acts or charges. It is important to be careful with on-line searches, however, because you need to be sure that the person you are reading about is the same person as your health care provider and not someone else with the same name. In addition, be wary about information from health rating websites that are purely written by former patients, because they can be biased towards negative reviews which may not accurately reflect the qualities and attributes of the person you are seeing.

Attack of the killer cantaloupes

Sometimes, trying to eat healthy does not always work out in the way intended. It's ironic that the person who decided to eat a candy bar or a bag of cheese doodles wound up faring better than some people who chose to snack on some cantaloupe. What some fans of the rounded green melon did not know is that a large batch of cantaloupes were contaminated with a bacteria known as Listeria monocytogenes. It is rare for this bacteria to infect humans but when it does, it is known as listeriosis. So far, as many as 68 people have been infected and 11 have been killed as from eating cantaloupes infected with this bacteria.

How can this happen, you ask? Many assume that fruits and vegetables are always safe because we are taught to eat them in plentiful amounts and favor them over processed foods. While that general recommendation still holds true, people need to be aware that there will always be a small risk when eating fruits and vegetables just as there are when eating meat. With meat, however, if you cook it enough, you will generally kill the harmful bacteria. With fruits and vegetables, however, it is sometimes impossible to reduce the risk of contamination ahead of time because it is usually eaten raw.

It is important to understand that there are harmful bacteria that live in the soil and one such type of bacteria is Listeria monocytogenes. It lives in the soil because it loves to eat dead plant matter. When the bacteria enter a fruit such as cantaloupe, they can be passed on to someone who consumes the fruit. Once in the body, the bacteria changes, can enter cells, and can even enter the blood if the immune system does not control it. That, in turn, leads to sickness. If it enters the brain, it can lead to death.

Newborns, the elderly, and people with weak immune systems are most likely to contract listeriosis, in addition to pregnant women. If pregnant women become ill, the fetus can also become ill and die. The most common symptoms of listeriosis are fever and muscle aches and vomiting.

Cantaloupe and bacteria are both "all natural." The take home message is that "all natural" does not always mean good for you and safe.To read more, see here.

Video Gamers Solve HIV Protein Puzzle

Video games and video gamers often get a bad rap in the media, usually unfairly in my opinion. Although my own video game playing has waned over the years, I grew up with Intellivision, Atari, Coleco, the original Nintendo, and REAL arcades in the 1980s that only cost a quarter to play. Hearing the noises of Pac-Man, Ms. Pac Man, Donkey Kong, Dig Dug, Super Mario Brothers, and countless others, was and still is, music to my ears. So I have a fond affection for video games (and all sorts of games) having grown in the Golden Age era.

These days, video games have advanced significantly to include huge online communities, live simultaneous international competition, rewards and prestige for earning achievements, and often require excellent visual-spatial skills and highly complex strategic decision making. The people who play these games and do well and them are highly skilled and many are very intelligent. My brother, an engineer who graduated from Lehigh and Georgia Tech, is a perfect example.

Researchers at the University of Washington figured they may be able to use the skills of video gamers to help them solve a problem they had been unable to figure out for over a decade. Specifically, the researchers were trying to determine the structure of a protein (known as protease) that forms retroviruses. This protein plays in important role in causing certain viruses to multiply, including HIV. The structure was difficult for the researchers and computers to decipher because the amino acids that make up the protein fold into very complex shapes.

In order to create a drug to deactivates the protein (which would then stop the virus from multiplying), the researchers needed to know its exact structure. Why?  Think of a lock and key analogy. Just like a lock will only open for a specific key based on the structure of both components, parts of the protein have structures that will only react to a medication made of molecules with a corresponding matching shape.

So the researchers at University of Washington made a video game named “Foldit” to see if they could get people to build models of the protein. The game was competitive and required the use of three-dimensional problem solving skills.
Result…In just three weeks, video gamers deciphered the structure of the protein. The discovery is expected to result in the development of new anti-retroviral drugs, which includes anti-HIV drugs.

Conclusions:

1. Human intuition can be superior to automated computer methods.
2. Some video gamers are geniuses.
3. Video game players provided a positive contribution to science.
4. Video gamers may have just opened the door to giving many sick people an “extra guy.”

Click here for reference

Amazing Images of EXTREME Bodies and Body Parts

Remember going to the library as a kid and being the lucky one to pick out that short thick Guinness Book of World Records book that week? I remember being fascinated by these books, the records that were in then, and the pictures of some of the amazing physical characteristics of some people.  It was partly an amazing collection of extreme physical characteristics among people, animals, and other living things.

Unfortunately, the short little thick Guinness books are gone and they have been replaced by the larger books that just don't seem to hold the same charm to me. But today, I found some newly announced 2012 world records from Guinness and wanted to share them with you.
First, here is the lady (Channell Tapper) with the longest tongue (3.8 inches) in the world. For the longest tongue in the world (a man) see here. This will give Gene Simmons a run for his money:

Second, here is what is described as the world's fattest woman (Pauline Potter), although I am told that the politically correct term nowadays is "persons of size." Either way, she's 643 pounds:

Third, here is Jesus Aceves, who is the closest possible match to a human werewolf. He has a rare condition called congenital generalized hypertrichosis (excessive facial and torso hair).

Fourth, here is the world's shortest man (Junrey Balawing, age 18), from the Philippines, coming in at 24 and 1/4 inches tall:

Fifth, here is Christine Walton, the woman with the world's longest fingernails, coming in at 10 feet, 2 inches on the left hand and 9 feet, 7 inches on the right hand:

Sixth, here is Rolf Buchholz frm Germany, who has the most body piercing and studs (453 rings and studs). This includes 94 around the lips, 25 in his eyebrows, and 278 in the genitals. Ow. Ow. Ow.

Seventh, here is Ram Chahaun, who has the world's longest moustache, which is 14 -feet long

Eighth, here is Aevin Dugas, who has the world's largest afro (4 feet, 4 inches in circumference):

Hope you enjoyed these pictures as much as I did. Feel free to pass this blog entry on to others who may like them too. Also, be sure to click here for more extreme body parts and even more and more extreme body parts.

Guest Blog Entry: Chakras 101

Today is the first of many new guest blog entries on MedFriendly. The purposes of guest blog entries are to introduce the reader to something I would not normally write about, branch out into new areas, and feature people with expertise on certain healthcare topics. The guest blog entry below was written by Ana Finnegan, a Registered Nurse, in Florida. She is very knowledgeable on alternative medicine and the art of Eastern healing.

The Skinny on Chakras 

If you have ever taken a yoga class, learned to meditate or simply wondered the meaning behind the band Third Eye Blind's name, chances are you have heard of chakras. Knowledge of the Chakra system comes from the ancient Indian practice of Tantra Yoga. The word Chakra comes from the Sanskrit word “Cakra” which means “a wheel or a disk of energy”. This energy or Prana is the vital life force essential to the function of the physical body. Balance of this pranic energy through each of the chakras is associated with optimum state of health both physically and emotionally. Just as a closed or misaligned chakra can deprive its corresponding organs of vital energy, a wide and misaligned chakra can overload its corresponding organs with too much energy. There are seven main chakras: The lower: root, sacral, solar plexus and heart. The upper: throat, third eye and crown.

The Lower Chakras

The first chakra is the root chakra. It is located at the base of the spine and the pubic bone. This chakra encompasses the genitals, reproductive organs, the adrenal glands, the kidneys and the spinal column. The color associated with this chakra is red. The second chakra is the sacral chakra. It is located in the sacrum, just behind the navel. Organs associated with this chakra are: the spleen, bladder and the kidneys. The color of this chakra is orange. The third chakra is the solar plexus chakra. It is located in the solar plexus area of the abdomen cradled by the ribs. Organs associated with this chakra are: the pancreas, the stomach, the liver, the adrenal glands and the kidneys. The color of this chakra is yellow. The fourth chakra is the heart chakra. It is situated midway between the shoulder blades over the sternum. Organs fed by this chakra are the heart, the thymus glad, the blood and circulatory system, and the immune and endocrine systems. The color of the heart chakra is green.  

The Upper Chakras 

The fifth Chakra is the throat chakra. Located in the throat, it feeds the thyroid and parathyroid gland, the lungs, the vocal cords, and bronchial apparatus. The color of this chakra is blue. The sixth chakra or the third eye, is located in the center of the head behind the forehead. This chakra feeds the pineal and the pituitary or master gland. The color of this chakra is indigo. The seventh chakra is the crown chakra and it is situated on the top of the head. This chakra also feeds the pineal and pituitary glands. The color of this chakra is white.

Chakra Tune-up and Balancing 

So now that we have discussed what the main chakras are and the organs they feed it is important to understand that chakras need to be balanced in order to for the physical body to perform optimally. It is considered preventative medicine in the world of alternative therapy and holistic medicine. There are many ways to balance one's chakras such as with the use of aromatherapy, crystals, music, chanting and meditating. The use of a pendulum is preferred by the author along with her own home made organic incense herbal blend. 

Mediation vs. Medication

If you thought meditating is for monks... better think again! Here are a few benefits of meditation:

Meditation has been shown to decrease blood pressure.

Meditation has a positive chronotropic effect much like Digoxin (it increases cardiac output and slows the heart rate).

Meditation has been shown to lower oxygen consumption and respiratory rate, leading to increased exercise tolerance especially in heart patients.

Meditation has been shown to enhance the immune system by increasing the activity of natural killer cells and by reducing the activity of viruses.

Meditation has been shown to enhance post operative healing by reducing inflammation.

Meditation has been shown to reduce allergies, arthritis, irritable bowel syndrome and other inflammatory conditions.

Meditation has been shown to decrease muscle tension and tension headaches.

Meditation has been shown to improve the quality of sleep as well as increase the amount of REM cycles by inducing deeper levels of relaxation.

Meditation has been shown to reduce anxiety by lowering lactate levels in the blood.

Meditation has been shown to increase Serotonin production thus improving depression and other mood disorders, as well as by reducing obesity.

Meditation has been shown to reduce PMS.

Meditating for Dummies

1.      Create a sacred space: Find a quiet spot, lite a white candle. Play soft instrumental music or mediating CD’s. Initially set a timer for 10 minutes.

2.      Quiet the committee: Concentrate on breathing, If you find your mind wandering, bring it back to the breath. You can even recite a mantra or short phrase such as SO/HUM. This is done when you breathe in you visualize the word. So in your mind and when you exhale you visualize the word HUM.

3.      Be Persistent: Meditate for 10 minutes everyday. It will become easier and you will learn to look forward to it.

I don't know about you, but I rather stock my medicine cabinet with scented candles, incense, Indian chants and lavender oils rather than the alternative!

Namaste!

Abandoning Alzheimer's Patients: My response to Pat Robertson

I was tempted to avoid venturing into this topic, only because I strive to keep my website and blog away from politics and religion. In that light, I am going to stay away from the politics and religion of this topic and just stick with the main theme of the story and respond based on my own experiences, which includes assessing patients who are known to have or are suspected of having Alzheimer’s disease and/or other serious medical diagnoses.

The context of this blog entry has to do with a comment that Pat Robertson made on his show, The 700 Club.

A viewer asked about his friend, who began seeing another woman after his wife developed Alzheimer's Disease: "He says that he should be allowed to see other people, because his wife as he knows her is gone. I’m not sure what to tell him. Please help." 

The fact that the question was asked in the first place (especially to a religious leader) indicated that the caller felt guilty and that he is doing something wrong.

Robertson acknowledged that it was a difficult situation but then stated that "I know it sounds cruel, but if he’s going to do something, he should divorce her and start all over again, but to make sure she has custodial care and somebody looking after her.” 

When someone asked about how this can be reconciled with marital vows, Robertson rationalized his response by saying that Alzheimer’s Disease is “a kind of death.”

The most difficult aspect of my job by far is having to tell a patients and their family members that the results of the evaluation indicate the presence of Alzheimer’s disease. It is extremely difficult because there is no cure, the disease course is slow and progressive, and it involves profound memory loss. The disease will take its toll on the patient, spouse, friends, and family. However, these patients need strong emotional and physical support from these individuals because these are the people who love and care about them the most. The reference to “custodial care” is a fancy way of saying that someone else will take the primary responsibility of caring for the patient, typically in a nursing home.

To be sure, not every spouse or family member can care for a patient with significant medical needs by themselves. It is indeed a difficult job, physically, cognitively, and emotionally. Many people need help taking on this care-taking role but at a certain point, the demands can become too great and the best decision for the patient and the spouse is for the patient to be cared for in a quality nursing home. However, this does not mean that the spouse divorces the patient and abandons them. Over my years of working in various inpatient services, I have seen family members who are regularly present by their loved one to provide the support they need. In any medical facility, it makes a world of difference having family and friends present who can advocate on your behalf to make sure the best possible care is received. In some medical facilities, when staff see that the patient has been abandoned by the family, it can unfortunately need to a detachment in treating the needs of the patient by some, most, or all of the staff.

Another problem with Robertson’s comment is that is can easily be applied to patients who are in the end stages of other terminal diseases, such as cancer, Lou Gehrig’s disease, or Huntington’s disease. People with terminal medical conditions are nowhere near the persons they once were when the physical ravages of the condition or disease have set in. Beyond physical impairments, significant changes in thinking skills, emotional functioning, and behavioral functioning often co-occur. Would Robertson suggest abandoning these patients too?

Anyone who has personal and/or professional experience that involves the impending death of a family member, friend, or patient, can attest to the importance of family support. Whether it is talking to provide cognitive stimulation and emotional support, putting on the radio or television, bringing in a favorite snack, making the bed more comfortable, helping with grooming and hygiene, making sure the proper medications are being given, or making sure the doctor is aware of new medical problems, these are just a few of the things that a spouse or family member can do that benefit the patient. Although some facilities provide excellent custodial care, no one will look after the patient better than a concerned, motivated, and loving family member.

Robertson’s comments can probably also be applied to patients who do not have a terminal disease but instead have a condition or disease that causes severe impairments in physical, cognitive, emotional, and/or behavioral functioning. Some examples are severe traumatic brain injury, stroke, and Parkinson’s disease. Would Robertson see the severe impairments be seen as “a kind of death” and if so, would be advocate abandoning these people?

As someone who witnessed my grandmother suffer from the debilitating effects of a stroke, I can attest that she was a completely different person. She had transformed from a the stereotypical short, pleasantly plump Italian grandmother who loved to talk with you, to an emaciated and aphasic (speech impaired) woman who seemed to have aged by 20 years. She could no longer dance to Perry Como songs at Christmas time or prepare baseball-sized meatballs in the kitchen as she was now bedridden and paralyzed on one side of her body. Gone were the nice welcoming kisses, hugs, and cute little phrases as they were replaced by confusion, bewilderment, and occasional obscenity use.

Although some may see this as “a kind of death” my father frequently took us to see her when I was a child because it was the right thing to do, even though it was difficult. When we were there, all of the support mentioned above was provided. But since Robertson focused on spouses, it is important to point out that her husband remained at her side for years until she passed away, despite only marrying her a few months before the stroke. She usually did not remember him and often referred to him by other names. Nevertheless, the thought of abandoning her and withdrawing support would simple never have occurred to him. Each day, this nice little old man, braved the New York City subway system and city crowds, despite all of his own medical problems – just so he could be there for his lady.

Man Found with 72 Bags of Cocaine in his Stomach

In this week's strange medical story of the week, a man was arrested at an airport in Brazil after he was was found behaving oddly, screened by security, and found to be in possession of drugs. However, this was not your average drug possession as the man was found to have swallowed 72 bags of cocaine. He is now going to faces charges of up to 15 years in prison. Below are some images of the cocaine bags inside of his stomach, courtesy of the Brazilian Federal Police and the Associated Press:

In Defense of Sponge Bob

Aye-aye maties! This week, a study came out in the Journal, Pediatrics, which concluded that watching Sponge Bob is associated with worse executive functioning in children. Executive functioning is a broad concept but in this context it refers to the ability to delay gratification. Children who watched Sponge Bob segments as opposed to the lighter paced PBS show, Caillou, were worse at delaying gratification. The theory is that the children were so mentally worn down after watching the quick Sponge Bob animation that they could not delay their gratification as well as the children who watched the slower animation on Caillou. This was based on results of the famous "marshmallow test" in which children were told that when the researchers left the room, they could ring a bell and eat two marshmallows or crackers immediately. But if they waited a few minutes they could have 10 marshmallows or crackers. Children who watched Sponge Bob ate the food right away.

No one knows how long this effect lasts or even if it is a valid reflection of a true association with Sponge Bob (or fast animation). To begin with the sample size for each group was small (20 per group), the children were 4 years old despite the target demographic for Sponge Bob being 6 to 11, and there may be other explanations that have nothing to do with fast animation. For anyone who watches Sponge Bob, it is very food-based. Maybe the children who watched Sponge Bob got hungry watching those delicious Krabby Patties being prepared and just wanted to eat something afterwards.

The ironic thing about this study from my own personal experience is that I know people whose children love Sponge Bob and are great students but whose parents banned Caillou because the character was talking rude to others and this was being imitated by the children. So, there are other factors to consider as opposed to how fast the segments go on a TV show. As someone who grew up watching fast paced shows such as Tom & Jerry, Woody Woodpecker, and the Electric Company, somehow I made it out ok and with enough executive functioning to earn a doctoral degree and run a website. So I think that the Sponge Bob Generation will be just fine -- as long as Plankton doesn't get his grubby little hands on that secret Krabby Patty recipe.

My memories and reflections of 9/11/01

Ten years ago, on 9/11/01, I remember walking into work at Jackson Memorial Hospital (JMH) in Miami, Florida. I was a graduate student at Nova Southeastern University at the time and was collecting data from brain-injured patients for my dissertation. As I was waiting for the elevator, I turned around and looked at the small television hanging in the corner wall. The news was on and I saw images of smoke coming out of a hole in large building. There was no audio, but it was obvious that the building was one of The Twin Towers. The hole was small, so I figured that a very small plane crashed into the building. In fact, this was one of the early rumors of what had happened. When I walked into the nursing station, more rumors were flying, including that this was a terrorist attack. When the second plane hit the other Twin Tower, there was no longer any doubt. In a prelude to the debate that later ensnared our country, doctors and other health care providers were openly debating whether to attack whoever was responsible, and whether nuclear weapons should be used. In the midst of the debate, nurses were calling their relatives in New York to check and see if they were ok.

Stunned by what was taking place and after watching the Twin Towers continuously smoking on TV, I decided to take a break from the TV coverage and to test a patient to get some more dissertation data. I shut the patient’s TV off, spent about an hour or so with him, and turned the TV on again. When I turned it on, all I saw was a massive plume of smoke and that the Twin Towers had collapsed. I thought back to just a few years ago when I had driven by the World Trade Center, looked up at the Twin Towers (not even able to see the top from the car window) and thought about how incredible of a disaster it would be if just one of those Towers ever fell over. When I had wondered about that several year prior, I was thinking of what would happen if the Towers fell over to the side. With the Towers collapsing downwards and not to the side, thousands of additional deaths through were likely avoided and the disaster cleanup was at least be more contained, although still daunting. It also didn’t avoid the release of large amounts of asbestos in the air from the Towers, exposing emergency workers and thousands of other to an insulation fiber known to cause mesothelioma.

At this point in the day, all non-essential personal were asked to leave the hospital. There were still reports of planes in the air and no one knew where they were going to next. The Pentagon had been hit by a plane and rumors were that another plane was coming for the White House of the Capitol building. People in large metropolitan cities were worried, and for good reason. Driving home down I-95 was bizarre because people were looking in the air for planes as weapons. I called my brother on the phone, who was living in Atlanta at the time, and he voiced a similar concern. We both were struck by how strange it was that we seriously needed to be worried if we saw a plane in the air at this point since all planes had been grounded by the FAA. My brother and father used to walk by the Twin Towers every day that past summer and if the attack had happened when they were there, we both realized that they could have been victims. Fortunately, my father was not working in NYC that day.

I remember getting back to my apartment and being glued to the TV like all of America that day and the days ahead. I barely got any sleep due to how much coverage I was watching. Soon, pictures of the victims came out and memorial videos were shown on TV. I particularly remember the song “Only Time” by Enya being played constantly during these memorials. During this song, which is very emotionally-laden, a picture was shown of one of the victims – a dad standing next to his two children at Disney World, as happy as can be, posing next to Tigger or some other character. That picture really hit me hard, because it symbolized how much innocence and kindness had been taken from us that day. It was impossible to watch it without a tear coming through. Thinking of all of the people who had to make a decision as to whether to jump to their deaths or be burned alive was frightening because you try to imagine yourself in that situation. Hearing phone messages of victims calling their loved ones for the last time was terribly sad. I did not have children at the time, but even then, it was not hard to imagine how devastating it must have been to think that you would never see your children or family again. Today, it just reminds me even more never to take your loved ones for granted.

When driving, I remember that everyone, and I mean everyone, had an American flag sticking out of their car window or attached to their car antennae. Everyone was proud to be an American. As the decade has passed by, many people have gone of with their lives, but hopefully, people will never forget what happened on that day. In writing this, I found a powerful reminder of that day , played to the Enya song noted above. If you would like to share your memories of 9/11 or pay tribute to a 9/11 victim, please feel free to do so below.

Announcing the New MedFriendly.com

As we near the 10th anniversary of MedFriendly.com in October 2010, I wanted to take a moment to update readers with many new features of the site.

1. NEW DESIGN: MedFriendly was given a complete redesign. The homepage is no longer cluttered and contains a new scrolling menu divided into three different sections: Information, Interactive, and Special Areas. The individual entries have been redesigned so the advertisements flow better with the content and use space more efficiently. Long entries will no longer begin with a long list of questions that can be clicked for more details, but instead starts immediately with content that is divided into different sections with labeled colored font. The blog you are reading has also been redesigned to be more reader friendly.

2. TWITTER: MedFriendly now has a Twitter page where you can follow us. To do so, click the Twitter (bird) icon on the homepage or click here. There is also a MedFriendly Facebook page.

3. BLOG: The MedFriendly Blog will be updated more frequently. Entries will be tied into content of the site and related to current events in the news. Guest blog entries will also return. The blog will also be where new features are announced as the What’s New section was removed. Other ideas for blog entries are welcome.

4. NEW EMAIL: Instead of having multiple email addresses, a new single email address is in place: MedFriendly@gmail.com. Feel free to use that email and your message will be replied to as soon as possible. Emails will be checked daily.

5. MORE DETAILED ENTRIES: Web statistics on MedFriendly show that articles with more detailed content are more popular than brief definitions. While brief definitions will continue to be added, there is a new focus on adding more detailed content entries.

6. REMOVAL OF POP-UP ADS: All pop-up ads have been removed from MedFriendly.