Sunday, November 22, 2009

King Tut in TO

I've just noticed that an exhibition of King "Golden Pharaoh" Tutankamen artifacts is coming to the AGO this month and will be sticking around until April. Anyone else want to go? :)

Tuesday, November 17, 2009

Surgery is a Lifestyle

Or so says my elective preceptor, a general surgeon/surgical oncologist. Life is something you fit in around it. Things for me to ponder, to be sure, over the next two years or so. In the meantime, I'm loving my elective; in the new year I'll get some exposure to ENT/head and neck surgery.

At some point I need to write about non-medical topics, though. Before that point, I did notice something curious about some of the heart murmurs we've been learning about over the past few weeks. Last Tuesday I examined a patient with a very loud systolic murmur, indicating aortic valve stenosis. Every time this patient's left ventricle contracted, there would be a loud, transient whoosh as blood passed through his narrowed aortic valve. After listening for a bit, it suddenly dawned on me that the murmur sounded almost exactly like the alien signal from Contact.

Still a very cool movie - and now it provides a handy way of recognizing certain types of valvular disease.

Sunday, October 4, 2009

Le mois d'Octobre

It's been a rather nice fall so far in Halifax. Nice, generally sunny weather (today's being a notable exception), and I've been enjoying Med 2 a lot so far. I've finally scrubbed into surgery and it's been great. Really great. I'll have to write more soon, but this appears to be the direction in which OR procedures are going:
Next time you go in for surgery, don't be surprised if the surgeon and staff introduce themselves before you go under the scalpel.

It's just one of the 26 tasks on a surgical safety checklist that hospitals across the province will be required to implement starting in January, because it has been proven to reduce patient complications and death.


The checklist includes common items such as requiring doctors and staff to check equipment, review patient information and resuscitation plans, and even identify themselves by name and role before they make their first cut.

The checklist will be mandatory for all surgeries in the province, and hospitals will be required to report twice a year on compliance.

The list is divided into three parts: tasks that must be completed before the anesthesia, before the first incision and before the patient leaves the operating room.
In case there's any concern that this sort of thing wasn't done previously, I can say that it's just a more systematic, formal way of approaching normal practice. But don't take my word for it:
"Everything on the checklist is a well-known standard of care," said Dr. Michael Baker, head of patient safety for the province, at a media briefing Thursday.

"There are no new ideas in the checklist," he said.

"The new idea is that the team needs to communicate and be obsessive-compulsive about the surgical process."
The video accompanying the article even has an example of a typical anesthesia monitor alarm. It helps remind me of the OR, and that I was taught (in Austria anyway) that the appropriate response to such alarms is to turn them off (I think it's an apnea alarm).

Saturday, September 19, 2009

Bodyworlds Returns!

The Bodyworlds exhibit is coming back to the Science Centre:
Four years after BODY WORLDS 2 brought record crowds to the Science Centre, the new blockbuster exhibition, BODY WORLDS & The Story of the Heart, will open to the public on October 9, 2009 for a limited engagement.

See through the lenses of anatomy, cardiology, psychology and culture how the heart nourishes, regulates and sustains life. The exhibition will give you a profound insight into the human body, health and disease, and the intricate world of the cardiovascular system with over 200 human specimens including whole-body plastinates, organs and translucent body slices.
From the sound of it, tickets should be bought in advance. As usual, I expect to be in TO around Christmas time, and I think it would be fun to organize a group trip. It's not altogether cheap, but it's cool and it must not be forgotten that it featured prominently in Casino Royale. What more do you need?

Saturday, July 18, 2009

Austrian Observations

Generally speaking, Austria is quite similar to what I'm used to in Canada, but, of course, different, and not just because all the signs are in German. A few brief notes:
  • Smoking: Everywhere, that is. I don't know if there exists the concept of a "no smoking" section in Austria, but I have yet to discover it. Sure, you can't smoke on trains or on buses, but it's been only a year or so since smoking was banned in most areas of hospitals. It's possible that the Landeskrankenhaus Innsbruck is behind larger centres. Of course, since many on the surgical floor still smoke, the compromise was to put smoking lounges just off the OR hallway (I had forgotten just how awful smoke is in very confined spaces). It's not really airtight, though, so the scent of smoke tends to waft down the hallway.

  • Shopping hours: Sunday shopping? Evening shopping? Like, after 7pm? Forget about it! Not possible, and even the local video store near me closes at 10pm weeknights. I'm sure some of the more touristy places in the Innsbruck Altstadt are open Sundays, but they sure aren't open in the evening. This would be a lot more inconvenient if my schedule was tighter, but fortunately I'm pretty much always done by mid-afternoon.

  • Free lunches: Self-explanatory, and applies both on the OR floor and in the main hospital cafeteria. The food isn't great, but it gets the job done, so to speak.

  • Coffee machines: Coffee vending machines, I should say. It tends to be expensive to buy coffee from bakeries, bars, restaurants, or coffee shops, as a small cup (about the same size as a Tim's small) will run you about 2 euros. Despair not, however, as you can get a cup of about the same size and quantity from a vending machine for 50 or 75 euro cents. Very reasonable, not to mention fast!

  • Trains, trams, and buses: Fast, convenient, everywhere. Even Innsbruck, population just under 120,000, has an efficient bus and tram network (good for me since I take the bus at least once daily). I seldom wait more than about five minutes; the outside might be ten. There are night buses too, though I haven't taken any as of yet. Vienna similarly has an extensive public transit network: U-bahn, tram, bus. Innsbruck makes the buses in Halifax seem slow and inconvenient... which they are. Rail is the other issue here; you can take the train everywhere and it's reliable and comfortable. They'll even apologize if it's 15 minutes late (the norm for Via Rail!). While the train can be a bit on the pricey side, it makes day tripping very easy. (Concerning Italian trains, while they are not remotely pricey, let's just reiterate that one should never trust a bargain too much...)

  • Language: In light of my less than stellar German skills, I've had an okay time managing here, primarily because most people seem to have some command of English. I'm working on improving, but it's slow-going, despite being surrounded by the language all the time. Arguably just as challenging is the local Tiroler accent, considered "quite strange" by some Viennese. I can probably get by simply by knowing "bitte schön", "genau", and "past".

I suppose that's all for now. Pictures to come later. Bis später!

Tuesday, July 14, 2009


So, it seems that Tim Hortons has now come to New York City:
The Canadian doughnut invasion has begun.

Over the weekend, 12 Dunkin’ Donuts restaurants in Manhattan and Brooklyn underwent a transformation, emerging Monday morning as the first New York City locations of Tim Hortons, a Canadian chain that sells coffee and baked goods.
It's so nice that New Yorkers will now be part of an exclusive set of locations that includes the two locations in New Minas, NS (not to mention the 24 hour Wolfville outlet), Hamilton, Finch subway station, and the Sir Charles Tupper Medical Building, along with every mall, airport, suburb, and indeed many gas stations in Canada. At least one New Yorker is just as excited:
Mr. Weprin said the arrival of Tim Hortons "shows New York City is on the move, we’re a desirable market," adding that he was "so excited to have Tim Hortons here." (emphasis mine)
Evidently this Weprin character is a city councillor, but surely he is simply a creation of The Onion and this is not actually a legitimate article in the NY Times.

Of course, it is exactly that. I wonder how long it will take for the novelty to wear off.

(Disclaimer: I probably go to Tim's at least a hundred times a year, if not more. It's the price I pay of not wanting to go outside for food/coffee/whatever when it's really cold out.)

Thursday, July 2, 2009

Change of Venue

I started this blog while in Waterloo ("wintering" there), and in September I returned to Nova Scotia where I may just stay forever. Except, of course, for my current travels, which have brought me to a hostel in Vienna. On Sunday I'll go to Innsbruck for a month-long clinical elective; this is pretty much the farthest and longest time that I've been away from home. Last year in Waterloo might sort of count as being "away", but being less than an hour's drive from friends and family doesn't quite count. The closest thing previously was way back in 2003 when I went for a 5 week French immersion program in Trois-Rivières. At that time, we were actually forced to speak French exclusively (or, well, as much as possible); now I *should* be speaking (some) German, but my vocabulary and grammar is pretty rudimentry not to mention very rusty.

Now, I'd planned to spend time studying and reviewing some German prior to departing, but... well, it was always hard to that during school, of course, and I was fairly busy and then travelling during the three weeks immediately after it was over. I do actually remember a surprising amount considering it's been *six* years since I've really practised it at all. Currently when I try to think of a German word for something, French inevitably comes up first as my "default" non-mother tongue. A bit frustrating. C'est la vie... (again with the français!)

Otherwise, I think travelling alone can be - unsurprisingly - a bit on the lonely side, but I'm grateful for some personal private space after 12 or so hours of planes and airports. It felt a lot longer than that, though, and how the Zurich airport can justify charging $10 for a coffee and donut is utterly beyond my comprehension. The Berliner was rather short on jelly at that.

Anyway, that's about all for now. Ideally I'll be posting more on this trip (especially to make up for not posting at all in June!).

Tuesday, May 12, 2009

Useless Products

Most commercials tend to make little impression on me, but one I saw just now convinced me that a confiscatory useless product tax at point of manufacture is in order:
Aqua Globes™ watering bulbs are an attractive solution for automatic houseplant watering. Fill the hand blown stained glass bulbs as the plant needs it. Aqua Globes™ watering bulbs are a great alternative to the daily chore of watering plants and an excellent choice for automatic watering while on vacation.
Now, I don't know about anyone else, but I haven't found watering plants to be much of a chore lately or ever. For only $14.99, though, I could purchase an Aqua Globe which would save this daily chore. Keeping in mind that you still need to fill the globe with water and stick it into the soil. And that I seldom actually need to water my plants *daily*.

How much time do you think one would save with an Aqua Globe? 30 seconds per plant? I'll grant that they look kinda... interesting - and they could serve as a conversation starter for guests:

Guest no. 1: Ohhh, what's that glass sphere in that pot?
You: It's an Aqua Globe (TM).
Guest no. 1: ...
You: It waters my plant for me.
Guest no. 2: You still have to put water in it, right?
You: Yup.
Guest no. 2: So what's the advantage?
You: Oh, it automatically releases water when the soil's dry, so it waters the plant better.
Guest no. 1: You know, your soil feels kinda dry...
You: Ohh!! My Aqua Globe (TM) is empty!

Anyway. This is a good example of a product designed to create a demand that, really, does not exist.

Wednesday, April 29, 2009

Conflicts of Interest

The ongoing inquiry into the events leading to Robert Dziekanski's death following tasering by the RCMP has provided a classic conflict of interest scenario:
A cardiology expert paid by the company that makes Tasers told a public inquiry Tuesday he doesn't think Robert Dziekanski's death was at all related to the controversial stun guns.

Dziekanski died on the floor of Vancouver's airport in the early morning of Oct. 14, 2007, minutes after four RCMP officers confronted him and stunned him several times with a Taser.

Dr. Charles Swerdlow, a cardiac electrophysiologist who receives compensation for sitting on Taser International's medical advisory board, appeared at the inquiry by video conference from California.

Swerdlow said if the Taser negatively affected Dziekanski's heart, it would happen almost immediately after he was stunned.

But he noted that an airport security guard has testified that he checked Dziekanski's pulse three times before firefighters arrived more than 10 minutes after his collapse. Trevor Enchelmaier told the inquiry that each time he checked, Dziekanski had a heartbeat.

"In Mr. Dziekanski's death, we know his [heart stopping] was not immediate, we know he had an adequate cardiac rhythm for a number of minutes following exposure to Taser," said Swerdlow, who works at Cedars-Sinai Medical Centre in Los Angeles and also teaches at the University of California.

"So nothing here fits with direct cardiac electrical stimulation."

Swerdlow also said that if the heart is affected by electrical current, the resulting heartbeat would be either too fast or irregular. The first time anyone noticed anything wrong with Dziekanski's heart was when firefighters arrived and found he had no pulse at all.
I gather that cross-examination of Dr Swerdlow has yet to occur, but I might ask him the following questions:
  • An airport security guard has testified that he was able to find Mr Dziekanski's pulse "three times" in the approximately ten minutes following his collapse prior to the arrival of the firefighters. Does evidence of a pulse in and of itself rule out arrhythmia or any other adverse effect potentially caused by multiple Taser "stuns"?
  • Did the security guard have adequate training or equipment (e.g. stethoscope, ECG leads) to ascertain Mr Dziekanski's condition?
  • What is the appropriate means of diagnosing an arrhythmia?
  • What level of electrical current would be sufficient adverse cardiac events or death? What are the causes of such results?
  • How do you know that Mr Dziekanski's cardiac rhythm was "adequate" in the period prior to his death and following the tasering? Were you present at the scene? If not, on what basis can you testify that his rhythm was "adequate"?
  • How much compensation do you receive from Taser International annually? Have you ever noted any examples of adverse cardiac events resulting from Taser use? Do you feel there is any conflict of interest in testifying in favour of the safety of a product whose manfacturer compensates you? Did you receive any additional compensation to appear at this inquiry? How often do you testify in Taser-related cases? Have you ever testified that the use of a Taser contributed to death or other adverse cardiac events?
I think that about covers it. I'd be very interested in the responses.

Saturday, April 18, 2009

Interview Time

Interview Weekend is once again upon us at Dal. Therefore, I present a music video that's almost as old as I am. For whatever reason, "Africa" by Toto has become some kind of thing song here. Enjoy.

Friday, April 10, 2009

Quacks in BC

"The regular docs treat the symptoms, whereas the naturopath tries to find the CAUSE."
So, they've done it. So-called naturopathic physicians will now be able to do the following:
  1. prescribe non-controlled medications (eg. they can prescribe Tylenol #3, all antibiotics, all mood altering medications - antidepressants, antipsychotics, mood stabilizers including lithium, immune suppressants such as prednisone, methotrexate), "after completing a certification training". A list of medications they cannot prescribe is attached at the end of the legislation (seems to be mainly narcotics / sedatives / chemotherapy agents)
  2. order Xrays / Ultrasounds (but no CTs)
  3. perform minor surgeries at or below dermis
  4. perform allergy challenge testing and desensitization
  5. insert finger/instrument/device into any body cavity, whether natural or artificially-created
Now, do naturopaths have the training for any of this, particularly minor surgery? For all their self-serving rhetoric, they do not have any hospital experience in their training, nor any mainstream medical exposure. No clerkship. No call. No residency. No OSCEs. Just dodgy self-regulation. And homeopathy.

Of course, I will not and cannot deny that many treatments in use today derive from natural sources. Digoxin, a very old drug used in heart failure, was isolated from Digitalis purpurea, a poisonous flowering plant also known as foxglove. That doesn't make homeopathy - a practice without any kind of rational pharmacological basis - a valid form of treatment, however, nor does it excuse the sort of rhetoric that seeks to set naturopathy apart from "allopathic" (i.e. mainstream) medicine:
  1. Vis medicatrix naturae: the body has the inherent capacity to heal in the proper therapeutic environment. NDs believe in the recuperative power of the organism, given the correct climate for healing. Determining the correct individualized therapeutic environment is at the core of naturopathic medicine.
  2. Tollum causum: remove the cause. Instead of treating the symptoms of disease the ND tries to cure the cause of the disease.
  3. Prima non nocere: do no harm. The ND is trained to use therapies that will not cause adverse side effects or cause secondary problems (i.e., iatrogenic disease) as serious or more serious than the original disease.
Regarding Vis medicatrix naturae, it's certainly true that the body has an inherent capacity to heal itself, but that "proper therapeutic environment" is absolutely key. For example, penicillin for a pharyngeal infection caused by Strep pyogenes is necessary to prevent secondary glomerulonephritis, the cause of which is related to the body's natural immune response to the bacteria. Untreated strep throat can also lead to rheumatic fever; proper treatment is certainly required. One wonders, then, what naturopaths think is unique about this principle.

The second principle is a frequent canard offered in support of naturopathy; that naturopaths treat the cause of disease rather than the symptoms, something that is supposedly the opposite of an MD's approach. This, of course, is simply non sequitur, which is not to say that purely symptomatic treatment is never warranted. On the other hand, naturopaths have a habit of inventing causes to explain a wide variety of non-specific symptoms:

Of course, Candida is everywhere and on you all the time. Most of the time it does nothing. To see what an actual bought of candidiasis looks like, simply Google "oral thrush". To see whether you might suffer from Candida "overgrowth", watch this video.

As for their last principle, "do no harm", it's nice to know that naturopaths have discovered the Hippocratic Oath. It's unfortunate, however, that they are under the delusion that adverse effects and problems secondary to treatments can be avoided. Since they seem mainly to cater to the worried well, however, most of their "treatments" are comparatively benign (if not entirely ineffective). I hope they behave responsibly enough to avoid going beyond their limited training and so avoid the aforementioned iatrogenic disease.

Wednesday, April 8, 2009

Reflections on a Consult Service

Since October I've been doing a first-year elective in Infectious Diseases. Mostly this entailed observing in the HIV clinic and on in-patient rounds in the QEII. Occasionally I'll get to listen to heart/lung/bowel sounds or help with history taking, though the latter typically only ever occurs in clinic. Initially, the plan had been to split my time equally between clinic and in-patient rounds, but the latter has ended up taking the lion's share of my time, something that I've liked.

Clinic is fairly non-threatening and low-key, and from the start I could appreciate the sorts of issues HIV patients face - side effects, compliance to meds, and all the psychosocial aspects unique to their situation. When I first went on in-patient rounds, I had to go meet the ID resident in Emerg where he was reviewing a consult. At this point, I could scarcely find my way around the hospital much less understand most of what I was hearing. As the afternoon progressed, I'd ask the odd question, but mostly I just listened, writing things down to look up later. I wrote down a lot.

As time went on, I met new residents coming onto the ID service more or less monthly. Everyone rotates through ID, and while most of the residents I've met have been in internal medicine, there have been others in physiatry, general surgery, neurosurgery, and ENT, along with a few actual ID fellows. I've really appreciated being able to meet so many people, to say nothing of the extremely varied patient exposure. I've been nearly everywhere at both sites of the QEII; ICUs, IMCU, Haem/Onc, CCU, MTU, Emerg, ENT, Ortho, Urology, various other clinics, and the dark, patient-less unit commonly known as Radiology. Even so, I still have only a vague sense of where many things are.

I'd say also that I've learned a lot about charts, how residents summarize patients for staff, and how a consult service works. I'm not sure whether I want necessarily to work on a service like ID in the end, but that's perhaps a topic for another post. In the end, I've enjoyed myself progressively more since January, both as I've learned more in class and as I've been lucky enough to end up with residents and staff who have been more open to teaching and having me listen and/or feel things for myself. This has really made all the difference. At this point, I can pretty much understand most of what the residents and staff are staying, and when I don't, I feel more confident and comfortable peppering them with questions. I know way more than I did in October, but the amount I don't know and have yet to learn always seems somewhat insurmountable.

I guess I'll get to that stuff eventually. My little assignment from today was to look up these:

Non-anion gap acidosis
Tumour lysis syndrome

Friday, March 20, 2009

BSG at the UN

Since BSG ends tonight (or, I should say, ended, as I've already watched it), I present Edward James Olmos and Mary MacDonnell at some sort of UN-hosted event on racism:

I can't really tell whether Olmos is in character or not.

Tuesday, March 10, 2009

CaRMS is Scary

And kind of exciting. Yesterday was match day for Canadian med students graduating in 2009. That will be my match day in three years, and I'm realising that that time will go by quickly, and that on the day I'll have my future career determined to a great extent.

Best to focus on the present, though. I'm still trying to figure out what I want to do. Surgery is interesting, areas of internal could be good. What do I want in terms of lifestyle, practice, and location? What *can* I get? It's hard to say. Fortunately I have lots of opportunities to try things out. But that CaRMS match day, though seemingly far off, requires preparation and lots of thought. Maybe it's best not to think about it too much, but I still seem to be (it's a decent enough way to avoid studying at least!).

Update: Ahem. CaRMS = Canadian Resident Matching Service.

Monday, February 23, 2009

Google Lies

Well, probably not intentionally. But don't trust Google Maps implicitly, for you might end up with something like this:

View Larger Map

Note the portion of Dalhousie University located at right, and you'll notice something called the Halifax Infirmary. Sounds like a hospital, right? Well, it was, until it was replaced and later demolished... in 2005. In fact, the original building has been vacant since 1998, as the "New" Halifax Infirmary opened in 1996. What's notable about this? Well, Google didn't exist until Sept. 1998, and Google Maps didn't appear until Feb. 2005, admittedly a few months before the old Infirmary was torn down. Though it had been vacant for some seven years before that.

The question remains - why is the HI still appearing on Google Maps in a location which for three-and-half years has existed as a vacant patch of gravel next to a pay parking lot?

Tuesday, February 17, 2009

Naturopathy in BC?

I'm not surprised this is happening in British Columbia:

Naturopathic doctors in B.C. could soon be allowed to prescribe medications if the provincial government goes ahead with plans to change its health profession regulations.

The changes would make B.C. the first province in Canada to grant naturopathic doctors the authority to prescribe drugs such as antibiotics, painkillers, and antidepressants.

But the B.C. Medical Association is concerned about the potential move, arguing patient safety will be put at risk if the changes are allowed.

In a letter written last month to the province's medical doctors, BCMA president Bill Mackie said the association "is significantly concerned with the expansion of scope proposed for naturopaths... "
Thoughts on this? The College of Physicans and Surgeons of BC is very opposed, mainly on the grounds of patient safety (which are quite well founded - to start with, naturopaths don't have remotely equivalent training to physicians of any kind, much less nurses or pharmacists, when it comes to prescribing drugs, ordering diagnostic tests, or, well, making diagnoses of any kind.

And isn't it kinda ironic that naturopaths - who disdain pharmaceuticals as part of their MO - want to be able to prescribe them? (I'm not into the whole "holistic" versus "reductionist" argument either. There is a way based on evidence and science and another based on an odd mix of traditional/folk techniques (some with actual benefits) and wonky homeopathy.)

Plus, when I think of naturopathic "medicine", I am always reminded of this:

TOR: No. You know, I am not a business man. I'm a holistic healer. It's a calling, it's a gift. You see, it's in the best interest of the medical profession that you remain sick. You see, that insures good business. You're not a patient. You're a customer.

JERRY: (He thinks this, the audience can hear his thoughts) And you're not a doctor, but you play one in real life.
Just because naturopaths call themselves doctors and stick "ND" after their name like it's a university degree (it isn't, at least not in Canada) doesn't make them such or qualified to pretend that they are.

Tuesday, January 20, 2009

Endoscopy is Cool

Gastroenterology is very procedure-based. I saw one of these today.

Down the esophagus, through the lower esophageal sphincter, through the body of the stomach, down the antrum, and out through the pylorus into the duodenum.

Monday, January 12, 2009

New name!

I think it's about time I rechristened this blog, particularly since I'm no longer living in Waterloo and unlikely to return there that soon (and certainly not to live). It is very wintry in Halifax, though, so I might consider going with "Habitating in Halifax" - nice and alliterative. That's perhaps a bit silly, though, so I might have to think of something else. I might change the template too. We shall see! I'm welcome to any suggestions of course.

Friday, January 9, 2009

Concerning winter air travel...

It's not too fun. In December, flying from Halifax to Toronto necessitated waiting from 8:30am to 3:30pm to find out that our flight was cancelled, and subsequently waiting until after midnight to depart on our rebooked flight. This rebooked flight routed us through Montreal, so we sought and found a quiet area in the departure lounge at Dorval to "sleep" for a bit before our 6:30am flight to YYZ. All in all, we spent about 24 hours from arriving at the Halifax airport to arriving at Pearson. It wasn't *that* bad, and I can't blame the airlines for the weather or icy runways (and unlike WestJet, Air Canada has many more flights on more routes, along with a "secret" reservations line for relatively quick re-bookings), but I'd sooner fly in the summer or, well, at any time of year apart from Dec/Jan.

The trip back was a dream in comparison. I had a brief stopover in Ottawa, whereupon I was called to the gate as I evidently needed to change seats. They put me in executive class and, as ever, the Seinfeld depiction is almost wholly accurate (though my meal was just a light lunch).

Random Stuff

I've been quiet of late, primarily because of being away from the internet (or else focussing on physiology). Next week we delve into the workings of the gastrointestinal system. Exciting, eh? Interestingly, Dr Des Leddin, the head of GI at the QEII here in Halifax (and our intial GI lecturer), appears in this CBC story concerning a study concerning the effectiveness of colonoscopies at detecting cancerous growths. That's suitably random, I think.

Otherwise, the next exam approaches, comprising 80 multiple choice questions with 8 for each week of this unit. I think I have just enough time to study, but we shall see. The other big news is that I have two opportunities for an international elective in the summer - (possibly) Thailand or Austria. I'm really not sure which I prefer at this point, though Thailand might be more of once-in-a-lifetime thing. How often do you get a chance to learn about rural community medicine in Southeast Asia? I'm open to any suggestions there!