Swine Flu, Bird Flu, ah... Influenza!

Today, swine flu is one of the trending topics on Twitter. Yesterday, the WHO warned of possible pandemic as Mexico tries to contain swine flu. There have been mixed attitudes toward the confirmation of severe cases in Mexico, Texas and California. Dr. Anne Schuchat, the U.S Centers for Disease Control and Prevention's Interim Deputy Director for Science and Public Health Program, says that the virus is already "beyond containment" because of how far the virus has already spread. Dr. Marc Siegel, associate professor of medicine at New York University School of Medicine, said the current outbreak was unlikely to become a pandemic. He states that although the virus is spread human-to-human, "that's a far cry from becoming a pandemic."

It is possible that this is not the approach the public should take when dealing with this new swine flu. Viruses like swine flu, bird flu, and just the flu in general are a big deal. Already, 2 antiviral medications (amantadine and rimantadine) are obsolete in the US. Although there are 2 others (Tamiflu and Relenza) that can be used it is important to remember that it is possible that these may not always be effective. Swine flu, like bird flu and the dreadful Spanish influenza can cause phenomenal mortality rates because they also affect normal and otherwise healthy individuals. (* For Twilight fans: the Spanish influenza in 1918 is what caused Edward Cullen to be dying when he was found by Carlisle and turned into a vampire*)


Medicine meets Communication

This article from CNNhealth.com entitled "Brain-Twitter Project offers Hope to Paralyzed Patients," reports that Adam Wilson, a doctoral student in biomedical engineering, is working on tweeting using brain waves.
His lab has developed a way to post messages on Twitter using electrical impulses generated by thought. That's right, no keyboards, just a red cap fitted with electrodes that monitor brain activity, hooked up to a computer flashing letters on a screen. Wilson sent the messages by concentrating on the letters he wanted to "type," then focusing on the word "twit" at the bottom of the screen to post the message.

There is much speculation about how this technology could possibly be used both in the medical field and commercially. The immediate use for this development could be to enable communication with those suffering from "locked-in syndrome" in which the brain functions normally although the body is unable to communicate with the brain so the patients cannot speak or move. It is these little steps in technology that will develop drastically in the next 5-10 years or less. Perhaps soon we would not even need to touch the screen to communicate with others. Ah, the power of the brain... crave the brain waves :)


Microblog of House M.D. Season 4, Episode 14: Living the Life

4:51pm: Who cares what he was allergic to as long as the treatment worked to get him out of the coma? Well, House wouldn’t be House unless he got to the bottom of it. Quinine allergy! What’s the point of drinking tonic water anyway if you don’t even put real gin in it? Uh, lame.

4:47pm: Oh no! He’s not allergic to flora, this actor is definitely dead.

4:45pm: Ah protocol. Do what those in authority deem to be appropriate whether or not your own expert opinion violates these protocol. There are some cases where protocol is stupid, but that’s politics.

4:41pm: Funny how a patient’s living or dying can change one’s outlook on life. The smallest of events can make someone question the future of their job or the certainty with which they joined the profession. It is strange how just one death out of hundreds could risk one’s career.

4:38pm: Aren’t we all waiting for that illuminating moment? The small, seemingly insignificant event that can trigger brain waves and help things gel together. The coincidence of looking at a sunflower pattern on a pillow and somehow having the thought process or brain wave of a different diagnosis…gotta love TV medical dramas =)

4:35pm: Living the life… we all are afraid of change. Why remain in a job that you hate if it makes you that unhappy. So what if it makes you popular, famous and rich? We all need to find courage to do what’s right for ourselves. Yeah, dying could definitely change our perspective on the state of our life.

4:30pm: The struggle between politics and getting to give optimal care of a patient. Such pointless arguing among doctors about who did what tests as opposed to trying to find the root of the problem with the patient. In the end, it seems that patients are not always the top priority of the doctors. People need to stop romanticizing doctors as superheroes. Being a doctor is a job too, and with the profession comes all the drama and group dynamics as any other job… its just that the stakes are sometimes higher and people’s lives can be lost.

4:25pm: Working in a team is so hard. So much deception- people do tests behind their team leader’s back. Medicine is sometimes guess work.

4:20pm: Wisdom about dealing with women from House MD… awesome! Yes House geeks: Get what the girl wants; even if she tells you that it is your choice.

4:15pm: This actor guy is right- his soap opera sucks. He behaves like a total loser- so what if he’s depressed? He is richer and more famous than most doctors. I still think Kutner is smarter.

4:11pm: House is crazy! Why does he care so much about some stupid actor? Cuddy is such a tolerant woman. I love her: so powerful, beautiful and smart. Girl power!

4:05pm: Whoa, this seems like some skanky medical drama. Oh wait! The strange kidnapper was House. I wondered for a second whether I had gotten the wrong show after I unlocked the episode from some sketchy website after spending time taking strange surveys.


Insurance doesn't cover cancer pills!

Today, this New York Times article entitled: Insurance Lags as Cancer Care comes in a Pill revealed the communication gap between patients, doctors, technology and insurance companies.
With oral cancer drugs, “the technology has outstripped the ability of society to integrate it into the mainstream in a smooth fashion,” said Carlton Sedberry, a pharmacy expert at Medical Marketing Economics, a consulting firm.
Cancer pills provide a convenient alternative to IV chemotherapy since it reduces the number of visits that patients need to make to the hospital. However, most insurance companies do not cover these pills even though alternative therapies are covered. This makes the cost of this treatment weigh heavily in the pockets of the patients. Additionally, there may be problems with controlling dosage quantities and interpreting side effects. This new wave of cancer therapy still has a long way to go before becoming mainstream as doctors, patients and society learn to deal with the challenges that arise.


Part II: Where are Microbes?

In February the inside of a dormitory microwave was swabbed with a RODAC plate. This was for BIOMI 2911 laboratory at Cornell University. For more details see: Part I: Where are Microbes? After incubating the plate for a few days at ~30C a variety of different colonies were observed. There were 4 small round bright yellow colonies, 2 small round light pink colonies, 2 large white colonies with concentration in the center, 2 white round colonies and 1 very tiny round bright pink colony. This diversity of organisms inside a microwave was surprising since it seems that the microwave radiation should be enough to get inhibit growth of microbes.

I decided to isolate and purify the small round light pink colonies since they seemed to be the most interesting. This colony of bacteria contained Gram (-), oxidase positive, catalase positive non-motile rod- shaped bacteria. The bacteria perform aerobic respiration only according to the results of a BCP-glucose shake, which remained purple and had turbity (growth) at the top only. It was postulated that the bacteria belonged to the Pseudomonas genera. However, upon PCR, electrophoresis and BLAST sequencing it deduced that the bacteria was 96% similar to Roseomonas terpenica. Roseomonas is a new genus established in the 1980s that is associated with bacteriemia and other human infections. It seems that it is also radiation resistant since it lives in a microwave... better watch out when microwaving food!


Diabetes insipidus

Unlike the name suggests, diabetes insipidus is not a subtype nor in any way related to the more common sugar diabetes (diabetes mellitus). In fact, diabetes insipidus is a metabolic disorder involving the pituitary gland and the kidneys. The pituitary gland secretes ADH, anti-diuretic hormone, that allows causes aquaporins to open in the collecting duct of the nephon in the kidney. If there is no ADH, then water cannot be reabsored into the bloodstream from the kidney, so one would produce vast amounts of dilute urine. A consequence of this extraordinarily high level of urine production is the never-ending thirst of someone with this condition.

Diabetes insipidus was addressed in the TV series House MD- Season 3, Episode 16- when a young woman came in believing that she was OCD because she drank water all the time. It was deduced that she was not OCD but rather had diabetes insipidus attributed to an accident on a balance beam. How could a simple accident cause such a condition? It is possible that head trauma could damage the posterior pituitary gland where ADH is produced. If ADH production or function is inhibited or disrupted then the body will be unable to regulate its osmolarity or water concentration. This is why diabetes insipidus is characterized by excessive thirst and the production of large amounts of dilute urine. This condition can be easily misdiagnosed as portrayed in the House MD episode.


The sad story of Medicare

Medicare is a federally administered system of health insurance available to persons aged 65 and over. On Wednesday, the New York Times discussed the alarming reality that more and more doctors are not accepting Medicare in Finding a Doctor Who Accepts Medicare Isn't Easy.
The article reports that as folks become eligible for Medicare they realize that this safety net or support network no longer holds because doctors are not willing to accept Medicare. Why are doctors such as internists, psychiatrists, gynecologists and other specialists opting out of this insurance system? The paperwork. Doctors spent many years getting to where they are so that they can practice medicine. Not so they can fill out files and files of paperwork.

As insurance systems like Medicare proliferate, the returns on being a doctor like an internist decreases. More time is spent dealing with the payment hassles, and less with the patient discussing relevant health issues. Moreover, the doctor gets paid less as a result of low reimbursement rates. Such systems devalue the doctors of this country. This is why doctors do not want to enter the internal medicine specialty... too much grunt work, too little return: financially and psychologically. The New York Times articles cites 2 converging trends: decreasing internists, and increasing numbers of internists that do not accept Medicare. This leaves the patient in a very tight situation.