William The Coroner’s Forensic Files

Tuesday, 11, May, 2010

You Say That Like That’s a Bad Thing.

Filed under: Medicine — williamthecoroner @ 11:30

tgace posts a story from Wired magazine…

Ralph Keeney wants to improve our lives—by making us confront our deaths. In a recent study published in the journal Operations Research, Keeney, a decision analyst at Duke University’s Fuqua School of Business, crunched data from the Centers for Disease Control to assess how many deaths in the US are due to personal choices—things like smoking, overeating, or unsafe sex. The results: A remarkable 55 percent of deaths for people age 15 to 64 can be attributed to decisions with readily available alternatives. In other words, most people are the agents of their own demise. That’s a vast difference from a century ago, when, Keeney estimates, a scant 5 percent of deaths were brought on by personal decisions (infectious diseases account for most of the rest).

And here I post my comment: So what? In 1900 infectious diseases accounted for most people’s deaths. Add in the problems with obstetrical care, changes in surgery, the average age at death was about 40. While this is better than the subsistence farmer of the middle ages (where the average age at death was about 25) it is only slightly better than the population statisics for hunter-gatherer populations, which is age 36. In the US today, the average age of death is, what 80 now?

The death rate will always be 100%. Keeney is putting accidents in the “brought on by personal decisions” category. And one must be careful taking statistics from the population to the personal. Smoking is bad for you. I don’t think anyone in the United States doesn’t know that now. As a population, smokers get sick and die earlier. Does that mean one individual smoker will have a shortened life span–I know people who smoke all their lives and beat the odds–so, no. I also know clean-living, healthy, children whose parents protect them and then they get a Wilm’s tumor.

Friday, 7, May, 2010

In Which I Get E-mail

Filed under: Medicine,Oddness,WTF? — williamthecoroner @ 12:48

One thing about being a doctor is getting questions.  Sometimes they are interesting, sometimes they are intrusive.  Usually, people don’t press the issue when they learn that I’m a coroner, and my usual response if they don’t get it is that I’d be happy to do an autopsy on them and give them the report in three weeks.  Funny, but if you offer to eviscerate someone at a party they tend to go away.

My inherent smart-alec tendencies keeping most folks away, the questions I do get are interesting.  Someone asked me yesterday about the “Graston Technique” which a physical therapist recommended to treat her spinal canal stenosis and chronic migranes.  I had not heard of this technique, so I looked into it.

Evidently, it is some sort of massage technique where the someone rubs the patient with these stainless steel…things.  The things are supposed to “untangle muscle fibers”  and “break up scar tissue”.  Now.  I’ve looked at a lot of muscles.  I’ve never seen any of them tangle like they show in the slide show.  I’ve broken up scar tissue.  With a scalpel.

Now, rubbing contracted, sore muscles will make them feel better, and you can massage trigger points and make the muscle relax.  The fibers aren’t untwisting, however.  This looks like deep tissue massage with oddly shaped stainless steel things.  Chronic inflammation, though doesn’t get better if you rub it.  After all, your Mom told you that if you pick at it it won’t get better.  STEROIDS treat chronic inflammation.  I also noticed in their list of clinicians: “athletic trainers, chiropractors, physical therapists, occupational therapists” does not include doctors.

The Graston technique might make someone feel good.  Or it might hurt like the dickens.  Deep tissue massage tends to hurt, I’m not sure I want someone rubbing me hard with a steel thing when I hurt.  Hands would appear to be safer in my opinion.  The other part of the technique involves warm up, stretching, and strengthening the affected muscles.  I think the last two are what’s working in most of these cases.

EDITED TO ADD:  Science-Based Medicine has some information about it HERE.  It’s quackery.  The scientific basis arises from two mouse studies, one of which suggests it doesn’t work.  Also, the patient pays $500 for the treatments, the “instruments” cost $2700, and it is a way to get a placebo effect from paying someone to hurt you.

Thursday, 18, March, 2010

Match Day

Filed under: Medicine,Teaching — williamthecoroner @ 18:50

It is Match day, that day when fourth year medical students learn where they will be doing their residency for the next three to ten years.  Very few medical students do rotating internships anymore–a repeat of third year doing pediatrics, medicine, surgery, obstetrics, etc.  There’s just too much to know. People track into a surgical internship and thence to general surgery, orthopedics, ENT, or whatnot or go into a medical internship and then off to general internal medicine or psychiatry or whatever.

From November to February students interview at places where they might like to go.  In the bad old days, a student might be given an contract for that one day only–no chance to look at any other program, take it or leave it.  Today, the programs and the students make rank order lists and they are matched by a computer.  Kind of like computer dating, only it tells you where you’ll be working for the next several years.

Our students matched well.  There were lots of sub-specialty matches.  There were good pathology matches–all of whom are heading for an academic career.

Thursday, 21, January, 2010

More Body Modification and Thoughts on Colours

Filed under: Forensics,Medicine,Social Commentary,WTF? — williamthecoroner @ 09:53

Longtime William the Coroner readers know that one of my interests in forensics is body modification. I have whole lectures about it–ones that really, really pissed off the photography department of the Cuyahoga County Coroner’s Office when I worked there. (Bloody dismembered bodies, OK, a scientific talk on body modification? No go.) I am interested in what people do to themselves and why. And how this stuff can bring them to the attention of a coroner. (more…)

Thursday, 14, January, 2010

Go Navy

Filed under: Medicine — williamthecoroner @ 11:24

The hospital ship, USNS Comfort is going to Haiti to render medical aid to the survivors of the earthquake.   It contains a 900 bed hospital, and hundreds of medical personnel  She will be supported by the resources of the USS Carl Vinson CVN 70 and the Burke-class destroyer USS Higgins. DDG76   The nuclear carrier can provide power and fresh water, and the destroyer will provide an escort and support USCG helicopters.

Boots on the ground will be provided by the 2,000 marines from the USS Bataan LHA 5, the USS Fort McHenry LSD 43 and USS Carter Hall LSD 50. They are joined by Forces Canada with the HMCS Halifax and HMCS Athabaskan.

During the first 48 hours or so, efforts will revolve around rescuing those trapped in collapsed buildings. After that, efforts will shift to aiding survivors. Time is everything.

Tuesday, 27, October, 2009

Dental School # 1 & 2

Filed under: Medicine,Teaching — williamthecoroner @ 21:48

Pulmonary pathology

LUNG051

Atelectasis, obstructive vs. restrictive lung diseases.  Asthma, emphysema, chronic bronchitis; occupational lung diseases and ARDS.

Pulmonary hypertension, infectious pulmonary diseases, abscesses.

Tuesday, 4, August, 2009

House Call

Filed under: Medicine — williamthecoroner @ 14:57

For the first time in my career, I made a barbershop call.  Interestingly enough, it was for living people, too.  Strange.

Sunday, 12, July, 2009

Sauce For The Goose

Filed under: Medicine,Politics,Social Commentary — williamthecoroner @ 18:30

I stole this, almost verbatim from CrankyLitProf.

Representative John Fleming (R – LA) has introduced a House resolution that I can get behind: HR 615 states that: “…that Members who vote in favor of the establishment of a public, federal government run health insurance option are urged to forgo their right to participate in the Federal Employees Health Benefits Program (FEHBP) and agree to enroll under that public option.”

On his personal site, Representative Fleming opines: “Under the current draft of the Democrat health care legislation, members of Congress are curiously exempt from the government-run health care option, keeping their existing health plans and services on Capitol Hill. If Members of Congress believe so strongly that government-run health care is the best solution for hard working American families, I think it only fitting that Americans see them lead the way. Public servants should always be accountable and responsible for what they are advocating, and I challenge the American people to demand this from their representatives.”

Preach it Cranky! You’re gonna dictate what kind of health insurance I get, you gotta have some skin in the game. Recall, please that one iteration of the Clinton health plan would have forbidden going outside the system, even if one had the money to pay for it. I want to repeat that for emphasis.

Previously, when the US Government attempted health care reform, one iteration of that plan would have prevented people from spending their own money on health care, going around the government system*

If our legislators have a dog in the fight, we might have a chance of something that won’t be a total goat-rope! I will point out that there is a word for people who insist on other people doing [being satisfied] with one thing but not being subject to it themselves. Hypocrites.

Rep. Fleming has a form letter you can print out and mail to your own reps. I know I’m going to, first thing on Monday morning.

*Michael Hurd, Baltimore Sun, 20 June 1994.

Wednesday, 1, July, 2009

1st July

Filed under: Medicine — williamthecoroner @ 21:18

It is the first of July. The medical year runs from July to June. On the first, everyone advances one step. MS-IV become PGY-I. (interns) Interns become residents, senior residents become fellows or attendings in their own right. At the med school, we’re most worried about the new ducklings.* (more…)

Friday, 24, April, 2009

Public Service Announcement

Filed under: Medicine — williamthecoroner @ 11:56

Test your vocabulary and give vaccines. Hat, tip, CrankyProf.

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