Dead Battery

Gramma turns the key, nothing. Lawn mower won’t start. Not even a grunt. Battery must be run down again.

I look behind the seat and sure enough the terminals are corroded. The negative doesn’t look too bad. Just dull gray lead with a rusty bolt holding the wire to the post. The positive however is covered with a thick jacket of whitish yellow gunk. I’m going to have to do some serious cleaning before hooking up the charger.

I tell Grams she might as well go read her book. Nothing she can do to help. I head for the workshop to get Granpop’s old toolbox. After he passed away, his tools were a mess. He didn’t take very good care of them in his waning years.

I remember cleaning up that old Craftsman toolbox, sanding the rust down to the metal inside and out. Then giving it a new coat of red enamel. It almost looks new again. Not exactly a factory paintjob, but you’d have to look close to realize it was repainted.

I even cleaned up his rusty old tools. Some of them were beyond salvaging. But most of them cleaned up pretty well. A few of the wrenches are missing. Should buy replacements one of these days.

The toolbox is heavy and pulls me off-balance as I carry it out to the old garage.

Metal scrapes against wood as I set the box down on the oil stained pine floor. The latch makes that old familiar click-clunk sound as I lift up on the lever to release it. That sound alone always brings back memories of Granpop and me fixing something around the old place.

Granpop was one of those guys who could fix anything.

Opening the lid I peer inside searching for the right size wrench for the job. The chrome sockets and extensions are cool to my touch and I try to sort them back into their proper positions. Gramma’s been in here and she never puts them back where they belong.

I notice several of the smaller wrenches are missing. I can’t remember if those were the ones I couldn’t save. I make a mental note to ask her if she lets the handy man use these tools or not.

Fortunately, I find a 7/16th box end wrench and proceed to loosen the negative terminal first. It’s easier to reach than the positive. Of course, the bolt just turns and I have to enlist the socket wrench to hold the other end as I loosen the nut.

Once the negative wire is free, I take a small wire brush and clean the rust off the bolt and washer until it’s shiny again. Next, I do the same to the lead terminal.

To slide the red rubber cap off the positive terminal and pushing it up the wire out of the way requires reaching my arm between the seat and the plastic gas tank. There’s not a lot of room to work on this one. Be nice if the seat would tilt forward out of the way.

With the same two wrenches I loosen the nut on the corroded terminal. The wrench clink clinks against the back of the seat with each turn of the rusty nut. Once I get too close to the negative terminal and there is a buzz of a spark as the two terminals briefly short. At least the battery isn’t completely dead. I try to be more careful and reposition the wrench so it doesn’t touch the terminal again.

Finally, the pieces come off and I can set them aside. I take the wire brush and knock the bits of corrosion off the terminal and polish it until it shines.

My back grows stiff from leaning over to reach behind the seat. There’s a tinge of gasoline in the air. It’s a beautiful fall day. Warm for this time of year.

The bolt cleans up fine, but I have to walk back to the workshop for a new washer. The corrosion has eaten away most of the old one. The red and brown leaves litter the yard and crunch under foot as I trudge back to the workshop along the gravel drive.

The old gray cat is sunning himself on the driveway and I stop and give him a rub.

Baseball

I feel the hot sting on the palm of my hand as the baseball strikes my glove. There is the whiz of the ball through the air and the loud pop as the ball smacks my thinly gloved hand. My hand is going to be sore tomorrow.

I don’t like playing catcher. My brother always throws too hard. I try to catch the ball properly, in the web pocket, but it sometimes still strikes my palm. There’s never enough padding in the palm. We don’t have a catcher’s mitt. I have to use my regular fielder’s mitt. I bet a catcher’s mitt would have more padding in the palm.

I can smell the tanned leather with its slight tinge of glove oil. I roll the hard slightly scuffed white leather ball with its red stitching in my hand. I’m squatting down in the catcher’s stance so I rise to throw the ball back.

I’m no good at throwing the ball. I can’t throw very far. I’m bigger and stronger than most of the other kids, but I can’t throw the ball very far. It’s embarrassing. When I play left field, and they always stick the worst players in left field, I haul back and throw it with all my might and it always falls short. I shrink inside and my face feels hot from the jeers and the groans of my playmates.

It will not be until years later that I will learn that the secret is not in the strength of your arm or your shoulder, but in the snap of your wrist. “It’s all in the wrist,” they’ll say.

I wish my dad (or someone) had taught me how to throw a ball. My dad had no interest in sports and I grew up with very little interest in them, either.

Starsky and Hutch have been watching the World Series on TV. It occurs to me that I don’t even know which teams are playing. Doesn’t really matter. That’s the thing about sports. It doesn’t really matter. They tell us that people are starving in Africa, but all anyone seems to care about is, “Who won the big game?” It doesn’t really matter. There will be another big game tomorrow, or next week or next year.

Still, I wish my dad had taught me how to throw a ball.

I Are Still Here

Oops, almost forgot I have a blog. Sorry, the Summer has just been so busy what with being gone all day at work and there's so many things to do in the evenings... Some days I don't even think about the computer.

I can't remember the last time I checked my email.

I will get a real post written soon, I promise.

Guess I better go check that email. I'd hate to miss any great "male enhancement" offers. :0)

I'm not touching you...

Nail Guns, Pick-up Trucks and the Housing Market

Anybody See Where That Nail Went?



Thanks to Michael Morse from Rescuing Providence for the photo.

I printed it out and tacked it up on the bulletin board in the trailer at work right next to the OSHA poster and just south of the tool supply calendar with the semi-naked lady on it.

Reactions from the crew range from…

“Ouchie, Momma!”

“Holy sh*t!”

“At least he used a galvanized nail.”

“That’s one way to get some extra zinc in your diet.”

And my favorite…

“Shoot yourself in the knee? That’s nothing. Anybody can do that. Shoot yourself in the foot. Now that takes marksmanship.”



Anybody Need a New Ride?

Speaking of the bulletin board at work, Bubba has a 1974 Ford F150 For Sale or Trade.

Needs a little TLC, but runs good.

Call after 5:00.

(Just between me and you… it needs a lot more than a little TLC.)

Anybody Need a New Home?

The housing crunch is hard on the construction industry. We’re still building houses, but for how long is anybody’s guess. Sixty percent of the new homes in the development we’re building are as yet unsold. Hard to believe seeing as they are so upscale…


They do manage to sell one once in awhile, but not at the same pace of a few years ago.

I’m certain I’ll have a job through the rest of summer, but some of the full-time guys are speculating that they’ll be living on unemployment come winter. I hope for their sake they’re wrong, but I won’t be surprised if they’re not.

I would think first time homebuyers should be able to pick up a bargain right about now.

On the job training

It occurs to me after reading over my last post that I failed to explain that I work as a carpenter building houses.

I originally got this job because the guy I was rooming with at the time was a full-time carpenter. I didn’t know much about building houses, but he assured me that the only skill I needed to know was not to shoot myself in the foot with the nail gun.

Since then I’ve learned that that isn’t exactly so, but I’ve been able to pick up a lot by way of on-the-job training.

I’ve worked for the same building contractor the past four summers. Last summer I even had my own crew, which meant I was able to make more money. This summer however, I’m getting a late start and won’t be able to work but a couple of months so I’m working for one of my former guys on his crew.

I don’t mind switching roles with him. He’s a sharp guy and knows his stuff. Pay cut is no fun though.

Naturally they nicknamed me “Doc” the first summer when I made the mistake of telling everyone I was pre-med.

And of course, everyone just assumes I’m going into gynecology. (Turns out to be the construction worker’s dream job.)

I get the usual ribbing like today during lunch break Bubba (who weighs about 300 lbs.) asked me if I would take a look at his hemorrhoids. Just as he feigned like he was about to drop his trousers right then and there I told him, “Hang on, I’ll do you one better. Let me get a blowtorch and heat up this screwdriver and we’ll just cauterize that bad boy.”

What I Did On My Summer Vacation

Sorry I haven’t been posting as much lately. I been working the past couple of weeks (when the weather cooperates) and I haven’t felt much like doing anything except sleep when I get home.

I considered doing a research project this summer, but figured this will probably be the last opportunity to save up some extra mad money to get me through the rest of med school.

I work construction and the physical labor along with the hot sun really takes it out of you by the end of the day. Especially if you’re a pasty soft med student whose been sitting on his duff all winter long.

I’m starting to get back into the swing of things now. I’m not nearly as tired this week. The first two weeks my tail was dragging.

It’s a good job but I wouldn’t want to do this for a career. It pays really well and beats a lot of other summer jobs out there. I definitely wouldn’t want to do this in the winter.

New Speakers

If you read my previous post, then you are no doubt fully aware that Neumed is not getting the FDA's recommended daily allowance of melodic content. The end result being that Neumed's life is woefully audio deficient.

And although that post was 90 percent jest, it did not fall too far from the truth.

I actually have a stereo in the living room. Only trouble is, the dual cassette deck died months ago and my CD changer died a couple weeks ago. So what little time I spend listening to that unit, I'm reduced to listening to FM radio. (Bleh...)

My iPod also died a while back and I'm not sure I'm going to bother replacing it. Probably will eventually, but these days when I want to listen to music, I find myself going straight to online music videos.


(Didn’t know you could hook a widescreen up to a Commodore 64, did you?)

So anyway, Monday I got tired of listening to cheap computer speakers (lip reading would actually be an improvement) and started looking into ordering some new ones. After pricing several and not finding anything worth buying, it dawned on me that I would be better off to just get a small bookshelf stereo and feed the computer's audio output into that.

So off I went to Best Buy to check out what they had. Sony had a nice sounding unit for about $200 that came with a subwoofer. (Neumed like subwoofer.)

I was tempted to buy it, but careful shopper that I am, I came home and checked online reviews and prices just to be safe. Good thing I did. Most of the reviews agreed with me on the sound, but several had a problem with the CD changer. Apparently it breaks after a year or so. Not good. I have enough audio equipment that's broken, I didn't need to buy something cheap that I knew wasn't going to last.

As I was wondering what I could get to drive some speakers I remembered an old stereo receiver I had in the basement. Don't know why I didn't think of it before. Anyway, I cleaned it up and patched it into the computer's sound card. Next I used some old car speakers just to test it out and make sure it was working and boy what a difference! I could actually hear the bass and kick drum! Everything sounded better.


I could probably get by with the car speakers, but they aren't that good. And I'm so excited about the sound improvement thus far, that I decided Tuesday night to order real stereo speakers through Amazon.

They are supposed to arrive today. I'm anxious to hear how the videos will sound through halfway decent speakers.

Oh, by the way, if you're wondering why I didn't just use my living room stereo? The speakers are too big. There's no room for them in my little study area. Besides I want that unit where it is. I intend to someday fix or replace the broken components and get that whole system back into operation.

Update: The speakers arrived about two hours ago. They sound good. Very crisp and clear. Different from my big speakers, but so is the room acoustics. Overall, I’m happy with them. They are definitely a step up from the car speakers and a world of difference over the cheap computer speakers.

Next project: Hooking up a subwoofer to the old Gramophone.

Oh, and here’s the type of music I really listen to…

Seven Songs to Warm Your Heart

Dragonfly tagged me to list seven songs I like -- or seven songs I’ve been listening to this week. (I’m not sure what the actual rules are.)

The trouble is, ever since the needle broke on my Gramophone I have all these cylinders and nothing to play them on.

Hutch suggested I check out something called YouTube and I must say it’s very interesting. Unfortunately, the Commodore 64 I got for Christmas didn’t come with speakers, so I have no idea what anything is supposed to sound like.

Not to worry though, because I can read lips pretty well, so I just make up my own little tune and sing all the parts myself.

Anyhoo, with no further ado, (notice how that rhymes) here’s the seven songs I’ve been lip reading this week:

Hungry by Jenny Craig

Doin’ Time by Busta Cap and the Powder Burns

Who, Who, Who… Who let the Cat Out? by The Pet Shop Boys

Dontchu Wish Ur Girlfriend was Phatt Like Me? by Kirsti and the Alley Kats

Hit Me With Your Best Snot by Phlegm & the Loogies

Laundry Blues by Skid Mark and the Stains

What’s That Smell? by Whiff & the Flatulents


I didn’t tag anyone for the six word memoir cause I can’t remember who has done it and who hasn’t (and I’m too lazy to check), so I tag Xiang Mei, Frankie Gan, Dr. Rob, CrazyRN2Be, Radioactive Girl, fizzlemed, and Kim (as the pump turns) to do either “The Six Word Memoir” or “The Seven Songs I Like” meme (or both if you’re so inclined).

The rules as best I can tell are:

1. Write your memoir using only six words.
2. List seven songs you’re listening to this week.

Then whatever you do, have mercy on us all and don’t tag anyone else unless you just can’t help yourself. :0)

Oh, and before I forget, if you haven't been tagged you can still play along by telling us the name of your favorite song.

Britney Snow Digs Neumed

Britney Snow (a.k.a. Meg Pryor of East Catholic) is lost in her American Dreams. Dreams of rock n roll, sock hops, soda shops and true love. Dreams of prom night. Dreams of long walks in the moonlight. Dreams of her beloved, Neumed.

When she’s dancing on Bandstand, she pretends she’s dancing with him. She secretly hopes he will ask her to the prom.

Perhaps her dreams will come true.

Procrastination or what?

Seems I’ve been neglecting my blog lately. Not intentionally, mind you. I had every intention of writing something every day this past week to make up for final exams, but I just didn’t and I’m not sure why.

Each day I start out thinking I’ll post something, but then the day goes by and I realize that I’ve done everything else except write.

Apparently I surf and blog more when I’m supposed to be doing something else.

When blogging is what I set out to do, I can’t seem to find the time. I just don’t seem to get it done.

Strange.

Anyone else like that? Is your blog more attractive when you’re supposed to be doing something else?

Finally Getting a New Roof

Well, it looks like we’re finally going to get a new roof. They delivered the shingles today and if the weather holds the roofers should be here tomorrow to start tearing off the old one.

None too soon I might add. I was afraid I was going to have to find new roommates. If this is your first time here, I mentioned how our roof has been leaking for years in an earlier post, The Joy of Living in Abject Poverty and how difficult it's been to get Slumlord to do anything about it.

Just to give you an example, here’s a picture of the ceiling in my bedroom.


Here’s a picture of Starsky’s ceiling.


Speaking of Starsky, he’s currently outside with Hutch waiting for the pigs to fly over in close formation.

Six Word Meme

A while back I was tagged by Tori (radioactive girl) to come up with a six-word memoir.

After much thought and due diligence, here are the words that will undoubtedly be etched on Neumed’s tombstone…

Must have been dropped on head.

Finally Done With Finals

Well, I had my last final today.

I think I did pretty well. Which, as any student knows, is the kiss of death. But I’m not going to worry about that now.



Instead, I think I’m going to go sleep for a week.

The good news is that Mom says I can play on the Internet now.

Alfred, Do Your Homework!

Okay, it's no secret that my Alfred got into medical school due to a clerical error. And it’s also no secret that the entire faculty and staff over there at the Amish School of Medicine have made it their sworn duty to see that no living human ever be placed in harm’s way should he somehow miraculously manage to matriculate. (Try saying that five times in a row.)

Be that as it may, he seems to be holding his own for the moment.

So even though the sun has decided to make a rare appearance today, Neumed will continue to diligently surf the Internet hit the books studying the 1000 or so pages of notes he managed to scribble on the back of various napkins, fast food wrappers and any other readily available blank piece of paper.

So if he happens to show up over on your blog, be sure to give him a firm reprimand and send him straight home.

Thanks,
Neumed’s Mom

The Perfect Mother’s Day Gift

Decisions, decisions. Should I go with the usual gifts…

A carton of Camels?
Or a couple packs of Redman?
Or another bottle of Old Spice aftershave?
Or maybe a year’s supply of ProActiv Solution?

Or then again, perhaps I should splurge on a quart of Jack Daniels?

Nah…

I guess I could always renew her subscription to Guns and Ammo.

What’d you get your Mom?

How was your day?

My brain is fried.
I need a haircut.
My sock has a hole in the toe.
The roof still leaks.
I don't know what to get Mom for Mother's Day.
Blogger seems to be on the fritz.
I have BO.
I should go run...

I think I'll just take a nap...

So, how was your day?

Introducing Starsky and Hutch

I believe I’ve mentioned in previous posts that I currently have two roommates. They probably wouldn’t appreciate my using their real names on the Internet, so I’m going to refer to them simply as Starsky and Hutch.


This didn’t take too much thinking on my part. I secretly nicknamed them the first time I met them.

Hutch is of average height and blond. He is the better looking of the two though that isn’t saying much and he’s the quiet reserved one of the pair.




Starsky is shorter than Hutch and dark-haired. He’s very outgoing and makes friends easily. To say that he’s butt ugly would be a kindness. In fact, he’s so ugly that clowns are afraid of him.

I’m kidding; of course, the truth is he is strikingly handsome. So much so that he could probably be a model or an actor if he chose to go that route. People often remark that he looks like a young Tom Cruise although I have to disagree. Except for the hair, I don’t think he looks anything like Cruise.

(He doesn’t see the resemblance, either.)

Both of my roommates are very musically oriented. I can’t carry a tune to save my life, but both of these guys can sing. However, Hutch is the real musician of the two. He not only sings, but also is a songwriter and plays piano and drums. One of the reasons he moved in with me was so he’d have a place for his drum set. Before they were living in a small apartment and he had to leave them at home.

Both of them are outdoorsmen and love hunting, fishing and camping. I on the other hand can take it or leave it. I’ve done my fair share of playing woodsman over the years, but living with these guys reminds me of summer camp when I was ten, minus the basket weaving and leather crafts.

When I have more time, I promise to recount a few of our more colorful exploits.

###

Photo Credits: Photos courtesy of the real Starsky and Hutch, Paul Michael Glaser and David Soul from the 1970’s television series.

Covering Your...

A Breath of Fresh Air

Okay, it’s Neumed’s turn to be smitten.

Maybe it has something to do with spring -- or perhaps it’s just because Neumed is a sucker for a pretty face -- but wouldn’t you know it, once again he has fallen in love.

Okay, okay, I’m kidding (a little). The last thing I want to do is embarrass the poor girl, but she really is a sweetheart and I thought you ought to meet her.

Her name is Suthacha_Xiang Mei and she is a medical student in Bangkok, Thailand. I had the pleasure of discovering her from a comment she left on this site last week. How she found herself in my humble little corner of the blogosphere, I have no idea.

Angels show up in the strangest places.


Why is Neumed so taken with her?

Well, aside from the obvious, the real reason I adore her so is that we westerners are such complainers… always going on about school, patients, working conditions, money, HIPAA, the government… it’s nice to hear from someone with a fresh perspective.

To give you an example (and keep in mind I’m not quoting her directly) this is something one of her friends wrote that she considered worthy of quoting…

“We are dreamers. We dream of a day when people love each others, where the Earth is a clean and safe place, and when people start to believe in their futures again. And for that, we try to work hard, step by step, in hopes of achieving this ultimate dream.” – Her friend, Frankie


Cute couple, no?

I can gush on and on about how wonderful this girl is, but I truly believe you should visit her blog, Memories in my Life and experience her kind, gentle spirit for yourself.

I have a hunch that you too will find yourself in love with her pure heart and the wonderful way she expresses her thoughts. And I’m certain you will bookmark her page and add her link to your sidebar so that together we can introduce this girl to the rest of the world.

Only the dog knows for sure

It’s Not Easy Building an Evil Empire

This past week has been the most fun I’ve had since I started this little excuse-not-to-study and it was all because of you guys. So thanks to everyone who was kind enough to add my link to your sidebar. You have no idea how much it means to me. (Or just how much you’ve helped me kick-start this little blog-o-mine.)

Believe me, it was getting very depressing posting stuff day after day and knowing that no one was going to read it. And I do mean, no one.

In fact, for a while there I was starting to think my sitemeter was broken. I kept tapping on the glass but the little needle just refused to budge off “E.” Day after day, other than Mom and a homicidal spambot… err, I mean friendly lovable cyborg, my stats showed little to no activity.

I felt like I was just talking to myself. (A little disconcerting to say the least.)

But all that has changed and I can now proudly proclaim that I HAVE READERS!!!

Wahoo! Happy dance!

Sure, I’m not breaking any world records, but it’s a start. Hopefully, everyone will keep coming back and we can have fun trading insults, jokes, tall tales and what not.

Suffice it to say, I like making new friends and I feel like I just gained a bunch of new friends practically overnight. This has been very exciting and only makes me want to work harder and keep coming up with new ideas.

So anyways, thanks again for the links, the advice and especially the words of encouragement. You have made my world a much brighter place.

I have to go study chem. now, or maybe neuro… no chem., wait Scrubs is on tonight, maybe I’ll go watch TV.

What the Heck is MyBlogLog?

I just added the MyBlogLog widget to my sidebar this weekend. Not really sure why.

I noticed that several of you have this on your blogs and it seemed kinda cool so I decided to take it for a test drive. Unfortunately I haven’t had the time to figure out how to operate the thing.

Too busy sleeping studying.

Here’s what I’m wondering:

1) Am I supposed to acknowledge visitors in some way?
2) Why doesn’t my name and avatar show when I visit your blog?
3) How do I add people to my community?
4) How do I join other communities?
5) Why does any of this matter?

That last question is the big one.

Other than having a cool looking iPhone-like widget decorating the sidebar, is there really any functional reason for MyBlogLog? Or is it just a colossal waste of time?

I guess we’ll find out eventually.

If you are familiar with this beast and there’s something I’m supposed to do with it that I’m not doing hit me upside the head leave me a comment and let me know.

My Master Plan for Total World Domination

I just finished up another block of tests on Friday and decided to celebrate by taking some time this week to promote the blog a little.

My master plan -- though shameless and totally void of social graces – has been to email a few other medical bloggers (most of whom don’t know me from Adam) to beg, plead, grovel (take your pick) for a link back to this site in hopes that I might lure a few of their readers into my web of deceit and corruption.

This has proven to be more time consuming than I first anticipated, however, I believe it is turning out to be a worthwhile effort…

• Several unsuspecting fools kind souls have actually taken pity on my plight and added my link to their sidebar


• A few even took the time to offer words of encouragement and advice on both blogging and medical school (Much appreciated.)


• Many of you assured me that Mom would eventually come around


• And, as expected, the more perceptive among you totally ignored me (sob)

To those of you who have honored me with a link on your blogroll, thank you so much. It is greatly appreciated and I will be forever in your debt. Any moment now, I expect the floodgates to open and my readership of 1 to skyrocket to the lofty heights of 4 or – dare I speak it aloud -- maybe even 5? (Be still my heart.)

I’m not through cultivating my own blogroll and will probably send out a few more emails as I come across interesting blogs. If I’ve somehow overlooked your blog, feel free to drop me an email at aneumed (at) yahoo (dot) com and I will gladly add you to the mix.

###

(Update: Neumed has just been informed that his 1 daily visitor is actually a spambot and not a human being. Sources close to the fledgling blogger indicate that he may be attempting to overdose on mass quantities of Little Debbie snack cakes. We will continue to monitor this situation and we’ll bring you the latest updates as they become available.)

Chicks Dig Neumed

Alas, Spring is in the air and this fair maiden has joined the ranks of the smitten. She strives in vain to update her blog, yet her mind keeps wandering back to her one true love. The ring on her finger, she knows is but a lie.

Her heart will forever belong to Neumed.

Ah, the joy of living in abject poverty

It’s raining again today. Seems like it’s been raining forever.

Wouldn’t be a problem except that the roof on this dump has been leaking for several years now and it’s steadily getting worse.

At first it was just water spots on the ceiling, but lately it’s started coming through and we have to keep buckets in strategic locations to catch the drips. Fortunately, nothing of mine has been damaged. My roommates haven’t been so lucky and they are threatening to move out if things don’t change.

Can’t really blame them.

We’ve told Slumlord (indirectly) about the problem, but nothing ever seems to get done. We have to go through a management company and they keep assuring us that he’s aware of the situation and intends to fix the problem. Can’t contact him directly because we don’t even know his name.

Twice roofers have come out to make estimates, but then we never hear from them again.

I would move out except this place is the cheapest thing I could find and it is the only place I know of that allows pets. (I have the dubious honor of having been adopted by a cat.)

So far today, it hasn’t rained hard enough to start dripping.

It's Everywhere, It's Everywhere...

This week's Grand Rounds lends new meaning to the phrase, "passing the buck" and the only way to fully appreciate the insanity is to experience it firsthand. So I suggest starting at the beginning and try not to get lost.

Here, hold this...

Getting in Shape for Spring

On Spring break this week. Trying not to think about school too much. Going to have to crack the books starting tomorrow, however.

And since we’re on the subject, Spring has me thinking I need to get in shape.

I’m not really overweight, but my BMI is not where I’d like it to be. I’m having trouble getting rid of the spare tire I developed during my undergrad years.

I run a couple times a week weather permitting, but it isn’t enough. I’ve started riding an exercise bike and climbing stairs on those days when going for a run isn’t convenient.


Also I started lifting weights again this week after several months of letting it go. Used to lift regularly during high school and tried to keep up with it during college, but these past few months of first year it totally fell by the wayside. I just felt I should be using the time more wisely.

I think that may have been a mistake. I feel so much better after a workout that I believe it will help improve my motivation and overall state of mind.

Besides, I don’t want to become an out-of-shape doctor. I feel like if I’m going to be one day counseling patient to lose weight, quit smoking and take better care of themselves, I better set the right example.

Worked back, legs and abs Tuesday and my upper back is nicely stiff and sore the today. Legs and abs not so much except for hamstrings and calves. They are just a teensy bit sore. I think all the running and the exercise bike has kept my legs in shape and that’s probably why they aren’t feeling the weights like my back is.

Have to work them harder next time.

Are You Thinking Primary Care?

A group of us were discussing this very issue this week and out of five of us, only one was considering primary care and he admitted that he would probably go with Emergency medicine or oncology instead.

Dr Kevin Pho has a good article this month in USA Today on the shortage of primary care physicians in America appropriately titled, Shortage of primary care threatens health care system.

By way of introduction, Dr. Pho writes…

Primary care should be the backbone of any health care system. Countries with appropriate primary care resources score highly when it comes to health outcomes and cost. The United States takes the opposite approach by emphasizing the specialist rather than the primary care physician.

Dr Pho (a primary care physician) then proceeds to lay out the problem pretty clearly in the body of his article…

How did we let primary care slip so far? The key is how doctors are paid. Known as "fee for service," most physicians are paid whenever they perform a medical service. The more a physician does, regardless of quality or outcome, the better he's reimbursed. Moreover, the amount a physician receives is heavily skewed toward medical or surgical procedures. A specialist who performs a procedure in a 30-minute visit can be paid three times more than a primary care physician using that same 30 minutes to discuss a patient's hypertension, diabetes or heart disease.

Dr. Pho also addresses this situation from our perspective as students and future doctors…

Medical students are not blind to this scenario. They see how heavily the reimbursement deck is stacked against primary care. Whether they opt to become a specialist or a primary care physician, they graduate with the same $140,000 of medical school debt. The recent numbers show that since 1997, newly graduated U.S. medical students who choose primary care as a career have declined by 50%. This trend results in emergency rooms being overwhelmed with patients without regular doctors.

Not everyone agrees with Dr. Pho. Here is a response to his article that Dr. Pho posted on his blog KevinMD that offers some insight by comparing the medical profession to the rest of the business world. Here is just a snippet of the opinion…

Your description of "fee for service" and how it is affecting the medical community reveals the incredible naiveté of doctors and other medical employees. This fee system is, indeed, how business in general works. Different prices for different products is what is termed "product mix" in the real business world. Every company is subject to this phenomenon Some products are incredibly profitable and some barely cover overhead, or are loss leaders. And many of the "consults" or services that I provided as a manufacturer of foodservice equipment earned absolutely no fees. Unlike you, I could not charge for my "professional time". I hoped that it would bring in profitable business and prepared my presentations and dialogues to bring about this result ,but had many failures or missed opportunities. The last two doctors I saw (for a skin condition and for gall stones) both came up with no diagnosis or proposed solution yet each charged me their "fee" of $110 and $230, respectively

In the end it all comes down to money. Can’t blame anyone really. It’s just a matter of being practical. If you can make more money as a specialist, there is little incentive to opt for primary care.

The solution to the problem is to find a way to make primary care a more lucrative field. Dr. Pho offers three suggestions in the conclusion of his original article, which I’ve paraphrased as follows…

1) Pay primary care for their time, rather than per patient
2) Forgive student loans if primary care is chosen
3) Pay primary care the same as specialists (See #1)

Personally, I think point number two is the most viable solution for the short term. I’m sure there are many med students who would seriously consider primary care if they didn’t have to worry about how they were going to pay off the debt.

###

References:

http://blogs.usatoday.com/oped/2008/03/shortage-of-pri.html
http://www.kevinmd.com/blog/

Mind if I take a look in the trunk?

Drug Advertisements on TV

What’s up with those drug commercials on TV? Am I the only one annoyed and even offended by Big Pharma’s attempt to manipulate us as physicians?

What ’s the point of having the patient show up at the doctor’s office already asking for a drug by name except to pressure doctors into prescribing that particular product? After all, the patient doesn’t have the slightest idea if that drug is right for them or not.

Is this not an attempt by Big Pharma to coerce physicians into prescribing these products? Aren’t they trying to manipulate us by the shear volume of requests; enlisting the buying public to do the dirty work for them?

The doctor then has to waste exam time explaining to the patient why he or she does not need that med or why he prefers a different product.

This creates a doubt in the patient’s mind that maybe they aren’t getting the best care. They can’t help but wonder if they wouldn’t do better if their doctor would only let them try the new magic pill.

I mean, how irresponsible can you get? Telling patients to ask their doctor if “the purple pill” might be right for them? Since when did the drug company and/or the patient become the one determining what is – or even if – a med should be prescribed?

New isn’t necessarily better. Most of these new drugs have a limited track record. There are far cheaper generics with decades of safety evidence that are probably a better choice for the patient. Furthermore, most of the advertising is for something equivalent, but usually more expensive than the generic alternative.

So what can we as doctors do?

Well, I believe we live in an over-medicated society as it is. I do not intend to add to the problem by writing scripts just because someone saw a TV commercial.

In fact, I plan to make it a point NOT to prescribe any med advertised on TV unless it is clearly the superior choice for the patient. Perhaps I’m being naive. After all, I’m just a med student at this point and haven’t yet experienced the real world of medicine and big business.

Nevertheless, I think the pharmaceutical companies are being totally irresponsible. I think there should be a ban on drug companies advertising directly to the public. I think they should restrict their promotional efforts to medical doctors; the only people who have the ability to evaluate the medication.

I don’t expect to see this happen any time soon. I’m not that naïve.

Dinosaur Sighting

I was back home the past few days because of a family situation that fortunately turned out to be nothing. Drove back to school last night and now I’m trying to get back into study mode.

Had some down time yesterday afternoon and decided to surf the net for a bit and read a few medical blogs. While doing so, I ran across a couple of new ones that I really think would be of interest to med students. (New to me, anyway.)

I made a quick blog post yesterday about one of them (Suture for a Living) and today I’m going to take a study break and tell you about the other one, namely, Musings of a Dinosaur.

Musings is authored by a family doc in private practice; thus his use of the term, Dinosaur. I spent about an hour reading through his most recent posts and I have to tell you it was difficult to drag myself away. His writing contains a nice mix of humor, sage wisdom, and practical advice in a style that is engaging and personable.

I don’t know why, but images of “Doc” from the old “Gunsmoke” television series readily came to mind as I was reading through his posts. (Although it’s obvious he has a modern practice and he’s not that old.)

Still, I couldn’t help wondering if he has one of these.


You know, for house calls.

But seriously, I digress. If it weren’t for my Dad needing help out in the garage, I’d probably still be reading. I’m going to add this one to my regular reading list just as soon as I figure out this whole RSS thingy.

Suture for a Living

Here’s an interesting blog I ran across today written by rlbatesmd, a plastic surgeon out of Little Rock, Arkansas.

When most people (including some med students) think of plastic surgeons they automatically think of Hollywood and bizarre cases like Michael Jackson. However, most plastic surgeons are serious, highly skilled doctors that play an important role in the health care industry.

Here’s how Dr Bates describes her blog…

I am a plastic surgeon in Little Rock, AR. I may "suture for a living", but I "live to sew". When I can, I sew. These days most of my sewing is piecing quilts. I love the patterns and interplay of the fabric color. I would like to explore writing about medical/surgical topics as well as sewing/quilting topics. I will do my best to make sure both are represented accurately as I share with both colleagues and the general public.

After browsing through her blog archives a bit, it is apparent that (aside from the quilting articles) Dr Bates has a serious teaching blog. Well worth checking out.

It’s not all boob jobs and tummy tucks.

###

Reference: http://rlbatesmd.blogspot.com/

Is it worth it?

My previous post about credit card debt and the trouble a couple of my friends are going through right now has me thinking a lot about finances and just how expensive it is to go to med school.

Sure, I added it all up before I ever decided to pursue this career. I calculated the total amount of student loan debt I’d have when I finally got out and just how many years it was going to take to pay it all off.

And I’ve considered the additional years of my life that I’m investing in academics while my friends from college are now out earning a living.

I knew all this going in, but that doesn’t mean that it ever goes away. No matter how involved you get with studying, the cost is always hovering in the back of your mind.

I know it was the right decision. I can’t think of anything else I’d rather do than practice medicine. I just wish it didn’t take so long and that it was more affordable.

Steer Clear of Credit Cards

I still don’t have a credit card. Not sure if I’ll ever get one.

I have two friends here at school currently struggling with credit card debt at a time when they don’t need the added pressures. One, a first year med student, already has accumulated over $5000 in CC debt (part of which he accumulated as an undergrad) and the other, a third year, has racked up nearly $12,000.

It boggles the mind to think about having that much debt hanging over your head in addition to having to worry about school.

Both have admitted that they got in trouble with the cards when they started using them for everyday expenses like pizza and beer.

I have a debit card for online purchases, groceries and other expenses. I think it is a much better choice.

How's your luck holding out?

If it weren't for bad luck, I'd have no luck at all...

TALENT, Ore. (AP) -- Big George Helms had tickets for last weekend's NASCAR race at the Las Vegas Motor Speedway, but died before he got to use them. He still made it to the track, though.

At 6-foot-5 and 400 pounds, Helms wouldn't have been able to fit into a race car. But after his death from a heart attack Dec. 28, loved ones decided to try to fulfill the 54-year-old's dream of participating in a NASCAR race, and arranged for the former logger's ashes to be driven around the track.

That would be my luck. Finally get the chance to take a spin in a NASCAR race car and croak before the big day arrives.


###

Reference: Oregon man takes posthumous NASCAR spin

Expensive Placebos Work Better

Ah ha, just as I suspected; cheap placebos don’t work as well as expensive ones. Here’s what a recent study revealed…

A 10-cent pill doesn't kill pain as well as a $2.50 pill, even when they are identical placebos, according to a provocative study by Dan Ariely, a behavioral economist at Duke University.

[snip]

Ariely and a team of collaborators at the Massachusetts Institute of Technology used a standard protocol for administering light electric shock to participants’ wrists to measure their subjective rating of pain. The 82 study subjects were tested before getting the placebo and after. Half the participants were given a brochure describing the pill as a newly-approved pain-killer which cost $2.50 per dose and half were given a brochure describing it as marked down to 10 cents, without saying why.

In the full-price group, 85 percent of subjects experienced a reduction in pain after taking the placebo. In the low-price group, 61 percent said the pain was less.

Very interesting, but not too surprising.

For the record, when Neumed goes to his doctor for a placebo, he wants the real thing. Not a cheap substitute. I don’t think that’s too much to ask.

###

Source: Costly placebo works better than cheap one

What were they thinking?

By now I'm sure you've heard about the clinic in Nevada exposing patients to Hep C and possibly HIV by reusing syringes and vials. Here is a follow-up story on ABC's Good Morning America which implies that this may not be an isolated case...

An outbreak of hepatitis C at a Nevada clinic may represent "the tip of an iceberg" of safety problems at clinics around the country, according to the head of the Centers for Disease Control and Prevention.

The city of Las Vegas shut down the Endoscopy Center of Southern Nevada last Friday after state health officials determined that six patients had contracted hepatitis C because of unsafe practices including clinic staff reusing syringes and vials. Nevada health officials are trying to contact about 40,000 patients who received anesthesia by injection at the clinic between March 2004 and Jan. 11 to urge them to get tested for hepatitis C, hepatitis B and HIV.

The article quotes Dr. Julie Gerberding, head of the CDC...

"This is the largest number of patients that have ever been contacted for a blood exposure in a health-care setting. But unfortunately we have seen other large-scale situations where similar practices have led to patient exposures."

I can't believe this happened at even one clinic, let along is going on elsewhere. Furthermore, I can't help wondering if this is just a case of the news media attempting to milk this story for all it's worth.

In any event, this should never happen in a contemporary health care facility.

###
Reference: CDC Warns of Safety Problems at Clinics

How to Keep Motivated

I hate studying.

Seriously, it’s the pits.

I don’t mind learning. I love to learn. If there’s something I want to know, I can read about it for days and not grow weary of the hunt. But when it comes to just cramming in knowledge for the sake of passing exams, forget about it.

So you see, no matter how badly I want to be in med school (or how badly I want to become the best doctor I can be) it’s hard to stay motivated day in and day out. I just don’t like to sit and study for hours at a time.

I’m just not made up that way.

So to deal with this problem, I decided to compile a list of the various things that motivate people to keep going when the going gets tough. And since we’re all pretty much in the same boat, I figured this list my help you.

Here’s what I’ve come up with so far…

1) Love

Don’t laugh. The dudes that came up with the phrase, “Behind every great man, there’s good woman” knew what they were talking about.

Love is the most powerful motivational force known to the human race. Many a man has been driven to move heaven and earth all for the heart of fair damsel. And if you have any doubt, just consider how devastating a broken heart can be.

Unfortunately, love is a rare commodity. If you can find a way to harness the motivational power of love, you will have the keys to greatness within your grasp. Without it, you will have an uphill battle all the way.

2) Financial Gain

Say what you will, but next to love financial gain is probably the second most powerful force in the universe. Few people do anything without some thought of reward or benefit for their troubles at the end of the day.

Don’t get bogged down with platitudes. Personal gain is a tool. Use it. If a picture of a Porsche or a Ferrari helps keep you focused, then go for it. You can decide what to do with your money AFTER you get out of med school. For now, you just need the energy to spend another hour on path.

3) Hero Worship (or if you prefer, “Self-improvement”)

This works for athletes, musicians, dancers, actors and other skilled artisans. There’s no reason it can’t work for you in your quest to become a great physician.

Find a mentor or role model; someone you admire and that you would like to emulate. Find someone you can look up to; someone who has accomplished great things and use that inspiration to help you strive harder.

It may not be a medical professional. If the work ethic or accomplishments of Tiger Woods or Michael Jordan inspires you to greatness, that’s all that matters.

4) Fear of Failure

I don’t really see this one as a very good study motivator. It apparently works for some people and it may work for you. Personally, I prefer to focus on positive rewards rather than negative consequences. I think positive thoughts yield a stronger motivation than negative ones.

5) Revenge

It’s often been said, “Success is the best revenge.”

I couldn’t agree more.

Of course, it doesn’t apply to every situation, but those situations don’t have anything to do with getting through med school so we can dispense with them for our purposes.

No, if you’re best girl dumped you in high school for some dumb jock with a Camaro, she’ll be kicking herself when she sees you cruising by in your Jag and pulling down six figures. ‘Nuff said.

Are You Into Medical Podcasts?

If you’re into the ipod and specifically medical podcasts, here are some good ones you should check out. I prefer to listen to them while I’m driving or when I go for a run.

I don’t listen to all of these, but I thought I’d list them for you to check out.

http://www.medpod101.com
http://www.icurounds.com
http://www.burndoc.com
http://www.instantanatomy.net
http://www.pusware.com/


Additional podcasts (several are on iTunes):

NEJM This Week
Annals of Internal Medicine Podcast
Learn Internal Medicine by MedPod101.com
Albany Emergency Medicine Lecture Series
MedicinePod101
Listen to the Lancet
MUSC Neurological Health Podcast
Neurology (the journal) Podcast
OR-live
Surgery ICU Rounds Podcast
Survey of Pharmacology
QuackCast
The Medkast
UTHSC Internal Medicine Residency Podcast
Goljan lectures
Dr. Jeff Guy

Trauma Surgery

In a previous post I mentioned the opportunity I had last summer to shadow an emergency physician for several days. As with most things in life, one thing led to another and I was subsequently invited to shadow a trauma surgeon the following week.

(Of course, they eventually figured out that I’m an idiot and consequently, I can never again set foot inside that hospital, but that’s a story for another day.)

Before they wised up and threw me out, here’s what I learned…

The best thing about trauma surgery is the variety. One time you’re doing abdominal surgery the next you may be performing cardiac or thoracic. There is no routine. You’re not performing the same surgery over and over again day after day.



Trauma surgery is where the action is. It is the exciting, fast paced emergency situations that you’ve come to expect on shows like ER or MASH. The injured patient is brought in to the trauma center and you usually don’t know what operation is required until you open him up and can see the full extent of the injuries.

The trauma surgeon has to be able to think on his or her feet and make quick decisions. There is no time to research a procedure prior to the operation. You have to be Mr. Fix-it, Johnny on the spot and a jack-of-all-trades. (I’ve run out of clichés.)

I was very impressed with the overall abilities of the trauma surgeon I had the privilege of shadowing. I’m not afraid to admit it was a bit intimidating. I came away with a better appreciation for emergency medicine overall and for the incredible skills of the surgeons.

You can’t help but ask yourself, “Will I be able to operate at that level of competence?”

Patience, Grasshopper.

The Big Fat Question of Money

In my post on Monday, I opened up the can of worms that everybody seems to be uncomfortable with. (Some more so than others.) That is, how much you can earn as a physician?

As I alluded to in that previous post, I personally don’t have a problem with the typical earning levels that doctors enjoy. And it’s not because I hope to be a doctor one day. I felt that way long before I decided to pursue a career in medicine.

In fact, for the record, I don’t have a problem with any person earning what they’re worth. You have to get paid. It’s a fact of life. You have to eat and food costs money. You have to think about what you can provide for your family.

There is nothing noble about working for peanuts.

What I do have a problem with are the people who get paid for doing nothing. And I don’t just mean people on welfare. I’m actually referring to people with do-nothing jobs, some of whom I’ve worked for in the past. But I digress…

So just how much do the various specialties make on average? Well, it just so happens the Bureau of Labor Statistics was kind enough to compile some data on that for us.

Table 2. Median compensation for physicians, 2005

Specialty	One year	Two years
Anesthesiology	$259,948	$321,686
Surgery: General	228,839	282,504
Obstetrics/gynecology: General	203,270	247,348
Psychiatry: General	173,922	180,000
Internal medicine: General	141,912	166,420
Pediatrics: General	132,953	161,331
Family practice (w/o obstetrics)	137,119	156,010
Source: Medical Group Management Association, Physician Compensation and Production Report, 2005.

The above chart isn’t going to make your mind up for you, but it should help you in evaluating which areas to consider. I know I found it interesting and I’ll probably opt for one of the specialties in the lower income brackets. It won’t be because I wouldn’t like to earn the big bucks.

No one goes into any career or business with the attitude; I want to make as little money as possible. Let’s face it, there has to be easier ways to make money than spending 11 years of your life slogging through the medical education process.

If money is your only motivation, you would be wise to forget about medicine and instead consider becoming an investment banker or a stock broker or any of a dozen other professions that don’t require you to sacrifice a major portion of this short life we’re given just to get your foot in the door.


###

Reference: Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 Edition, Physicians and Surgeons. http://www.bls.gov/oco/ocos074.htm

New Pocketscope

Just picked up my second otoscope / opthalmoscope kit today for the physical exam course. I’ve had to borrow one for the last couple of days since mine just up and walked off.

I’d bought one from an upperclassman last semester for $130 but it mysteriously disappeared last week somewhere between class and home. I think someone stole it while I was at the library, but I can’t be sure. I may have just gone off and left it somewhere. Not that I normally do that sort of thing.

I’m usually very careful with expensive stuff like tools and equipment. This time I just wasn’t paying attention.

Anyway, I was able to pick up a second Welch Allyn from a friend of my roommate for $150. It’s in better shape than my first one, but I could almost buy a new kit for what I’ve spent so far.

This one is not leaving my sight. I may chain it to my wrist.

Choosing a Specialty

On Friday I wrote about emergency medicine, which today has me thinking I should say something more about choosing a specialty. Not that I’m an expert on the subject, mind you. I’m simply expressing my own thoughts on the matter.

In my humble opinion, choosing a specialty is a lot like choosing to go to med school in the first place. It really boils down to two basic things:

1) What do you want to be doing day in and day out for the next 30 odd years?
2) What level of income are you going to be comfortable with?

Now I’m sure there are those who will immediately object and say that I’m over simplifying things, or worse, that money shouldn’t be a factor. They will be quick to point out a dozen other factors you should also consider such as what sort of personality traits you possess and so on and so forth.

But the truth is, if you really examine those other factors they are merely subsets of the two I listed. Your personality traits, for example, are simply characteristics that go into determining what you will be happy doing for the rest of your working life.

Are you an outgoing person who likes dealing one on one with people? Or are you the studious type who would rather bury yourself in the lab doing research? Ultimately, you’re going to be drawn towards the things you like to do.

And then there is the “hot button” question over compensation. That’s right, I’m talking about all that dirty old money, wampum, bread, moulah, greenbacks, coin, jack… whatever you want to call it.

Bring up the subject of doctors and money and somebody is bound to get upset. Don’t ask me why. As far as I’m concerned, it’s just part of the job description. It is nothing more than statistical data to be used in figuring the cost / benefit ratio. Getting emotional about it won’t change which direction the sun comes up every morning.

Earning potential is a factor that comes into play when choosing any career path. Medicine is no different. How much of an influence it has on your decision is entirely a matter of personal choice.

For that reason, I refuse to enter into discussions with my fellow students (or anyone else for that matter) over the question of how much doctors should earn. If your motivation for entering the medical profession is purely altruistic, fine. If not, that’s fine too. Won’t make you a better doctor one way or the other in my opinion.

I’m not about to waste my time arguing about it.

Are You The Next Dr. Carter?

Like a lot of medical students I first became interested in pursuing medicine as a result of watching shows like ER on television. So naturally, my first choice as a specialty all through pre-med was emergency medicine. I was just sure I was destined to be the next Doctor Carter.

Of course, it doesn’t take long before you realize that the ED is nothing like on TV, but the initial interest is sparked and so it is only natural for ER addicted med students like myself to consider that specialty.

Rest assured, I have not settled on a specialty yet. That would be foolish this early in my education, but here are some of the facts (or Pros and Cons as I like to call them) about emergency medicine that I’ve gathered so far. (This list is not all-inclusive and what I list as Pros and Cons may be just the opposite for someone else.)

The Pros:

1) Emergency medicine is practical and fast paced
2) You get to save lives for real, day in and day out
3) You spend more time treating patients rather than writing notes
4) The work hours are fairly decent (at least, I thought so)
5) You see a wide variety of patients
6) You don’t have to worry about getting paid

The Cons:

1) You don’t get to develop long-term doctor-patient relationships

2) You have to deal with more trauma cases (gore) than the average doctor. This may seem cool at first, but trust me, seeing a 3-year old involved in a serious accident will break your heart. It doesn’t seem cool after that. Yes, there is the satisfaction that goes along with being able to help put that child back together, but it is still tough to deal with

3) EP’s (Emergency Physicians) don’t get paid as much as some other specialties

I could probably list more, but these are the ones that stand out to me.

If any of this appeals to you, do whatever you can to get the opportunity to shadow an emergency physician for a few days. I have and it was a worthwhile experience even if I do eventually decide to go in a different direction. As I said earlier, I haven’t completely decided on a specialty yet, but emergency medicine is definitely at the top of my list.

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Photo Courtesy of NBC

The New Blog

I’m not sure exactly what direction this blog will go. For now I’m just going to write whatever is on my mind at the moment and not worry about developing a theme.

I will probably write a little about medical school, my pre-med experience, the application process, and the decision-making process I went through (and still sometimes question) in deciding to go into this profession. But I doubt that this will strictly be a medical school blog.

In case you haven’t already picked up on the vibe, I want to try and work humor into the mix as much as possible. For me blogging is mainly an outlet for letting off steam.

I am still playing with Blogger trying to figure everything out, so posts may be spotty for a while. But please keep coming back and checking out what’s new. Any comments or advice is always welcome.

Thanks for stopping by,

Neumed

Turning to Stone

Once when I was younger, a friend and I were headed down to our favorite fishing spot when we came across this woman bathing naked in the stream. All of a sudden my friend takes off running like his pants were on fire.

Thinking we were about to get caught, I took off after him.

When I finally caught up to him, panting and all out of breath I asked, "Why'd you run away?"

"Are you kidding?" he exclaimed, "My mom told me if I ever saw a naked lady I would turn to stone. I felt something getting hard, so I ran."

About This Blog

About the Author
Neumed (sometimes also known as, Jim Anderson) is not yet a medical professional. He is but a lowly medical student, so please don’t ask him for advice. Instead, see your doctor.

Neumed will do his utmost to always cite the source of any medical information contained within these pages and provide you with a link to said source when available.


Disclaimer
All information provided on these pages is to be used for entertainment and/or educational purposes only. It should not be used as a substitute for seeking professional care, diagnosis or treatment of any medical condition or disorder.


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All case reports presented on these pages are typically composites of multiple patients with identifying information changed for the sake of confidentiality. All opinions expressed herein are those of the author only and do not represent the positions of his school, employers or any medical facility or organization with which he is affiliated.


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