Subaqua Sternal Rubs

That's the view of a recent New York Times economic editorial.

So, how can Medicare's ballooning costs be contained? One idea is to let people die earlier.

For the last few decades, the share of Medicare costs incurred by patients in their last year of life has stayed at about 28 percent, said Dr. Gail R. Wilensky, a senior fellow at Project HOPE who previously ran Medicare and Medicaid. Thus end-of-life care hasn't contributed unduly of late to Medicare's problems. But that doesn't mean it shouldn't be part of the solution. "If you take the assumption that you want to go where the money is, it's a reasonable place to look," Dr. Wilensky said.

End-of-life care may also be a useful focus because, in some cases, efforts to prolong life may end up only prolonging suffering. In such cases, reducing pain may be a better use of resources than heroic attempts to save lives.

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Argh… Tomorrow marks two weeks until midterms start… Consequently, I have been spending the whole day studying, with the one exception of driving to the Grand Beach Resort to sell my old microwave. (Yeah, where they are forbidden.)

In order to save time for studying, I even ate my lunch hobo-style: soup out of a can that I didn't even bother to heat. Hopefully there will be something more interesting (or warmer) for dinner.

Ok, 30-second break over, back to the books!

Oh did I forget to mention:

It's hard to see, but I have too many bites to count. For some reason, the mosquitoes here love to bite around the ankles. It is finally dry season though, so hopefully their population will dwindle as the amount of standing water decreases…

… include having your weekly run to the supermarket dictated by the scheduled arrival of the "real" milk. It is shipped down from Florida and usually is on the shelves by Saturday, with a convenient expiration date of the next Friday. Today, however, the one store that does sell "real" milk is redoing the dairy coolers, so the shipment isn't expected until Tuesday or Wednesday. I had to settle for UHT milk (ugh!), which they were nice enough to have a sale on. Funny thing was that the milk I bought today has the same expiration date of milk I bought a month ago. That just doesn't seem right to me…

So you may be asking yourself, "How does Carsten have time in medical school to make 4 posts?" Well, I'll tell you. As I got back from class today, there were two workmen from the construction company that built the dorms standing in front of my door. They wanted to replace my window. Granted there was a crack in it, but not huge, and it was still water-tight, so I never wrote up a work order requesting a new window. But evidently someone else did - because they insisted I needed it replaced, even though I told them they could save themselves the trouble. Unfortunately, I needed to stay in the room as the work was being done, since I have a key to every room in the building on a "key board" in my room.

Well 2 and a half hours of hammers and electric drills, they are finally done, and I can study in peace.

I actually had the mother of someone I know die of a hemorraghic stroke, as a complication of T.P.A. in the ED where I worked. I wonder if this new therapy could have reversed that?

Most of the 700,000 strokes in the United States each year are caused by a clot that cuts off the flow of blood to the brain. Over the past decade, the clot-busting drug T.P.A., or tissue plasminogen activator, has been effective in treating many of them.There has been no effective treatment for the 10 percent to 15 percent of strokes caused by bleeding in the brain.

More than half the victims die within a year, and only one in five recover well enough to regain mobility.

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Yes, that's what I am doing - practicing my manual dexterity skills Maybe soon video gaming will be a new class in medical school? Definitely more useful than some of this stuff

THE running joke that playfully follows Dr. James Clarence Rosser Jr. when he prepares to operate at Beth Israel Medical Center in New York is that this ebullient man possesses hands too large to perform traditional surgery.

Instead, Dr. Rosser prefers laparoscopic surgery, a technique that relies on an ultra-small video camera to help him manipulate long, slender instruments inserted into patients through small incisions. It is, he said recently, as his hulking 6-foot-4 frame loomed over a surgical simulator using instruments he designed, an elegantly efficient approach to repairing the human body.

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Back in High School, I took part in a novel new program called New Visions: Health Careers Exploration. It was an awesome program where I spent half of each school day of my senior year in a hospital, participating in both academic classes (A&P, Health Economics, Ethics, etc.), as well as direct observation of all aspects of a hospital, up to and including open-heart surgery and the autopsy of a 1 year old. One of our assignments was debating current issues in health care, and I chose the "pro" side of euthanasia. At the time, Oregon's "Death with Dignity" act had just recently been passed. Coming across the following article: 1) brought back memories of the fun times I had in the program, and 2) reminded me of how much I disagree with George W. Bush and his "faith-based" policies that are blurring the line between church and state.

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Those now-ubiqitous camera phones are actually useful for something… Though I can't see this spreading beyond dermatology. (No pun intended.) Imagine a patient gets into a car accident, snaps a photo with his camera phone, sends it to the ED, and gets back a diagnosis: "Yup, you've got a tree impaling your chest."

Dialing for a diagnosis, doctors in Switzerland say cell phone photos of leg ulcers usually provide enough information to assess and treat most patients, saving those patients the trouble and cost of transport to the clinic.

"We were able to show for the first time that telemedicine for chronic wounds is feasible under routine conditions using this new generation of mobile telephones and direct transfer via e-mail," the researchers report in the February issue of Archives of Dermatology.

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Just got back from the weekly Physiology laboratory. On the menu this week: Blood pressures. The lab called for taking a blood pressure on a partner, then getting a pressure taken by the partner. Following this, one member of the group was selected to get their blood pressure taken while laying flat, and then while standing, notating the different systolic/diastolic values as well as the pulse rate.

This would take me about 2 minutes or less. Maybe 10, if I wanted more accurate orthostatics. (lying flat vs. standing) So how long did this lab take? Oh, only about 2 hours…

As a "professional" blood-pressure-taker (professor's words, not mine), I basically ended up teaching my small group on how to measure blood pressures. For example, where to place the cuff, how not to cause tissue necrosis by leaving the cuff on the arm pumped still pumped up to the diastolic pressure, and learning to tell the difference between Kortokoff sounds, and the sounds caused by movement of the stethoscope over the skin.

I guess it's good to get back into clinical practice, no matter how trivial…