You Cited Wikipedia?!?

 

I am mostly working from home this month (I still have clinic a few days per week) with the goal of answering one question: Is Wikipedia accurate?  Wikipedia is easily one of the most polarizing sources for information available, especially in academia.  Teachers hate it and students love it and most people have formed some opinion on the site.  I admittedly love the web site and the whole concept behind the site and have developed a formal plan to answer the question of Wikipedia's reliability as a source of information.

As far as I know, every medical resident in the country has to participate in a research project during the course of their residency.  The requirements for my project were quite broad.  It has to be academic and focus on some aspect of medicine.  That was the only requirement.  As I said, I use Wikipedia quite frequently and some of my colleagues even make fun of me for doing so.  I decided to focus on this amazing source of information to determine how accurate (or inaccurate) the information contained on the site actually is.  In the coming posts I will explain how I went about answering this question.  Stay tuned.  The results might surprise you.

The Name's Bond

This weekend Sarah and I (and Katie) went to the theater to see Skyfall, the newest James Bond film.  It was the first time I had been to a movie theater in a few years.  I am not a huge movie fan in general but like Bond quite a bit.  I've been in a big kick over the past few weeks with all of the advertisements and have even watched a few of the older movies I have on DVD.  Today I was shopping on Amazon and found the whole Bond collection on Blu Ray (excluding Skyfall, of course) for only $130 and decided to get it as one of my Christmas gifts (I didn't want to wait as the collection was on sale and normally retails for around $300).  I am looking forward to watching all of the Bond films, starting with the first one Dr. No all the way up to the most current films starring Daniel Craig, not to mention all of the extras that come with the Blu Ray collection.

Traveling Back Through Time

Besides the autumn "fall back" in time this weekend, a couple of other things happened over the past few days which made it seem like I was time traveling into the past. 

Last week our DVR quit working out of the blue.  While I was on the phone with the cable company, it came up that we did not have a home phone line and asked if we had thought about getting one.  The last time we had a home phone line, we paid $20 a month for it and the only people who used it were the state police bugging us for donations.  I really didn't see the purpose in paying for the service so we discontinued it.  However, our cell phone service in our apartment is very poor.  I think it is due to the way our apartment building is constructed.  It can be very difficult to talk on the phone and dropped calls are common.  Obviously this is annoying and starting next summer I will begin taking at home phone call for the clinic I work at, so having a reliable phone line is a must.  So we went ahead and added a land line phone.  We got the phone service and upgraded our internet speed to 20 Mbps (I was clocking it at over 30 yesterday) for just $1.25 more per month (how could you pass that up for the internet speed boost alone???).  We bought a new home phone yesterday at Amazon.  I wasn't even sure if they still made phones like that.  I never thought I would buy one again.

The other thing that happened recently was on Saturday I was at the hospital interviewing fourth year medical students for positions in our residency program.  It was just three years ago when I was in their shoes interviewing for spots myself.  I remember how incredibly anxiety inducing the whole situation was.  Even though it was just three years ago, it seems a lot longer than that as a lot has happened in those three years.  How quickly the tables can turn.

An EPIC Week

I've spent close to 10 hours this week in a classroom learning about EPIC, the new electronic medical record software our hospital will be switching to shortly.  As soon as I discovered that there was actually a class to teach us how to use the software my expectations immediately were lowered.  Then when I got to the class, we were told that this was a very basic introduction to the system.

The fact that doctors are being forced to use these insanely complex systems is absurd in my opinion.  We have a dictation and charting system that has been used for years that is effective and quick.  With more and more demands on our time I question the value of having doctors doing what basically is secretary work.  Furthermore, if we are going to be forced to use these systems, they should be intuitive and easy to use.  They should not require a ten hour course to learn "the basics" and we should not have a screen that has about 100 button choices to chose from.

You might be fooled into thinking that being younger and growing up around computers would benefit me.  I am sure that to a certain extent I can pick up on things quicker since I've basically been around computers my entire life.  But no way could I walk up to a computer running one of these systems and figure out how to get it to do what I want it to without training and/or experience.  That's a real problem in my opinion.  These systems should be as intuitive as using Google.

Wings. Beer. Sports.

This past weekend was the first full weekend I've had off in over a month.  I took full advantage of it by doing nothing and it was everything I imagined it would be.  Below are pictures summing up what went on.  Lots of sports, to say the least.

Birthday Wishes

Thank you so much to everyone who wished me happy birthday.  Despite work, I had a pretty good weekend.  Sarah got me this tasty and amusing ice cream cake from Dairy Queen.

This weekend I have completely off and I have a 10 wings for free coupon to Hooters so I am going to take full advantage of that on Saturday afternoon.  Enjoy!

Communist Medicine

For the second straight year I received my flu shot because I was forced to do so.  I had no choice but to risk my job by saying no.  There is a huge push in this country to practice evidence based medicine and not to treat unless absolutely indicated.  Despite this, every where you look you are bombarded with information on the flu shot.  You can't even go to the gas station it seems like without seeing signs advertising places where you can get your flu shot.  There is huge pressure from society to get this shot that quite frankly doesn't even work that well.  According to the CDC, for the 2010-11 flu season the vaccine overall was only 60% effective.  Furthermore it works best for the people who need it the least: young, healthy individuals.  It frustrates me that so much emphasis is placed on a medicine that only works so-so.  Also, I read a lot of epidemiological studies (that's how I know that sinus infection you've got most likely is caused by a virus) and I have never once found any evidence that me getting the flu shot protects anyone (i.e. the patients I see) other than me, and yet I am forced into getting it.  It is absolutely absurd, non-logical medicine.

While I'm ranting on the tests I am forced to get, I get one to two PPD tests per year to test me for tuberculosis.  In my entire educational career I cannot remember one person who has had tuberculosis, save for one guy who had Pott's disease.  I would love to see the number needed to screen to get one positive on that test.  Meanwhile, the government says we need to cut back on screening for breast cancer, a disease that effects one in eight women, which is much more common than tuberculosis.

Pet Peeves

Unlike many other cities such as Chicago where the traffic is just awful all of the time, you never really know what to expect here in Indy when it comes to the traffic on the morning commute.  On the best days there is minimal traffic and flow is uninterrupted.  On the worst days flow will be thick throughout with occasional bumper-to-bumper interruptions.  What's particularly interesting is that there seems to be no pattern to the change in traffic flow.  It can be at any time during the commute and on any work day.

Last Thursday happened to be pretty bad in terms of traffic and there was one reason: the police.  There were police everywhere with multiple cars pulled over.  One part of the expressway goes from 3 lanes to 2 lanes and has an immediate 90 degree turn (I would love to meet the engineer who designed this route...) and this morning a cop had a car pulled over right before the drop to two lanes, resulting in a nearly mile long line of stop and go traffic.  I drive the morning commute every day here and the overwhelming majority of people are driving sanely.  Why, why, why do the police find it necessary to send half of their force out to pull people over during this time of the day?  It creates ten times more problems than it solves.  There has to be something better for them to be doing.

No new ridiculous ER visits.  I take that back, there have been a couple but when I ask them the logical question (Did you call your doctor?  This, of course, is assuming they have a doctor.) they often tell me their doctor told them to come to the ER, despite the fact that it was obviously not an emergency.  I could probably write an entire book on gaps in our health care system, but suffice it to say that in my opinion we need to re-evaluate how health care is delivered in our country.  The old fashioned model of the doctor's office with appointments may not be adequate in today's society.  Places like immediate care centers are helping to fill these gaps and reduce resource wasting like ER visits for sore throats.  

Area Woman Rushed to the ER with Fatigue for One Year

Area woman presents to the ER looking pale as a ghost and complaining of fatigue for one year.  Labs showed that she was quite anemic and iron deficient.  When asked why she waited so long to be checked out, she was unable to provide an answer.

Area Woman Has Emergent Menstrual Period

Despite having no indication of being pregnant, such as missed period, morning sickness, breast tenderness, 24 year old area woman reports to the local emergency room at the time of her normal period complaining of vaginal bleeding thinking she was having a miscarriage.  When asked if she was pregnant, she responded "I don't know."  When asked if she had taken a home pregnancy test, she answered "no."  A serum beta HCG was run stat which was negative, and a much relieved patient was discharged home I am sure to return to her much productive life.

Tales From the ER

I finished pediatrics last week and have since moved onto emergency medicine.  I enjoy seeing kids quite a lot but not enough to do it full time.  I like the variety of seeing both kids and adults.  One of the things that makes pediatrics challenging is that it involves a fair amount of hand holding (i.e. reassurance) and you get a lot of non-medical questions.  In medical school we learn about things like omphalocele and intussuception.  In reality, most of the questions in pediatrics seem to involve how much formula the baby should be drinking and how often they should be pooping, neither or which was discussed much or at all in school.  Just like everything else in life, the more you do something, the better you get.  I am much more comfortable discussing such things now than I was a year ago.

As I mentioned, I have started emergency medicine.  Working in the ER is quite a bit different than working in outpatient medicine.  There is really one goal: decide if the patient is sick enough to be admitted or treated at home.  Despite being clearly labeled as a room for emergencies, it is really quite fascinating the number of patients who walk in who clearly do not have an emergent condition.  I am sure there are a number of reasons for this and to investigate these numerous reasons would be way beyond the scope of this post.  At any rate, I thought it would be amusing to share some of the chief complaints and diagnoses that come into the emergency room, most of which clearly aren't emergencies.  In a tribute to one of my favorite web sites, I will try to write the posts in a news story fashion, a la the Onion.

Reproductive Endocrinology 101

I'm doing this post in an effort to explain what is going on with the IVF stuff.  In order to explain IVF, a simple understanding of the female menstrual cycle is required.  The above picture is a perfect example of the phrase "a picture is worth a thousand words" as it graphically explains what happens during a normal menstrual cycle.

Basically, hormones from the brain (FSH & LH) stimulate multiple follicles in the ovary.  As the follicles grow, increasing amounts of estrogen cause tissue in the uterus to grow, preparing for implantation of an embryo and pregnancy.  Eventually one of the follicles is selected as the "dominant follicle," the other follicles die off, and a massive surge in LH causes the dominant follicle to ovulate.  At this time, the hormone levels drop off with the exception of progesterone.  Progesterone is produced by the unit that contained the follicle before it was ovulated.  Progesterone maintains the uterine lining in preparation of implantation and pregnancy.  If pregnancy occurs, the placenta develops and it takes over the role of producing progesterone.  If pregnancy does not occur, progesterone levels decrease and the uterine lining built by estrogen cannot be maintained.  The lining sheds resulting in a menstrual period and the cycle starts over for the next month.

For IVF, medicines like follistim and menopur are given to help encourage follicle growth.  After a short trial of these medicines, lab work and ultrasounds are done to assess follicle growth.  Once an appropriate number of follicles are produced, another medicine such as ganirelix is given to prevent the natural LH surge and ovulation.  This is to allow for continued growth of the follicles.  The goal is to grow as many follicles as possible without over stimulating the ovaries, which can be dangerous.  Once an appropriate number of follicles are present, a "trigger shot" is given to induce ovulation.  Shortly after the trigger shot, just prior to ovulation, the follicles are retrieved using a long needle.  The follicles are then taken to a lab where a sperm cell is injected into the egg.  The embryo is then implanted into the uterus resulting in pregnancy.

In order for the female ovulation and menstrual cycle to work correctly, it requires an amazing and  complex set of hormones and body systems communicating in perfect harmony.  I think it's absolutely amazing how this system works as well as it does.  It's also pretty cool how it can be manipulated to achieve what we want it to do, like pregnancy.

Lost In Translation

One of the clinics I work at has a large Hispanic population, most of whom speak only Spanish and require a translator.  Generally speaking I am not used to working through a translator and this additional step can make things a bit difficult (as if the job of taking a history, doing a physical, coming up with a diagnosis, and then coming up with a treatment plan wasn't difficult enough).  You really need a good translator to effectively communicate.  Last time I worked at this clinic my translators were only OK.  I found people giving inconsistent histories and explaining symptom complexes that really didn't make any sense.  I truthfully wasn't sure if it was the language barrier or different cultures or if the patients weren't really all that sick.  But what can I do?  I don't speak Spanish, so I just tried my best with what I had to work with and moved on.

Speaking of moving on, the Olympics ended a few weeks ago and now Sarah and I have found another sporting event to dominate our time for the next couple of weeks: the US Open.  We're both pretty big tennis fans.  I love prime time at the Open.  Some of those matches go on way into the night.  Here's hoping for some closer matches in the upcoming days.  Sharapova has steamrolled through the first couple of rounds.

Shot Time!

Schools have started around the city and for the past couple of weeks we have been getting the typical "The school says he/she needs shots before they can start." routine.  What gets me about this is that I am sure they are notified earlier than 12 hours before school starts, and yet they wait until the day before school starts and call and expect us to drop everything we are doing to fit their kid in last minute.  We can usually do it but some of the parents are kind of pushy about it, which can be annoying.  How about some planning?

Sarah and I were in Cincinnati this past week for the Western & Southern Open.  We saw some good tennis, and most of the big stars were there, except I missed Maria and Maria (see below).  I took a pretty cool picture of the stadium with a colorful sky in the background, which I posted below.    I have a wicked raccoon-like sunburn on my face from my sunglasses, and I think the sun got to me a bit because Thursday morning I put my shoes on before my pants!  We enjoyed the tennis and got to see Sarah's uncle and cousin which was fun too.

Maria Sharapova:

Maria Kirilenko:

A Return To Normalcy

The older I get, the more I enjoy the Olympics, especially the summer Olympics.  They provide a lot of drama and you really feel for the athletes as they fight for gold on their sports biggest stage.  The fact that they only happen once every four years adds to the excitement.  Sarah and I have watched a lot of coverage the past two weeks, which basically lasts from after dinner to midnight.  While I've enjoyed these games a lot, I am ready for them to be over so I can return to my normal routine.  Below are my favorite moments from the London games.

• Michael Phelps becomes the most decorated Olympian of all time.  If I were to name the most dominant athletes that I have watched in my lifetime, Michael Jordan, Tiger Woods, and Phelps are the first three that come to mind.
• While we are on the topic of swimming, Missy Franklin's gold debut was spectacular.
• Gabby Douglas winning the individual gold, putting her in a select group of elite US Gymnasts.
• Walsh and May winning the beach volleyball gold.  They were both amazing, but May has the incredible ability to be at the right place at the right time.  Her digs were amazing.  Walsh says she wants to return in 2016 and that is something I'd love to see.
• Usain Bolt is a beast.  Enough said.
• David Boudia's stunning gold in diving.
• US Women's soccer winning gold against Japan, the team that beat them in the World Cup.  I'll cheer for this despite the controversy.

The Hardest Part

In general, my profession is pretty rewarding.  With that being said, there are some hard parts to the job.  Probably the hardest part is telling someone their family member passed away.  I had to do that last this morning.  Absolutely my least favorite part of my job.

The 30th Olympiad

Sarah and I dominate the Olympics.  The older I get the more I enjoy them, and the summer Olympics are by far my favourite.  While they have popular sports like basketball and tennis, I prefer to focus on the more rare sports that only get national attention every four years.  Below have been some of my favorite story lines thus far.  Keep in mind that this post was written a few days before it was published so a lot has happened in that time.

U.S. Swimming and the Phelps/Lochte competition.  The swim meets can be downright entertaining and who doesn't enjoy a little competition between teammates?  Personally I find Lochte a bit annoying and am hoping Phelps will shut him up in the pool.

 I am admittedly a bit of a closet women's gymnastics fan.  I don't follow the sport throughout the year but I do enjoy watching it at the Olympics.  I do think Jordyn Wieber got the shaft a bit.  I understand limiting 2 members per country so that the competition isn't dominated by a single team.  The flip side of the argument is that if you want to have a competition against the World's truly best gymnasts, you have to have the best one's there and this rule does not allow that.  Why is it her fault she has great teammates?

 Women's beach volleyball is obviously a bit of a guilty pleasure, but Misty May Treanor and Kerri Walsh dominate their sport (have never lost a set in the Olympics) and it's always fun to watch a team dominate.  Actually, the older I get the more I like volleyball.  I watch it occassionally on the Big 10 Network.

Other sports I'm watching closely are tennis and women's soccer (we actually win in the women's division).  I'm sure once track and field starts I'll be watching it closely too.  Also, London looks absolutely fascinating on TV and would love to visit there sometime.

I'm working this weekend.  Everyone else have a good weekend.  I'll be using apps on my iPhone to keep up with all of the Olympics results and news.

A Beautiful Mind

I've spent the previous month in a locked geriatric psychiatry unit at the hospital.  A few of the patients were admitted for depression and suicidal ideation, but the overwhelming majority were admitted for poor behaviour from their nursing home or assisted living facility.  Poor behaviour typically includes verbal abuse towards the staff, but can also include physical abuse towards the staff or other residents, and sometimes sexual misconduct, sometimes eloping from the building.  The patients would be admitted so that some concoction of medicines could be generated that would improve their behaviour to at least acceptable levels to return to their previous environment.

Except for the patients there for just depression, everyone was confused.  They had no idea why they were in the hospital, or even that they were in a hospital at all.  They thought it was Christmas Eve despite sitting outside in extreme Midwest heat.  Some had hallucinations and many had delusions.  One woman insisted that she was pregnant and that her kids were still in school, despite the fact that she was 85 years old herself.  Attempts to redirect the often pressured behaviour often resulted in agitation and sometimes aggression.  Reasoning was completely out of the question.  I interrupted this behaviour as ranging from amusing to downright unbearable.

Every Tuesday we would have meetings with the patient's family.  We would have to explain to them why their parent's are behaving this way and why they have a completely different personality now compared to the past.  We would have to explain the multiple side effects of the medicines being used (one of Zyprexa's side effects: death) and the unfortunate situation of not having anything better to use.  We would have to explain to them the terminal nature of the diagnosis, that eventually they would forget how to walk and even swallow which would lead to their death, and that there was nothing anyone could do about it except hang on for the ride.  Interacting with the families made a sad situation even more depressing because you realize that the patients were "normal" people at one time with real lives.  Sometimes just seeing them in their confused and crazy state makes it easy to forget this.  I learned a lot this past month, mostly on how to talk to family members with parents who are going through this terrible process.  I also learned that I do not want to get old.

Two Down, One To Go

It's hard to believe this, but tomorrow I start my first day of my third year of residency, which for me is the last year until I finally go out on my own and get a real job.  Last week the incoming first year residents had orientation and while I didn't spend much time with them during their orientation I did spend all day Thursday and Friday with them during ACLS re-certification (Advanced Cardiac Life Support).  It was interesting to talk to them and answer their questions and hear their fears about the upcoming year.  So much has happened in the past two years that I kind of forgot that I had the exact same concerns and fears when I was first starting residency too. Now I just go to work everyday and don't really think about these things much.  It just goes to show you how many things I've learned in the past two years.

I now have one more year of monthly rotations.  I spend three days per week at my rotation which changes at the beginning of the month.  I spend the other two days per week at my clinic, seeing my own patients.  It should be an exciting year.  I anticipate within the next couple of months I should have a pretty good idea on where I'll be working full time in the future.  One year from now I will finally be out on my own, which is both exciting and scary (I will likely have the same concerns when I start my real job as the new residents have about starting residency.).

They released a flier to post in various departments of the hospital with the name, picture, and pager number of all the residents.  Being a senior, I am at the top of the page along with my lone senior classmate.  The picture is symbolic of me making it to the top of residency.  I better enjoy being on top while it lasts.  Next year I start all over again at the bottom of the totem pole.

Among the Clouds

Previously, I mentioned the troubles of bridging the gap between the music stored on my computer and being able to listen to this music on my main stereo, which is not in my office where my computer is located.  Actually, my main stereo isn't even hooked up currently.  It is much too large for an apartment and since all of the rooms in our apartment are within close proximity, just listening to the music on the computer isn't too bad most of the time, unless you are in the bedroom, which is where the Bose sound dock comes in.

At any rate, in the future when we have a house I am going to need a way to efficiently connect my music collection on my computer to my stereo.  I've been thinking about ways to do this recently.  I know there are several devices out there that can do this, including the Logitech Squeezebox, which I might end up buying.  But this week I stumbled upon an answer to this problem that is really quite brilliant: Take the computer out of the equation.  How would you do this, you might ask?  Simple - use the cloud.

In simple terms, cloud computing is basically a hard drive not within your computer that a person can access and store files (it has other functions, but this is the basic idea).  You typically access the drive through the internet using either a browser or an app.  In the past few weeks I have accidentally acquired three cloud drives, the best one being the Amazon Cloud.  We are Prime members, so my cloud drive has 20 gb of storage (I think the usual free amount is 5 gb).  This drive allows me to upload my files so that I can access it anywhere there is an internet connection.  The best part is, music files do not count against your storage total, so I basically have an unlimited drive that I can store music on and access it anywhere.  In addition, there is a great app for the iPhone to access and play the music.  I have already used it in my car to stream music over my car stereo's bluetooth connection and it works great.  Using a simple device like Apple's Air Port Express, you can easily stream the music from the cloud into your stereo, completely eliminating the need for a personal computer at all!

I must say I am quite excited about this.  I have already started uploading parts of my music collection.  The upload part can be a bit cumbersome but it will be worth it in the end.  I should be able to access songs, create playlists, and basically do everything with my music just as if the computer were right next to me, except the computer isn't even being used.  Instead I'll use my iPhone to control the music (it really can do everything), or an iPad if I can swing that.  It's really quite brilliant.

Re-Reviewing the iPhone

The 4S is the first iPhone I've ever owned.  I've had it for several months now (I think it was released last October) and have had time to get used to it and learn what it can do.  With this being the case, I must say that the iPhone is one of the most amazing objects I have ever owned.  Technology evolves quickly so it is easy to forget that just a few years ago devices like this didn't exist.  But if you take the time to think about what all it can do, it really is a remarkable device.

Besides the obvious features of communication via phone, text message, or email, the phone has more or less replaced my camera for all but the most special occasions.  The camera is quite good.  It can shoot full high definition video as well.  I surf the internet using the quite good Safari browser or apps like Wikipedia or IMDB.  I check the weather forecast.  I check locations and get directions using Google Maps.  I check the latest sports scores.  I almost don't even need a computer the internet experience is that good.  I watch TV on the phone on HBO Go.  It's how I'm re-watching the Sopranos.  I read books on the phone on my Kindle app.  I listen to music using Pandora, even connecting the phone to my car stereo by bluetooth.  I keep a calendar of all my events so I know where I'm going and what I'm supposed to do.  I play games on the phone, which some of them are quite good.  I use it at work to look up drugs and their doses.

This single device has replaced or greatly reduced my need for a camera, a computer, a GPS device, a TV, a bookshelf or textbooks at all, a stereo, a calendar, and a gaming system, and it fits in the palm of my hand.  Not only does the iPhone do all of these things, but it is so intuitive to use a toddler could figure out how to do most of it.  The device is nearly perfect (I do have a few complaints, but they are so minor they aren't worth mentioning.).  Oh yeah, did I mention that it could make phone calls? 

On a side note, I'd like to say happy father's day to all of the dads out there.  Dad, I hope you enjoy your TV.  And I'd like to thank Joe for picking up a copy of A Game of Thrones, the book.  It should hold me over until season 3 picks up on HBO.

The Sound of Music

Long gone are the days where if you wanted to buy an album you would go to a music store to make the purchase.  In fact, even I can barely remember those days.  Today, if you want to purchase a song you just hop on the Internet and go to Amazon or iTunes and download the song or album to your computer.  I don't even think I own any "CDs" anymore.  I have a 200 disc changer sitting in my closet collecting dust.  It is just barely over 10 years old yet it seems so archaic its presence in my home seems laughable.

The personal computer equipped with Internet access is the best music machine ever made.  Never in the history of music have you been able to store so much music, have access to so much music so quickly, been able to set up play lists with the touch of a button so easily.  The only problem with having your music stored on your computer is having access to the music through your home stereo.

When I was growing up I had a man cave (or was it a boy cave?) in my parent's basement, equipped with a computer connected to a high out-put stereo and two speakers that were each about three feet tall.  Ever since moving out of my parent's basement, however, I have not had such a convenient setup.  I've never again had a computer in the same room as my stereo, which is now in my living room.  That seems just a bit awkward.  I haven't figured out a good way to stream the music wireless.  The PS3 does a decent job but you have to have the TV on, which I really don't like.  Truthfully I haven't tried a lot of other devices, but I worry about difficulty browsing my library (which has 40,000+ songs) using a device other than a computer and mouse.  This is something I am going to have to look into more seriously once we move into a house.

However, in the meantime I mostly listen to music at my computer or in my car.  Otherwise, I save the living room for TV.  However, I enjoy listening to music in the bedroom and bathroom in the mornings when I get ready for my day.  This presents a similar dilemma as I do not have a computer in my bedroom either.  To solve this problem, I decided to get an iPod sound dock.  I never thought I would buy such a device, but it seemed like an easy way to get my computerized music to a stereo.  Plus, the iPod has a great interface for going through music.  I did a little bit of research, saw a review on Attack of the Show, and decided to go with a Bose Sound Dock.  Of course it was a bit costly, but the sound it produces is really quite impressive.  It can easily fill a large room with sound, and most of the reviews I read said Bose made the best-sounding docks on the market.  My only complaint thus far is that it doesn't have bluetooth built-in.  But otherwise it is a great sounding little stereo that easily allows me to listen to my computer music someplace other than my computer.

While we're on the subject of music, Sarah and I went to Cincinnati last week to see Radiohead at Riverbend Music Center.  We had lawn seats (which was artificial turf, how odd).  The concert was decent, though it wasn't as good as when we saw them in St. Louis earlier this year.  Overall, I don't think Riverbend is as good as Klipsch (formerly Verizon Wireless Music Center) here in Indy.  It didn't sound as good and it needed to be twice as loud.  We enjoyed the show regardless.  Below is a picture from our lawn seat.

You Are What You Eat, Part II

I was diligent about entering my food into myfitnesspal for four to five weeks.  To be honest, I've gotten away from it a bit.  But four to five weeks of data is enough to have a pretty good idea about what I'm eating and how many calories I am taking in.

I have my program set to maintain weight, as opposed to lose weight.  At my height and current weight, according to the program, I can take in around 2,300 calories per day.  I found that on most days I would eat between 1700 and 2000 calories.  I did this pretty consistently for a month.  I believe the calorie amount because I didn't change the way I eat too much and I have been the same weight since about junior high.  Counting the calories did make me change the way I eat a little bit.  For example, once I found out that two double stuff Oreos were 140 calories, I backed off on the amount of cookies I ate a bit in order to stay under my daily calorie limit.

Of course, the other side of the equation is exercise.  I'll be honest, I absolutely loathe exercising.  It will be a 90/90 day (90 degrees, 90% humidity) and I'll see people running around our neighborhood and they look absolutely miserable.  I have no idea what would possess you to just get out and run.  I don't particularly like other exercise activities either.  While I was counting the calories Sarah and I started going to the gym a few times per week but we have since fallen off that phase.  I don't even know how much it was helping if at all.  I felt good about going (even though I didn't enjoy it) but I'm afraid I was getting more psychological benefit than physiological benefit.

In this weekend news, I had my first shift at the free clinic down the street from where I live.  It was very busy!  Last night Sarah and I ate at the Kona Grill.  My steak was very good, and Sarah had some fancy sushi, seen below.

The Race!

Memorial Day weekend is one of my favorite weekends of the year as it is the unofficial start to summer and race weekend here in Indy.  We had another great Indy 500 weekend this year.  My friend Mike made his second voyage all of the way from Rochester, NY to attend the race.  My parents were nice enough to let us use their van as the transport medium.  This was the first Indy 500 for Sarah.  She enjoyed going and was nice enough to drive us too and from the track.  The weather was nice, though a bit warm.  None of us got arrested or injured too badly.  BoilerPip's dad and sister came with us this year, and it was the first time his sister had been to the race and she enjoyed it.  I think everyone enjoyed hanging out at Broad Ripple and Downtown.  It was a very good race with Dario Franchitti winning for the third time of his career.  All and all it was a successful weekend and it's tough to believe it is over as now we all have to get back to our ordinary daily routines.

I'm looking forward to next year as we will be ordering tickets through the track ourselves this time instead of relying on scalpers or Wyatt's uncle.  Should be a great time.  Hope everyone else enjoyed their holiday weekend!

How Do You Mess Up This Business Model?

I work about a mile from Hooters and over the past several months it had become my routine to stop in on Friday at dinner time, have a beer, wait for the evening commute traffic to calm down, and get wings to go for Sarah and I.  I got to know a couple of the girls who worked there and I wouldn't even have to order cause they already knew what I wanted.  It was kind of like Cheers.  The area where the restaurant was located is a bit run down (though I think it is improving) and a lot of other restaurants around have closed.  A month or so ago I asked one of the girls if they had heard anything about the restaurant closing and she told me their lease was up at the end of May and they were going to go to a month-to-month lease afterward.

Last weekend I wasn't able to go because I had to work Friday night.  Suffice it to say that I was a bit shocked this Friday when I left work and pulled into the parking lot to discover that the restaurant shut down.  It was completely vacant, lights shut off, looked like no one had been there for years.  Apparently last Sunday was the last day of business (Sarah and I were in St. Louis that day watching the Cardinals play.).  I left the parking lot, got on the expressway, and drove to Buffalo Wild Wings in Carmel.  Sarah placed an order over the phone and despite getting there when they said the food would be done I still had to wait 20 minutes.  Nearly an hour and a half after leaving work I finally got home.

I actually like Hooters wings better than Buffalo Wild Wings, but with that being said Buffalo Wild Wings is pretty good and there is a location 5 minutes from where we live so we won't starve for wings.  But it won't be the same picking up wings there.

The Legend of Zelda: Twilight Princess

IGN Score: 9.5
System: Wii/Game Cube
Release Year: 2006


After finishing Skyward Sword a few months ago I said I was going to go back and re-play Twilight Princess to see if it really was as good as I remembered.  I just finished the game this past weekend and my thoughts are below.

In my opinion, Twilight Princess is the best Zelda game to date.  What really sets the game apart from the others is its story, a tale that is intriguing and fun and at times quite dark, which is very rare for the usually tame Nintendo games.  Thanks to Wikipedia for the following plot summary.

It begins with Link as a young adult working as a ranch hand in Ordon Village. One day, the village is attacked by monsters, who carry off the village’s children. Link pursues the attackers, but encounters a wall of twilight. A shadow beast pulls him beyond the wall into the realm of twilight, where he is transformed into a wolf and imprisoned. Link is later freed by a twilight creature named Midna, who guides him to Princess Zelda. Zelda explains that Zant, the King of the Twilight, has stolen the light from the three Light Spirits and conquered Hyrule. In order to save Hyrule, Link must restore the Light Spirits.  

During this time, Link also helps Midna find the Fused Shadows, fragments of a relic containing powerful dark magic. In return, she helps Link find the village's children. After Link restores the Light Spirits and Midna has all the Fused Shadows, Zant attacks them; he takes the Fused Shadows, turns Link back into a wolf using his magic, and critically injures Midna. Link then brings a dying Midna to Zelda. Zelda tells Link that he needs the master sword to be restored to human form, then heals Midna before vanishing mysteriously. 

After Link is returned to human form, Midna leads him to the Mirror of Twilight, the only known gateway between the Twilight Realm and Hyrule. However, they discover that Zant has broken it. The sages there explain that Zant tried to destroy it, but he was only able to shatter it into fragments; only the true ruler of the Twilight can completely destroy the Mirror of Twilight. They also tell them that a century ago, they used it to send Ganondorf, the leader of a band of thieves, to the Twilight Realm.

Link and Midna set out to retrieve the missing shards of the Mirror. They use the repaired mirror to open a portal to the Twilight Realm. Before they enter, Midna and the sages tell Link that Midna is the true ruler of the Twilight; Zant changed her into an imp after he usurped her power. In the Twilight Realm, Zant informs Link and Midna that his god, Ganondorf, granted him great power to do whatever pleases him, on the condition that he use it to conquer Hyrule. After Link defeats Zant, Midna recovers the Fused Shadows and then destroys Zant after he reveals that only Ganondorf's death can undo Midna's curse. 

Returning to Hyrule, Link and Midna find Ganondorf in Hyrule Castle, with Zelda suspended above his head. After Link defeats Ganondorf, the Light Spirits are then seen reviving Midna, who is restored to her true form.  

After saying her goodbyes to Link and Zelda, Midna returns home while using a tear to destroy the Mirror of Twilight, thus severing the only known link between Hyrule and the Twilight Realm.

This entire story, with the exception of a couple of temples near the end, takes place in medieval times in the familiar land of Hyrule, complete with all the familiar provinces and locales, including Death Mountain and Lake Hylia, the Gerudo desert and the Zora Domain and Kakiriko village.  You ride around by horse or foot, not random birds.  The people of Hyrule are some of the most memorable as well, with the mailman being one of my favorites (pictured below).  Like I said before, the whole game feels like Ocarina on steroids, which is a very good thing.  This is the best Hyrule has ever looked and it is a wonderful backdrop to the very intriguing story mentioned above.

The battle game play isn't as good in Twilight compared to Skyward Sword, but keep in mind Twilight was a Wii launch title, and additionally it was first made for the Game Cube.  So I don't think it is fair to compare the two because 1:1 motion controls using Wii MotionPlus didn't exist in 2006.  The overall game play, however, is just as good if not better.  In Twilight, you aren't bothered with numerous search and retrieve missions that seem pointless.  There are a few of these but they aren't nearly as annoying and they clearly relate to the story being told.  Also, the game doesn't get interrupted constantly to remind me of the obvious.  You get to fight on horseback and you use the Wii controller to aim things like the bow and hookshot so there is some element of motion controls.  Plus you don't have to calibrate the controller every 5 minutes in this game.

Again, the music is the best the series has seen and it is one of the best game soundtracks I've ever heard.  It is so good, I actually have the album and will occasionally just listen to the music.  The music is quite enjoyable and provides a great compliment to the intriguing scenery.

The temples in Twilight are quite good, with the Snowpeak Ruins and Hyrule Castle temples sticking out in my mind as the best in the game.  Overall the temples in Skyward Sword are better and that is the one category that I think Skyward Sword wins between the two games.  However, the temples in Twilight Princess are by no means bad.

All of this adds up to what I think is the best Zelda game to date, Twilight Princess.  It is similar to Ocarina, with enough differences to have its own identity and enough improvements to make it better.  And it feels and looks like a Zelda game, which I think Skyward Sword frequently does not.  It is a game I'd be willing to play for a 3rd time, which is very rare for me, but that's how enjoyable I have found this game to be.  I kind of miss playing it already.

You Are What You Eat, Part I

Older people frequently mention how younger people act like they are invincible.  When I was younger I didn't consciously think like this but looking back on some of my actions I think I definitely had that attitude at times.  I did things when I was younger without thought that I do cautiously today.  For instance, when we used to go on family vacations I didn't think twice about the consequences of flying.  Today, I'd be lying if I said I wasn't a little nervous when taking off or landing.

Eating follows a similar trend.  In the past I've eaten whatever I wanted.  I'm starting to get a little more cautious there too.  I am in the worse shape in my life.  I admittedly hate working out.  And while I don't eat completely unhealthy, I have my moments, usually with late night double stuff Oreos.  Two things concern me.  First off, I'm gaining weight in the abdominal area without really gaining total weight.  I think this means I'm likely losing muscle mass.  Secondly, I am having weird health things happen to me that I've never had happen in my life.  Mostly dermatological conditions in my extremities, like warts and bouts of folliculitis.

In an attempt to get somewhat healthy, I started tracking what I've been eating using My Fitness Pal.  I've been doing it for about two weeks and once I've established more data I'm gonna publish my results in the second part of this post.  The results are a bit surprising and educational for sure.  Anyone interested in losing weight or trying to eat healthier can join the site for free.

Number One or Number Two?

I am doing Opthalmology right now.  Suffice it to say that I am very bad at eye diseases.  At times it can be a bit embarrassing but then I think about how complex the eye really is and how specialized you'd have to be to be any good at eye exams and that thought eases my mind.  A lack of education, testing emphasis, and training is what limits me.  I really have learned a lot of information in the past 6 years but I think it's the nature of the business to concentrate on what you don't know and not give enough credit for what you do know.

Game of Thrones

A few weeks ago when I was discussing Skyward Sword I made a comment about how it was odd that I liked Zelda games because I am not really into medieval fantasy, which is exactly what the Zelda series is about. I've recently discovered that I actually do enjoy these stories I just never realized it.

One night a few weeks ago I was bored so I turned on HBO On Demand. I had heard of Game of Thrones but really didn't know much about it. I decided to turn on the first episode to check it out and I am completely hooked now.

The show is based on the book series A Song of Ice and Fire by George R.R. Martin. The show takes place in the medieval times on a fictional continent and follows mostly two families as they battle for power of the throne and to protect their families. There is some wizardry and magic involved but it mostly takes a back seat to more traditional fighting styles of the times. The show is well written and acted, and at times features uncomfortable violence and a fair amount of nudity. In typical HBO fashion, the show is just awesome (It's average rating on IMDB: 9.4). It's a show that couldn't exist on any other channel other than HBO. If you haven't checked it out already and you're into this sort of thing I'd highly recommend it.

After I started watching this show I had to admit to myself that I find this genre intriguing. I even watched the first Lord of the Rings movie this weekend and enjoyed it more than I remembered when it first came out. And as I replay through Twilight Princess, I realize that I really do enjoy this genre. The medieval times, the knights and jousting and fighting, and even throw in some wizards if you want. It's pretty cool stuff. I'm halfway through Twilight Princess, and once I'm finished there it is off to The Elder Scrolls V: Skyrim. I'm on a big kick!


Game of Thrones Season 1 Trailer:

Who Do You Think You Are? I am!

Congratulations to the Loogootee boys basketball team for winning the 1A State Championship on Saturday. This was our first state championship of any kind and it really was a long time coming as we've had several great teams in the past but have never been able to win the whole tournament. It really was nice to see our team and our fans celebrating in Banker's Life Fieldhouse on Saturday. Congratulations, guys.

Hoosier Hysteria

When I was in high school I was a big high school basketball fan. BoilerPip and I went to all of Loogootee's games and we would even occasionally travel to see some of the state's best players. After graduating from high school I watched and followed high school basketball less and less to the point where I don't follow it at all anymore. It's not that I don't enjoy it, it's that moving out of state, being busy with work and school, and not knowing the players really kind of puts you at a distance as to what is going on.

Loogootee played in the semi-state this past weekend and I was kind of on the fence as to whether I wanted to go. I haven't been to a game all season and I don't know any of the players. But the game was in south Indy and I heard we were really good so I decided to go. I went into the game really having little to no emotional attachment to the team. I must say, however, that by half time that completely changed. Despite not knowing any of the players or really knowing anything about the team, I really wanted them to win. It was like I was back in 2001 when I was a die hard fan and went to every game. It goes to show you that it isn't so much about the specific players involved but the team and community.

Loogootee pulled off the victory against a pretty good Edinburgh team and will move on to the state finals next Saturday at Bankers Life Fieldhouse. I must say, I thought the team looked really good and without knowing anything about Rockville I think they have a good chance to win next weekend.

March is one of the best sporting times of the year with the NCAA tournament. Yesterday I was reminded of the excitement of the IHSAA tournament and how thrilling it can be for a team and a community. Even though the tournament under the class system isn't as challenging as the old single class tournament, it still can be quite exciting and fun. Onward to the state capital once again for Loogootee. Hopefully this time we can pull off the victory. After seeing the game yesterday I think we have a great chance.

The Guy in Gynecology

As a primary care doc I see anything and everything that walks through the door. I'm lucky enough to get a first chance at most patients before they are sent off to a specialist. You'd actually be surprised at some of the patients who come in to see me. Anyway, this past month I spent up in Lafayette doing gynecology/Women's health. I've always enjoyed women's health professionally (it involves a lot of endocrinology and physiology, and delivering babies is probably the most rewarding thing I've done in my career). With this being said, the topic is a bit frustrating to me. Between my resident clinic and moonlighting clinic, I see between 20-30 patients per week. If you figure that women make up half that population, and a certain subset of that population will have health care needs specific to women, you would figure that I would deal with the topic a fair amount. Let's be honest, women's health is about as primary care as it gets. And yet, in the 18+ months of residency that I've completed, I can probably count on two hands the number of patients that I've seen with these complaints. Even up in Lafayette I met some resistance, despite having a medical degree and license (i.e. I couldn't be more qualified).

I'm kind of glad the rotation is over. On the one hand, it was an easy rotation, but I get tired of watching other people work. As I said, this topic is pretty primary care and I feel pretty comfortable being able to handle 95% of it. I find that the longer I do rotations, the more I know and my questions are now different than what they used to be. I guess that these are all signs that the educational process is working. I want to just work with my own patients now and not watch other people work.

On a different note, Sarah and I made a quick trip to St. Louis this weekend to see Radiohead in concert. Radiohead is my favorite band and in my opinion, are the best rock band of my generation. This is the second time I've seen them, the first being in Cleveland in 2008. They played a great show, with a surprising and variable set list, and the light show behind stage was awesome! Sarah and I really had a good time. Below is a video for the song "Separator" from the "King of Limbs: From the Basement." Enjoy!

The Legend of Zelda: Skyward Sword

The Legend of Zelda: Skyward Sword
IGN Rating: 10
System: Wii
Release Year: 2011


When reviewing a video game it is common to break it down into various categories and rate the game both in individual categories and as a whole. When I review the individual categories for Skyward Sword, I would consider it to be the best Zelda game created. The Legend of Zelda series is an iconic game series featuring protagonist Link trying to save the land of Hyrule and princess Zelda from the evil Gannon. The stories typically feature Link trying to return the omnipotent Triforce back to Zelda's royal family in order to bring peace back to Hyrule. The Zelda series is right up there with Mario in terms of video game importance in my book, so picking the best game out of the series is like picking the best player on the Dream Team or voting for Playmate of the Year - there's some stiff competition and a lot of great entities to choose from.

There is no question Skyward Sword has the best game play of the franchise. I've always thought of motion controls as somewhat of a fad - good for non-serious games like Wii Sports but not so good for "real" games. I have since changed my mind. The 1:1 sword movements with the Wii Motion Plus on this game are amazing. You actually have to swing your controller in certain directions in order to attack enemies, depending on how they are blocking. It adds tremendous depth to the game play and eliminates "button mashing." Sometimes I wish I could just press a button to do simple things but when fighting enemies the game play is just awesome. I never want to go back to the old way of doing things. My only complaint here are that you frequently have to recalibrate the controller, which is only a button press, but does get annoying.

The series is known for it's ornate temples that Link must conquer in order to progress through the game. The temples require intelligent problem solving skills and feature unique and interesting themes. Skyward Sword probably has the best temples of the series, especially in the second half of the game. They are unique and just awesome to play through. The Sandship and the Ancient Cistern were a couple of my favorites.

The graphics are the best the series has seen as well. At first I wasn't a big fan of the Japanese anime-style graphics, but they quickly grew on me and I think they suit the series well. The game is fantasy based so I think graphics that are too realistic would be goofy, and yet a normal cartoon appearance would be too childish. I just wish Nintendo would catch up to where the rest of the video game industry was over 5 years ago and go hi-def. I'd love to see this series in 1080p.

As with everything else in the series, the games feature a fantastic soundtrack. Overall I don't think the music in Skyward Sword is as good as previous games, but it still has some great songs and kudos to Nintendo for finally utilizing an orchestra to perform in the game.

In general I'm not a big fan of action-adventure, fantasy, role-playing games or titles such as The Lord of the Rings, so it is somewhat unusual for me to like the Zelda series in the first place. It has a huge nostalgia factor with my childhood, starting with the great SNES title A Link to the Past from 1992, and I've been hooked on the series since. Many, including myself, regarded 1998's Ocarina of Time to be the best video game ever created. In my opinion, Ocarina held the designation of the best Zelda game until 2006 when Twilight Princess was released. Maybe it was because it was originally released for the Game Cube, or maybe it was because I wasn't really playing games at the time of its release (I was busy with med school at the time.), but I always felt like Twilight Princess flew under the radar. It definitely did not get the attention Ocarina received, and yet I felt like it was better than Ocarina.

To me, Twilight Princess was like Ocarina on steroids. It contained Hyrule and all of the familiar places from Ocarina and A Link to the Past, but everything was bigger and more grand. It also had several new places to explore. The story was intriguing, unique, and dark. The music was the best the series has seen, even still, in my opinion. And even in their infancy, the Wii motion controls worked really well for the game.

The problem that I have with Skyward Sword is that a lot of this nostalgia is gone. There is no Hyrule. Instead you live on some random island in the sky, and instead of traveling by horse, you fly around on birds. It's really random and honestly I don't care for it at all. There are no fields or lands to explore really, instead you just fly directly to the locations you need to be. Skyrim this game is not.

Speaking of the locations, they feel "man made" to me in this game. They feel like obstacle courses created specifically for adventure. After playing games like Skyrim and the desert stages in Uncharted 3, some of these locations are somewhat disappointing. I think some of this is due to the limitations of the Wii, but it is tough traveling back to 2002 when I'm playing games in 2012. And you return to the same locations over and over again in this game, so you spend a ton of time in each location. I would love to see this series in high-def and have a bit more of an open-world, more realistic feel.

One of the reasons why you return to the same locations over and over again is because the game has a number of find and retrieve portions which to me serve no purpose other than to be annoying and take up time in-between the temples, which as mentioned above is where all of the fun is located. And while we're on the topic of annoying, I have no idea why Nintendo thought it would be a good idea to remind me of the obvious every time the obvious occurred. I do not need to be interrupted and told every time my hearts are low. I know they are low because (1) there is a heart meter on the screen, (2) the game already beeps at me when I'm low on hearts, and (3) I am likely getting my ass kicked in a battle at the time. Making me interrupt the game so that I can be notified of all of this is really just pointless.

I know this post was super long and likely doesn't excite the interests of most of the readers. However, it took me 45 hours to beat this game and it is one of my favorite game series of all time, and there are only a couple of games per decade released in this series, so I thought it deserved a large post. Don't get me wrong with some of my complaints. Skyward Sword is the best game made for the Wii and probably the best game of the Zelda franchise. For me, however, it is a game where the total does not equal the sum of the individual parts. For as great as the game is, I miss Hyrule and the familiar locations and themes that I am used to. I realize that Nintendo can't keep making the same game and so changes have to be made, and to be fair, most of my complaints are minor compared to all of the pros offered in the game. However, if I had to pick which game I thought was best, I would still pick Twilight Princess. To make sure I am remembering correctly, I have started replaying Twilight Princess. I beat the game in 2009, which is the last time I've played it. I'm an hour in currently and I miss the Wii Motion Plus already. Final verdict on this debate to come in a few months when I finish Twilight Princess for the second time.

Bleomycin Says "Suck It."

After dealing with this wart on my thumb for years, trying almost every therapeutic option available, I finally was able to get rid of it with 4 injections of the anti-cancer agent Bleomycin in one sitting. The injections were quite uncomfortable and the tip of my thumb turned purple and necrotic and looked like it was dying for about two weeks but the wart slowly flaked off and I was left with normal healthy skin.

I know this may not seem like a big deal to most people, but it was to the point where the lesion was affecting my job. I was very self conscious when touching people to do an exam, especially little kids with their parents watching every move I make. And after fighting with it for several years and failing I was beginning to think I was either going to have to live with it or amputate my thumb. So I am very happy now that I can approach people with my hands and not have to worry about what they are thinking about my thumb.

A picture of my thumb, post Moxa treatment. You can't see the actual lesion itself because the burn is covering it. You can see the distribution, however. It was quite large.




My thumb as it appears now, 6 weeks out from Bleomycin treatment.