2012-11-26T08:52:33.697-05:00So we’re back from a great trip, and I’m struggling with how I’ll to respond to the “how was it” questions on returning to work. Elaine has already spoken to two of her siblings at length and seems more sure than I. In fact there’s enough surety that she’s composing an email about our trip. I hope she sends it to me!But I want to get a little of this down so I’ll remember what a great time we had and, more importantly, why it was such a great time.So the questions. Where did you go? Why there? What did you do? Was it what you thought it would be? Isn’t that a long way? And from my family – what did you eat?Oosterdam at Circular QuayWe went on a cruise. We sailed on Holland America’s Oosterdam from Sydney up the east coast of Australia to the Barrier Reef, then through the coral sea during a solar eclipse, weekended in New Caledonia, then back to Sydney. No sea sickness, though the catamaran trip to the barrier reef and back certainly came close. We’ve never been on a cruise before, unless you count the overnight ferry ride from Piraeus to Chania we took on our honeymoon, or the subsequent Heraklion to Santorini jaunt that taught me the dangers of mixing ouzo with high seas, which is one reason we’ve avoided cruises this long.The other reason is our resistance to demography. Isn’t a cruise for the newlywed and nearly dead? Sure, we’re old(er), but not that old. We want to explore on our own! We would rather travel alone than go with the crowd. Explore the byways not the highways. But in the course of resisting the typical sales pitch I was psychically roped into a cruise by an even stronger demographic pull – my geekness.Jaccaranda Tree outside Sydney Town HallAs the byline of my blog attests, I’m a husband, father, physician, geek. But those of you who know me well know that this isn’t always the order of priority. So when I became aware of Insight Cruises (insightcruises.com) MacMania cruises via my favorite podcast network (twit.tv) I longed to cruise China in the company of fellow geeks. That didn’t work out. Neither did South America and Cape Horn. Job, money, life got in the way. But I heard tales from those who went, saying things I wish I could say. Regret is a powerful teacher, and I’m a quick learner. Or at least susceptible to targeted marketing.So when MacMania 15’s itinerary was announced to be an Australian/New Caledonian/Solar Eclipse cruise I put down our deposit and for a year resisted every reason (and there have been a *lot* of reasons) to cancel. All the old reasons were there, and added to those were family. Without revealing what’s not mine to reveal, I’ll just say there has been serious illness in my family in the past year and many would put family first. Let’s just say many in my family have put family first, and if not for them I wouldn’t have had the opportunity to go.We visited Sydney in all it’s Fall (springtime) glory. We learned what a Jaccaranda tree is, that Ibises are Australia’s pigeon’s, bushy-tailed possums it’s squirrels, and the Melbourne Cup it’s Kentucky Derby. It’s a gorgeous city of neighborhoods that’s utterly walkable, with a great transit system too. We know because we used it a lot going back and forth to the airport to retrieve the bags we left there. The ferry system around the harbor is world class and cheap, even if little else in the city is. But you don’t have to pay to listen to birds you’ll not hear in the states, nor to see plants you’ve never seen before. It’s odd to walk among an utterly recognizable cityscape with an utterly foreign flora and fauna. Nov 13, 2012 Eclipse Collage as shot by Tom , our cruise mateEclipse stories are legend, and now I know why. Despite knowing exactly what’s coming, it’s startling to actually see it with your own eyes. If you want to see what we saw, view Steve Sheridan’s videos on youtube. The first is the eclipse as seen from our vantage point on deck. Steve was shooting right behind Elaine and I. He is also geek enough[...]
2011-05-29T19:04:36.153-05:00After seven good years my Mini Cooper is gone, replaced by a 2012 Ford Focus.
2011-05-24T22:37:39.534-05:00Start by overeating. Blend in two glasses of wine. Elevate to 6200 feet above sea level. Put on an elliptical machine for 30 minutes or until done, whichever comes first.
2011-04-24T12:39:04.178-05:00So this is what bolted in the garden last week. How to cook it. That was the question.
2011-05-24T22:25:09.367-05:00"My dear Kepler, what would you say of the learned here, who, replete with the pertinacity of the asp, have steadfastly refused to cast a glance through the telescope? What shall we make of this? Shall we laugh, or shall we cry?" --Letter from Galileo Galilei to Johannes KeplerSomalis in Minnesota have experienced a higher than predicted rate of measles and resultant excess of preventable deaths in the past year. A similar measles outbreak occurred in 1996-97 in Minnesota in children who were members of a religious group who eschewed immunizations. It also happened in 1977. Same place, same disease, same issue.California and elsewhere have seen outbreaks of Pertussis (whooping cough) in recent years.And last but not least Polio continues to win skirmishes in a war thought won 60 years ago.I personally participated in immunization drives to combat a measles outbreak in Philadelphia in the late 1980's. I've also had the "privilege" of performing a lumbar puncture on a three month old infant with Hemophilus Influenza Type B. All of which leads me to struggle with how to respond to those who continue to warn of the risks of immunization. Autism! Seizures! ADHD! Asthma! Diabetes! Death! And worst of all Peanut Allergies! OMG!Are you as non-plussed by the sensationalism, hucksterism, and general snake oil feel to the anti-immunization fringe as I am? Puh-lease save me your "What your doctor doesn't want you to know...", "We have real qualifications too...", "Just buy this..." and especially your "God doesn't want you to vaccinate...".Yes, Immunizations are risky. We no longer use oral polio vaccine because of the risk of vaccine associated polio. We use inactivated polio instead.Yes, Immunizations are not perfectly effective. But perfection is the enemy of the good, and immunizations are much more than good enough, measuring higher even than chocolate or Cliff Lee on the goodness scale.Immunizations are not a choice between disease and no disease; they are a choice between less vaccine preventable disease and complications (with all the costs that come with vaccination) and more vaccine preventable disease and complications (and all the costs that come with no vaccines.) If you wish to save money, vaccinate. If you wish to reduce overall morbidity and mortality, vaccinate. These choices are not imaginary; they are written in the history of those who've made them before us, and those who forget the past...Lastly, immunization is a social act. The risks of vaccination are borne by those who vaccinate, while the benefits of immunity are received not only by the vaccinated but also by those who aren't, whether they ask for it or not. The least the un-immunized could do is gracefully and thankfully accept that saner, braver folk are not only willing to tolerate their fear but also work to ensure that it doesn't kill the rest of us. But history also tells me that this expectation is too great. Sigh.Sometimes my patients ask me "Do I have to take this medicine for the rest of my life?" or, in another version "Should I get this immunization?", and my answer to both remains the same. Yes, until we know better, or until something better comes along. Knowing better or identifying something better is often hard, except in the case of immunizations. That one is easy. For most of us anyway. So long as we wear head protection.[...]
2010-04-29T12:52:48.660-05:00I'm waiting for my flight back to PHL from SeaTac after a week in Seattle-Vancouver-Olympia and feel compelled to share the benefits of a week of good karma.As I learned during a forced layover in Rouen several years ago the travel gods kneecap your best laid plans for a reason. In this instance last minute changes resulted in my 'discovering' the Chucknaut Drive in northwest Washington, the Skagit Valley Tulip Festival, Mallard Ice Cream in Bellingham, the Sunset Inn in Vancouver's Davie Village, Milestones Restaurant in Kitsilano, the Cedarbrook Lodge, and the best meal of the trip - homemade (literally!) pasta with asparagus, fennel, and red onions by none other than Chef Daniel Lipson (husband of noneother than Penn's own Michelle Seelig) who moonlights daytimes as a Physician Assistant at Group Health Puget Sound. If there were ever an argument for slow travel, this trip was it. Get off the interstate peeps!I was in Vancouver for the Society of Teachers of Family Medicine. As is true of all good meetings I learned more than I thought possible and benefitted repeatedly from serendipity.For example I would never have planned 20 minutes in a private informal discussion with Jerome Kassirer, emeritus editor of the New England Journal of Medicine, but that's what happened when he chanced upon me in an out of the way spot we both discovered while waiting for his talk. Was he hoping to nap too? And what a talk! His slides aren't up yet but here's a podcast of his thoughts on industry-medicine relationships. Standing ovation from a full house. At 4:30 in the afternoon! Be still my heart.The mantra of business travelers is free (fast) wifi and breakfast, but Cedarbrook Lodge (right at SeaTac!) provides the fast free wifi, breakfast of charcuterie, hard boiled eggs, outstanding coffee, oatmeal, juices, bagel, croissant, cheese, yogurt, artisinal bread, in the room you see here. The view out the floor to ceiling windows is even better. Great rates through online booking sites. If you have an early flight out of SeaTac you *can't* stay anyplace else. Did I mention the free all you can eat malted chocolate balls in three different flavors (mint, chocolate, and butterscotch)? Inconceivable!I met some great new folk, caught up with old friends (Congratulations Mike R.), and remain impressed that our specialty is attracting some enthusiastic and energetic young talent like our own Mario DeMarco who talked about experiential learning in residency properwise. The man haz powerpoint skillz.And who could ask for more than a dropped ball in the 11th to seal a passable if not winning road trip for the Phillies?Glad to be coming home. The gate agent is calling...[...]
2010-01-31T21:49:41.698-05:00Kurt Vonnegut first got my attention as a freshman in college. I ran across this when he passed away a few years ago and thought I had lost it. Fortunately a friend's request got me looking again and reminded me how Yossarian and Billy Pilgrim are related.
2010-01-30T16:16:51.155-05:00I'm a confirmed MacHead, so everyone who knows this about me has been asking whether (Ha!) or more appropriately when I'll get an iPad.
2010-01-30T08:12:48.752-05:00Sore throats are easy, right?
2010-01-13T09:02:01.223-05:00Official Google Blog: A new approach to China
2009-11-21T10:42:32.674-05:00And in my final post of a trifecta today, and to reassure those of you who worry that I buy too much into the Two Cultures phenomenon, I give you a prime example of the intersection of humanities and science.
In a public lecture shortly after becoming the director of Argonne, Dr. Crewe bemoaned the growing gulf between scientists and laymen.“There are too many people behaving like the proverbial ostrich and hoping that science will go away if they bury their heads in the sand,” he said, “and this in spite of the fact that the last few decades have indicated strongly that science will not go away.”
2009-11-21T09:41:13.235-05:00I can't believe I missed Robbie Aronowitz' NYT mammogram editorial on Thursday!
THE United States Preventive Services Task Force’s recommendation this week that women begin regular breast cancer screening at age 50 rather than 40 is really nothing new. It’s almost identical to the position the group held in the 1990s.Nor is the controversy that has flared since the announcement something new. It’s the same debate that’s gone on in medicine since 1971, when the very first large-scale, randomized trial of screening mammography found that it saved the lives only of women aged 50 or older. Despite the evidence, doctors continued to screen women in their 40s......Even though [the screen at 40] consensus was more asserted than definitively proved by experimental evidence or clinical observation, it soon became dogma......You need to screen 1,900 women in their 40s for 10 years in order to prevent one death from breast cancer, and in the process you will have generated more than 1,000 false-positive screens and all the overtreatment they entail. This doesn’t make sense. We could do more research and hold more consensus conferences. I suspect it would confirm the data we already have. But history suggests it would never be enough to convince many people that we are screening too much.
2009-11-02T12:07:08.798-05:00I work with many wonderful orthopedists who continue to see patients without regard to payor. That isn't true for most private orthopedics groups in town who continue to refuse medical assistance patients. Still, I wasn't expecting this... – orthopedists asking for my pay to be raised.
2009-10-31T18:05:50.409-05:00Thanks for all the b-day wishes. I must say it's been a pretty perfect day. And how often can you say that when you start by waking up in a hotel in Poughkeepsie on a cold rainy October day?
2009-10-19T12:06:02.398-05:00TAL is hit or miss, but they've hit close to home (work actually) with their episode Someone Else's Money. The sad part is that the examples of bureaucracy run amok are among the more routine and least outrageous.
2009-08-25T09:51:43.494-05:00Art is essential.
2009-01-20T09:20:14.521-05:00I'm a city boy. Noise and activity. Light and sparkle. But walking across the desert this morning I was struck by its absolute dark and soundless nature. Until, that is, I looked up. I've seen stars before, but this was heaven.
2008-11-24T12:10:37.809-05:00And nicely, too.