Flappin' in the Wind

Anyone who owns a dog has seen the magic of the tongue. It's always wet, allows them to pick "food" off the floor, lap up water, and depending on the breed, is often the exit pathway for many a droplet of gooey saliva. When exercising, it elongates, falls out one side of the mouth, and flaps in the wind with each dog gallop.

According to Miller's Anatomy of the Dog (which I'm assuming is like Netter's...) there are no less than 8 pairs of muscles and 5 (count 'em - FIVE) cranial nerves that control the tongue. Definitely more wiring than ours. When dogs run, the tongue acts as a source of heat loss - tongue blood vessels dilate which causes the tongue to swell and extend. The endless moisture is from oodles of glands. There are four pairs of salivary glands that drain into the mouth and numerous tiny salivary glands on the surface of the tongue. Cool beans! :D

Taxes...

It's almost that time of year again, and since this is a light month, I thought it would be wise to get those darn tax forms out of the way. This was the thinking a few hours ago, when I started the process. The thinking now, after much hair tearing, teeth gnashing, and strings of uncontrollable expletives, is WHO THE HECK WRITES THESE TAX CODES??

how much of this can one take:

24. enter your standard deduction (see margin for choices)
25. Subtract line 24 from line 22. If line 24 is more than line 22 enter -0-
26. If line 22 is over $109,475 or you provided housing to a person displaced by hurricane katrina, see page 33. otherwise, multiply $3200 by the total number of exemptions claimed on line 6d

I was doing fine until about halfway through when it became clear that to answer one question one needed to turn to three different places and that this question was just one in a series seemingly unending pain.

There has to be an easier way. How come there's no federal offered e-filing? Actually, there is a e-file link (as well as a free file for those who qualify) on the IRS webpage, which would have made all this much less painful. HOWEVER, those who use this service should take care to read the privacy policy of the 3rd party private company that you'll be going through to complete the e-file... I believe it was HR Block's site that stated that it's policy was to share your information with other parties - a vile act apparently termed "crossmarketing." It's against the law for tax preparers to sell your tax info - unless you unknowingly agree to it by clicking the "I've read your extremely wordly and legal document and agree."

If you find this hard to believe, read the policies for yourself, or check this out: http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2006/03/09/BUGEAHKOC034.DTL

The Luxury of Normal Lungs

We often take our bodies for granted, and it's not until a part malfunctions that we take notice of what the different parts do for us, day in and day out.

Today is officially "lung day." Few people think about the miracle of how our lungs work, and how they work for so many years without fail. We don't have to think to breath and we don't really have to think about our lungs until something goes wrong. Contrast this with the elderly patient with emphysema or chronic bronchitis who struggles to get enough air with every breath. Some of these people lug around oxygen tanks for the rest of their lives and get short of breath with minimal exertion. Their lungs are often colonized by bacteria that rarely affect someone with normal lungs.

A common reaction is "well, they smoked too much, and that's what happens when you smoke." Partly true, which is why it's painful to see that all too cool teenager with the oversized sweatshirt and the cigarette butt hanging out his mouth. Or the middle aged patient who knows smoking is bad for him, but doesn't quit because "there are people who smoked their whole lives and didn't die of cancer." But lung disease has other causes - including occupational (asbestos, silicosis, etc) and recreational (pigeon farmer's lung, etc).

What's frightening is that there are other causes of lung disease, most of which are still not identified, but may be commonplace enough to be affecting whole groups of people. Take, for example, a discussion about chronic obstructive pulmonary disease (COPD) with a colleague from China. I was informed that one of their main causes of COPD is "kitchen smoke." Now, I'm sure the abundance of cigarette smoke and the air pollution are probably potent additive factors in the development of any lung disease in that country, but "kitchen smoke" is an actual documented cause! Apparently, in developing countries, relevant sources of indoor pollution include biomass and coal burning for cooking and heating. In fact, rural women exposed to biomass fumes may be more likely to suffer from chronic lung conditions than urban women even though the prevalence of smoking is higher among the latter group! (Biomass fuels = wood and forest residues, animal manure and waste, grains, etc) And this topic isn't just a problem amongst "those third world countries."

Here's something closer to home - Microwave-popcorn factories produce a substance one would never suspect as an occupational hazard: the butter flavoring in microwave popcorn. In November 2000, the National Institute for Occupational Safety and Health launched a study of the health of workers at the Gilster-Mary Lee popcorn plant in Jasper, Mo. The study, based on 117 workers, found:

- Younger employees who had never smoked had about five times the rates of chronic cough and shortness of breath compared with a national sample.
- Current plant employees had 3.3 times the rate of airway obstruction when compared with the national sample.
- About 72% of microwave-popcorn production workers reported work-related irritation to their eyes, nose or throat.
- Workers in microwave-popcorn production reported chronic coughs, attacks of wheezing, chest tightness and shortness of breath more frequently than workers in other areas.
- Reports of doctor-diagnosed asthma and chronic bronchitis were twice as frequent as expected from national data.

Of course, there was the obligatory reassurance that the doses of butter smell that consumers inhale is highly unlikely to cause lung problems. But butter smell?! What's next?

The Songs of Humpback Whales

Nature is endlessly fascinating...

1) Whales are musicians: Humpbacks have a range that covers eight octaves, from a bass so low that humans can't hear it to a magnificent soprano. Their highly structured songs include multiple themes that are constantly repeated and even rhyme. The whales embellish like jazz musicians, seeing who can improvise in some attractive way better than the other whale. Aside from attracting mates, singing is also believed to establish a hierarchy among male humpbacks. (Acoustic monitoring on a humpback whale (Megaptera novaeangliae) feeding ground shows continual singing into late spring, Proceedings of the Royal Society B: Biological Sciences Volume 271, Number 1543 / May 22, 2004)

2) Whales have been found to sing in dialects. Blue whales off the Pacific Northwest sound different than blue whales in the western Pacific Ocean, and these sound different than those living off Antarctica. And they all sound different than the blue whales living near Chile. (Jan 2006 issue of BioScience)

3) Whalesong has grammar! During mating season, which lasts six months, all humpback males sing the same song to woo the ladies. Over time, the group's song becomes progressively more complex, although researchers don't know quite why. Presumably, as one whale finds mating success by tinkering with the song style, the rest of the guys imitate it to better their chances, said study co-author Ryuji Suzuki, a Howard Hughes Medical Institute predoctoral fellow.

Mathematical analysis of the whale song shows there are complex grammatical rules. Using syntax, the whales combine sounds into phrases, which they further weave into hours-long melodies packed with information. (Suzuki et al, Journal of the Acoustical Society of America, March 2006.)

Digital Cameras

I've been looking to buy a digital camera recently and have been trying to figure out which one would be the best fit. After some "research," all I can say is PHEW! Maybe I'm just behind the times - am still using a regular film camera, and a dummy one at that - but all this technology and jazzy language is WAY beyond me...

For example, what in the world does this mean:

"Although there is a little corner softness at F2.8, notably there is little evidence of purple fringing. There is a little CA at the very edges of 28mm...

All words that one understands individually (well, most of them anyway) but strung together make absolutely no sense. Um, I'll take the one that points, shoots, and gives a good picture.

Obviously we can see SOMEBODY won't be a very technologically savvy 80 year old...

What makes us happy?

Dr. Daniel Kahneman, Princeton professor of psychology and public affairs and the only psychologist ever to win the Nobel Prize in economics, thinks he might have a clue. His study involved 909 working women living in Texas and used the "Day Reconstruction Method" questionnaire. Subjects kept a diary of everything they did during the day and the next day, consulting the diary, they relived each activity and, using 12 scales, rated how they felt at the time.

The Good:
sex, socializing with friends and relaxing

The Bad:
commuting, housework, and facing a boss
poor night's sleep and tight work deadlines

The Surprising:
TV-watching high on the list, ahead of shopping and talking on the phone
Taking care of children low on the list, below cooking and not far above housework

How little difference money made: As long as people were not battling poverty, they tended to rate their own happiness in the range of 6 or 7 or higher, on a 10-point scale. After controlling for other factors, Dr. Kahneman and his colleagues found that even differences in household income of more than $60,000 had little effect on daily moods. Job security, too, had little influence.

Divorcees slightly more cheerful than married women

Compare to this study results of a TIME poll on happiness: "What one thing in life has brought you the greatest happiness?" 35% said it was their children or grandchildren or both, religion a runner-up at 17%, and spouse was far behind at just 9%

The discrepancy with the Texas study illustrate one of the key debates in happiness research: Which kind of information is more meaningful—global reports of well-being ("My life is happy, and my children are my greatest joy") or more specific data on day-to-day experiences ("What a night! The kids were such a pain!")? The two are very different, and studies show they do not correlate well.

Kahneman likes to distinguish between the experiencing self and the remembering self. His studies show that what you remember of an experience is particularly influenced by the emotional high and low points and by how it ends.

The power of endings has been demonstrated in some remarkable experiments by Kahneman. One such study involved people undergoing a colonoscopy, an uncomfortable procedure in which a flexible scope is moved through the colon. While a control group had the standard procedure, half the subjects endured an extra 60 seconds during which the scope was held stationary; movement of the scope is typically the source of the discomfort. It turned out that members of the group that had the somewhat longer procedure with a benign ending found it less unpleasant than the control group, and they were more willing to have a repeat colonoscopy.

Asking people how happy they are, Kahneman contends, "is very much like asking them about the colonoscopy after it's over. There's a lot that escapes them." Kahneman therefore believes that social scientists studying happiness should pay careful attention to people's actual experiences rather than just survey their reflections. That, he feels, is especially relevant if research is to inform quality-of-life policies like how much money our society should devote to parks and recreation or how much should be invested in improving workers' commutes.

Near Death Experiences (NDE)

I was browsing through the DVD section at the local library, looking for a light movie, perhaps a comedy, for the upcoming weekend. I did find a comedy, but in perusing the racks also found something that caught my eye. "The Near Death Experience" by Raymond Moody, M.D., Ph.D. I had read about NDE's years ago, and thought it was a fascinating phenomenon that was difficult to explain and replicate, and then promptly forgot about them. So I had to borrow this DVD and watch.

The DVD was extremely interesting. The first section involves five people describe their NDE. I'm not sure what to think about NDE's. Part of me feels like they probably are very real experiences to the people that experience them, and we, as humans, probably all have the capacity to experience NDE's. But there's also part of me that wonders, of the people who experienced NDE's, how many of them were on the more sensitive, more "magical thinking" side (as the DSM IV - the text psychiatrists use to diagnose psychiatric disorders - puts it) and how much of what one's NDE experience depends on cultural experiences. For example, a fair number seem to see a white light at the end of a tunnel, and feel the "presence" of God, but that's a pretty archetypal scene of heaven that is tied into popular American culture. What of a Buddhist or Muslim or someone who grew up as a bushman in Africa - do they also see the same thing, or does their version correspond to what their culture believes about the end of life? Also, it would have been nice to have a person recounting a bad NDE experience. Apparently, a smaller number of people have NDE's where they see images of biblical hell similar to Dante's inferno. The question this raises is how much does the content of a NDE correlate to who that person was in their life? Is a murderer more likely to have a bad NDE?

The second part of the DVD was more interesting. Apparently Dr. Moody is a philosopher who went to medical school, became a psychiatrist, and has spent his career studying NDE, death, and dying. The DVD talks about some of his research on NDE's which is truly fascinating. Dr. Moody draws from his philosophical background and he talks about an underground place in ancient Greece where people used to be able to go to "talk" with deceased loved ones. The ruins have actually been found, and Moody was able to piece together that the setting for the "talk" involved a pool of water the person would stare into from which the deceased would rise and interact with the living. He also brought up examples of this looking into water or a mirror in popular culture (Alice in Wonderland, Snow White, and most recently Lord of the Rings.) In addition, there were "medical reports showing that at least half of all persons whose spouse dies report a spontaneous contact from that person after death." Based on this, he built a "psychomanteum" and used it as his research laboratory. The psychomanteum was basically a big mirror in a dark room with a chair the subject could sit in. Prior to entry into the room, Moody would prepare the subject by asking them in depth questions about who the deceased was, what they were like, etc. Basically have them really revisit all their memories of the deceased. Then the subject would go into the room and sit there for a half hour or so. Apparently a good number of them came out with experiences that they had seen the deceased in the mirror or interacted with them. There were also olfactory and physical experiences as well.

Again, am not sure what to make of this. I think there was a lot of priming going on and this just goes to show that the human mind is a fascinating thing. I'm hestitant to say that these were "hallucinations" as some critics have claimed, because the fact that we have no way of explaining the experiences that happened to these people does not mean that they were not "real" or that these people were "crazy." I don't doubt that to the people who had experiences in the psychomanteum, their experiences were "real." At the same time, I don't know how to explain how they had those experiences.

We, as a society, tend to try to label things and file them in a system that we understand. Understandable why we do so, but the fact that we do means we are limiting what's possible in our world. For example, a patient with chronic pain with normal medical tests used to be disbelieved by many physicians, but now may be given the label of "fibromyalgia." The patient reports an inordinate amount of pain and in her own reality, likely experiences that much pain. The fact that we cannot understand how or why she has that much pain does not detract from the validity of her experience in "her world." Similarly, a schizophrenic who hears voices in his head telling him he is evil truly lives in that reality. The fact that most people do not share that reality leads to a labelling of that person as "crazy," but that does not alter the fact that schizophrenia is a possible experience for all human beings and a true reality for that person. Anyway, all this is just a lot of rambling to say that just because the medical establishment cannot explain something does not mean that we should regard those that believe in it as "heretics." To do so would mean we're stuck in the box we've created - holding on to our version of reality as the only possible version of reality.

Illiterate...

I remember a time when I used to write well... that was before medical school I'm afraid. As a child I used to read everything in sight and loved it. That led to great ease and comfort with writing prose. Unfortunately, after medical school, especially after studying for the licensing exams and all the medical reading that entailed, the level of non-medical reading dropped off dramatically... as in zero. The thought of picking up a book to read for fun started the throbbing in the eyes that had just resolved hours after closing the darn medical review book. Alas, with the paucity of reading, my grasp of the English language has gone down the drain. I can throw around a bunch of medical jargon that sound like gibberish to most people, and can abbreviate medical terms like no other, but often find myself having word finding difficulties on words I used to know. Or when I read my writing and realizing that it sounds objective and dry, just like those scientific papers we're trained to read and write... pity.

However, am happy to share that now that the medical reading level has stabilized at a mangeable level, I've renewed my old passion of non-medical reading. Hopefully that will awake those brain cells that have been dormant for the last XXX years. And hopefully when medical reading picks up again in a few months, I'll still be able to do some real reading... we'll see. :)

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Just read was "The 5 People You Meet in Heaven" by Mitch Albom. That man writes well - the imagination behind the book was wonderful and the prose runs well. Ending is OK but definitely a good, quick read that's thought provoking.

He cried.

they left a great party
having had a real good time
she didn't think he should drive
but he insisted it was fine

he drove that beast of a car
fast, faster, and faster still -
enjoying the unfettered freedom
found on a desolate road

she said
slow down
we're going too fast
swerving back from lane to lane

he said
shut up
and let me drive
pushing the pedal down with might

faster, faster, and faster still
the bodies swung from side to side
the metal rattling from the engine's roar
her feet digging into the carpet floor

what happened next
he did not see
couldn't remember
but was on his side

they turned too fast
she saw it come
and grit her teeth
but couldn't scream

when he came to
bright yellow lights
people talking
people walking

he couldn't get up
couldn't figure out
where he was
where she was

the doctors watched
as the stretchers rolled in

the girl
no pulse and cold to touch
pale of face
with red crushed ribs

the boy
wide eyed with matted hair
trembling chin
strapped down in place

words drifted by his stricken face
... trauma activation
... SUV ...rollover
... didn't make it

he watched the ceiling move and change
these people floating all above
damned the mask lying on his face
these pins pricking and stabbing his legs

outside the nurses clicked and clucked
did you know, both 19
driving alone
and way too fast

a pair of highway patrol uniforms
shook their heads, guarding his room
idiot drove under the influence
we'll lock him up, manslaughter

it all came back
he screamed her name
crying, calling,
to see her face

she's dead
he's told
hold still or else
you'll hurt yourself

he pushes
he pulls
a sting in his arm and all of it fades
into a most welcomed darkness.

No one is safe...

Some people have unfortunate things happen to them. Unfortunately, most of us believe these things will only happen to others, and many of us spend the majority of our lives sheltered by these beliefs.

One of the good things about being in the medical field is that we come face to face with the fact that bad things happen, and bad things happen to everyone. Death, disease, you name it. Not all dead people are old people. Disease does not discriminate. And even though we're confronted with this reality more than your average person, we still try to believe that we won't be so unlucky... but you really never know.

When you see a patient in the late twenties present with a stroke, or watch a colleague in the late thirties have a heart attack in front of you, you understand that shit happens and you are definitely, definitely not exempt...

Quote of the day, week, and year...

It is a serious thing to live in a society of possible gods and goddesses, to remember that the dullest and most uninteresting person you may talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship, or else a horror and corruption such as you now meet if at all only in a nightmare. All day long we are in some degree helping each other to one or the other of these destinations. C.S. Lewis

pilfered from a friend's webpage - someone who I am honored to know and always learning from... :)

Outsourcing Life

Compared to the last century, the pace of life is faster, we're busier, and portions of everyday life get delegated to other people.

AM: wake up, get ready for work, buy coffee +/- baked good for breakfast

Work, work, work

Lunch: Buy a quick lunch and scarf it down before you rush back to work

Work, work, work

PM: Drive home and wonder what it is you're going to be eating tonight. By the time you're home you're exhausted and starving and need food NOW! All the big plans in the AM of cooking a nice meal are out the window. Assuming you had time to think and plan out dinner, as you're making the dinner, you're snacking away, and by the time dinner's ready, you're full. So now you have leftovers - yum.

But it's not just food. We "outsource" a bunch of other things - babysitting the kids, washing the car, cleaning the house, mowing the lawn. The busier you are, the more you outsource, until you're left with work, work and more work. It reminds me a interesting phrase - when people are young they trade their health for more money, and when they're old, they use the money to try to buy back their health. Except here the trade is "life" for money, and money to try to buy happiness because of the emptiness left from missing out on life.

Don't get me wrong. I'm not saying mowing the lawn is one of the irreplaceable pleasures of life. But life happens in the mundance experiences from moment to moment and in those forgettable and unforgettable times you share with people you care about. The meaning you give to life goes beyond what it is you're actually doing. And if you're not even able to be present to take part in those experiences, mundane or not, are you truly living life?

Hawai'i

Saw 50 first dates again. Geez, I miss Hawai'i. The people, the weather, the lushness, but especially the spirit and joie de vivre...

Ke aloha nô!