Random Thoughts

Have you ever questioned why things are the way they are?

Have you ever stopped to ask why it is that you do what you do? Are you doing something because you truly want to, or are you doing it to get something else? Or doing it because it will look good? Or because other people will think it looks good?

Have you ever stood back and objectively looked at human beings? We must look pretty funny to non-humans, what with our hair in odd places (eyebrows, armpits, groin). On a basic level, we’re just one big open bag (gastrointestinal tract) inside an even bigger bag (the skin). We have to constantly eat and defecate to keep on going. And yet, we’ve got a skewed sense of beauty. We’re proud of what the human race looks like, and we have models, actors, and other public figures that we strive to look like. We take great pride in our hairstyles, brow arches, and the clothes we wear to cover our bodies. All this preoccupation leads to issues like vanity, worry, body dysmorphic disorder. Wonder if pigs and other animals have the same issues. Methinks they’re smarter than that! :)

Have you ever pondered the ever increasing pace of the working world? Email, blackberrys, computers. People getting laid off and the survivors having to pick up the slack. Things keep on getting faster and there’s always a never-ending to-do list to attack. How does one screen three hundred emails a day on top of a busy workday, when fifty years ago in the same job, there was about half the workload to be done? How does one manage to stay afloat and get through without feeling like each week is a struggle to just get to Friday? How is this pace of overworking acceptable and sustainable?

Why do we not sleep enough at night, wake up exhausted every morning, and instead of tackling the root of the problem (not enough sleep), we instead down a large cup of coffee to get ready for another activity-packed day? Why do people then wonder why they age prematurely, are chronically tired, and cannot sleep well at night?

Have you ever wondered why there’s an expectation that boys and girls will grow up, get married, and have babies? Is it sane to spend thirty years on education, an additional twenty-plus years to raise several children, then wonder where life has gone? Who came up with this brilliant plan??

Is it crazy to work like a madman to earn the big bucks, borrowing from future health and relationships, then when the wealth has accumulated and the health has gone, to spend the paper we call money to try to recapture lost youth and regain a sense of well-being?

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Blah de Blah's Disease

Sheesh. There are a lot of long winded names in dermatology. Take, for instance:

Bullous Congenital Ichthyosiform Erythroderma
Tumid Lupus Erythematosus
Palmoplantar keratoderma mutilans

These are just “moderately” long terms, but a mouthful to say. Imagine having to use the full term several times in a conversation with a colleague. Tongue twisting! So we’ve resorted to acronyms that “people in the know” understand. Like “bullous CIE” or “tumid LE” or “PPK mutilans.” Which is fine once you’ve learned the lingo, but I still remember starting out and hearing “tumid LE” thrown about in a Grand Rounds discussion. Having no idea what that was, and embarrassed that I was likely the only person in the room with no clue, I wrote it down, planning to look it up in our textbook. Not surprisingly, there was no glossary entry under “tumid Ali" or "ali.” It tooks weeks to figure out that they were saying LE, as in lupus erythematosus, not anything related to the Ali family!

There’s also a bad habit of having several different names for the same condition. For example, bullous congenital ichthyosiform erythroderma is also known as epidermolytic hyperkeratosis, which is also known as bullous ichthyosis, but is not the same as nonbullous congenital ichthyosiform erythroderma, which is also known as lamellar ichthyosis, itchthyosis congenital type 2, non-erythrodermic autosomal recessive lamellar ichthyosis, which is not the same as congenital ichthyosiform erythroderma. Or phytanic acid storage disease, which is also known as heredopathia atactica polyneuritiformis or refsum syndrome. People, we’ve only talked about 4 diseases so far!

Actually, this one takes the cake: Severe Combined immunodeficiency, which is also known as Glanzmann-Riniker alymphoplasia, or essential lymphocytophthisis, or swiss-type agammaglobulinemia syndrome or alymphocytosis or Omenn syndrome or Reticuloendotheiliosis with eosinophilia or thymic alymphoplasia. Phew!

Then there are the last names. Everyone who ever had a say in trying to figure out the disease seems to have their names attached. Conradi-Hunermann-Happle syndrome. Rothmund-Thomson Syndrome. Christ-Siemens-Touraine syndrome. Zinsser-Engman-Cole syndrome. If you had figured out the cause of a deforming or lethal genetic disease, would you want your name to be attached to that disease? I mean, one can see how it might be ego-stroking on some level, but I for one would not want my name attached to a horrible disease.

And even if you like that kind of ego-stroking, have pity and think of the consternation it will cause for future generations! While bullous congenital ichthyosiform erythroderma is a long name, at least the name means something – the disease is congenital, scaly, has red skin, and blisters. Whereas Conradi-Hunermann-Happle means nothing unless you were Conradi, Hunermann, Happle, or their contemporaries!

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Signs of Growing Up...

I still vividly remember that, as a kid, whenever I met my parent's friends and other adults, they would ask the same silly questions:

"What grade are you in?"
"Do you like school?"
"What's your favorite subject?"

It seemed like all the adults in the world had gotten together and decided on exactly which questions to use when talking to children. I remember thinking that when I got to their age, I wouldn't just ask such boring questions.

Well, one of our attendings brought her teenage daughter to work the other day. And we're both sitting in said attending's office, waiting for her. A little awkward... I racked my brain to come up with a unique, fun question, and finally broke the silence with:

"So, what grade are you in?"

Doh! Guess I'm now officially part of the boring "adult question-asking conspiracy"... :o)

Pearls of Wisdom

Sayings from the Dhammapada:

Hard it is to train the mind, which goes where it likes and does what it wants. But a trained mind brings health and happiness. The wise can direct their thoughts, subtle and elusive, wherever they choose: a trained mind brings health and happiness.

More than those who hate you, more than all your enemies, an untrained mind does greater harm. More than your mother, more than your father, more than all your family, a well-trained mind does greater good.

This post is from Ellie's wonderful website - take a look when you have a chance. :)

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Rats are Smarter Than You Think.

Did you know that rats can evaluate what they know and do not know?

Metacognition is a type of thinking where the thinker can reason about his/her own thinking. Confused yet? Here's an example - before you start a new assignment, you have an idea of how capable you are of completing the assignment. You've evaluated your ability to carry out the new task (also known as prospective monitoring).

Apparently, rats can do the same. Jonathon Crystal, a comparative psychologist at University of Georgia, did the following study (published in Current Biology):

Rats were given a choice to take a test. If they opted to not take the test, they got a small amount of food pellets. If they opted to take the test and passed it, they got a larger amount of food pellets. They were not penalized if they failed the test.

The test involved playing noises that were either very short (2-3 seconds) or "long" (4-8 seconds). The rats had to classify the noises as "short" or "long." When the noise was in between and difficult to categorize, the rats more often opted to not take the test.

Granted, since they can't tell us what they're thinking, we're extrapolating a lot of information. But it's still a pretty neat little experiment.

Metacognition is not a new concept in the animal world. We do it. Rhesus monkeys and other primates are known to have metacognition. And anyone who's ever had pets knows that we probably know very little about their thoughts and feelings.

Now, rest assured that rats too, are smart little buggers.

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Happy Birthday to Me!

Happy 1st birthday to the WV blog! Who woulda thunk?

I was browsing through the last year's contents, which brought back all these memories that have (already!!) been forgotten. Which is why it's nice to have them written down somewhere. The posts are different now - less varied, less frequent. Very interesting to see how the quality of something changes, just as we all change.

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Four months from now, I'll be 1/3 of the way done with residency. Amazing how time flies... Derm residents across the country are starting to get ansy - there's a "in-service" exam coming up in April. It's a yearly exam that's supposed to be an example of what our board exam is going to be like, and it's chock full of minutiae.

You know it's bad when a textbook chapter (on plant dermatoses) states that identifying plants are difficult, and that the way to do it is to collect the possible offending specimen and "involve a plant taxonomist." Which is what any normal physician in practice would do. However, for board exam purposes, we're supposed to know that the family Urticaceae, Genus Urtica, Laportea, and Dendrocnide, Species dioica, urens, pilulifera, canadensis, gigas, moroides, photinophylla are members of the nettle family. And we're supposed to know the different potential allergic reactions caused by specific members of the species... And that's only one detail in one field.

Who would have known that dermatologists had to be, among other things, infectious disease specialists, pathologists, botanists, immunologists, and trivial pursuit junkies? No one who practices medicine keeps these useless details in their heads. That's what peripheral brains are for. And textbooks. But, for boards purposes, these things must be crammed in. So let the cramming begin!

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A positive note about the cramming - you remember Baloo's song in The Jungle Book, The Bare Necessities? Well, he mentions prickly pears. Now that I am more learned about the plant kingdom, prickly pears have these things called glochids. Glochids are tufts of hundreds of short, barbed, or hooked hairs that arise from pin-cushion like structures called "areoles". These glochids can be like little fishhoods and cause irritation and itching after they get imbedded in the skin. You see the kind of useful information we're learning? Now the next time someone comes in with a prickly pear itch, I'll know how it happened. And, perhaps I'll sing to them the words of the wise Baloo:

Now when you pick a pawpaw

Or a prickly pear

And you prick a raw paw

Next time beware

Don't pick the prickly pear by the paw

When you pick a pear

Try to use the claw

But you don't need to use the claw

When you pick a pear of the big pawpaw

Have I given you a clue ?

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Live and Let Live

Just watched the movie "Born Free," starring Virginia McKenna and Bill Travers.

It's a beautiful story. I went online to look for more information about the story behind the movie, and found that the actors created a foundation for wild animals.

Came across very disturbing information on the foundation website. Have you ever heard of "canned hunting?" In South Africa, there are tourist places where, for a certain sum of money, you can shoot a caged animal and take it home as a trophy kill. The people who run these places actually hand-raise and bottle feed wild and exotic animals so that they are not afraid of humans. Then they put them in a cage, and guarantee the tourist a nice "trophy." In addition, these "hunters" are advised how to lame a lion by shooting it in the shoulder so no damage is done to the head. Some even break the lion's limbs so killing the maimed animal is easier on the operators of such places. What kind of sick subculture is this?

What kind of twisted thinking makes people pay for the mounted head of a dead animal? If the thought of a mounted human head disgusts us, why would any other animal's head be treated differently? Even if you don't have a moral issue with hunting, what part of a premeditated kill, where you have a gun, safety outside of a cage, and a victim who cannot and does not know to run, is glorious?

And what kind of people operate such places? How can you sleep at night, knowing that animals that you raised, who trusted you, were ultimately betrayed by you for money?

Live and let live. Is that too much to ask?

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