Sunday, April 29, 2007

Extra... Special

Extra, accessory, supernumerary.

All adjectives to describe things on the body that are in excess of what is expected. And usually, in a less than expected place. Usually harmless. More of a intellectual curiosity which may, under some circumstances, lead to social awkwardness. Let's take the tour of some of the excesses of the human body - shall we start from head to toe?


Ectopic eyebrows and ectopic eyelashes: Yup, extra brow and lash hairs where they're not supposed to be. This is a relatively common condition in dogs, but also occurs in humans. The brows can be seen on the forehead. Lashes can be seen in a variety of places. It's most often described in the ophthalmology literature as somewhere on the eyeball...


Supernumerary teeth, aka Hyperdontia: More teeth than usual, may be impacted and lead to other dental disturbances. Can occur as an isolated anomaly, or be associated with genetic syndromes like Gardner's syndrome and cleidocranial dysostosis.

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Supernumerary digit: more than 10 fingers or toes:

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Supernumerary nipple: Extra nipples, often along the "milk lines"

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And apparently, these extra nipples can be found in odd places:

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Most of these are cosmetic issues that can be easily removed. However, in this age of transplanting, perhaps instead of rushing to remove these extra special parts, people can hold onto them, as they may come in handy some day - a non-rejectable replacement of the original! ;)

Thursday, April 26, 2007

Lie Back, Relax!

Did you know that four legged animals like cats and dogs and bears can lie flat on their backs? Am not sure why it initially surprised me, and am not sure why it has taken me several decades to learn this fascinating fact. Check out these pictures!


No Words Needed:
Check out this guy's pillow. 'Tis the artic version of buckwheat filling...
Check out this tired guy:

Why do some of them sleep like this? Perhaps it's akin to people's sleep positions? :)
Why don't more of them sleep like this? Is it because they loose flexiblity with age?
Here's a nice picture to end the day: Man's best friend in his version of paradise...

Hope you day went well!

Wednesday, April 25, 2007


Have you tried Wii yet? It's pretty cool.

It's been a while since I've played "video games," and I've never really liked the violent ones or the uber-competitive ones. In fact, the last game I remember liking was Civilization. Plenty of friends like Xbox and all the other fancy consoles that come out every few years, but I've never really gotten into them. So wasn't that excited about a friend's Wii.
Was wrong.
Wii is pretty darn neat. We just played tennis and bowling, but the fact that it is so interactive is amazing. It's like you're actually playing the game! Was therefore NOT surprised to read about how well Wii sales are going. The remote sensor thing is a brilliant idea - wonder why no one thought of it before? Catchy name too. Although when I first read about it, I remember thinking that this "W two" machine was not named well... :)

Tuesday, April 24, 2007

Drug Company Marketing

Ipanema posted a thought-provoking article on pharmaceutical company advertising today.

Most of the people I know consider drug companies a necessary evil. Necessary because, sadly, they are the ones with money who are willing to spend money on research of new drugs. (Although the type of research done is far from "pure" research [for the sake of finding knowledge] and more of the "we're doing this because it may make us billions" kind of research. Which means that drug company research is heavily skewed towards medications that will target the majority of the population. Which also means that diseases for which a fewer number of people are afflicted are called "orphan diseases," and get no research funding, because even if you find THE CURE, drug companies would not be able to make a killing off of it. They're in it for the dollar signs, people. Anways, back to the main point...)

Evil, because they are well-oiled advertising machines. They know how to make money, and they pull out all the stops to do so.

There's been publicity on drug company marketing to physicians and how this influences prescribing behavior. It is true that drug company reps market heavily, and while many individuals physicians will claim that this marketing has no influence on prescribing patterns, it's hard to argue with the fact that drug companies have data that their marketing works, and that they would not spend money if it did not work.

Their way of marketing to physicians is somewhat despicable. They know that most physicians (at least the younger generation) are being trained in an era of "evidence based medicine." Which means that we look for scientific data to back up claims. If someone states that med X is better than med Y, we want to know who said that, and on what basis. Show us the data. So they do these research "studies" to back up their claims. Now, research studies vary from the very solid, randomized, double-blind studies to wimpy few patient pseudo-studies. A good number of drug company studies fall into the latter end, and are more marvels of statistical maneuvering than solid scientific data. Yet because they do these "studies," their mouthpieces (the reps) can quote data at doctors and claim that they are "better" than their competitors. And sometimes one wants to know if med A, which is the same class as med B, is truly better, but no drug company is going to sponsor a med A vs. B trial, because what if their med turned out to be worse?? They'd rather not have anyone know! So instead, they compare med A to placebo or some other control that is guaranteed to show that med A is better. Problem is, med B, C, D, and F and all better than placebo. And we'll never know which one is the best.

So the reps come to doctor's offices and advertise their products. Did you know they are actually taught what kinds of questions that doctor will ask, and trained on how to answer? They choose their reps carefully - intelligent, young, usually good-looking young men and women. It's actually hard to turn these people away - do you shoot the messenger because you don't agree with the message? It's hard to be rude to someone when you know that they, like you, are just trying to make a living.

But, for those of you suspicious souls out there who suspect that your doctor is in the drug companies pocket, it's usually not that simple. For most physicians, changes in prescribing pattern is probably NOT a conscious decision to give you a certain medication because they get something nice in return. We're not out to get you.

And, lest anyone forget, drug company spending on physician marketing is but a part of their total advertising budget. My friends, they are marketing to you. Yes, YOU. In fact, you have a catchy name: direct to consumer, or "DTC." Pharmaceutical companies spent more than $4 billion in 2004 on direct-to-consumer advertising. Which means people come into the office and request medications by name. Based on a 15 second TV ad that often oversells a product that may not be appropriate.

Ugh. The closing thoughts are that drug companies may be doing far more vile things than what have been described in this post. It's just that I don't know about them...

Sunday, April 22, 2007

Truth Shall Set You Free

Guys, THE TEST is over. 'Twas less painful than expected, but most importantly, no one has to worry about it anymore... until next year.

Was surprised to hear that people in other specialties don't prepare for their in-service exams - they just show up and take it. Some take it post-call. Would that I were so brave! When you're taking a test with some of the highest scoring test-takers in the country, AND you *know* that you know very little, AND the senior residents are studying like madmen, you study because you don't want to be the lowest scorer - in the country.

Fear, my friends, is a wonderfully strong motivator.


Speaking of fear - Watched Merlin last night. Interesting storyline, OK movie, special effects left much to be desired. There's a lot of different versions of the King Arthur legend, and I still prefer the Mist of Avalon one (book version).

One thing, though, hit a chord. The gist of the movie was that "Mab," a pagan goddess, realized that with the arrival of Christianity, she was losing the following of the people. So she creates the wizard Merlin to try to bring the people back to her. She fails miserably, and is portrayed as a cold, calculating, almost evil goddess in the story. Merlin spends most of the movie trying to defeat her, but her magic is much stronger than his. In the end Merlin succeeds, after realizing that Mab's hold over people is possible only because people grant her that power. And when people stop fearing Mab, and stop remembering her, they are freed from her power.

It reminds us that the things that we dislike and fear often seem to have a life of their own. These fears grow large and powerful because we unwittingly and continuously feed them with our thoughts and emotions. And the beauty in this realization is that if we are able to step back and look at a self-created vortex of fear, we'd realize that ultimately, one has the choice to continually feed the nightmares, or finally face them with this self-awareness and make the conscious decision to leave them behind.

Here's to you and me, as we work on removing our fears.

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Sunday, April 15, 2007

Creepy Crawlies

We have this online website where one can take "practice exams." It's a great website that serves as good review of the material learned, except when you look at the questions and don't even know what they're asking. I just got my butt kicked on the "creatures of dermatologic significance" section, which includes all the creepy-crawly things that can cause skin problems. Like pubic lice, spiders, caterpillars, fleas, snakes, ticks, etc.
Sometimes they show you a picture and want the genus and species. Ticks are a favorite:

Lone star tick AKA Amblyomma Americanum, which transmits Rocky Mountain Spotted Fever via Rickettsia rickettsii, Human monocytic erlichiosis by E. chafeensis, and Tularemia via Francisella tularesis.

Dermacentor variabilis, AKA dog tick, which carries Rocky Mountain Spotted Fever, Human monocytic erlichiosis by E. chafeensis, and Tularemia

Ixodes scapularis, aka deer tick of the east (aka Ixodes dammini but not to be confused with Ixodes pacificus of the west), which transmits Lyme disease via Borrelia burgdorferi, human granulocytic anaplasmosis via E equi and E phagocytophila.

These pictures are easy to tell apart, but let me just say that ticks do not pose the same way for test pictures, and sometimes you just can't tell what kind of tick they are...

Back to studying...

photo credits - all pictures from google pictures. Will post links later...

Sunday, April 08, 2007

Mom is Always Right

Major case of tunnel vision going on right now. Well illustrated by following conversation:
Mom, I'm so tired. Everyone at work is exhausted too.
Preparing for this test is just taking a huge toll on everyone!

Well, you gotta do what you gotta do.
Now how does this test affect you again?
If you don't pass, do you not get your license?

No, Mom. I already have my license.

Will they stop you from going to the next year?


Will you have to retake it?

Well, you have to take it every year,
but no, you don't have to retake it if you fail.

So what are ya'll so worried about?

Well, your program director gets your score,
so you don't want to be TOO far off the curve.
That'd be really embarassing.

Hm. I see.
So you're studying all hours of the day
and stressing out just so you won't be embarassed.

Um, I guess so...

Thursday, April 05, 2007


Maybe I’m just too naïve.

When I meet someone for the first time, the assumption is that they are good people. Trustworthy. Honorable. Honest. I want to believe the same of the people I work with on a daily basis. And it's been really hard to come to terms with the fact that this is not the case.

Have never thought about using others as stepping stones to get ahead in life. Have seen a few people do it along the way in school and at previous jobs, but have always tried to stay AWAY from those (seemingly) crazy people who were willing to do whatever to get what they wanted. Am shocked to find that there is a high percentage of said crazy people in dermatology. Maybe I shouldn't be so shocked. It's just striking to see so much pathology in such high functioning people.

Or is it pathology? If “the majority of people are like this,” then perhaps I'm the oddball. The things they want – money, fame, power – in the grand scheme of things, don't mean that much to me, so it's hard to understand what makes them tick. Just work hard, try to do a good job, and keep your nose in your own business. Making someone else look bad so you look good is childish. It's a shame to think of such intelligent people wasting time and energy on plotting and playing little games for material things that, in the end, REALLY don't matter. And to top it all off, the expert players are the ones you least expect – the “silent and deadly” ones (look innocent, outwardly innocent and friendly, who have the longest and bloodiest daggers up their sleeve.) I mean, you expect this from politicians, but from academicians??

I must sound so truly naïve to those “in the know”.

Have been told that politics, backstabbing, stepping on other people, is the way of the world. That every workplace is the same. Have also been told that, because of this, I should never trust anyone at work. That I should not say anything that could be possibly be used against me.

The last point is good advice, but it's hard to imagine not trusting anyone. Don't think I'd like to spend my waking hours worrying about who might stab me in the back. Or working in an environment where I can't trust those I work with. And I know I don't EVER want to become like them. Because how can someone like that be happy with their world, or who they are? How can they intentionally hurt other people and think that the means justifies the end?

I am too naïve. But sometimes, I'd rather be naïve. I'd rather go on believing in, looking for, and seeing the good in people. It does a body good.

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Sunday, April 01, 2007

The Undeniable Beauty of Living

Just finished watching the movie Contact.

It has a beautiful message.

The movie touched on some interesting points. That in each “group” of people there are those that are fanatics about what they stand for. People who chose to believe in only their self-constructed portion of the world and choose to reject the possibility of multiple portions making up a whole. Scientists who believe that science is THE answer, so things that cannot be proven cannot exist. Religious men who believe that God is the answer, but believe that all things that do not fall under their limited ideology of what “God” is and what God stands for, is blasphemy.

I don’t know what the answers are. I believe each of us needs to struggle with these ideas and reach our own conclusions. What I do believe is that, when you strip away all the pretenses and man-imposed rules and values of a field of study, be it religion, or science, poetry or dance, that the fundamental goal of many of these fields is the same – they are all paths that can help us find truth. They are ways for us, human beings limited by, but at the same time, blessed with this body and mind, to transcend the limits of what we know.

When one looks at those who excelled in their fields – not necessarily those of great fame or world reknown, but those that truly delved into their field of study, one finds that these great people, after a lifetime of study in vastly different fields, seemed to reach curiously similar conclusions. Were Walt Whitman, Albert Einstein, Mother Teresa, and many of the mystics of old to gather around a table and share their views, they would likely have more in common than a group of self-professed followers of a given field of study. Through their life-long learning, they’ve reached the pinnacle of their field and from that vantage point, had the opportunity to catch a glimpse of the truth. And they understood that Truth is all inclusive.

I don’t know what the truth is, and I don’t know how to get there. But this movie reminds that truth is not one extreme or another - that real truth is somewhere in between. We’re reminded that the search for truth is more worthwhile that the petty small events that we get caught up in. But that the petty events are not exclusive of this search for truth – that they too are part of it. The challenge is to find the truth amidst the noise. To be in the world but not of it. And these experiences also remind us to never forget that all of us are born with the potential to find truth. What a beautiful thought.

I’d like to leave you with the following quote from Contact:

I had an experience. I can't prove it, I can't even explain it, but everything that I know as a human being, everything that I am tells me that it was real. I was given something wonderful, something that changed me forever. A vision of the universe, that tells us, undeniably, how tiny, and insignificant and how rare, and precious we all are. A vision that tells us that we belong to something that is greater then ourselves, that we are *not*, that none of us are alone! I wish I could share that. I wish, that everybody, if only for one moment, could feel that awe, and humility, and hope. That continues to be my wish.

May you find that which it is you seek.

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