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Tuesday, May 29th 2007

Memorial Day Grand Rounds

Welcome to Grand Rounds Volume 3, Number 36. Before we jump into it, for those Americans visiting (or anyone with such an inclination): no matter how you honored the fallen yesterday, no matter your politics, please take another moment to remember those who have made the ultimate sacrifice.

It has been a real honor to put together Grand Rounds this week. There were, as usual, a ton of great submissions.

In the debate over whether to filter Grand Rounds, I stand on the populist side. I think I’ve included everything that was submitted. Even the submissions that ended up in my spam box. Hopefully, despite that, it isn’t terribly verbose.

The categories this week are as follows:



Joe Wright over at Hemodynamics has an eloquent post on how his understanding of life and death changed through medical school; how that long awaited moment of “spiritual catharsis” never came for him.

The Pioneering Portfolio of the Robert Wood Johnson Foundation has a great blog up called Pioneering Ideas. Amongst their posts is an excellent series on health care courts.

There is a wonderful post over at Unique But Not Alone celebrating the third birthday of Jen’s daughter, Meghan, and recounting the trial of her premature birth.



Dr. Descartin over on The Story of Healing tries to sort out how that answer choice on a pharmacology test became a reality, as her sister is diagnosed with breast cancer.

We’ve passed the fourth anniversary of Amy’s diagnosis with diabetes. She details how you know you’ve reached a milestone when you start dreaming about diabetes. In case somehow you don’t know, she is writing over at Diabetes Mine.

Allison at Lemonade Life, stretches into her archives and pulls out a very moving piece on her diagnosis with juvenile diabetes and the passing of her pediatric endocrinologist who helped her through her early years with the disease.

There’s some pondering going on over at Episcopal Chaplain at the Bedside. Marshall doesn’t understand why physicians studying family grieving wouldn’t consult the research of those who often provide the console – chaplains, social workers, and nurses.

What is wrong with the title Chronic Babe? Nothing says Jenni, who very nicely defends her decision to take a negative term associated with her disease – chronic – and redefine it as something positive for herself.

Kerri from Six Until Me writes about a pretty funny screw up from Drugstore.com. She orders a glucose meter and gets…well, you really need to go read it to find out.

Rachel wonders what the news on Avandia’s heart risk potentially means for her as a type II diabetic. She’s writing over at Tales Of My Thirties.

Following Elizabeth Edwards and Tony Snow’s public battles, Laurie asks if some cancers are the new chronic diseases. She’s posting at A Chronic Dose



Inside Surgery presents info on Sentinel Lymph Node Dissection in breast cancer patients. The procedure aims to potentially spare the patients more dramatic axillary lymph node dissection.

Tara over on Aetiology, goes over Rocky Mountain Spotted Fever after a number of recent cases in Wyoming and her recent run-in with a dog tick.

It is always fun when, as a medical student, you get clinical stories of something you read in a textbook. Roy at Shrink Rap provides just that, with a post on valproic acid induced hyperammonemia and the ensuing encephalopathy.

I never knew there were so many online resources on genetic diseases. Bertalan has laid out a beautiful collection of them over at Science Roll. It really is an impressive set of websites.

Going over one of their weekly visual diagnosis quizzes, NY Emergency Medicine interviews the Director of Emergency Ultrasound at Bellvue Hospital who lays out what to look for on U/S in emphysematous cholecystitis.

Dr. Sinclair uses a Pallimed post to go over the mainstream media’s coverage of new research of the addictive properties of opiates.

A tough way to be reminded of a lesson. Always think about giving fluids before giving vasopressors in septic shock. So says a submission from Clinical Cases & Images as Dr. Dimov looks at the story of a $30 million dollar malpractice award to a woman who lost her legs and several fingers to pressor related peripheral ischemia.



Medical tourism. I’m not sure I ever expected those two words to come into mainstream use. They have though. In the first post on the topic, David Williams of Health Business Blog has an interview with the author of Patients Beyond Borders.

In the second post, InsureBlog takes on the topic of medical tourism by going over the issues of state side follow up care, costs and liability.

Healthline Connects has a discussion of some rumblings that Medicare may stop reimbursing for medical errors.

On the topic of medical errors, Behavioral Ecology Blog says that recent tragedy at MLK/Harbor Hospital in Los Angeles had no undertones of racism.

The woes of HIPPA are well known to some medical professionals. Nurse Ratched details how HIPAA’s requirements strain her relations with patient’s families.

It seems a pertinent time to discuss patient privacy issues in light of the recent population reduction of the medical blogosphere. Mexico Medical Student thinks the recent shuttering of some prominent blogs due to privacy issues is merely an acute thing as people get acclimated to medical blogs.

Highlight Health does a recap of the blogosphere’s response to the disappearance of so many of its own. Walter includes some proposals for how to improve the ethics of medical blogging.

Dr. Trofatter at Fruit of the Womb bemoans how the U.S. lags behind in defining contraception as a basic human right.

Off the discussion of contraception being guaranteed, and onto a discussion of pooled funding for medical care in pregnancy. Louise, writing on Colorado
Health Insurance Insider
argues for guaranteed maternity care coverage through pooled insurance company resources.



Over at Agraphia: two parents (one a doctor) + a baby + a rash + Nair = pretty funny. Zac is the author.

Aaron Singh, writing on The Differential, has a hero in medicine…his just happens to be the cousin of my comedic hero, Sasha Baron-Cohen.

If you haven’t heard – the basic science years of medical school are basically just learning vocabulary. A post on Idiopathic Iatrogenesis spells out the parallels of learning a language and medical school.



Geena and Code Blog have a really tragic tale about dancing the line between reassuring patients and lying.

Keith spells pretty special lengths he goes to, to try to get a scared patient to a hepatologist. The post is on Digital Doorway.

One reason ERnursey knows she can trust her docs in the emergency room? I’ll let her tell the story.

I’m going to try to refrain from nodding my head in agreement so much that I strain my neck. Dr. RW, of Notes From Dr. RW thinks the NEJM is becoming a tabloid.

What is a two-fer? Kim, in a very funny post, explains over at Emergiblog.

Rickety Contrivances has a post wherein a volunteer chaplain gets cornered into a debate on abortion with a patient’s family he was very close to.

Dr. Val, of Revolution Medicine, writes about her experience with sexism in medicine. Her story is pretty shocking…maybe I’m just naive.

Donorcycle wonders what is so difficult for health care professionals about the idea of brain death.

A mother with a beard prompts Neonatal Doc to start blogging again.

Dr. George’s medical officer does some amazing work after he witnesses a traffic accident. It is all spelled out in a post on Odysseys of George.

Bongi is a surgeon in South Africa. On Other Things Amanzi he details how the level of violence in Mpumalanga forces him to confront his own mortality.



Dr. Lei wonders about the benefits of personalized nutrition plans based off commercial DNA tests. Very good questions and concerns over at Eye On DNA.

Mt. Everest has become too much of a tourist attraction. At Medicine For The Outdoors, Dr. Auerbach urges the Nepalese and Tibetan governments to limit climbing permits to those with the experience to try for the summit.

Universal Health details the American Nursing Association’s pandemic flu planning and also provides a great link to the Department of Health & Human Services’ pandemic flu blog summit.

Dr. Brown breaks down a new study in the journal Contraception which tries to document the reasons Americans have unprotected sex. The explanation and analysis on Teen Health 411 is excellent.

Stretch. Stretch. Stretch. But do it the right way says Dr. Bookspan. She’s posting on The Fitness Fixer.



What Tech Medicine is hyping is too cool. An Enclyclopedia of Life. You really need to go read what Dr. Schwimmer has to say about it.


This Is Going To Be Amazing When It Is Up And Running

The funny thing isn’t that a therapeutic robotic pet exists, as Dr. Deb informs us. It is that the Guinness Book of World Records has a category for World’s Most Therapeutic Robot.

Disorganized, dysfunctional meetings stink. I think we can all agree with LMF over at Ad Libitum.

The police come to Dr. Bishara’s aid after a flat tire. In praise of all men and women in any sort of uniform over at The Doctor Blogger.

Med Journal Watch wonders why we’re wasting fish oil on dairy cows when a study says it doesn’t improve their milk prediction.

Wow. You made it all the way through. I’m proud of you. It has been great putting this together this week…largely because it was a distraction from studying.

It is hard to give Dr. Genes enough credit for the work he puts into making Grand Rounds run every single week. It really is incredible.

Next week Grand Rounds will be over at Inside Surgery (who had a very good clinical submission this week, which you should go read).

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