30 Days of Google #10: The versatility of Google Docs via @soxnevad

<div dir="ltr" style="text-align: left;" trbidi="on"><span style="font-family: Arial, Helvetica, sans-serif;">I love exploring Susan Oxenvad’s amazing blog </span><a href="http://d97cooltools.blogspot.com/" style="font-family: Arial, Helvetica, sans-serif;">Cool Tools for Teachers</a><span style="font-family: Arial, Helvetica, sans-serif;"> – do visit it and also follow Susan on Twitter. On her blog I came across a post</span><span style="font-family: Arial, Helvetica, sans-serif;"> with this this brilliant representation of ‘<a href="http://d97cooltools.blogspot.com/2012/03/heres-glog-to-create-visual.html" target="_blank">Great ways of using Google Documents</a>’. Not only does she illustrate how amazing and versatile Google Docs is for learning in the classroom, but she also demonstrates a fabulous way to use a Glogster for giving out information visually.  If you click on each part of the glog you will be taken to a post explaining that particular section of Google Docs. I have looked through those and they are great posts.  I am SO impressed with this! How about you? </span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><span style="font-family: Arial, Helvetica, sans-serif;">Susan's glog gives the option to embed, so that is what I will so! Don't forget to visit the original post <a href="http://d97cooltools.blogspot.com/2012/03/heres-glog-to-create-visual.html" target="_blank">here</a>.</span><br /><br /><br /><iframe frameborder="0" height="758" marginheight="0" marginwidth="0" scrolling="no" src="http://edu.glogster.com/glog.php?glog_id=2673930&scale=58" style="overflow: hidden;" width="560"></iframe></div>

30 Days of Google 30 Days of Google #10: The versatility of Google Docs via @soxnevad

I love exploring Susan Oxenvad’s amazing blog Cool Tools for Teachers – do visit it and also follow Susan on Twitter. On her blog I came across a post with this this brilliant representation of ‘Great ways of using Google Documents’. Not only does sh…

Read more »

I Need a Ten Day Surrogate!!

<div dir="ltr" style="text-align: left;" trbidi="on">Cheeeeers Chuckleheads; Matt-Man here for <i>I’m With Stupid</i>.<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnS6XJajWitzh4vVCfSBONV8x4YukETT2PYYRKRTQpopFO0cflTEpUMkY8bL-FZ4hY0Cn61-rgYVOHpt77kQlUzb9RR_BSPbI3_rJ33h8_Yjkzd4C6EMegqyH20MncRyj6FprI1dIdol8/s1600/Schmoop+Sleeping.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="295" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnS6XJajWitzh4vVCfSBONV8x4YukETT2PYYRKRTQpopFO0cflTEpUMkY8bL-FZ4hY0Cn61-rgYVOHpt77kQlUzb9RR_BSPbI3_rJ33h8_Yjkzd4C6EMegqyH20MncRyj6FprI1dIdol8/s400/Schmoop+Sleeping.JPG" width="400" /></a></div>As many of you know, my BFF/OSP Schmoop, is awaiting to go under the knife of <a href="http://news-these-days.blogspot.com/2012/11/hes-not-even-black-but-dr-rawalpindi.htm" target="_blank"><i>Dr. Rawalpindi</i></a> on December 14th in order to have parts of several of her less than stellar performing internal organs removed.<br /><br />As we await to see if we will have unemployment money coming in so we can remain in the Bagwine digs, we are making logistical plans in order to make this lifestyle upheaval relatively painless in spite of the cutting and gouging upon her gizzards and innards. <br /><br />Her brother will take her to the hospital and remain with her through her three to seven hour surgery as well as her seven to ten day post-operative stay.<br /><br />Schmoop, should she receive her unemployment benefits as she should, has already informed ODJFS to deposit her money grab of socialism directly into her bank account.<br /><br />She and I have discussed household bill payments, food stockpiles, and my transportation issues to and fro work as the car will be in Columbus with her brother as he remains with her during her traumatic nearly two week stay at OSU Medical Center.<br /><br />We seem to have been very practical and thoughtful in our considerations as to what needs to be in place prior to her departure, however, there is one infinitely more important item of business that overrides all of the aforementioned particulars that should be in place prior to her gutting…<br /><br />I Need a Ten-Day Surrogate!!<br /><br />That’s right.<br /><br />Both Schmoop and I have agreed that I need supervision while she is gone, so…I am looking for a woman to come and be my companion for ten days and help me make it through this difficult time by offering emotional and moral support, as well as performing,<i> “other duties as assigned.”</i><br /><br />I wouldn’t ask this of any of you except for the fact that Schmoop being in a foreign hospital bed, surrounded by foreign doctors all what with their hands up inside of her, performing major life-saving surgery on her is one thing, but having it take place around the Christmas holiday?<br /><br />Can you imagine how that makes <i>ME</i> feel?<br /><br />More often than not, it’s all about the patient, while those like me, sit at home wondering if the love of his life made it through surgery, all the while searching for that elusive can of Chef Boyardee Ravioli in the cabinet, and desperately longing for a caring and friendly, feminine shoulder upon which to cry.<br /><br />Seriously?  I don’t need that hassle, and more importantly, it’s just not fair.<br /><br />Schmoop all gassed up, will be having highly trained medical professionals rummaging through her body, and afterwards will receive an adjustable bed, and catered meals.<br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5FvYoWZpbSW7W4ZuVvbXZQ8IlCD49fHOlafWt8zrX2mQfy_YkSqlq2Bo8ymtOGV4v5WUEbY-1W3swtZnqzQit-wI1tvnrN7GWsWriIR1WbEO54dajb-jDI0LN64mmtfOKE3gqgSz2LIw/s1600/french+maid+hot+sexy+nude.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5FvYoWZpbSW7W4ZuVvbXZQ8IlCD49fHOlafWt8zrX2mQfy_YkSqlq2Bo8ymtOGV4v5WUEbY-1W3swtZnqzQit-wI1tvnrN7GWsWriIR1WbEO54dajb-jDI0LN64mmtfOKE3gqgSz2LIw/s400/french+maid+hot+sexy+nude.jpg" width="400" /></a></div><br />And what will I be receiving for my worry and longing for her to be home? Uh-huh, that’s right…<br /><br />Heartache!!<br /><br />So, if you are a woman between the ages of 35 and 55, are able to make a good sandwich, can do laundry, light housekeeping, and can pop a top off a can of beer while wearing very little clothes while watching football with me, contact me.<br /><br />I have a position open for you.  While it may last only ten days, if you really put out a good effort, it could be a temp to hire full-time position.<br /><br />Send your resume and references to the following addresses…<br /><br /><i>Cheers!!</i><br /><a href="mailto:mattmaniws@ymail.com"><i>mattmaniws@ymail.com</i></a><br /><a href="https://twitter.com/MattMan_IWS" target="_blank"><span style="color: blue;"><i>@mattman_iws</i></span></a></div>

I Need a Ten Day Surrogate!!

Cheeeeers Chuckleheads; Matt-Man here for I’m With Stupid.As many of you know, my BFF/OSP Schmoop, is awaiting to go under the knife of Dr. Rawalpindi on December 14th in order to have parts of several of her less than stellar performing internal org…

Read more »

Architecture on the Edge of Darkness

In 2011 I served on the jury for the <a href="http://www.evolo.us/category/2011/">eVolo Skyscraper Competition</a>, an experience I recounted about a year ago in <a href="http://archidose.blogspot.com/2011/12/book-review-dynamics-de-realisation-and.html">a review of the massive <i>eVolo Skyscraper</i> book</a>. One thing in particular that I mentioned then was "the visual <i>darkness</i> of the entries, the apparent gloom that seems to accompany thinking about the future." Upon receiving the <a href="http://shop.evolo.us/product/evolo-2012-skyscraper-competition-poster">eVolo Skyscraper Competition Poster</a>, which features stamp-sized renderings of over 600 entries, I had the same thought. But actually looking at the front and back of the whole poster, below, it seems that maybe lightness is more prevalent than darkness; an optimistic turn in one year? <br /><br /><img alt="evolo-poster.jpg" src="http://www.archidose.org/Blog/evolo-poster.jpg" title="eVolo Poster" /><br />[eVolo 2012 Skyscraper Competition Poster | image <a href="http://shop.evolo.us/product/evolo-2012-skyscraper-competition-poster">source</a>] <br /><br />While I attributed the darkness in eVolo entries to dystopian visions of the future where skyscrapers remedied the environmental ills we created, a similar darkness is found in some of the winners and finalists for the <a href="http://krobarch.com/winners.asp?winner_year=2012">2012 Ken Roberts Memorial Delineation Competition</a>, or KRob for short.<br /><br /><img alt="krob2012-4.jpg" src="http://www.archidose.org/Blog/krob2012-4.jpg" title="KRob 2012" /><br />[Winner - Robert Gilson's Best in Category - Professional Digital/Mixed | image <a href="http://krobarch.com/winners.asp?winner_year=2012">source</a>] <br /><br />Darkness does not pervade the majority of the drawings featured this year—and it's probably less of a defining characteristic of the drawings than terms like mixed-media or moody—but where I found it, it was fairly heavy, damp even. The above winner is a case in point: The sun is out, but the shadows are deep, the air is smoggy, and the tree-like overhead constructions sit over broken-down caravans; all of it adds up to a fairly bleak scene.<br /><br /><img alt="krob2012-1.jpg" src="http://www.archidose.org/Blog/krob2012-1.jpg" title="KRob 2012" /><br />[Finalist - James Blair, Cornell University - Student Digital/Mixed | image <a href="http://krobarch.com/winners.asp?winner_year=2012">source</a>] <br /><br />The finalists above and below are from fairly subterranean vantage points, natural places for darkness to be a companion. In each case light filters down, but not enough to escape the heavy blacks and grays. <br /><br /><img alt="krob2012-2.jpg" src="http://www.archidose.org/Blog/krob2012-2.jpg" title="KRob 2012" /><br />[Finalist - Joshua Harrex, University of Technology, Sydney - Student Digital/Mixed | image <a href="http://krobarch.com/winners.asp?winner_year=2012">source</a>] <br /><br />The last example below, which comes from my alma mater, is basically a dusk or night scene where the darkness is made even thicker by the driving rain. It's like a film noir, and we are taking shelter under the canopy; we notice the building across the street but also the clock near us and the man who is holding an umbrella. The architecture is almost secondary to the feeling and the setting, both of which are much heavier than the typical rendering.<br /><br /><img alt="krob2012-3.jpg" src="http://www.archidose.org/Blog/krob2012-3.jpg" title="KRob 2012" /><br />[Finalist - Justin Pohl, Kansas State University - Student Digital/Mixed | image <a href="http://krobarch.com/winners.asp?winner_year=2012">source</a>]

Architecture on the Edge of Darkness

In 2011 I served on the jury for the eVolo Skyscraper Competition, an experience I recounted about a year ago in a review of the massive eVolo Skyscraper book. One thing in particular that I mentioned then was "the visual darkness of the entries, the…

Read more »

Health, Medical, and Science Updates - Stone Hearth News

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><span style="color: rgb(51, 51, 51); font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 24px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); display: inline !important; float: none; ">Health, Medical, and Science Updates, a newsfeed of sorts, concierged by Stone Hearth News, selectively tracks and reproduces fresh and reliable news and information about health, medicine, science, and the social sciences. </span></div><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><span style="color: rgb(51, 51, 51); font-family: Georgia, 'Bitstream Charter', serif; font-size: 16px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 24px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); display: inline !important; float: none; "><br></span></div><a href="http://www.stonehearthnewsletters.com/">http://www.stonehearthnewsletters.com/</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Health, Medical, and Science Updates - Stone Hearth News

Health, Medical, and Science Updates, a newsfeed of sorts, concierged by Stone Hearth News, selectively tracks and reproduces fresh and reliable news and information about health, medicine, science, and the social sciences. http://www.stonehearthnews…

Read more »

Non-compliant puppy

<span style="font-size: large;">Every year I photograph Bones for our Christmas card.  Over the years he has posed in various Christmas accessories.  This year, however, is different.  He has not been compliant at all!</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">First off I tried him with two little antlers.  No good, he shook his head until they flew off.</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">Then I bought a little mini clip on santa hat.  This had pretty much the same result as the antlers. </span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">Next up was a little Christmas jacket.  He just sulked in this one.</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">I had to enlist Ciaran to bribe Bones with some ham for the final outfit and we managed to get one usable picture.  I won't show the picture so that you can get a nice surprise if you receive a card in the post from me!!!</span><br /><span style="font-size: large;"><br /></span><span style="font-size: large;">Here he is ignoring me and refusing to sit up! </span><br /><span style="font-size: large;"><br /></span><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCqQBUWlzBSW6siZuYV2BknOEp4wdwvPi7JbvLY8hOxjVFaP8p8HoE5tZti_Rtpfg7EOVdP7GTmuKfeFaQAwstW2nyqBfLn3gMuBRt7-ojnVhAtEeRF-UJUfWfV237UZgzXlxeA8ieTqUa/s1600/IMG_2593%5B1%5D.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCqQBUWlzBSW6siZuYV2BknOEp4wdwvPi7JbvLY8hOxjVFaP8p8HoE5tZti_Rtpfg7EOVdP7GTmuKfeFaQAwstW2nyqBfLn3gMuBRt7-ojnVhAtEeRF-UJUfWfV237UZgzXlxeA8ieTqUa/s320/IMG_2593%5B1%5D.JPG" width="239" /></a></div><span style="font-size: large;"><br /></span>

Non-compliant puppy

Every year I photograph Bones for our Christmas card.  Over the years he has posed in various Christmas accessories.  This year, however, is different.  He has not been compliant at all!First off I tried him with two little antlers.  No good, he shoo…

Read more »

End of the Line in the ICU - The Brooklyn Rail

<br><p style="margin-top: 0px; margin-right: 30px; margin-bottom: 20px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-family: Georgia, serif; font-size: 15px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">Last year I graduated from nursing school and began working in a specialized intensive care unit in a large academic hospital. During an orientation class a nurse who has worked on the unit for six years gave a presentation on the various kinds of strokes. Noting the difference between supratentorial and infratentorial strokes—the former being more survivable and the latter having a more severe effect on the body's basic functions such as breathing—she said that if she were going to have a stroke, she knew which type she would prefer: "I would want to have an infratentorial stroke. Because I don't even want to make it to the hospital."</p><p style="margin: 0px 30px 20px 0px; padding: 0px; font-family: Georgia, serif; font-size: 15px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255);">She wasn't kidding, and after a couple months of work, I understood why. I also understood the nurses who voice their advocacy of natural death—and their fear of ending up like some of our patients—in regular discussions of plans for <span class="caps">DNR</span>tattoos. For example: "I am going to tattoo DO <span class="caps">NOT RESUSCITATE </span>across my chest. No, across my face, because they won't take my gown off. I am going to tattoo DO <span class="caps">NOT INTUBATE </span>above my lip." <br><br>Another nurse says that instead of <span class="caps">DNR, </span>she's going to be <span class="caps">DNA,</span> Do Not Admit. We know that such plainly stated wishes would never be honored. Medical personnel are bound by legal documents and orders, and the <span class="caps">DNR </span>tattoo is mostly a very dark joke. But the oldest nurse on my unit has instructed her children never to call 911 for her, and readily discusses her suicide pact with her husband. You will not find a group less in favor of automatically aggressive, invasive medical care than intensive care nurses, because we see the pointless suffering it often causes in patients and families. Intensive care is at best a temporary detour during which a patient's instability is monitored, analyzed, and corrected, but it is at worst a high tech torture chamber, a taste of hell during a person's last days on earth. <br><br>I cared for a woman in her 90s whose family had considered making her a <span class="caps">DNR,</span>but decided against it. After a relatively minor stroke that left her awake but not lucid, Helen* went into kidney failure and started on continuous hemodialysis. Because she kept pulling out her IV lines and the feeding tube we had dropped into her nose and down to her stomach, we put boxing glove-like pillow mitts on her hands. When I approached with her medicine, Helen batted at me with her boxing gloves, saying, "NO. <span class="caps">STOP.</span>" She frowned, shook her head and then her fist at me. Her wishes were pretty clear, but technically she was "confused," because when asked her name, the date, and her location, she failed to answer. During the next shift, Helen's heart stopped beating. But despite talking with the doctors about her advanced age and the poor state of her health, her family had nonetheless decided that we should "do everything we can" for her, and so Helen died in a frenzy of nurses pumping her with vasopressors and doing chest compressions, probably cracking several ribs. <br><br>That was a situation in which a patient's family made a decision that probably caused Helen to suffer and did not help her. But there are circumstances where it is the healthcare team that chooses to push on with intensive interventions. And there are circumstances where bureaucracy, miscommunication, and the relatively low priority, among very busy physicians, of making decisions about how far to pursue medical care cause patients to linger in the <span class="caps">ICU </span>weeks past the point when any medical professional thought meaningful recovery was possible. <br><br>Consider another example, of a patient with advanced cancer, in this case an elderly woman with a well-informed husband who knew his wife was dying and that she didn't want to end her life with an extended <span class="caps">ICU </span>stay. After her last tumor resection this woman developed an infection, and during a meeting with her husband the attending physician explained that the main problem we were immediately dealing with was the infection, which was bad and could well be something she would not recover from. The patient's husband explained that he knew that his wife didn't want to be there and that her underlying diagnosis plainly meant that her life was going to end, that they both understood this and didn't want to painfully draw things out. Then he asked if he had any decisions to make—in effect being as blunt as he could without simply insisting that they withdraw care then and there. <br><br>The doctor said no. She said that the patient needed to complete the course of antibiotics to see if the infection could be cured, after which they could approach the question of whether to continue with intensive medical care. I imagine the doctor saw some distinction between letting the patient die of her primary, terminal diagnosis and letting her die of a complication. So the husband's efforts to stick up for his wife went unheard, and she stayed in the <span class="caps">ICU, </span>comatose, for about two more weeks—quite the opposite of her stated wish—before everyone agreed to let her go. <br><br>On the other side of the spectrum are the poor forgotten patients, the ones who linger because nobody will speak up for them and the medical team is not legally allowed to decide to do anything short of maintaining life, day after day. One man with a severe stroke languished over a month while his family members dodged the responsibility of visiting, witnessing his condition, and making a decision about his care. Every morning the health care team rounded on him and we discussed the various states of decay of his body—he had severe diarrhea, frank blood in his urine, and ventilator associated pneumonia—and then moved on to discuss the efforts being made to contact his family and impress upon them the need for action. The <span class="caps">ICU </span>had nothing to offer him, and someone needed to choose: he would either have a tracheostomy and permanent surgically placed feeding tube in order to be moved to a ventilator dependent nursing home, or have his care withdrawn. <br><br>Similarly, we had a homeless woman with a severe brain injury. CT scans of her brain showed an undifferentiated mass of swollen tissue—this is very bad. We were draining cerebrospinal fluid out of her head because the swelling had obstructed the flow of this fluid, causing hydrocephalus and increased pressure within her brain. Her pupils did not react to light, and she had no corneal reflexes—that is, when you touched her eyeball, she didn't flinch. What kept her from being brain dead was the fact that her ventilator was set to "pressure support," meaning that she initiated breaths, and she still had a cough reflex. <br><br>The first day I took care of her, when she'd already been there over a week, I was told that there was a plan to seek a court-appointed guardian to make her health-care decisions. Any friend or relative could have become her decision maker, but this woman was alone. A few days later—why did it take that long?—the social worker presented the patient in court and a lawyer became her official guardian. This lawyer was unwilling to withdraw care. Further, he was unwilling to make the patient a NO <span class="caps">CODE.</span> If her vital signs became unstable and she started to die, we would have to use vasopressors, chest compressions, and defibrillation to keep her heart beating and keep her alive. <br><br>After this, she remained in the <span class="caps">ICU </span>for over a week, and the medical team began itching for ways to get her off of the unit, because she began to be seen as a living corpse taking up a critical care bed and its associated resources—things that could save a different very ill person. Eventually, their only objective was to wean her off of the ventilator and move her out of the <span class="caps">ICU, </span>so that her continued care would be someone else's issue to deal with. <br><br>These four patients had different injuries and different circumstances. What was common to them was that they all suffered the bodily harm and indignity of being physically invaded in every sense, robbed of their integrity entirely, and pinched and poked continuously during the last days and weeks of their lives. Since nobody at the time thought they were going to get better, the people doing this to them—myself and other nurses—had an overarching question: Why? <br><br>All of us love the opportunity to help save a life. That happens in intensive care, and it is exciting and miraculous. But in the instances I've described, and many, many others, nobody involved is under the delusion that a life is being saved. This is where we become cynical, and where many nurses choose not to reflect on the painful purgatories trapping our patients. Rather, they express their opinions succinctly in wry conversations about <span class="caps">DNR </span>tattoos, and they master—or bluff—an exquisite segregation of the mental and physical work of caring for these patients from their own emotional energy. They do this in order to be able to continue working. They get over the absurdity of certain circumstances, and they manage not to care. <br><br>I've not accomplished this. The absurdity weighs me down, and so I want to describe it to you. Medical science can do incredible things. But you would not believe the type of life these life-sustaining treatments often allow. <br><br>People who are at the end of their life and are being kept alive artificially have a way of shutting down. Fighting this process is not a peaceful act. Most of the patients I've described were on ventilators, with plastic tubes pushed into their mouths and down their tracheas in order to provide respiratory support. The tubes are taped to their faces, and patients who can move at all are usually both tied down by their arms and sedated when on a ventilator, because it is so physically uncomfortable that patients will use their last ounce of strength to pull the tube out of their mouth. These patients were already comatose due to their injuries, but other critically ill patients who were previously awake and responsive become unable to speak while on a ventilator. Once intubated, patients are unable to clear their respiratory secretions—phlegm—and so we stick smaller rubber tubes connected to suction into the breathing tube, down their trachea and towards the entrance to the lungs themselves, in order to vacuum the secretions out of their lungs. You can imagine that this too is uncomfortable. <br><br>Patients obviously can't eat, so they will have had a feeding tube pushed up their nose or through their mouth and their esophagus, down into their stomach. This often takes a few tries, requiring us to pull up the bloody tube, re-lube it, and push it back in at a different angle. If a patient is ill long enough, these instruments will be replaced with a tracheostomy in the neck rather than a tube down the mouth and a feeding tube going directly into the stomach rather than down through the nose. These are for patients who aren't expected to be able to eat or breathe independently in the long term. <br><br>These patients often develop diarrhea, sometimes simply because of the liquid food they receive—cans of smelly, nutritionally balanced tan colored slush—and sometimes because they've acquired a very hardy and aggressive bacteria, C. difficile, that is widespread in hospitals and causes profuse, foul stool. If they have diarrhea several times a day and their skin is exposed to it, the skin begins to break down, and so we place a rectal tube in their bottom, held in place beyond the rectum with a small water filled balloon. The diarrhea drains into a clear bag that hangs on the side of the bed. Sometimes when a patient is very sick, as in the case of the man whose family avoided him for over a month after his stroke landed him on my unit, they lose their rectal tone and the tube falls out. This is how I found myself up to my elbows in diarrhea with another nurse, struggling to clean the crevasses of his body and tape an ostomy bag around his bottom, the last hope to contain the flow of stool so that the patient wouldn't sit in a continuous puddle of it while permission for his death was pending. <br><br>Breathing tubes, feeding tubes, and rectal tubes are only part of it. The patients of course have urinary catheters and IVs, often larger IVs that are placed centrally—threaded straight toward the heart to allow us to push drugs in concentrations that would damage smaller veins. Healthier hospitalized patients complain sometimes about their IVs and frequently about their urinary catheters—a rubber tube up your urethra isn't pleasant. If the patients I'm describing could talk, though, I think the urinary catheter would be the least of their complaints. <br><br>In addition to the invasion of tubes, <span class="caps">ICU </span>patients live in a world of bright lights and loud alarms, continuous stimulation. People pry open their eyes and shine flashlights into them, then pry open their mouths. <br><br>We treat most patients with small shots of heparin in their subcutaneous flesh, in order to prevent blood clots. This makes them bruise easily, and patients who've been with us for a while are often peppered with tiny bruises from the shots. Then there are the bigger bruises caused by painful stimulus given by doctors and nurses who are monitoring the arousability of the patient, the depth of their coma. If he doesn't wake up when you shout, or when you shake him, what about when you pinch and twist his trapezius muscle, or grind your knuckles against his sternum for a while?<br><br>It's been said that dying is easy, and it's living that's painful. Not so in the world of intensive care. Patients who have a hope of recovering from their injury, genuinely surviving it, may be fighting to live. For them the torturous days as an <span class="caps">ICU </span>patient are required in order to surmount their injury. And there are always cases where nobody knows what the outcome may be, where the right thing to do is maintain physical function and give the body time to heal. Many patients will survive with deficits, will not return to their former selves but will be able to leave the hospital, go to rehab, begin the hard work of adjusting to another kind of life. But time and again we care for patients who are fighting to die, and having a very hard time of it, because in the <span class="caps">ICU </span>there are only two ways to die: with permission, too often not granted or granted too late, or in the last-ditch fury of a full code blue. <br><br>We are not helping these people by providing intensive care. Instead, we are turning their bodies into grotesque containers, and reducing their lives to a set of numbers monitoring input and output, lab values, and vital signs, which we tweak to keep within normal ranges by adjusting our treatments, during the weeks and days immediately preceding their death. This is the <em>opposite</em> of what should be prioritized when a person is known to be nearing the end of their life without the hope of getting well. <br><br>I want this to change. People who choose to do the work of caring for the gravely ill must concentrate on monitoring and responding to changes in their vital signs, administering their medications, examining all of their physical systems, coordinating their various tests and procedures, bathing them and cleaning up their bodily messes, dressing their wounds, keeping them comfortable, and communicating with their families. I don't think that we should also have to deal with feeling that our work is morally questionable and at times, reprehensible.</p><p style="margin-top: 0px; margin-right: 30px; margin-bottom: 20px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; font-family: Georgia, serif; font-size: 15px; line-height: 1.5em; color: rgb(51, 51, 51); font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">Americans have a lot of work to do in developing a more sensible, fairer, and less wasteful healthcare system. That work needs to include taking a hard look at the conditions of patients whose lives may end in intensive care, both at the level of the entire health care system and at the level of the individual—our wishes for ourselves and our family members whose health is failing or has already failed. Our goal is to help these people, and assuming that prolonging their lives for the longest time possible is the only way to do this is a foolish and harmful mistake.</p><a href="http://www.brooklynrail.org/2012/11/express/end-of-the-line-in-the-icu">http://www.brooklynrail.org/2012/11/express/end-of-the-line-in-the-icu</a>

End of the Line in the ICU - The Brooklyn Rail

Last year I graduated from nursing school and began working in a specialized intensive care unit in a large academic hospital. During an orientation class a nurse who has worked on the unit for six years gave a presentation on the various kinds of st…

Read more »

The Health Care Blog

We run guest posts by influential bloggers across healthcare every day, featuring pieces by observers at the center of the stories transforming the field.<br /><br><br /><br>You can think of us as a little bit like the Huffington Post with a focus on medicine, science and the business of medicine. Since passage of the Obama administration's health reform law, we've paid close attention to the Affordable Care Act, tracking the implications of the landmark legislation for the industry and consumers, as well as the looming legal battle over the law's future in Washington.<br /><br><br /><br>We also pay pointed attention to the healthcare startup scene and the new technologies that are changing healthcare. Since the national drive for health information technology less than a decade, we've tracked trends and ideas on the technology side of healthcare.<br /><br><br /><br>Is the cloud really going to change everything? Is there going to be a Facebook for healthcare? (Hint. You probably already know the answer.) Will doctors ever embraceelectronic medical records? What's the next big thing that hospitals and health systems are turning to in data and analytics?<br /><br><br /><br><a href="http://thehealthcareblog.com/">http://thehealthcareblog.com/</a>

The Health Care Blog

We run guest posts by influential bloggers across healthcare every day, featuring pieces by observers at the center of the stories transforming the field.You can think of us as a little bit like the Huffington Post with a focus on medicine, science a…

Read more »

Webinar recording: Get the hang of a Google hangout (27/11/2012)

<div dir="ltr" style="text-align: left;" trbidi="on"><br /><div dir="ltr" style="text-align: left;" trbidi="on"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHOpalYAZiJNq7KHf9twX7c3oLnP9g2Vi-ZeU_cz39iPvGsM9kNrOeTl0_ZKACm0npmdubC6MNr54iA4NakJ_RCexTGen9uMLItT9EPnTymdrt0x2ioxKgorceKP2l_uH_C71oNZwMIyM/s1600/webinar+recording.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="53" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHOpalYAZiJNq7KHf9twX7c3oLnP9g2Vi-ZeU_cz39iPvGsM9kNrOeTl0_ZKACm0npmdubC6MNr54iA4NakJ_RCexTGen9uMLItT9EPnTymdrt0x2ioxKgorceKP2l_uH_C71oNZwMIyM/s400/webinar+recording.JPG" width="400" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;"><b>What is a Google hangout?</b></span><br /><span style="font-family: Arial, Helvetica, sans-serif;">Google+ is Google's new social networking tool. I have only just discovered its amazing potential since attending the Google Teacher Academy in New York in October. Google has put a lot of funding into developing Google+ and they are committed to making it work well for education, so it will just get better and better I am sure. Once you have created a </span><a href="http://www.wikihow.com/Create-Circles-in-Google-Plus" style="font-family: Arial, Helvetica, sans-serif;">circle of friends</a><span style="font-family: Arial, Helvetica, sans-serif;"> in Google+ you can choose to hang out with them on Google+. This allows you to video chat, IM chat, watch YouTube videos together, and more. </span><br /><u><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></u><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;"><b>Summary of benefits</b></span><br /><span style="font-family: Arial, Helvetica, sans-serif;">Google Hangouts are part of Google+, Google's new free social networking tool. On a Hangout 10 people (possible 15 on Google Apps) can:</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*video chat</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*IM (instant message) chat</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*watch YouTube videos together</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*collaborate on a Google Doc</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*use a whiteboard collaboratively</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*add effects for fun</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*record the Hangout directly on YouTube</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*live stream for more viewers</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*A minimum of two people </span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*and more… </span><br /><br /><strong><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">A Slideshare showing the steps</span></strong><br /><span style="font-family: Arial, Helvetica, sans-serif;">This slideshare was used in the SchoolNet webinar of the same name and shows the steps in creating a hangout.</span><br /><br /><iframe allowfullscreen="allowfullscreen" frameborder="0" height="356" marginheight="0" marginwidth="0" mozallowfullscreen="mozallowfullscreen" scrolling="no" src="http://www.slideshare.net/slideshow/embed_code/15447237" style="border-bottom: #ccc 0px solid; border-left: #ccc 1px solid; border-right: #ccc 1px solid; border-top: #ccc 1px solid; margin-bottom: 5px;" webkitallowfullscreen="webkitallowfullscreen" width="427"> </iframe> <br /><div style="margin-bottom: 5px;"><span style="font-size: x-small;"><strong><a href="http://www.slideshare.net/fionabeal/get-the-hang-of-a-google-hangout" target="_blank" title="Get the hang of a Google+ hangout">Get the hang of a Google+ hangout</a> </strong>from <strong><a href="http://www.slideshare.net/fionabeal" target="_blank">Fiona Beal</a></strong></span> </div><strong><u><br /></u></strong><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large; font-weight: bold;">Webinar recording:</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">Last week SchoolNet had a webinar whih was presented by me (Fiona Beal) on 'Get the hang of a Google Hangout'. Here is the recording</span><u>. </u><br /><a href="http://meet78641452.adobeconnect.com/p6kgz1ndmhz/" style="font-family: Arial, Helvetica, sans-serif; font-weight: bold; text-decoration: underline;">http://meet78641452.adobeconnect.com/p6kgz1ndmhz/</a><span style="font-family: Arial, Helvetica, sans-serif;"> (22 mins)</span><br /><br /><strong><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">Ideas for using a hangout in the the classroom</span></strong><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Read a story</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Bring in an expert/guest speaker/author|</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Share from a Slideshare</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Homework tutoring</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Professional Development meeting</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Work on a project together</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Virtual penpals</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Global classroom discussions</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Career Day wit panelists</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Attend other hangouts (Google has a whole library of hangouts)</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Extended discussion on a class topic</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Subject-related hangouts</span><br /><span style="font-family: Arial, Helvetica, sans-serif;">• Conduct workshops and seminars</span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><strong><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">Additional reading and viewing</span></strong><br /><strong><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;">a) A tutorial </span></strong><br /><span style="font-family: Arial, Helvetica, sans-serif;">Please note that Google updates its products continually so some features in this video might look different.</span><br /><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span><iframe allowfullscreen="allowfullscreen" frameborder="0" height="315" src="http://www.youtube.com/embed/7K06lHu4gDk" width="420"></iframe><br /><br /><span style="font-family: Helvetica Neue, Arial, Helvetica, sans-serif; font-size: large;"><b>b) Further Reading</b></span><br /><span style="font-family: Arial, Helvetica, sans-serif;">*<a href="http://www.wikihow.com/Use-Google%2B-Hangouts">How to use Google Hangouts</a> </span><br />*<a href="http://www.wikihow.com/Use-Google%2B-Hangouts-for-Teaching" style="background-color: #f9f7f1; font-family: Arial, Helvetica, sans-serif;">How to Use Google+ Hangouts for Teaching</a><br />*<a href="http://www.google.com/+/learnmore/events/" style="font-family: Arial, Helvetica, sans-serif;">How to create a Google event</a><br /><div><br /></div></div></div>

webinars Webinar recording: Get the hang of a Google hangout (27/11/2012)

What is a Google hangout?Google+ is Google's new social networking tool. I have only just discovered its amazing potential since attending the Google Teacher Academy in New York in October. Google has put a lot of funding into developing Google+ and …

Read more »

Medical apps could hurt, not help - Sioux City Journal

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">When the iTunes Store began offering apps that used cellphone light to cure acne, federal investigators knew that hucksters had found a new spot in cyberspace.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"We realized this could be a medium for mischief," said James Prunty, a Federal Trade Commission attorney who helped prosecute the government's only cases against health app developers last year, shutting down two acne apps.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Since then, the Food and Drug Administration has been mired in a debate over how to oversee these new high-tech products and government officials have not pursued any other app developers for making medically dubious claims. Now, both the iTunes Store and Google Play Store for Android users are riddled with health apps that experts say do not work and in some case could even endanger people.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">These apps offer quick fixes for everything from flabby abs to alcoholism, promising relief from pain, stress, stuttering and even ringing in the ears. Many of these apps do not follow established medical guidelines. Few have been tested through the sort of clinical research that is standard for less new-fangled treatments sold by other means, a probe by The New England Center for Investigative Reporting (NECIR) has found.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">While some apps are free, thousands must be purchased, ranging from 69 cents to $999. Nearly 247 million mobile phone users worldwide are expected to download health apps in 2012, according to Research2Guidance, a global market research firm.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">In an examination of 1,500 health apps that cost money and have been available since June 2011, the center found that more than one out of five claims to treat or cure medical problems -- exactly the sorts of apps that FDA-proposed guidelines suggest need regulation. Of the 331 therapeutic apps, 142 -- or 43 percent -- relied on cellphone sound for treatments. Another dozen used the light of the cellphone, and two others used phone vibrations. Scientists say none of these methods could possibly work for the conditions in question.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"Virtually any app that claims it will cure someone of a disease, condition or mental health condition is bogus," says John Grohol, an online health technology expert, pointing out that the vast majority of available apps have not been scientifically tested. "Developers are just preying on people's vulnerabilities."</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Satish Misra, a physician and managing editor of the app review website iMedicalApps, adds: "They take some therapeutic method that is real -- and in some cases experimental -- and create a grossly simplified version of that therapy using the iPhone. Who knows? Maybe it works." But until testing shows otherwise, "my feeling would be that it doesn't."</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">There are many outstanding health apps, particularly those intended for doctors and hospitals, that are helping to revolutionize medical care, according to physicians and others. Among the most well-regarded apps for consumers: Lose It for weight loss, Azumio to measure heart rates and iTriage to check symptoms and locate the closest hospitals with the shortest emergency-room wait times.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">But consumers have almost no way of distinguishing great high-tech tools from what Prunty called the "snake oil." Without government oversight or independent testing of apps, people mainly rely on developers' advertisements and anonymous online reviews, many of which are positive but some, such as this one, are not: "Shame on Apple for even allowing this piece of crap on here. ... It preys on people with health issues."</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">When contacted, Apple declined to discuss anything about its apps. The company has issued lengthy guidelines for app developers, which say it will reject apps that crash, have bugs or do not perform as advertised.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">A Google spokeswoman also declined to discuss its apps or its rules for developers. Google's content guidelines also ban sexually explicit material, gratuitous violence or anything that may damage users' devices.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The FDA is drafting regulations that outline what types of health apps will need government approval before they can be marketed in the United States. But the regulations have been bogged down by debates, hearings and legislative back and forth over whether government oversight would stifle innovation.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"Applying a complex regulatory framework could inhibit future growth and innovation in this promising market," six Republican members of Congress wrote last spring to the heads of the FDA and the Federal Communications Commission, reflecting some of the concern.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">A few private groups are working to assess the quality of various apps. iMedicalApps gets health care professionals to review software applications that mainly interest physicians. Happtique, a subsidiary of the Greater New York Hospital Association, is about to launch the nation's first app certification service, which will evaluate apps for safety and effectiveness. It will award some apps the high-tech equivalent of the Good Housekeeping Seal of Approval. "We truly believe people need a trusted source," said Ben Chodor, Happtique's CEO.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Misra, an internal medicine resident at Johns Hopkins Hospital, says he's most concerned about apps that claim to test or treat consumers for serious diseases. These apps can sometimes give inaccurate information or can lull people into ignoring symptoms that might need medical attention.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Cardiac Stress Test, for instance, says on Google Play (where it sells for $3.07) that it can determine "if you are ready for sports or if your heart is not in a healthy condition." A person takes his heart rate after performing 30 squats in less than 60 seconds and enters the number into the app's calculator, which then reports whether the user's heart is in shape for exercise.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"It's hard not to imagine how this app could give folks a false sense of security," Misra says, noting that assessing someone's cardiac status is not just a matter of looking at heart rate.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Simon Bertrand, who developed the app for his own use, said it is designed to help healthy people monitor their heart, similar to apps that monitor weight or body mass. "If you are in poor health condition ... go to see a doctor," he said in an email.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Later, in an interview by phone from France, Bertrand said his app was being offered for sale on Google Play within minutes of submitting it to the company. "It's just a test. It's not an application that claims to cure."</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Apps that rely on cellphone light, meanwhile, cannot possibly have any therapeutic value, experts say. While light treatments can be used to relieve some medical problems, cellphone light is in the wrong spectrum and far too weak to make any impact at all, said the FTC's Prunty.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"Using the light of the cellphone is automatically suspect," Prunty said, which is why the agency decided last year to file complaints against two developers who claimed cellphone light could cure acne.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The FTC argued in its complaints that the developers' claims were "false or misleading." AcneApp, which sold for $1.99 on iTunes, claimed that blue light fought bacteria and red light helped heal skin. "Rest the iPhone against your skin's acne-prone areas for two minutes daily to improve skin health without prescription drugs," it said. The app was downloaded 11,600 times, according to the FTC complaint.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">A similar app for Android phones, Acne Pwner, was downloaded 3,300 times, the FTC said.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">AcneApp cited a study in the British Journal of Dermatology, which suggested that light therapy was almost twice as effective as over-the-the counter blemish treatments. But the FTC said in its complaint that the study "does not prove that blue and red light therapy" effectively treats acne.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The two companies settled the complaints, without admitting any violation of the law, by paying fines of $14,294 in AcneApp's case, and $1,700 in Acne Pwner's case.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Gregory Pearson, the Houston dermatologist who helped create AcneApp, "was not making any claims of efficacy," said his attorney, Sesha Kalapatapu.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Cellphone lights are being marketing to treat other conditions too including seasonal affective disorder (SAD), a type of depression that occurs during the winter because of lack of sunlight. But SAD experts say even the most powerful cellphone lights are far too weak to treat depression.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">There's also little proof that apps relying on cellphone sounds can be effective, yet there are many such apps.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">AG Method, which sells for $9.99 on the iTunes Store, says that users can get relief for everything from insomnia to toothaches by listening to something that sounds like running water for 20 minutes. "Put the sound-source on the maximum pain," it says. All the while, "HEALING IN PROGRESS" flashes in big red letters on the iPhone screen.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"There is no plausible, physiological way in which something like this would help," Misra said.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">But that may not stop people from buying it. "People in pain are very gullible. They would pay their last dollar for relief," said Penney Cowan, executive director of the American Chronic Pain Association.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Tiziana Formica, a spokesman for AG Method, said in and email: "AG Method is the result of 25 years of research and includes several technologies and methodologies developed and widely tested."</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Even health apps that seem more conventional often have fundamental flaws. Many don't conform to clinical practice guidelines.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">An app to help people with tinnitus, or ringing in the ears, was sold in both the iTunes and Google Play stores until early August and contained multiple medical misconceptions.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"Ringing Relief Pro," which sold for $2.99, advertised itself as "an easy and inexpensive way to cure your tinnitus. ... Simply play the low frequency hum that sounds best to you for 90 seconds and your ears should ring no more!" It claimed that tinnitus occurs "when tiny hairs in your inner ear get stuck in the bent position and send false signals to the brain."</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">In fact, tinnitus is not caused by stuck ear hairs and can be a sign of many underlying medical conditions, including hearing loss, high blood pressure, allergies and anxiety, says Rhonda Ruby, an audiologist who has treated patients for 35 years at the West Newton Hearing Center in Massachusetts.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"There is no cure for tinnitus," she says. "When you download these sorts of apps without consulting a medical professional, it's like putting a Band-Aid on something and not figuring out what is causing the problem."</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Ed Williams, the app's developer, withdrew the app from the market after being contacted by the New England Center for Investigative Reporting. A 28-year-old computer scientist, he said he developed the app after reading a newspaper article about researchers who discovered that a low-pitched sound could provide tinnitus relief.</p><p style="margin: 0px 0px 15px; padding: 0px; border: 0px; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"I am not a medical expert, and I wouldn't want anyone using my app in lieu of medical treatment, but it does seem to work for some people," he said. Once he was told about the proposed FDA regulations, though, Williams said he wanted to submit the app for government approval.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 15px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: normal; font-style: normal; font-size: 14px; line-height: 22px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; color: rgb(34, 34, 34); font-variant: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">His tinnitus app may not have done very well, but Williams also developed Fake-A-Call, which allows people to set up fake phone calls when they are in meetings or awkward social situations. He said it has been downloaded millions of time and earns him thousands of dollars every month.</p></div><a href="http://siouxcityjournal.com/medical-apps-could-hurt-not-help/article_3bb53399-b67b-5bbd-bb18-2dd32029ad18.html">http://siouxcityjournal.com/medical-apps-could-hurt-not-help/article_3bb53399-b67b-5bbd-bb18-2dd32029ad18.html</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Medical apps could hurt, not help - Sioux City Journal

When the iTunes Store began offering apps that used cellphone light to cure acne, federal investigators knew that hucksters had found a new spot in cyberspace."We realized this could be a medium for mischief," said James Prunty, a Federal Trade Commi…

Read more »

Itchiness is contagious, just like yawning - The Body Odd

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0.8em; padding-right: 0px; padding-bottom: 0.8em; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">For some people, hearing about a bug bite or a rash is enough to cause them to furiously dig at their own unaffected skin. Even some doctors who treat people with shingles report feeling itchy after witnessing their patients scratching. And we'd bet many of you readers are feeling itchy right this very second. </div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0.8em; padding-right: 0px; padding-bottom: 0.8em; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">It seems humans commonly catch itches from one another, but scientists hadn't proven it—until now. Researchers found that itching is contagious much like yawning and laughing.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0.8em; padding-right: 0px; padding-bottom: 0.8em; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"With itching, there [was] only anecdotal evidence that watching [a person] itch induces itching," explains Henning Holle, a lecturer in the psychology department at the University of Hull in England. "We wanted to know whether contagious itch would effect everyone."</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0.8em; padding-right: 0px; padding-bottom: 0.8em; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Holle asked 51 adults to take a personality test that ranks the Big Five personality traits of openness, conscientiousness, extroversion, agreeableness and neuroticism. Then using functional magnetic resonance imaging, or fMRI (a technique that detects brain activity by monitoring blood flow in the brain), the subjects watched either a video where someone was scratching herself or tapping her arm or chest. The fMRI allowed the researchers to see the subjects' brain activity as they responded to the video images.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0.8em; padding-right: 0px; padding-bottom: 0.8em; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Two-thirds of the people who saw the scratching video scratched themselves. This finding mirrors what experts know about other socially contagious behaviors such as yawning and laughing: most of us "catch" yawns and laughter. </div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0.8em; padding-right: 0px; padding-bottom: 0.8em; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">"Most people tend to experience contagious itch—some are more prone to it than others," Holle explains. "I was really surprised by the amount of people who spontaneously scratched."</div><div class="j_content_poll j_widget" data-poll-id="44646" data-align="right" data-editor="null" id="j_content_poll_1" style="margin: 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "></div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0.8em; padding-right: 0px; padding-bottom: 0.8em; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">Watching an itch sparks activity in the anterior insular, primary somatosensory area, and the prefrontal and premotor cortices. These regions, part of the itch matrix, also activate when a person actually feels an itch, meaning that watching someone scratch makes the brain think it is experiencing an itch.</div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0.8em; padding-right: 0px; padding-bottom: 0.8em; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">After establishing that itching spreads socially, Holle wondered what caused it. He suspected itch might spread because of empathy. There is some evidence that people feel pain empathetically: When someone sees a family member receive an electric shock, the observer also feels pain (as this is in a lab setting the people aren't actually receiving the shock). It turns out that people who exhibit more empathy do not scratch more than those who are less compassionate. But people who are more neurotic, those who experience the biggest mood swings and exhibit anxiety, depression, jealousy, and guilt, are more susceptible to contagious itch than others. The neural activity in the prefrontal cortex reinforces the self-reported data indicating that people with neurotic tendencies are more likely to catch an itch.  </div><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0.8em; padding-right: 0px; padding-bottom: 0.8em; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 16px; vertical-align: baseline; color: rgb(51, 51, 51); font-family: georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 25px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; ">"This introspective awareness might explain why people are more prone [to contagious itch]," he says.</div></div><a href="http://bodyodd.nbcnews.com/_news/2012/11/12/15115633-itchiness-is-contagious-just-like-yawning?lite">http://bodyodd.nbcnews.com/_news/2012/11/12/15115633-itchiness-is-contagious-just-like-yawning?lite</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Itchiness is contagious, just like yawning - The Body Odd

For some people, hearing about a bug bite or a rash is enough to cause them to furiously dig at their own unaffected skin. Even some doctors who treat people with shingles report feeling itchy after witnessing their patients scratching. And we'd bet …

Read more »

to send or not to send

...that is the question.<br /><br />Hey everybody! First off I want to thank you all for your sweet comments and emails about the living room. I'm so happy to have accomplished everything on my list. You'll notice that I didn't say the room is 'finished' as there is always more I want to do, but we won't go there today.<br /><br />We had a great time with family in Chicago over the Thanksgiving holiday and I also got a chance to visit with some very good friends whom I don't get to see often enough.<br /><br />Such a good time was had in fact, that it made me think about Christmas cards. Well, the visit and the fact that every other car we passed on Sunday had a christmas tree on the roof.<br /><br />Last year I didn't send out Christmas/holiday cards (gasp) and I have to tell you, if felt pretty damn good. It was on my list, but I simply just ran out of time. But after the initial guilt wore off, it was rather nice to have one less thing to feel obligated to during this crazy time of year.<br /><br />Big but though, I LOVE getting Christmas cards. I'm an enigma I know. I love seeing how much everyone's kids have grown (even though I see all of that already thru Facebook) and I'm thrilled to get something in the mail that isn't a bill or a solicitation. And, they are just so damn cute!<br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzvpvXgHPPUpokxxQfpXE3epgaOO2afbgyFvTGrwAbjS99X7g-Jj_Wfw3u34sAAxDNzvWhWIiVJF54OeyafHHa0RlGhGrnYUR29U0WqgLUTCrm80mC1OVWyAPsJqPO9Q-AHJakBhCz1TK0/s1600/flat_holiday_photo_cards_chic_colors.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzvpvXgHPPUpokxxQfpXE3epgaOO2afbgyFvTGrwAbjS99X7g-Jj_Wfw3u34sAAxDNzvWhWIiVJF54OeyafHHa0RlGhGrnYUR29U0WqgLUTCrm80mC1OVWyAPsJqPO9Q-AHJakBhCz1TK0/s320/flat_holiday_photo_cards_chic_colors.jpeg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="http://www.tinyprints.com/" target="_blank">Tiny Prints: Chic Colors</a></td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw7xOKl2NxQ8Rr-vitiW68f3C80Nhfx0L_C3Qi9PAZ4im5IpVa12-4Z4FKsDKcDiqNz30fh4lpwKjgN1fSzx1_Rl6zxQdzs4BauZW_mwjYM4spkX_pFrKBKNNE7p5a9WkV3lxe2p6SAblq/s1600/ornament_cards_gingham_grosgrain.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjw7xOKl2NxQ8Rr-vitiW68f3C80Nhfx0L_C3Qi9PAZ4im5IpVa12-4Z4FKsDKcDiqNz30fh4lpwKjgN1fSzx1_Rl6zxQdzs4BauZW_mwjYM4spkX_pFrKBKNNE7p5a9WkV3lxe2p6SAblq/s320/ornament_cards_gingham_grosgrain.jpeg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="http://www.tinyprints.com/" target="_blank">Tiny Prints: Gingham Grosgrain</a></td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnwm_AAmrjO2vDOqRvzypE-YMyYB42R0d2trncJPkd8WKAj0AXlkqh1QhVXvJv8JU3e2aFdf2CcV8h4vJZQWmRY6IX8V7RsKJCd15M05MAE0o3vOCsuWQQlC-popKceXk4k5i4L0JEWox1/s1600/STATIONERYCARD_5x5-31050-5770-MERCHLARGE_FRONT-v1344029349000123654.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjnwm_AAmrjO2vDOqRvzypE-YMyYB42R0d2trncJPkd8WKAj0AXlkqh1QhVXvJv8JU3e2aFdf2CcV8h4vJZQWmRY6IX8V7RsKJCd15M05MAE0o3vOCsuWQQlC-popKceXk4k5i4L0JEWox1/s320/STATIONERYCARD_5x5-31050-5770-MERCHLARGE_FRONT-v1344029349000123654.jpeg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="http://www.shutterfly.com/cards-stationery/new-years-cards/new-years-cards" target="_blank">Shutterfly</a></td></tr></tbody></table><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjonddYURU_5cxNVD266BuT6nc0ClXEcLTOxxiVF1gJlU3ruChMz4p9sTvsAH4Zu5z8E_29f5R-vNpMoySiF3W1f7cCW-jfVQEjzFENAALhNpmX5TgYFvp1yDF6RH9YlgA0c7ckvyuyvoeN/s1600/STATIONERYCARD_FOLDED_5x7-27107-6073-MERCHLARGE_FRONT-v134402796400090507.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="231" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjonddYURU_5cxNVD266BuT6nc0ClXEcLTOxxiVF1gJlU3ruChMz4p9sTvsAH4Zu5z8E_29f5R-vNpMoySiF3W1f7cCW-jfVQEjzFENAALhNpmX5TgYFvp1yDF6RH9YlgA0c7ckvyuyvoeN/s320/STATIONERYCARD_FOLDED_5x7-27107-6073-MERCHLARGE_FRONT-v134402796400090507.jpeg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="http://www.shutterfly.com/cards-stationery/christmas-cards/joyful-and-bright-holiday-card" target="_blank">Shutterfly</a></td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXZrlaYdGAB_axD8blBzb8IC73yHe9rbmcB0fh8Xkr_knS_t7tLG8BrfUTypdYErn0ReMTUImwXeXsfbijCX8UUzXM0SGSDJb9Q1AZMQSwxzx85MDfRWqYxPIA59bjd00lzLrXaBmXusUo/s1600/be-bright-christmas-card.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjXZrlaYdGAB_axD8blBzb8IC73yHe9rbmcB0fh8Xkr_knS_t7tLG8BrfUTypdYErn0ReMTUImwXeXsfbijCX8UUzXM0SGSDJb9Q1AZMQSwxzx85MDfRWqYxPIA59bjd00lzLrXaBmXusUo/s320/be-bright-christmas-card.jpeg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><a href="http://www.shutterfly.com/cards-stationery/christmas-cards" target="_blank">Shutterfly</a></td></tr></tbody></table><br />So, what do you think? Are you sending out holiday cards this year? Are they necessary in our social media world where we know all of everyone's everything? Do you have a method or place to get them from that removes the stress? Do I need to save you a seat next to me in 'I didn't send out Christmas cards' hell?

to send or not to send

...that is the question.Hey everybody! First off I want to thank you all for your sweet comments and emails about the living room. I'm so happy to have accomplished everything on my list. You'll notice that I didn't say the room is 'finished' as ther…

Read more »

The patient I couldn’t heal - Salon.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); list-style: none; line-height: 20px; color: rgb(0, 0, 0); font-family: Times; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">I take pride in closing surgical incisions. After a cold blade opens the skin and the internal work is done, the only thing the patient sees, or knows, is their incision. Maintaining symmetry, I use the finest threads and the gentlest instruments in an attempt to restore what once was. Some surgical residents leave the wound dressing to the operating room nurses; I personally dress the wound to reassure the patient that his tissues were handled with the utmost respect. For me, it is the last step of any operation.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); list-style: none; line-height: 20px; color: rgb(0, 0, 0); font-family: Times; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">But as I closed Mr. H's wound, others in the room looked at me as if I were crazy. After eight hours of surgery, why would I be so careful with something as trivial as the wound closure? The anesthesiologist became impatient, and the medical student stood by awkwardly. Undeterred, I carefully aligned the skin edges and neatly applied the dressing.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); list-style: none; line-height: 20px; color: rgb(0, 0, 0); font-family: Times; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">A grapefruit-size tumor in Mr. H's kidney had invaded the spleen and part of his intestine. It was covered with ominous blood vessels, trying to engulf the neighboring organs. The tumor was removed, along with the kidney, spleen and a six-inch segment of intestine. He was going to the intensive care unit with drainage tubes in his chest and abdomen. He needed a breathing tube in his throat while blood was still being poured into his veins.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); list-style: none; line-height: 20px; color: rgb(0, 0, 0); font-family: Times; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">The incision wrapped halfway around his body. The glistening yellow fat and the beefy red muscle came together layer by layer as we closed the gaping hole. The anesthesiologist peeked over the surgical drapes and insisted that I expedite the closure with staples instead of suture. I grudgingly agreed but still took great care to ensure Mr. H's skin closure would be perfect. I somehow believed that a nice scar would hide the ruin within.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: rgb(255, 255, 255); list-style: none; line-height: 20px; color: rgb(0, 0, 0); font-family: Times; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-position: initial initial; background-repeat: initial initial; ">My attempt at perfection unraveled a few days later. It started with a little redness at the corner of the incision. I probed the wound with a Q-tip and ensured the underlying fascia – the dense fibrous tissue encasing the abdomen – was intact. Removing the Q-tip, I saw the characteristic creamy pus of a wound infection. I could smell it. I removed one staple to allow adequate drainage and packed the small defect with a tiny strip of gauze.</p><div class="toggle-group target hideOnInit" data-toggle-group="story-13068369" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 1px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; outline-width: 0px; outline-style: initial; outline-color: initial; font-size: 14px; vertical-align: baseline; background-color: rgb(255, 255, 255); list-style-type: none; list-style-position: initial; list-style-image: initial; color: rgb(0, 0, 0); font-family: Times; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: 18px; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; opacity: 1; position: static; z-index: auto; "><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: transparent; list-style: none; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">Mr. H's wife was distraught about her husband's complicated operation and poor prognosis.  And now his wound was infected. I explained to her that wounds can heal in different ways. When tissues are sewn together side-to-side, the fat joins to fat, muscle to muscle, and skin to skin. But when left open with gauze, the gap fills in with pink granulation tissue from the bottom up. Wounds have a remarkable ability to heal, I told her, but her skepticism was clear. We discussed that overall his recovery was coming along nicely. Only a few days after a big surgery, his remaining kidney was working, he was breathing on his own again, and it seemed that he was ready to come out of the ICU. We were all hoping for a speedy recovery.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: transparent; list-style: none; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">But our optimism would quickly fade. The last three months of Mr. H's life were spent in intensive care; his hospitalization plagued by widespread infection and heart, lung and kidney failure.  Staple by staple, his incision unzipped in a matter of days. The wound looked as if I never closed it – three inches deep, four inches wide and nearly 2 feet long. The fascia was intact, a single layer of tissue keeping the outside from his ravaged insides. We reinserted the breathing tube, put drains into infected pockets of his belly, and administered strong antibiotics. Unable to eat, we gave him nutrition through his veins — this was what he had wanted.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: transparent; list-style: none; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">Every morning and every evening I would gently remove a 12-foot strip of gauze from the ruined closure, tenderly wash and inspect the bed of the wound, and repack the defect with a fresh, moistened gauze. Weeks went by, and he regained enough strength to turn on his side to allow me to change the dressing – always nodding approval at my attentiveness. I would ask about his pain, examine him for pressure sores and offer a compassionate smile to his wife. I knew his chances of survival were poor and felt crippled by my inability to do anything about it. He was physically deconditioned and clearly depressed.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: transparent; list-style: none; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">Day in and day out I tended to his wound with the same passion with which I closed it. And sure enough that massive incision began to close. My medical school textbook calls it "healing by secondary intention." Thousands upon thousands of cells at the base of the wound would lay down a matrix of tough collagen fibers and proteins. Microscopic blood vessels would creep in and deliver more healing cells that would break down the matrix and build it back up even stronger. Slowly but surely the rising scaffold would bridge the canyon and close the gap.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: transparent; list-style: none; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">It took two and a half months for the final scar to form; there was nothing left to pack. By that time, Mr. H was breathing on his own but was so debilitated he could hardly speak – he didn't seem to have any desire. We arranged to get him home so he could die peacefully in his bed, surrounded by his family.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: transparent; list-style: none; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">A couple weeks later, I received word from his home health nurse that he had died. She ensured me that his family was with him at the very end, and his pain was well controlled. His wound had healed completely.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: transparent; list-style: none; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">As I read that email, I reflected back on the time I spent with Mr. H. I thought about my obsession with that wound, my painstaking focus on closing it perfectly. First with staples, and then with gauze. I wondered why, after a long and complicated surgery, I cared so much about bringing the skin edges together so evenly. I knew the prognosis was poor. I could have let his nurses pack the wound.</p><p style="margin: 15px 0px; padding: 0px; border: 0px; outline: 0px; font-size: 16px; vertical-align: baseline; background-color: transparent; list-style: none; line-height: 20px; background-position: initial initial; background-repeat: initial initial; ">Mr. H brought me face to face with my own imperfections and limitations; every physician has a patient that does. As a surgeon, I realized there are some patients we just cannot save. As a resident, my role in making management decisions in Mr. H's care and taking out his tumor was limited. But whether removing a large tumor, changing wound dressings, or laying a hand on a dying man's shoulder, we do what we can do to the highest degree. Yes, wounds certainly do have a remarkable ability to heal.</p></div></div><a href="http://www.salon.com/2012/11/27/the_patient_i_couldnt_heal/">http://www.salon.com/2012/11/27/the_patient_i_couldnt_heal/</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

The patient I couldn’t heal - Salon.com

I take pride in closing surgical incisions. After a cold blade opens the skin and the internal work is done, the only thing the patient sees, or knows, is their incision. Maintaining symmetry, I use the finest threads and the gentlest instruments in …

Read more »