Sunday, September 17, 2006

Leaving Leave of Abscence

Like any corporate merger, eventually the smaller guy loses out.

And in the most cliché, but most sincere, meaning possible, I didn’t lose anything I gained an alliance.

No seriously, the Blog Alliance is a much better blog and is where all my energy is concentrated now…for blogging that is.

Leave of Absence was created one intoxicated night to compensate for DJ’s Greatest Novel blog. He quit posting for some time and I haphazardly tried to fill the gap. Now I just don’t have time to keep up two postings.

I appreciate anyone who ever read my postings, but you can still read them and more at www.theblogalliance.blogspot.com.

Godspeed.

Sunday, July 02, 2006

Congrats to the New AP

Congratulations Dad.

Monroe Public Schools and Monroe High School (MHS) hired a highly qualified person to take over for the vacant Assistant Principal (AP) position. Although the mathematics department is losing its chairperson and its best teacher, you are the right fit to join Coach Carducci and his team at MHS.

I know you are extremely happy with this new job, but I imagine 31 years of teaching in the classroom are going to be hard to leave. It will be hard to say good-bye to your “baby”, AP Statistics. I know it will be hard not to go to B-211 every morning and it will be a shame that room will not have the posters adorning the walls.

However, I imagine your new office will be heavily influenced by your classroom décor. Hopefully the Indiana Jones poster makes it to the new office and I’m sure everyone would like your infamous Pink Floyd “poster” to make the trip as well.

I know the faculty and students will have someone who can relate to them and help them out when needed. I also know that you will work hard to get done what needs to get done and not over-step your bounds as a first year AP. I think suspending your first kid will be slightly different than grading papers, but you’re ready for that responsibility and power…unlimited power. Just joking.

I’m really happy for you and proud that you are the new AP. You’ll continue to do what you’ve always done and what you’ve taught me: work hard, be honest, always be there for other people when they need it and most importantly have fun and enjoy what you do. When you love what you do, you’ll never work a day in your life. (I hate that saying though.)

If I can offer any advice it is this. It didn’t really work for me in the past, but it is worth a try if you are stuck in a bind. If you ever make a mistake and some people start to get down on you about it just say this: “Hey, if you wanted it perfect you should have hired Jesus.”

Congratulations on becoming the new AP at MHS.

Tuesday, June 20, 2006

Go Ahead, Call Me

Oh the cell phone gods are pleased with me. I think the people who call me are as well. Although I was recently told that the whole “Andy never calls anyone back” talk has been over-played now for roughly two years. That’s nice to hear.

Regardless, this is one New Year’s resolution I have really worked hard to keep. I’ve done a great job so far. Just looking at my last 60 calls, I answered 19/39 on the first call.

That might not sound too great, but hold off on your criticism. My phone shows repeat missed calls from the same person, but it does not show repeat answering if the same person calls me.

For instance, Higgins called me four times on the 26th of May and I answered all of them on the first call. However, that shows up as only one answered incoming call.

My parents called me four times this past Friday 5.08, 5.27, 5.49 and 6.19 pm. I was in the radiologist’s office waiting to see if we were going to have to board this patient for an emergency appendectomy. My phone shows four missed calls, but when I answered two of their calls on Saturday it only read as one answered call.

Finally, Saturday morning DJ called me at 4.41, 4.42 and again at 4.42. He was sitting on the couch next to me, but thought it would be fun to reenact the touching Saved by the Bell scene between Zach and Zach’s father. I had answered the three times before, but again it looks like I only answered 1/4 calls from DJ, when in fact I answered 3/6.

All the examples are just given to illustrate that the 19/39 is probably not entirely accurate. I answer my phone and I call those people back almost all the time. I feel very good about my progress and I’ll continue to work, but I feel as if I have reached my goals.

The voice mail message has changed as some of you have noticed. Why? Crazy residents who need to get a hold of me 100 times a day. The resident wasn’t happy that I didn’t leave my pager number on my voice mail. I switched it for this person, but I’m gonna go back to the silly German/English message soon. Crazy residents make me want to drink lots and lots of alcohol. But I generally like to drink lots and lots of alcohol, so why should I be mad at the resident for making want to do this? Because she drives me bananas.

The sh*t is tornado. T O R N A D O.

So the phone answering and calling people back is going great. What about my other Resolutions?

Swearing? Pathetic. F**k it.
Eating healthy? I had a cheeseburger, fries and an apple for lunch 3/7 days last week.
Exercising? Not too bad, but not too good either.
Being a better person? That’s probably not gonna ever happen.

Saturday, June 10, 2006

Free Pens and Poor Research

The Truth About the Drug Companies by Marcia Angell is not a new book. Even the epilogue is roughly a year old and now I can finally afford the paperback print. I’m just getting around to reading it and this week I was able to witness Angell’s phrama critiques in person.

Side note: for those of you who don’t know Marcia Angell is a brilliant woman and physician and a former editor of the New England Journal of Medicine. She became one of the most hated women in the world in the mid to late nineties when she illustrated breast implants did not cause breast cancer and that the class action law-suits against physicians and the companies producing the implants were not legitimate.

In Angell’s epilogue she discusses the controversy of the COX-2 inhibitors (Vioxx, Celebrex and Bextra). Studies have repeatedly shown that COX-2 drugs are not much more gastrointestinal (GI) protective than normal non-steroidal anti-inflammatory drugs (NSAIDs) and moreover they actually increase the risk of myocardial infarctions (MI) or heart attacks.

Side note: COX is an enzyme called cyclo-oxygenase. There are two isozymes (similar enzymes chemically, but with different functions). COX-1 has “housekeeping” properties in the GI tract. Essentially it helps protect against too much acid production and subsequently GI ulcers. COX-2 is entirely involved in inflammatory reactions. NSAIDs block both COX-1 and COX-2 enzymes, which increases the chances of ulcers. Hence, COX-2 inhibitors were created to theoretically decrease GI side effects by only blocking the COX isozyme involved in inflammation. This theory has been verified to be incorrect.

The ineffectiveness of COX-2 inhibitors was best shown with the Merck drug Vioxx. However, because Merck funded the original studies of this the adverse reaction results were omitted. A few years later, the research was reviewed and Vioxx was not more protective against adverse GI effects, such as a bleeding stomach ulcer versus traditional NSAIDs and more importantly it increased the risk of heart attacks in patients taking this medication.

The FDA advisory panel dragged their feet and then eventually pulled the drug from the market. After that the other COX-2 drugs, Celebrex and Bextra (both Pfizer products) were reviewed. These drugs carry the same cardiovascular risks but to a less extent and were allowed to continue on the market by the FDA panel. The final vote of the panel was 5-4 and six of the nine members had some sort of affiliation with Pfizer.

Fortunately I had never really had any interactions with drug reps, because when they find out I’m a medical student they ignore me.

This past Wednesday I thought I would have an early day because there were only two colonoscopies in the AM and then the day was over. Wrong. Consults and an Infectious Disease (ID) conference kept me at Henry Ford Wyandotte Hospital for the whole day and then some. (Sorry Ozkar I got home so late.)

Side note: for those of you who don’t know who Ozkar is, he’s my four-month-old kitten. He rules.

Outside of the conference rooms there were drug reps with nice pens promoting their products. Many medical students and physicians have began a group called, “Say No to Free Pens” and boycott drug reps and their handouts. The drug reps are creepy salespersons most of the time and often lie about their products. But they also give free samples to practitioners and these physicians can use them to help individuals who do not have insurance or their coverage is poor and the medication is too expensive. So these companies are not all bad and I have no problem taking their free pens.

The conference discussed antibiotic resistance and new antibiotic medications. There is an increasing concern in the ID community and in medicine in general about resistance to antibiotics. One serious bacterium has become resistant to most medications: Methicillin-resistant Staphylococcus Aureus or MRSA (pronounced mur-sa). MRSA infections were once thought to be only nosocomial (hospital) infections, but now is being found more and more in the community setting. MRSA is resistant to almost all medications and the last line of defense is an antibiotic called vancomycin. However, there have now been six cases in the world in which MRSA is now resistant to vancomycin. Four of these cases have been in Michigan.

A recent study was done to see if a new drug produced by Pfizer, linezolid (Zyvox), was more effective at treating MRSA infections than the traditional vancomycin treatment. The study was funded by Pfizer and found that linezolid was just as effective and perhaps more effective than vancomycin in treating MRSA.

The drug reps were quick to point this out and even a leading ID physician at Henry Ford Hospital in Detroit commented on the importance of this study. However, it was a family physician in the crowd who pointed out the major flaw in this study.

The study did not use the proper dosing regimen of vancomycin and therefore the drug would be less effective in general. Oops. The drug reps did not mention that nor did the study. Luckily, linezolid has a low side-effect profile and serious adverse reactions such as a MI have not been seen.

This is another example similar to the COX-2 studies of a pharmaceutical company influencing the research and promoting results that are not entirely accurate. It’s frustrating as an aspiring physician and insulting to think that these companies believe extravagant advertising can substitute for poor scientific research.

I still took several of these reps pens, but every time I go to write with it I’ll now that it is not the miracle drug Pfizer has tried to say it is.

Tuesday, May 30, 2006

Nerd Alert!

As I got done shaving today and looked in the mirror and I saw I still have acne. I’m 25 years old. Then I thought about all my other physical imperfections and my personality traits and I realized I’m a nerd.

The terms nerd, geek and dork are three terms commonly thrown around as if they are synonyms. They aren’t.

A nerd, despite what some might say, is not a Never Ending Radical Dude or hair on an elephants butt. Nope, a nerd is a person who has distinctly different personality traits coupled with certain physical attributes.

A geek is similar to a nerd, but just more socially awkward.

Finally, a dork lacks social abilities altogether. He/she has a much more severe case of geekness.

It would be interesting to know if these three terms are a continuum or if they are three distinct personalities. For instance, could a nerd progress to a geek or dork. Interesting. I don’t know?

So I’ve developed a screening test to determine if one is a nerd, at high risk for being a nerd or at low risk. If others have told you that you are socially inept and you score in the nerd range, then you may be a geek or a dork.

Here’s the NSA (Nerd Screening Assessment):
Physical Scale
1. You are over 23 years old and still have medical problems commonly seen in adolescence, i.e. acne. (This excludes life-long chronic disease that are diagnosed in children, i.e. epilepsy, heart murmurs, etc.).
2. You wear glasses. (You do not get a point if you use contacts at any time. So if you wear glasses only at night while you are in your house, this does not count).
3. You have some form of orthodontics in your mouth, i.e. a retainer.
4. You began puberty later than the rest of your peers. (Sure this is out of your control, but it seems to correlate well with nerds, geeks and dorks. It could be what caused the social inadequacies, so this may be a chicken or the egg argument. Regardless it made the screen).
5. If you are a male and you have been beaten-up by a female (at any point in your life. However, if you have been beat-up because the female was defending herself, this does not count. If the latter event has happened, you need to take the ass-hole screening test).

Personality Scale
1. You were 20 years or older the first time you had sex. (This means you made it through two full years of college without intercourse).
2. You wake up early to watch Saved By the Bell, or you own all five seasons (yes even the awful episodes with Tori).
3. You skip out on parties or gatherings because you prefer to be alone. (This can be done 5-8 times within a calendar year. You only receive a point if you have done it more than eight times in one year).
4. You are out of college or are over the age of 25 and you have cardboard cutouts of cartoon characters or characters from movies in your living room, i.e. Homer Simpson or Chewbacca).
5. You dislike all sports or athletic events. (This includes any sport that could potentially be on ESPN, minus poker).

Each yes to one of the statements counts for one point. A female can only receive a maximum of nine points because number five on the physical scale only applies to male.
If you had 8-10 points – you most likely are a nerd.
If you had 5-7 points – you are at high risk for being a nerd.
If you had below five points – you are at low risk for being considered a nerd.

I scored perfect on the physical attributes and very high on the personality characteristics scales. I have a total of nine points, which does put me into the nerd category. I’m just thankful my friends don’t mind being around a nerd…or do they?

Are you a nerd? Take the screen and find out.