Book Meme Compilation

For those of you interested in the book meme that has been floating around, here is a compilatioin from Milkriverblog.

Friday Varmit Blogging: Raccoon

This is from a year or so ago. I thought the pics were lost but I came across them while sorting through back up files. I had just built the walkway behind my house, and had to put some sod around it to replace the grass I had removed. I noticed that every morning, the sod would be turned upside down or rolled back and drying out. This happened for about 2 weeks before I finally got fed up and borrowed a game camera to catch this sucker in the act. Raccoons, aka Procyon lotor, are very ingenuitive and are always out for an easy meal. Since they haven't been able to get in our trash yet, this one was doing a natural thing, uprooting my grass for insects. I covered the vulnerable areas and he finally quit destroying my yard.

Don't forget to check out the Modulator's Friday Ark.

Bronchitis Sufferers Can Skip Antibiotics

Via Kevin, MD

CHICAGO Jun 22, 2005 — A study found that bronchitis sufferers who are otherwise healthy do not get better any faster by taking antibiotics. "Antibiotics for the vast majority of people don't seem to make much difference," said Dr. Paul Little, author of the five-year study of patients in England. Moreover, many bronchitis cases are caused by viruses, which antibiotics do not fight...Continue Reading

The article comments that many clinicians and most patients will be probably surprised. To my knowledge, this is not a new finding. Here is what the Sanford Guide to Antimicrobial Therapy(2004 edition), which is a pocket-sized book that most primary care physicians I know have on hand, says about acute bronchitis:

Antibiotics not indicated, use antitussives +/- bronchodilators. Purulent sputum alone is not an indication for antibiotic therapy. Azithromycin (most commonly in the form of a "Z-Pack") was no better than low-dose vitamin C in a controlled trial (Ln 359:1648 2002). Expect cough to last 2 weeks. If fever/rigors, get chest x-ray.

I really think most physicians, are aware of this, but writing a prescription for an antibiotic can be the difference between a pleasant 5 or 10 minute office visit and a 20 minute fight with an otherwise friendly patient in which everyone comes away unhappy. I am more strict about this than most doctors I know, but even I have bad days and give in to the temptation to do the wrong thing for the patient just to satisfy them.

Here is a very discouraging, yet common scenario:
An otherwise healthy patient has a cough for 2 days, this patient is important, busy, and doesn't have time to be sick. He goes to a doctor to try to "treat it early", the first doctor writes a prescription for a Z-pack which is a 5 day course. That gets him to day seven which is halfway through the natural course of a viral bronchitis. He goes back to the same doctor or a different doctor the next day because he is not any better and needs a "stronger antibiotic". Then he gets another prescription for a broad spectrum antibiotic, which he really doesn't need, and finally gets better around day 10-14. Causing the perception that only the "stronger" antibiotic works on them. Here you have, as I see it, a popular pathway to antibiotic resistant microbes.

I love taking care of my patients, but just because they walk away happy doesn't mean I have done the right thing for them or for public health. Sometimes I remind patients that we can put a man on the moon but we can't find a cure for the common cold, they usually either laugh and agree or get more pissed off and don't come back.

ADDENDUM 7/3/05: I noted above and in the comments that I thought most physicians knew that antibiotics did not cure most caes of acute bronchits, but they still heavily prescribed just to improve patient satisfaction as well as their for their own satisfaction. I still believe there is some truth to that, especially among the more recent graduates who were trained in the era of antibiotic resistance. But since then I have had the opportunity to attend a conference where I began to consider that maybe many docs don't know better. The conference was about new drugs. Ketek was the item of consideration and the pharmacologist who was giving the conference stated that we should "just make sure we are treating bacterial infections". At that point one of the physicians mentions the new research findings and then follows it up with "that will put me out of business". The pharmacologist's response was that unfortunately we have enough people who give themselves lung disease by smoking that we won't have to worry about a shortage of patients who fit the criteria for antibiotic therapy. I will also admit here that I have a few friends who are physicians who will treat themselves or their families with new broad spectrum antibiotics, which tend to be readily available as samples, at the first sign of a cold. I mention all this to point out the fact that, physicians as well as the general public need to have this drilled into their heads.

Here is another mention of the subject from Mike the Mad Biologist.

Blog Break

I will be even less productive than usual through the weekend or maybe a little longer. It will take at least that long to convince my wife that I would not rather be married to my computer than to her.

Evolution of Chickens

I did a Yahoo search for "evolution of chickens". This wasn't quite what I expected.

Weekend Beer Review: Abbey Belgian Style Ale

I had not planned to have any beer this weekend, but I had an old friend call me yesterday to tell me he was about half way through a 10 hour drive to visit. Naturally an occasion like this would involve a couple of beers so I told him to pick the flavor. His choice was Abbey Belgian Style Ale. It is a decent beer, with a fruity aroma and a spicy, clovelike taste. It is brewed in Fort Collins Colorado, by New Belgium Brewery, which also produces Fat Tire(more on that later). Their website mentions that the beer tends to go well with dessert. I can't attest to that, but I can say that it is not best served with taco soup.

The Snail's Tales beer for review this weekend is Cooper's Extra Stout

PostSecret

This is a postcard from an artsy website called PostSecret, which has been linked in my sidebar for a month or two but I just now got around to mentioning it. People send in anonymous postcards with secrets they have never told anyone. Some are pretty dark and some are just funny. PostSecret allows anyone to post one pic to their own site, if it is for the purpose of linking. I chose this one because it gives me a familiar feeling. I don't sit and think about my dying moments that often, but something like this sometimes crosses my mind when I find myself wasting time or not enjoying things because I am dreading something else. It usually causes me to start getting out of bed 2 hours earlier everyday or just being extra nice to random people. Another thing that is especially striking to me here is the clear blue sky in the background. My idea of a perfect day is a nice cool sunny day, when the air is so crisp, it seems like you could count the leaves on a tree 3 miles away. Days like these are always good for a change of mind.

Pollinator Friday: Carpenter Bee and Garlic

click to enlarge

This is from my mother's garden. Though I love garlic in my food, I have never given much thought to the plant itself, Allium sativum. I was impressed with this plant's size and its flowers. This plant is about 4 1/2 feet tall and was being worked over by several carpenter bees. The carpenter bee, subfamily Xylocopinae, is divided into large carpenter bees-Xylocopa species and small carpenter bees-Ceratina species. The name carpenter bee comes from the fact that they bore holes in wood to make nests. They can cause significant damage to wooden structures, but they are generally considered to be beneficial insects because of their role as pollinators. It looks similar to a bumble bee, but can be distinguished by its relatively bare shiny black abdomen.Here is some more info on the Carpenter bee.

Don't forget to check out Modulator's Friday Ark.

Book Meme

This is the first meme I have been personally invited to participate in so I cannot refuse. It came from Wayne at Niches.

Number of books I own:

From my seat here in my office at home I counted 283, adding the others propped up around the house, in storage, and at work, probably around 700.

Last book I bought:

Guns, Germs, and Steel: The Fates of Human Societies by Jared Diamond

Last book I read for the first time:

Guns, Germs, and Steel: The Fates of Human Societies by Jared Diamond

Five books that mean a lot to me:

Sociobiology by E. O. Wilson
Beginnings by Isaac Asimov
Time’s Arrow and Evolution by Harold F. Blum
Dune by Frank Herbert
The most recent edition of the Tarascon Pocket Pharmacopoeia

Five bloggers to send this to:

Snail’s Tales
Keats’ Telescope
Artsy Science
afarensis
Niftyfingers

As noted by Wayne who inflicted this meme upon me: You are free to further inflict the meme, kill the meme, or let the meme die of starvation.

Weekend Beer Review: Guinness Draught

This is my favorite beer of all time. It now comes in bottles and cans. They use something called a widget (second pic) and a boost of liquid nitrogen that causes it to foam on opening, giving it that creamy straight from the tap taste (Click here for more details about the widget and packaging). Most people know about this beer and either love it or hate it. I just wanted to say a couple of things about my experience buying this beer.

I usually get the cans which come in 4-packs and are 14.9 oz each. This is another example of the extortionist prices I have to pay for good beer here, it usually costs me about $7.50 per 4-pack. The other liquor store which is a little closer charges nine-something.

As many of you probably know, the word draught is a variant of the word draft, and is pronounced dräft. When I go to the store here, I just call it “cans of Guinness” rather than saying the word draught correctly; or incorrectly pronouncing it the same as drought, like most do. A friend warned me that if I walked in there talking like that, I would be lucky to get out of there with any beer at all. I can’t complain though, because its not really a problem and I’m sure a lot of people go through a lot more for a lot less. Brilliant!

The Snail's Tales Beer for review this weekend is Efes Pilsener from Turkey

Arachnid Friday: The Blood Suckers

Most of you science types, when you are on your toes, will correctly refer to ticks and mites as arachnids instead of insects. I have seen a few people slip up lately though so I thought I would post my only tick pics to make this point and to provide a little medical info. I believe this is a Wood Tick which includes the American Dog Ticks and is in the family of hard ticks known as Ixodidae. The other family is Argasidae, or soft ticks. There are many important diseases that are spread by ticks. From my medical microbiology text, here is a list of the diseases followed by their etiologic agents.

Rocky Mountain Spotted Fever--------Rickettsia rickettsii
Tularemia--------Francisella tularensis
Lyme disease--------Borrelia burgdorferi
Ehrlichiosis--------Ehrlichia species
Q fever--------Coxiella burnetii
Colorado tick fever--------Orbivirus
Relapsing fever--------Borrelia species
Babesiosis--------Babesia microti
Tick paralysis--------Neurotoxins from tick saliva

Luckily most of these diseases can be effectively treated with doxycycline. The exceptions are Tularemia for which streptomycin is effective, Colorado tick fever which is a viral illness and requires supportive care, Tick paralysis which improves with removal of the tick along with any retained mouthparts, and babesiosis which requires a combination of drugs geared toward protozoans.

My personal experience with tick bites has changed since my arrival to the world of private practice.
In residency most commonly it went like this: You have a very sick patient in the hospital whom you have been working on for several days, and is not getting better or is declining. Amid all the head scratching and pimping someone remembers the possibility of tick-borne illnesses which can have a large range of systemic manifestations. Someone goes back and asks about a history of tick exposure, and at that point even if the only clue is that their grandmother was bitten 4 weeks earlier, you are going for it and ordering an extensive serologic work up (aka tick titers). Then the results usually turn up negative a week later, after you have begun empiric antibiotic coverage and the patient is dead, better, or at a larger instituion.

The new scenario for me is someone comes to clinic after having been bitten by a tick or having seen a tick and may have had a local reaction to the bite but no other symptoms and they are worried about Lyme disease. Then we have to talk about the risk/benefit of using prophylactic antibiotic therapy which is generally not recommended except possibly in areas where it is endemic. Sometimes I have someone who has a tick exposure along with some systemic symptoms such as fever or rash. Usually I give them a prescription for doxycycline and close follow-up.

My pics are not that great, but here are some great tick glamour shots from Artsy Science.
Now for the obvious but necessary defensive statement: Remember, this is only for fun and should not replace a visit to a physician if you are ill. Also note that doxycycline is usually not recommended for children.

Don’t forget to check out Modulator’s Friday Ark.