Head Louse: Pediculus humanus capitis

I previously posted pics of these human head lice about 6 years ago.

Now I have a new toy sitting in my office waiting for an opportunity to get some better pictures of small critters of this sort. Today I plucked this head louse from the head of a little girl who was brought in to my office to see me for a cold. My astute nurse pointed out the fact that she had lice so I grabbed one to view under my new microscope. The first part is at the lowest power then the final two parts are at a higher power. The final part was done when it was still alive and its innards were still moving. I used a Celestron LCD digital microscope for the video.

And don't forget to check out Modulator's Friday Ark!!

A Rotoscoped Animation of Rotary Nystagmus Due to BPPV

A few years ago when I made my claymation version of the Dix-Hallpike and Epley Maneuvers for BPPV, I also made a lame attempt to show an example of rotary nystagmus with a claymation eye but that didn't turn out so well and I forgot about it. I have now returned to the subject but with a new twist. I used some new animation software to create an animation of rotary nystagmus. I also threw in the claymation portion of the Dix-Hallpike video with a few modifications to parallel the test findings. It turned out even better than I expected it to. I used Toon Boom Studio 5 to rotoscopically animate a normal close-up video that I made of a face with one eye in the frame. Then I manipulated the eye layer of the drawing to simulate the rotational movements of the eye associated with BPPV. Here is the final product:

Knucks: The Official Handshake of the 2009-2010 Flu Season

Yesterday, while preparing to go a football game, I became excited, thinking about all the old friends I would see. Then I thought about all the hands I would be shaking. After hearing several reports of local influenza activity, I became just a little worried about getting the flu myself. That's when I had the idea; you'll get nothing but a set of knucks from me brother. So I decided to make an image to help spread the idea. I know I am not the first to think of this as a more sanitary version of a greeting or high five, but I couldn't find anything on the web presenting it this way, so here you go. If you prefer the term fist bump, here is a blog sized version and here is the larger version. Feel free to pass on these links or even to hotlink the images if needed.

Please keep in mind, I am not trying to add to the hysteria we are facing with the novel H1N1 (swine) flu (I've already dealt with plenty of that). I just think that during this time of year, it is good to minimize unnecessary contact, wash hands frequently, and to keep your hands out of your eyes, nose and mouth especially when you have been out in crowds.

The Good News of Health Care Reform

I got the idea for this cartoon after recently attending a statewide conference for family physicians. During one of the gatherings a senator had to field some questions from some of the physicians regarding their patients concerns over euthanasia and 'death panels' as part of the new healthcare system. My initial thinking while formulating the above scenario was mocking the hysterical reactions to health care reform, but it also reflects my concern for the inefficiency we might get if we let the government take over our health care.

An Ode to Floaters

I have had floaters for long as I can remember, but they have never really been that bothersome until my last visit with my ophthamologist. My prescription was increased a little and since then, it seems like my floaters have been getting in the way just a little more often. That is what made this scene from Family Guy especially funny to me when I saw it for the first time a few nights ago. It is from the fifth season, episode 11: The Tan Aquatic with Steve Zissou, which first aired on 2/18/07. This is one of the many scenes from this show that have me convinced that the writers of this show are geniuses.

Here is another link to the scene if the YouTube version goes down.

BrainGate's First Test Subject Dies at 27

I hadn't heard any big news lately on BrainGate, which is a type of neural interface system mentioned several times here previously. That is until a few days ago when I saw that someone had come to this site with the Google search term "Matt Nagle cause of death". Then I followed that same path and found an obituary from the Boston Globe, stating that he had died on July 16 from sepsis. There are no other details relating to the cause of death. The article does mention that the brain implant had previously been removed, from that statement I only assume that his death was not related to that particular experiment, but more likely to one or some of the many comorbidities of quadriplegia. It appears that his death is now being investigated as a homicide.

I give my condolences and best wishes to his family and friends.

Purple Pill Stop Motion Video

This is a brief video I made using my good old Sony Cybershot. I wanted to make a video running at 30 frames per second and to use my Sony Acid Music Studio software for a video. This was the first time I used the music software to make a tune and synchronize it with a video; it was surprisingly easy to do. I used quicktime pro to make the initial video from all the stills. Then I converted the video to AVI format for use with Windows Movie Maker, with which I added the titles. Next, I opened the video with the acid music studio software and created the music from about 7 or 8 sample loops, then I saved the audio file and added it to the video using windows movie maker.

The star of the video was a promotional purple pill clock given to me by a Nexium representative. It had been lying around the house and my kid had claimed it as his own, but he let me borrow it for the production. Nexium is a medication in a class of medications known as proton pump inhibitors which are very effective for symptoms of GERD and problems related to gastric acid secretion.

Click the above picture or here to see the small version (1.6 mb, .wmv, 32 sec), large version (3.6 mb, .wmv, 32 sec), or you can see it on YouTube.

This video and my other stop motion, claymaion and time-lapse videos can be seen here.

Grand Rounds Is Up

Grand Rounds volume 3 number 22 is now up at Pure Pedantry, presented in excellent fashion with an Oscars theme so go check it out.

A Dizzy Diagnosis: Benign Paroxysmal Positional Vertigo

click to view video 

BPPV is a disorder of the inner ear which is a cause of vertigo in approximately 20% of patients who present to their doctor with this complaint. This occurs when otoconia are dislodged from their usual position within the utricle and they migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position). This Diagnosis can be made using the Dix-Hallpike Test and is frequently treated by use of the Epley Maneuvers.

In my practice, I make this diagnosis more often than many of my peers, mostly I think because I look for it. To me, it is about the only bright spot when dealing with the chief complaint of "dizziness". This is because treatment is so effective and no medicines are required. Patients have called back in a day or two just to tell me that it worked because they are so surprised. Honestly, when I first started doing it, I was surprised as well. It seems like most of the family practitioners that I talk to have heard of this simple procedure, but most of them never try it because for some reason it seems too magical or tricky. For that reason I have created this claymation video to serve as a visual aid for those who are interested. Keep in mind that this is not my specialty, this is not intended to replace a visit to your doctor if you experience vertigo, and you shouldn't try this if you don't have the training to know when you shouldn't do it. This is just a fun little video to give you very basic idea of how it is done. I will gladly accept any criticism of the technique, but don't expect me to change the video because the patient has been thrown out. Enjoy.

Claymation Eye Movement

7 sec., 1.5 Mb, QuickTime

This video was made during the same session as the Dix-Hallpike and Epley Maneuver video was made. I was going to try to demonstrate Rotary (torsional) nystagmus which becomes apparent with a positive Dix-Hallpike test. However the clay was too soft and the toothpicks in the back of the eye kept moving around instead of the eye moving properly, so I just did the best I could at making the eye look around and look as real as possible.

Being Overweight (but not obese) Provides "Cushion" in Motor Vehicle Accidents

Via American Family Physician:

A recent volume of the American Journal of Public Health reports that the best Body Mass Index for a man to survive a motor vehicle accident is around 28, which is overweight but not obese. Having a BMI of less than 22 (normal or underweight) or greater than 35 (30+ is obese) was associated with a greater likelihood of fatality. The study did not find an association between BMI and risk of fatality in women.

I was not able get the entire article, so I am unsure of all the proposed mechanisms of this benefit, but it appears that researchers are attributing this advantage of being overweight to a "cushioning effect". Though it seems obvious that having extra adipose tissue would provide a some protection from mechanical injury, I would also add that there may be a metaphorical "cushion" in terms of having metabolic reserve in the event of a prolonged recovery period from severe injury.

What is sNN0031?

NeuroNova, a Swedish biopharmaceutical company has been engaged in developing drugs designed to stimulate neurogenesis. One of these drugs is sNN0031 which, according to press releases, "is an active ingredient in a drug approved for use in humans, but not for brain disease and in a form not suitable for this type of treatment." In rodent models, the drug caused movements to normalize within 5 weeks and remained so through the 10 week follow up period. Human trials are planned for this year, but I am not sure if they have yet begun.

That is what I do know about sNN0031. What I don't know is the name of and indication for the drug already in use for humans, which is called sNN0031 when given intracerebrovascularly for Parkinson's Disease. I initially thought this would be an easy search on the net but so far all I have found is that the drug's true identity has been "undisclosed".

Both educated guesses and wild guesses are acceptable here.

This drug trial was brought to my attention in the Feb/Mar Seed Magazine article, The Reinvention of the Self .

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.

Medicinal Maggots Update

Here is another story from Reuters and Yahoo Oddly Enough:

LONDON (Reuters) - Phyllis Hulme's family and friends were aghast when she told them doctors planned to put maggots on her leg ulcer....Read on

More on Medicinal Critters

Laughter is the Best Medicine......Usually.

From NewScientist: Laughing Helps Arteries and Boosts Blood Flow

Laughing appears to be almost as beneficial as a workout in boosting the health of blood vessels, a new study suggests.

"Thirty minutes of exercise three times a week and 15 minutes of hearty laughter each day should be part of a healthy lifestyle," says Michael Miller of the University of Maryland Medical Center in Baltimore, US, whose team has shown that laughter relaxes arteries and boosts blood flow. Read more

This does not appear to be the case for asthmatics however, at least for pediatric patients according to this related story from NewScientist: Laughter is Major Asthma Trigger

Laughter is more likely to trigger an asthma attack in a child than exercise or smog, according to an Australian study.

Richard Henry and colleagues at the University of New South Wales analysed all cases over a six-month period of children who were taken to the emergency department at Sydney Children's Hospital because they were suffering from an asthma attack. Almost one third had what Henry calls "mirth-triggered asthma". Read more

Blood Pressure Demographics

Blood pressure demographics: nature or nurture ... ... genes or environment?
BioMed Central: "Hypertension is a growing worldwide problem associated with an increased risk of cardiovascular morbidity and mortality. However, the rates of prevalence of hypertension are higher in some populations than others. Although ethnic and genetic factors have been implied in the past to explain this, the environmental influence and psychosocial factors may play a more important role than is widely accepted. Examining the non-genetic influences in future hypertension research may be necessary in order to clearly define the local blood pressure demographics and the global hypertensive disease burden."