Joss Whedon, I’m calling you out!

***This post includes Dollhouse spoilers. You have been warned.***

I was watching the Dollhouse episode entitled “Hollow Men” (2×12) the other day. And there was this scene. You probably know the one I’m talking about. It involved lots of needles. It involved cerebrospinal fluid. And it involved absolutely indefensible pseudo-medical ridiculousness. It looked a little like this:

Now, at first it didn’t really occur to me to say anything about it. I just cringed in the way that I usually cringe at complete medical BS, and mentally started preparing my usual speech to any of my patients who might have seen the episode about how “television is absolutely nothing like reality, so please bear with me while I try to figure out whether you have meningitis or not.”

And then I saw this blog post:

“That’s why Boyd the Dollmaster lured her and company out to Rossum — to harvest her spinal fluid. And let me tell you, based on that spinal tap scene, I hope I never have to have that procedure in my life. Because, yeesh, it looked painful.”

And I thought, great, Joss Whedon…lumbar punctures the way they happen in reality aren’t scary enough? Now we have to make people think we’re going to lower them screaming onto a bed of giant horse needles? Seriously? My job isn’t hard enough? There’s not enough anti-doctor sentiment running around?

Now I have to convince my overly-to-the-point-of-unnecessarily-anxious patients that, even though spinal taps are certainly no fun, they’re not actually about to be inserted into a hyper-futuristic-and-evil-looking torture device!

And then I remembered…

I have a blog now.

Yes, ladies and gentlemen, it’s time to buckle up. Because what we have here is another occasion in which a writer sacrifices any semblance of medical plausibility in order to grab at false drama. And I’m going to call him out.

(Ok, you knew I had to drop that in here somewhere.)

What is cerebrospinal fluid?

Cerebrospinal fluid (CSF) is a watery substance that surrounds the brain and the spinal cord. It is produced by the choroid plexus in the ventricles of the brain, circulates through the blue area you see below, and is absorbed into the venous circulation through structures called arachnoid villi in the skull.

The function of cerebrospinal fluid is to support the metabolism of the brain while providing a cushion against mechanical injury. It’s what separates your soft brain tissue from your hard skull so you don’t bruise it every time you shake your head in despair at the medical misinformation you’re seeing on the TV screen.

(And it’s apparently a repository for imprint-immunity. ::shrug::) PS: That part I could suspend my disbelief for. It wasn’t great medicine, but the hand-waving was perfectly adequate for what they were trying to do, in my opinion.

What is a spinal tap?

A spinal tap, also known as a lumbar puncture, is a bedside procedure in which a doctor uses a needle to draw cerebrospinal fluid out of the space that surrounds the spinal cord. (Whedon got at least that much right.)

So what’s your problem?

That was practically the only thing he got right. Ok, that and kind of the general color of the “cerebrospinal fluid” that ended up in the syringes. (Although it was too dark. Cerebrospinal fluid isn’t THAT yellow. Maybe she had xanthochromia? Okay, we can go ahead and say that the Active architecture is responsible for that. ::sigh::)

Here are my main problems with the sequence:

Boyd: “The entire process was designed to extract your spinal fluid without killing you.”

Really, Boyd? You went to the trouble to design a whole process to extract CSF without killing the subject? Really? Wow. How ingenious of you. Was Topher in on it?

You know, even as a supervised medical student (the lowest of the low, training-wise…ask any nurse in the universe), I still never killed a patient with a lumbar puncture. As a matter of fact, none of my classmates did either. Or my residents. And we did a good number of lumbar punctures during my training.

The normal spinal tap procedure is perfectly adequate for life-preservation purposes. You didn’t have to design a new, overcomplicated device for the sole purpose of doing a simple bedside procedure.

But thanks for your thoughtfulness.

Basic anatomy

Okay. We’re going to start with that needle array. Ignore the ridiculous size of the needles; we’ll attribute that to TV-screen needs. Scroll up and take a close look at that picture at the top of the post. Where the heck do the Evil Rossum Folks think the spine is?

As far as I can tell, here’s where the needle array would hit Echo’s back:

And…um…here’s where a spinal tap is actually supposed to take place:

Only there?

Yes, only there. That’s the place you do a lumbar puncture: in the space between the vertebrae of the lumbar spinal column. Take a second, and put your hands on your lower back. Feel the top of your hips? Good. Move your hands to the center of your back until you feel your spine. That’s about where a lumbar puncture is supposed to happen.

Too much higher and you risk hitting the spinal cord, which is the long, thin extension of nervous tissue that serves as the communication wire between the brain and the body.

Actually, it’s lucky that Boyd and his Evil Rossum “doctors” have no idea where the spine is. Those needles were seriously hitting her all the way up to the level of her shoulders! Paralysis, anyone?

Positioning

Although, to be honest, even if the needle array was in a straight line directly beneath Echo’s spinal column, she’d probably still be all right. The needles would never get past her vertebrae.

The vertebrae are the bones that protect your spinal column from injury. And what’s a spinal tap if not a carefully controlled, therapeutic injury?

In order to get to the place where the CSF lives, you have to direct a needle BETWEEN the vertebrae of the spinal column. It’s not as easy as it might seem. And you certainly can’t do it blindly, by positioning a needle under a person and then lowering the person onto the needle. That’s just absurd.

This is a picture of a needle being directed between the vertebrae of the lumbar spine. The person in the picture is facing to your left. The needle is coming in through the person’s back.

That needle position would probably get to the CSF. But you’d never be able to do that to Echo, not the way she was lying on the table. Flat. On the table.

I’ll show you a couple of pictures of lumbar punctures from various educational materials. See if you can catch a pattern that Echo does not follow.

Every time you see a person getting the procedure done in these pictures, they’re CURLED UP.

That’s because the vertebrae, in their general orientation, are really well-positioned to protect the spinal cord from any intrusion. You have to change their general orientation to get any kind of access at all to the spinal cord.

Usually you ask a patient to curl up on their side, or dangle their legs over the side of the bed and curl their chest to their knees. This opens up the vertebrae in the back, at least a bit. Enough to pass a needle through. Hopefully.

Since Echo is flat on her back, I’d bet that the bony processes that you see to the right of the needle-position picture would block any intrusion that the needle array could possibly threaten. You know, if the needles were even positioned between the vertebrae. You know, if the needles were even positioned under the spine.

Infection control

The Evil Rossum “doctors” are sticking needles (supposedly) into Echo’s spinal column. To extract CSF from a space that communicates with Echo’s brain.

Luckily, they’re using proper sterile technique, so she doesn’t get an infection in that very attractive-to-buggies culture medium.

Oh wait. No, they aren’t. They’re wearing bunny suits and nitrile gloves. Those aren’t sterile materials. But we can forgive that; they’re cheap costumes and it’s a flipping TV show. And anyway, even I agree that it’s important to have “hands of blue” at least somewhere in your Evil Corporation.

So we’ll let that one pass, because at least they’ve properly prepared the site (oh, sorry, sites) of the puncture(s), making sure the overlying skin has been cleaned so the needle doesn’t carry bacteria with it into the spinal column.

Oh, wait. No, they didn’t. As a matter of fact, it even looks like several of those needles are going right through Echo’s bra-thingy. Okay. Not sterile. At all.

Okay…at least they’re wearing masks and caps. I guess that’s going to have to be good enough.

No local anesthesia

We all know that Joss Whedon likes to torture his characters. (And emotionally torture his audience, when he can manage it.) So of course Boyd’s Evil Rossum “doctors” aren’t going to bother with local anesthetic when they’re performing a painful procedure.

But in real life, you numb the area before digging around with a needle. It’s just what you do.

Okay, okay, I get it. Joss Whedon did absolutely no research on lumbar punctures for the “Hollow Men” episode, and as a result, he’s made your job harder and you’re annoyed. This post is getting really long.

Yeah, it is. Thanks.

So. In summary.

Boo to Joss Whedon for potentially scaring the crap out of my patients for the sake of a big, dramatic torture scene that makes no medical sense whatsoever. It’s unnecessary. Patients already have enough scary stuff to deal with.

And on my end, it feeds right into the exceedingly popular “doctors-are-evil” stereotype that I have to fight every day in order to even start doing my job.

Lumbar punctures are not fun for the patient, and are also not fun for the physician. But they’re not as bad as Joss Whedon wants you to think they are. So please don’t freak out if you have to get one.

Sources:

Junqueira, Luis Carlos; Jose Carneiro. Basic Histology: Text and atlas. 11th ed. McGraw-Hill, 2005

Pictures:

http://www.walgreens.com/marketing/library/contents.jsp?doctype=10&docid=000303

http://stolemyhubcaps.com/movietxt.htm

The contents of this site, such as text, graphics, images, and other material contained on the Site (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Site!

If you think you may have a medical emergency, call your doctor or 911 immediately. This blog does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by this blog, or other visitors to the Site is solely at your own risk.

The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an “as is” basis.

If you use this as if it were real medical information, I will be incredibly upset. But I still won’t lower you onto a bed of horse needles. Because that’s just silly.

When Your Audience Might Know More Than You Do

“My mother has rheumatoid arthritis, and there’s no way she could pick a lock like your character did in chapter twelve!”

“There was an article on that exact condition in the March 2003 issue of the New England Journal of Medicine, and it said that. . .”

“Dude. I don’t know much about osteogenesis imperfecta. . . but “osteo” means “bones”, and you’re talking about the kid’s pancreas. . .”

Using real-world diseases in a work of fiction has a large number of potential pitfalls. Here are a few tips about how to make your pestilential plot point a little more plausible.

Research is your friend.

If you’re going to use a specific, known disease in your story, seriously consider doing a fair amount of research. Chances are, some of your readers will have that condition, or their mothers will, or they’ll be physicians or nurses or physical therapists, or other people who know their stuff. They’ll know if you’re making things up, and they won’t hesitate to call you on it. It might seem like a lot of extra work to make sure you don’t lose those readers, but in my opinion, it’s worth it.

If you’re not swimming in spare time that you can use for research, though, there are a couple of tricks to help you avoid the otherwise-nearly-inevitable eye-rolls.

Start from the symptoms, then mix-and-match.

You need your character to have trouble breathing. You need a vague, plausible disease process to serve this plot point, but that’s all you need; the story itself is elsewhere.

(1) Pick an organ system.

Points to you if you picked the lungs. Bonus points if you also thought of the heart! (I plan to do a series of posts on the various organs and what they do, but it’s probably going to take a while.) Let’s go with the lungs, for now. Disease-of-the-lungs = breathing problems. Good. Plausibility meter just ticked up a notch.

(2) Pick a disease type.

What you choose for this will depend on the way you need the disease to act.

Let’s say that based on your story, your character needs to develop their lung condition slowly, and the lungs need to degenerate in a way that can’t be cured, just delayed. You’d probably want to go with an autoimmune disease for that one. Autoimmune-disease-of-the-lungs. Okay. Another tick of the plausibility meter.

(I’m also planning a series of posts on disease types [infection, mechanical injury, autoimmune, cancer, etc.] and how they generally act as a class. But if you’re in a rush and can’t wait for me to churn those puppies out, find your nearest friendly medical library; the librarians there will probably be able to help you out. Medical librarians rock. Shout-out to medical librarians!)

(3) Wave your hands in a distracting manner.

You’re a writer. You know how to do this. You have a character with an autoimmune disease of the lungs. Now dazzle your audience with your shiny description of his struggle to become a world-class athlete before his lungs crap out on him! Good job; most people will now read right through, because there’s nothing silly, easily disproven, or pseudo-medical in your prose that will snag their attention away from the story you’re telling.

If you have a disease in mind, but it’s not exactly right. . . back off on the specificity.

If you’re too specific with the disease you’re using, you’ll run into a couple of problems if you start taking liberties.

(1) Your knowledgeable readers will roll their eyes at unexpected things.

Reader- “Hey, I have Parkinson’s, and I haven’t been able to get up out of a chair on my own for five years! There’s no way he would be able to get out of the house in time!”

(2) You’ll spend way too much time describing how your character’s disease differs from the actual disease.

Author- “Yeah, it acts just like Guillain-Barré Syndrome, but it develops slowly, over a period of years and she was born with it instead of contracting it from. . .”

Reader- ::snooze::

Very few people will fault you (or probably even notice) if you take some small liberties with a disease process in your work of fiction. As long as you stay as close to plausibility as possible, you can mold the disease to fit the story. But the more you play with a specific process, the more chances you have to really get your facts wrong. People can only suspend their disbelief so far before the suspension cable snaps.

If you’re going to play with the disease process, consider avoiding the actual disease-name-drop. Vagueness can be your friend, in certain circumstances. But don’t cross the fine line that separates artistic-licensed vagueness from information-withholding. You’ll lose readers that way, too.

Information-dumps will get you in trouble.

If you don’t know much about the disease, your info-dump will be a minefield. Avoid the temptation to describe what you think is going on in your character’s body. Focus instead on the symptoms he experiences, and his reactions to them. And make sure everything you say moves the story forward in some way.

If you do know a lot about the disease, your info-dump will be a quagmire. Avoid the temptation to describe the biochemical anomaly in loving detail. You’ll lose your entire audience, even people like me who love this kind of thing. Maybe you’ll be a little safer if you write hard sci-fi. But I like hard sci-fi, and I still want things to move along while I’m getting my recommended daily allowance of awesome-science-idea.

All in all, it’s best to know what you’re talking about. Research is key. But sometimes it’s not possible, or the plot point is too small to justify the time it would take. At that point, I hope that these tips will help you get on with your story.

Picture: http://www.icanhascheezburger.com

The contents of this site, such as text, graphics, images, and other material contained on the Site (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Site!

If you think you may have a medical emergency, call your doctor or 911 immediately. This blog does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by this blog, or other visitors to the Site is solely at your own risk.

The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an “as is” basis.

If you do use this as if it were real medical information, I will stand by your bed and describe a biochemical anomaly in loving detail. I will adjust my volume according to your depth of sleep.

If you shock a flatline, I swear I will come to your home and beat you with a wet chicken.

Beep…… Beep…… Beep…… Beep…… Beep…… Beeeeeeeeeeeeeeeeeeeeeeeeeeeee..………………Clear!………………… KA-CHUNK!!!!!!!…… Beep…… Beep…… Beep…… Beep…… Beep…………………

You know what this sounds like. You know exactly what this sounds like. You’ve heard it on practically every hospital TV show, every movie in which someone is rescued near death in a spaceship with a sickbay…over, and over, and over.

And it’s WRONG!!!

I’d like to take some time and explain why, how to not be THAT WRITER, and what you can do instead.

When a person’s heart stops in a hospital, it’s known as a code. Codes are nuts. Doctors really do run through the halls of the hospital, and it turns into an absolute madhouse. There’s a lot to do during a code.

There’s actually too much to talk about. So let’s focus on the heart monitor, for now. One of the first things that happens during a code is that you place monitors on the patient so you can keep track of what’s going on inside their body.

The beeps you hear on a heart monitor are an audible notation of the electrical activity that is going on in the heart. The electrical activity of the heart is the signal that says when the heart muscle is contracting to pump the blood to where the blood needs to go.

That long, extended beep is a flatline. It means that there is no electrical activity going on in the heart that the heart monitor can pick up. That means the heart is not beating correctly.

So what does shocking do for a person who’s having heart problems?

Contrary to popular usage, the heart doesn’t work like a car, where you can just jump a dead battery. The purpose of a shock to the heart is to DISRUPT an electrical pattern that does not result in an adequate heartbeat. The shock stuns the heart, hopefully so it will reset itself into a normal rhythm.

This is why you don’t shock a flatline, no matter how easily-recognized it might be to an audience of uneducated viewers. The flatline means that there’s no electrical pattern to disrupt, organized OR disorganized. The heart is pretty well stunned as it is, and re-stunning it won’t help you a bit.

According to usual medical practice, here are the shockable heart patterns, and what they look like on a heart monitor:

Ventricular Fibrillation: This is when the ventricles of the heart are fluttering, which doesn’t result in a sufficient squeeze to get the blood where it needs to go. It looks like this:

Pulseless Ventricular Tachycardia: Basically, a heartbeat where the ventricles squeeze so fast that the pumping chambers of the heart don’t have time to fill…and the blood doesn’t get where it needs to go. It looks like this:

So, what DO you do with a flatline? (Also known as “asystole”)

Well, it’s a little less dramatic than what the TV would have you believe. First, you make sure that the blood is still going where it needs to go. This is accomplished with chest compression, which is the technique of pushing on the chest in a way that squeezes the heart from the outside.

(By the way, chest compressions are EXHAUSTING. In a hospital setting, there are a bunch of people who volunteer during the code for chest compressions, and they rotate in and out every few minutes. You just can’t keep it up for more than a few minutes, even if you’re in fantastic condition.)

Beyond that, you push drugs into the patient’s circulation that act in ways that encourage the electrical activity of the heart to start up again. Meanwhile, you try to figure out what caused the heart to stop beating, and try to get that problem solved.

Here’s a list of usual causes of asystole: pulmonary embolism, tension pneumothorax, very low blood pressure, very low body temperature, cardiac tamponade, heart attack, acidosis, very high potassium, very low potassium, low oxygen, drugs (medications or illicit drug use), poisons.

So, if you really, really want a flatline on your monitor, the dramatic tension of the story shouldn’t be action-adventure oriented. Yeah, there are people running everywhere and doing everything during a code, but a flatline wouldn’t have anyone diving for the paddles. The tension from a flatline would come from the dialogue between the doctors, as they discuss what could be the cause of the patient’s asystole.

And there’s a time limit, which gives you the tension that comes from a ticking clock. If doctors can’t get the heart to restart in a reasonable amount of time, the patient will likely suffer so much brain damage that it’s more reasonable to stop efforts and let them go.

So, if you have a patient with a flatline: go for relatively quiet, dramatic tension. Have a doctor with a personal stake in saving this patient’s life, watching the clock tick as she desperately tries to figure out why the patient’s heart stopped. The family, standing by, waiting anxiously and praying. The nurses and students rotating through compressions, giving nervous glances to each other as the seconds and minutes pass. The pharmacists, at the ready with the next combination of drugs to try. It’s an atmosphere that’s so thick with real tension, you don’t need to add any electrical shocks to it.

But if you do want to dive for the paddles, and yell “CLEAR!” and have the patient twitch on the table…yes, that all does happen. But for the love of all that’s good and medically accurate, put one of the shockable rhythms on your monitor!

Sources:
http://www.acls.net/aclsalg.htm

http://content.onlinejacc.org/cgi/content-nw/full/43/10/1765/FIG1

http://www.12leads.com/asystole.htm

The contents of this site, such as text, graphics, images, and other material contained on the Site (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Site!

If you think you may have a medical emergency, call your doctor or 911 immediately. This blog does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by this blog, or other visitors to the Site is solely at your own risk.

The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an “as is” basis.

If you do use this as if it were real medical information, I will come to your home and beat you with a wet chicken. Even if you don’t shock a flatline.

Welcome!

Hi!  Welcome to my blog!

I’m Dr. Grasshopper.  At the time of this posting, I’m finishing up medical school and seeking residency in the field of internal medicine.  I’m also a science fiction and fantasy author.  I’ve often been struck how much these two fields overlap.

As I went through medical school, I’d get an email every few months from a writer buddy:

“Hey there!  How’s school!  I need a 34 year old woman to be exposed to an object for five minutes, then drop suddenly dead exactly three and a half days later.  She needs to bleed out of every orifice, and her face needs to be a sickly shade of green.  And oh, it would be great if she didn’t smell too bad, because it shouldn’t be discovered until the stunning climax of my novel.  How’s your work-in-progress?  Love, your writer buddy.”

Good times.  But it occurred to me that writers might be interested in the process I use to help my friends out with problems like this.  So, I figured I’d write a blog about using medical knowledge to enhance storytelling.

So here it is.

Some things you may want to know:

What topics do you plan to cover?

Well, pretty much anything I feel like covering.  But, what I’d really like to do is provide a bit of groundwork for starting from a desired symptom and working your way to figuring out how to make it happen in a marginally medically plausible way.  Some posts will be symptom-based, and will discuss different ways to produce the symptom.  Some posts will be about broad categories of diseases, and how they work.  Some posts will be organ-system-based, and will basically be me geeking out about how cool the human body is.  And of course, I reserve the right to post miscellany as I see fit.

How often do you post?

Whenever I can.

Can I ask you to talk about a particular topic that may be relevant to my work-in-progress?

Sure.  Shoot me an email at doctorgrasshopper (at) gmail (dot) com.  (You can also leave feedback there.)  However, I’d like to point out that I’m not going to be able to promise that I’ll get to it in any amount of time. . . so please don’t ask me to help you on a deadline.  Also, I may not get to it at all.  You understand.  You have a busy life, too.

Will you design a disease for my work-in-progress?

Probably not.  But I may see if I can bump you in the right direction for your own research. . . if I think it would make an interesting blog post.

Does that mean you won’t answer my email?

I won’t be able to answer emails directly; I may answer in a blog post, though.  No promises, other than that I’ll do my very, very best.

I have a (insert dear family member) who is suffering from (insert horrible disease), and your blog post about it was so flippant that it was insulting.  It almost seemed like you were celebrating the awful things that (insert horrible disease) does to a person.  Do you have any idea what this is doing to my family?

Yes.  Yes, I do.  I see it every day.  It’s my job.  And I’m so sorry you’re going through that.

The things I talk about on this blog are the things that destroy people and tear families apart.  I am very aware of that.  However, this blog is intended to be an intellectual exercise, and I prefer to talk about these topics as if they didn’t create soul-destroying tragedies.

By focusing on imaginary people instead of real ones, I get a chance to focus on the diseases themselves instead of the pain and suffering that they cause.  These processes are fascinating, and the adaptations of the human body are, too. I hope I can share with you how much I love the knowledge that feeds my profession, in a way that will let you bring it into your stories.

I’m going to use this site as a medical resource.  I’m going to print out one of your blog posts, bring it to my doctor appointment on Monday, and use it as a basis to argue with my doctor’s advice, because information I get on the internet is clearly superior to my doctor’s knowledge and experience.  Is that okay?

No, NO, NO, NO!!!! This is not a medical resource.  Look at the title.  This blog is only applicable to IMAGINARY PEOPLE.

If you need information about an illness or injury, talk to a doctor, not the internet!  There are a few good sites for basic, BASIC medical information on the web, but you probably don’t have access to the sites that are truly useful for real medical practice.  The stuff you find on the internet is NO substitute for a medical professional.  Information is one thing; interpretation and application of that information is entirely another.

Doctors don’t go to medical school for their health.  It’s physically, mentally, financially, and emotionally painful.  Let’s ignore the long hours and financial hardship for now.  Practically everyone in my class who showed up with an important relationship was alone by the end of second year.  I had a friend who lost her children because of medical school.  If you could replace the function of a doctor with a simple internet search, PEOPLE WOULD NOT GO TO MEDICAL SCHOOL.  The costs are just too high.  All of the costs.

If you have a problem, see a doctor.  The internet will not help you.

And just so you really, REALLY get it, here’s a bunch of legal jargon that explains how I feel about the matter (from http://www.WebMD.com, modified to fit my site):

“The contents of this site, such as text, graphics, images, and other material contained on the Site (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Site!

If you think you may have a medical emergency, call your doctor or 911 immediately. This blog does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by this blog, or other visitors to the Site is solely at your own risk.

The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an “as is” basis.”

I will likely repeat this warning at the end of practically every blog post, because the general tendency of people is to be really stupid in really creative ways.  But really.  Don’t be an idiot.  And especially, don’t use me as an excuse to be an idiot.

That was pretty harsh.

Yes, I know.  Sorry about that.  Sometimes I get frustrated.  Thanks for understanding.

Can we get on with the content?  I want to see if this is worth my time.

Sure!  Here we go!