A Word About My Anonymity

Hi, Folks!

As always, thanks for reading my blog! I’m really enjoying doing these posts for you, and I’ve been loving the emails and comments you all have been sending me.

A word about my choice to use a pseudonym for this blog:

So, the other day I did an ego-search for things related to “How To Kill Your Imaginary Friends”. . . and realized that a friend of mine quite definitively linked my real name to it in one of the posts on his own blog. With the best of intentions, definitely. He just wanted to point his readers over to me.

But that made me realize that I haven’t been as clear as I intended about why I chose to write this blog under a pseudonym.

Right now, the medical field (at least at the medical-school-level) is a little unsure about how they feel about the whole blogging issue. As a matter of fact, everything I’ve heard is pretty much on the “don’t go looking for trouble” end of the enthusiasm spectrum. Especially since suing doctors into oblivion appears to have replaced baseball as the national pastime.

To be honest, this would probably be less of a concern if I were already comfortably settled in a job. As it is, though, I’m at the shaky start of my career. I don’t know the medical field all that well, and I don’t know what might or might not have an effect on my ability to get a job in the future. For now, in real life, I need to stay as non-controversial as possible. (And for all of you who know me, you know how difficult that is even without something like this going on!)

Hence the pseudonym.

Once I’m all settled and comfortable, and have a better idea of how blogging will interact or fail to interact with my career, I may go ahead and out myself. To be honest, I imagine it would only help the fiction aspect of my writing career, as I’m currently a rather obscure and rather new short-story author.

But for now, I have a request for anyone who knows me or knows who I am: I hope you will help me keep my identity as difficult-to-find as my fiction currently seems to be. It’s not like people couldn’t figure out who I am if they tried. . . but let’s not make it easy, okay?

I know I’m being paranoid, but I’d rather be paranoid than inadvertently screwed by my own ignorance.

Thanks so much for your help.

Dr. G

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Published in: on February 28, 2010 at 2:08 am  Comments (3)  

Snake Oil: Lifted from BoingBoing

Snake Oil

This is cool!

Published in: on February 26, 2010 at 10:54 pm  Leave a Comment  

In Other News…

Match lists were due yesterday. I turned mine in. And now I’m waiting with bated breath.

What are you talking about?

Medicine is one of the few professions that still has a kind of apprenticeship period; it’s called “residency.” And how do you get into residency?

In the last year of med school (where I am right now), there’s this fun process called The Match.

In the fall, you turn in an application to a bunch of schools whose program you like. The schools decide which applications they like, and invite those students to interview for their residency program.

Through the winter, you travel around and interview at any program you still want to attend. I myself interviewed at seven programs; some of my classmates looking for more competitive residencies applied to upwards of sixty.

At the end of interview season, each student turns in a “rank list” of the programs they liked, favorite to least favorite.

The programs also make a list of the students they liked, favorite to least favorite.

Then, everyone puts their list into a central computer. The computer puts all the lists into a giant bag, shakes them all up, and figures out the best way to fit students to programs and programs to students. The results are skewed to student preference.

On Match Day, in the middle of March, you get your residency assignment. If you participate in the Match, you’re legally obligated to fill the slot you were assigned.

If you don’t get a spot in the Match, the next day starts The Scramble. Which is exactly what it sounds like. Programs that don’t fill and students who don’t Match engage in a frenzied free-for-all, and you get what you can, no matter where it is or how crappy the program (or student) is.

If I Match, I could move to any one of four cities. If I don’t Match, and I’m lucky enough to get a spot from the Scramble, I could be sent pretty much anywhere in the country.

I really, REALLY don’t want to have to Scramble. So send good vibes my way, okay?

Published in: on February 25, 2010 at 4:57 pm  Comments (7)  
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Book Plug!

N. K. Jemisin is one of my favorite short-story writers. You owe it to yourself to read a copy of “L’Alchemista”; I think it’s still archived on Escape Pod, so you can listen to it, too. She’s also got a story up for the Nebula this year:“Non-Zero Probabilities,” which was in Clarkesworld in November ’09.

And, joy of joys, she’s releasing her first novel today!

Find this book. Read it. I haven’t yet, but I’m sure gonna!

Published in: on February 25, 2010 at 4:44 pm  Comments (1)  
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Tools for the Toolbox: Going Viral

“Tools for the Toolbox” is a series of posts that describe disease types and organ systems. Eventually I hope to include enough information that a writer might be able to do some creative mixing and matching to produce the symptoms they want to give a character. Because it’s really frustrating to throw darts in the dark and hope something lands near the bull’s-eye. Hope it helps!

I’ll start this discussion of viruses by saying that Virology is a field of study in and of itself. So there’s no way that this blog post is going to come even close to being comprehensive or even extensive. I’m doing highlights only, and I may post further information at a later date.

Viruses act in a huge variety of different ways. So instead of talking about individual viruses and what they do, let’s talk about HOW they do what they do.

Viruses don’t have much of a life. As a matter of fact, they aren’t really alive. They’re just tiny organic machines that exist to make copies of themselves. If that doesn’t get your sci-fi juices flowing by itself, check your pulse. Or your level of consciousness.

Let’s build a virus!

So. In order to make copies of a thing, you need an original. In the case of viruses, the “original” copy is a strand of genetic material. It will be DNA or RNA, but not both. Regardless, the genetic material contains instructions for making a new virus, just like human DNA contains the instructions for making a human being. This picture shows DNA and RNA, side-by-side for comparison.

So, now we have a strand of genetic material. Let’s roll it up into a ball, and stuff it into a pouch made of proteins. This pouch or coat is called a “capsid”.

The genetic material (DNA or RNA) would be contained inside. Some capsids carry structural proteins and enzymes within the coat. Pretty handy, since there’s not much room inside. (Viruses are small! Like, really small!)

And for some viruses, that’s all they bother with. They’re called naked viruses.

OoooooooOOOOooooooooh!

Settle down. (Rhinoviruses are such teases.)

Other viruses are a little more modest. In addition to their capsid/coat of proteins, they also like to give themselves an extra layer. This is known as an “envelope”, and is made of a “lipid bilayer”, which is what the cell membranes of our cells are made of. It looks like this:

You can see the genetic material, coated by the capsid, enveloped by the envelope.

So, now we have a virus.

The driving purpose of a virus… THE VERY REASON FOR ITS EXISTENCE… is to make copies of itself. But it can’t! It’s a strand of genetic fluff wrapped in one or two layers. It doesn’t carry the proper materials or machinery to make copies. Doesn’t that suck?

Um…I’m not really worried about the existential satisfaction of the common cold.

Me either, to be honest. But it does really suck. Because instead of throwing up its non-existent hands at its complete and utter lack of purpose-fulfilling-equipment, it decides to hijack someone else’s.

Namely, yours.

I have viral-purpose-fulfilling-equipment?

Yup. The cells in your body contain the equipment for replicating genetic material. And the virus wants it!

So, here’s the virus’s rather overdramatic modus operandi. It drifts around, aimless and without propulsion, until it lands by chance on a cell. Then, it injects its genetic material into the cell! It’s like hijacking a factory and replacing its blueprints with your own. (Not, I feel I should point out, that I’ve ever hijacked a factory or replaced its blueprints with my own.)

Particularly not this factory. Or its blueprints.

Anyway, the cell then turns into a virus-producing factory! It’s forced to use its own machinery and resources to make hundreds and hundreds of viruses! As a matter of fact, the cell-factory is pushed into overdrive by its hijackers, and eventually so many viruses are created that there’s just no room in the cell anymore. So the cell EXPLODES, spraying new, copied viruses everywhere!

And then it all begins again.

A little diabolical, no?

Aren’t there any defenses built into the cell? Viruses have been around for a long time, after all.

Well, kinda. Once infected, the cell is pretty much a goner. But that doesn’t mean it gives up. During the hijacking/infection process, the hijacked cell displays some of the viral proteins on the outside of its membrane. It’s like sending up a panic flag. This alerts the rest of the body that the cell has been infected. The flag also gives information about the infecting agent to other cells nearby so they can get their defenses up, and sends a message to the immune system that there’s an attack going on.

It’s a really nifty process, and its ingeniousness blows me away. (I love the immune system, though learning it the first time really sucked monkey balls! I blame the naming scheme. Everything and its brother was named CD28 or CD32 or whatever. Almost impossible to keep straight.)

Who gets viruses?

Everyone.

Different people get exposed to different viruses, though. As with any other illness (besides genetic and autoimmune diseases), the types of viruses you’re exposed to depends on your surroundings and your lifestyle. A few examples:

– Human Papillomavirus (HPV) is spread through sexual contact.
– Cruise ships, dormitories, and nursing homes are great places to catch the Norwalk virus.
– Poliovirus is more likely found in areas of poor sanitation.
– Drug abusers who inject substances into their bloodstream are at risk for Human Immunodeficiency Virus (HIV) and Hepatitis B and C.

Different people also have different ways of responding to viruses. Some people might catch it and pass it along without developing any symptoms at all, while other people may be laid up for days or even die from the infection.

For example, Respiratory Syncytial Virus (RSV) causes a slight head-cold in adults…but can cause a life-threatening bronchiolitis (infection of the bronchioles in the lungs) in infants.

What are typical symptoms?

Depends on the virus.

You got your “flu-like symptoms” for your respiratory viruses: Fever, cough, sore throat, runny nose, headache, body aches, chills, fatigue, etc.

You got your fun vomiting-and-diarrhea pattern for your gastrointestinal viruses.

You got your lymphadenopathy-plus-sore-throat-and-fever pattern for Epstein-Barr virus (mononucleosis, or just “mono”) and the initial stage of HIV infection. (lymphadenopathy = swollen lymph nodes)

There are others as well.

And then the virus can kinda do its own thing from there. HIV attacks the T cells of the immune system. Mumps also likes the T cells for an initial replication site, then heads over to other tissues like the salivary glands and the testes. Herpes viruses (which include everything from cold sores to chicken pox/shingles to painful genital rashes) like to camp out in nerve ganglia when they’re done with their initial infection. Then they flare up in the distribution of the nerves they’re hiding in whenever the fluctuations of the body’s immune system give it a chance. (ganglia = collections of nerve cell bodies)

Basically, you can model your virus on any of the above patterns, and then let it attack your character in any way you want it to. But remember that it’s more plausible to start with a few, easily explained symptoms within the same body system (neurological, gastrointestinal, respiratory, etc.) than it is to justify a total, multi-system shutdown immediately on infection. The multi-system shutdown can happen, certainly…but let it build up.

Note: Sometimes a virus’s symptoms will correlate with the method of spread. For example, the rhinovirus (common cold) is spread through the air and causes respiratory symptoms. Norwalk virus is spread through the fecal-oral route (that’s exactly what it sounds like…) and causes gastrointestinal symptoms. HIV is spread through blood and fluid contact, and it attacks white blood cells. Many viruses don’t follow these kinds of patterns, but it’s something to think about when you’re world-building.

How do you cure them?

Well, that’s a tough one. There are antiviral medications that interfere with the life cycle of a virus and minimize the damage an infection can cause, but viruses themselves aren’t really cooperative when it comes to general medical treatment.

Usually, medical personnel defer to “supportive treatment” when dealing with viruses. That is, keeping the symptoms of infection under control while the body’s immune system mounts its own defense and fights off the infection itself. If a baby has severe diarrhea and vomiting during his bout of viral gastroenteritis, he should be hospitalized so his fluids can be replaced. If a college student develops respiratory distress from an influenza infection, his breathing can be supported with a ventilator. And so on.

Antibiotics have absolutely no effect on viruses.

But Good Housekeeping told me that…

Antibiotics have absolutely no effect on viruses.

But I took penicillin once for…

ANTIBIOTICS HAVE ABSOLUTELY NO EFFECT ON VIRUSES.

Do we have any questions about antibiotics and whether or not they have any effect on viruses?

. . .

Good. Please don’t come into my office and demand I give you antibiotics for your viral infection. Please don’t come into my office and demand I give your child antibiotics for her viral infection. This happens way too often, and it really pisses me off. It’s actually one of the reasons I decided not to go into Pediatrics as a specialty, and why I hope to avoid outpatient medicine as much as possible.

Some ways to use viruses in fiction.

-Use a virus if you need an epidemic that spreads quickly, like Captain Trips in The Stand.

-Use a gentled virus as a tool for altering genetic material, like they do with gene therapy.

-Use a virus if you want to create superbacteria in a population, since a population that incorrectly takes antibiotics for viral infections will teach its bacteria how to resist any medicine it’s exposed to. Like with MRSA. Or A. Baumannii, which killed my grandfather. (Yes, this is NOT some science fictional concept, and this is NOT some fuzzy problem that we’re just passing off to our children to solve later. This is killing people RIGHT NOW. Really, really IMPORTANT people. Is your grandfather next?)

-Use a virus if you need a disease that quickly mutates. This could prevent even your genius protagonist from coming up with a cure, or could make any treatments that she cooks up completely ineffective, just in time for your exciting climax. Like with HIV or influenza.

So, viruses are pretty diabolical little buggers. Versatile diabolical little buggers. And let’s be honest: what story doesn’t need a good bit of diabolical in it? Or a good bit of versatility?

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 hijack your factory, and replace its blueprints with my own. Because I’m diabolical like that. And rather versatile.

Sources:

http://www.flu.gov/

Robbins and Cotran. Pathologic Basis of Disease. 7th edition. Elsevier, 2005

Pictures:

Published in: on February 20, 2010 at 8:53 pm  Comments (11)  
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PPS:

Oh, and if we can get 100 people to look at this site today, we can simulate the classic “delta wave” of Wolf-Parkinson-White syndrome! That’s the widening of the base at the beginning of the big spike called the “QRS complex”. The picture’s a little small, but it’s the shaded gray area in Inset B.

You’re a geek, Dr. Grasshopper.

Yes. Yes, I am. Happy Valentine’s Day!

Picture:

Published in: on February 14, 2010 at 4:06 pm  Comments (6)  
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PS:

It cracks me up that my views-per-day plot looks an awful lot like an EKG.

Although now it looks like we’re in atrial flutter. And the QRS complex is getting a little wide. Bad sign for a heart…good sign for blog readership stats, though!

Thanks for unintentionally amusing me, everyone! And as always, thanks for reading!

Picture:

Published in: on February 14, 2010 at 3:56 pm  Leave a Comment  
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How To Talk Doctor! Lesson 1.

Let’s warm up with the Amateur Transplants! (Warning: contains generally-frowned-upon four-letter words. Probably not safe for work, at least for those four seconds.)

Okay, class. Settle down now. Timmy, I saw that. Open your books to page “-itis”, and we’ll begin.

Lesson 1: -itis

-itis = inflammation.

“Inflammation” is a condition that is characterized by
-Rubor (redness)
-Calor (heat)
-Tumor (swelling)
-Dolor (pain)
-Functio laesa (loss of function)

It’s the body’s normal response to a threat: bacterial infection, a splinter in your finger, etc. Certain tissues might get inflamed as a result of an autoimmune process, in which the body attacks itself.

Put the “-itis” suffix after any body part or organ to mean “inflammation of the ________”. For maximum obscurity, use the fancy doctor-word for the body part or organ.

Let’s try it!

Pancreatitis = inflammation of the pancreas

Dactylitis = inflammation of a digit (finger or toe)

Hepatitis = inflammation of the liver (hepatic = liver)

Myocarditis = inflammation of the heart muscle (myo = muscle, card = heart)

Senioritis = inflammation of the senior

Blogitis = inflammation of the comment thread in a controversial blog post.

Thank you for your attention; class dismissed.

Pictures:

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’ll digitally palpate your external obliques for the purpose of initiating repeated contraction of your thoracic diaphragm, in turn causing the emission of multiple monosyllabic vocalizations, and possibly triggering involuntary micturation.

Published in: on February 13, 2010 at 6:46 pm  Comments (3)  
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Superballs, Pockets, and Fun With Awesome Molecules

Dear Dr. Grasshopper,

I’m writing a military sci-fi novel, and I’ve run into a medical snag.

I know (or like to think) that there are certain toxins which can rob the blood’s ability to transport oxygen. Would you happen to know what the emergency treatment is for such a situation, or could you point me in the right direction?

Yeah, man!

You’ve basically described a classic case of carbon monoxide poisoning. Which was one of my favorite topics early in med school. (I even used it as a plot point in a novel I started writing. . . and then trunked because it had no plot.)

How does your blood carry oxygen?

The red color of your blood is from all of the red blood cells floating in it.

Red blood cells are really just sacks full of four-unit proteins called hemoglobin. This a representation of a hemoglobin protein:

Each of the parts of the protein has a little “pocket” that contains a unit of heme. I think heme is a truly awesome molecule, so I’m going to show its structure below. Notice the “Fe” in the middle. That’s the symbol for iron, and it’s very important to heme’s function. The other letters are also symbols for atoms; this tells you what the molecule is made of. C = Carbon, O = Oxygen, H = Hydrogen, N = Nitrogen.

Just look at it for a sec. Isn’t it gorgeous?

Quit geeking out, Doc.

Must I?

Yes. Get on with it.

Fine. Back to the point.

Heme has a good affinity for oxygen for the purposes of oxygen transport: It binds oxygen tightly enough to carry it around, but loosely enough to let it go when it arrives at its proper destination. (This “oxygen + hemoglobin” combination is called “oxyhemoglobin”.)

Enter carbon monoxide. Carbon monoxide is made up of one carbon atom and one oxygen atom. (The name tells you that, if you break it down.) Carbon monoxide also likes to bind to heme, in the same spot where oxygen likes to bind, right in the “pocket”.

Problem is, it binds WAY TOO TIGHTLY to the pocket, and is very difficult to release. (This “carbon monoxide + hemoglobin” combination is called “carboxyhemoglobin”. See, medical terminology isn’t THAT scary, is it?)

Carbon monoxide can not be used in the same way as oxygen. And it takes up all the heme groups that should be used to transport oxygen. And it doesn’t like to let go of heme once it’s grabbed on.

Long story short: Carbon monoxide interferes with proper oxygen transport, which seems to be the scenario you’ve described.

Fun with chemistry! Competition

Bear with me; we’re going conceptual. But I promise, it’s relevant to the subject matter.

First, picture a tank with a bunch of superballs bouncing around in it. That’s what goes on at a molecular level in most substances. A bunch of molecules bounce around, colliding with each other at random.

Now picture these superballs with extra appendages or depressions, three-dimensional fittings like puzzle pieces. If two balls hit each other in exactly the right orientation, they’ll attach together. The pairs, once formed, can also break apart spontaneously.

That’s how molecular events occur. And for these purposes, let’s say that these events are pretty common.

Now.

You have a population of red superballs with a particularly-shaped depression in them; they can only admit a certain shape of superball appendage upon collision. Now, two populations of superballs have that particular shape of appendage, one green population and one yellow population.

They can both attach to the red balls, but once they’re attached, the yellow balls don’t let go quite as easily as the green ones do. So, if you have equal populations of the two, eventually you’ll end up with more yellow-red pairs than green-red pairs. The yellow out-competes the green for attachment sites.

The only way you’ll get more green-red pairs than yellow-red pairs is by making sure the population of green balls FAR outnumbers the population of yellow balls.

Treating carbon monoxide poisoning, using molecular competition

This basically explains the basis of treatment for carbon monoxide poisoning. The red balls are the hemoglobin, with its particularly-shaped pocket. The green balls are oxygen, that can attach with some affinity. The yellow balls are carbon monoxide, which have a much higher affinity for the hemoglobin.

So, if you have a bunch of carbon monoxide bouncing around the system, oxygen will be out-competed for binding sites in the pockets of the available hemoglobin. The only way to correct this is by increasing the population of oxygen molecules as far as you can; putting in something like ten green balls for every one yellow one. Eventually your population will consist of mainly green-red pairs (oxyhemoglobin) and very few yellow-red pairs (carboxyhemoglobin).

So, the treatment for carbon monoxide poisoning is basically, saturate a person with oxygen in order to outcompete the carbon monoxide.

In answer to your question:

You can use carbon monoxide for your scenario if you want to; it seems to fit well. At that point you’d just turn up the oxygen on the bridge or find your character an oxygen mask, and out-compete the carbon monoxide.

Alternatively, you can propose another toxin that interferes somehow with the hemoglobin molecule, and then make up an antidote that (a) displaces the toxin from its site of interference or (b) binds up the toxin to keep it from getting to the site of interference.

Hope that helps! Thanks for writing!

Pictures:

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’ll fill all of your pockets with superballs. They will become very bouncy pockets.

Published in: on February 6, 2010 at 11:59 am  Comments (7)  
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