Tuesday, March 25, 2008

GUEST POST: Lobotomy Revisited (by Brian Carty)

The second guest post from Brian Carty of Hot Medical News, covering the... well, less-covered side of medicine! Enjoy "the history of the lobotomoy"! There's a great video that goes along with this post. Watch it here.

By Brian Carty, MD, MSPH
March 25, 2008

Do you remember Rosemary Kennedy, John F. Kennedy's sister? Maybe not, since she spent most of her life hidden away in an institution in the Midwest. She had a lobotomy, a brain operation for mental illness, in 1941 when she was 23. Her father, Joseph Kennedy, arranged the operation. The procedure left her mentally incapacitated. Whether she was mentally ill, mentally retarded, or both, is unclear, but her disruptive behavior led to the operation and its unfortunate outcome. She died of natural causes on January 7, 2005 at the age of 86.

The lobotomy, also called leucotomy, was devised in 1935 by the Portuguese neurologist Egas Moniz for the treatment of various psychiatric disorders. In this procedure, holes were drilled in the skull and a blade was used to cut nerve fibers from the frontal lobes (the front of the brain, just behind the forehead) to the rest of the brain. The term lobotomy came to include a variety of surgical procedures on the frontal lobes which were performed for psychiatric disorders.

An estimated 50,000 lobotomies were performed in the US in the 1930s and 40s. Although electroconvulsive therapy was introduced in the 1930s, it is useful mainly for the treatment of depression. Otherwise, before effective psychiatric drugs were available in the 1950s, the only other treatments for the severely mentally ill were incarceration and physical restraint.

By today’s standards, conditions in the mental hospitals of the time were unimaginable. Many patients were severely agitated, extremely violent, and incontinent. The hospitals were dirty, overcrowded, and understaffed.

Many severely ill patients benefited from lobotomy with decreases in violence and agitation. However, lobotomy often caused serious adverse effects, including disturbances of mood and personality, euphoria, poor judgment, impulsivity, loss of initiative, intellectual deficits, and seizures.

For many patients, however, a decrease in agitation and violence, even when accompanied by neurologic injury from frontal lobe surgery, was understandably considered an improvement. When the first effective antipsychotic drug, Thorazine (chlorpromazine), was introduced in the US in 1954, the number of lobotomies performed plummeted.

Surgery for psychiatric disorders is still performed rarely today. The procedures have become more selective and less extensive and now include deep brain stimulation with implanted electrodes. Similar surgical procedures and deep brain stimulation are sometimes done for movement disorders and chronic pain. Surgery for psychiatric disorders is still controversial and, when performed, is most often used for treatment-refractory obsessive-compulsive disorder (OCD). OCD is a disorder characterized by obsessive thoughts and compulsive behaviors such as repeated hand washing or checking to see if doors are locked. OCD can severely affect functioning and quality of life.

It is worth noting again that surgery for psychiatric disorders must be judged with reference to conditions which existed at the time the procedures were introduced. Although lobotomy is viewed by many as barbaric, the operation gave many patients a limited improvement which was otherwise unobtainable. The wisdom of hindsight should be applied sparingly; newly introduced medical treatments often cause unintended harm. The history of lobotomy should remind us that future generations will inevitably view our current best treatments as primitive.

Tuesday, March 18, 2008

GUEST POST: Are Ya Juicin' It? Anabolic-Androgenic Steroid Abuse

Welcome to our second guest poster on All Scrubbed Up... Brian Carty of HotMedicalNews.com. Here's an indepth look at the effect of steroids in body builders. Chilling stuff.

By Brian Carty, MD, MSPH
March 14, 2008

Irritable, angry, aggressive, but feeling strong and invincible, Mr. A, 32, a bodybuilder and prison guard, stopped at a convenience store to call his boss. Car trouble on the way to work.. He would be late.

Bodybuilder and enhanced performance

[With permission of Steve Michalik. Mr. Michalik, a former Mr. America and Mr. Universe, once used steroids and suffered as a result. He is now an energetic and outspoken opponent of steroid abuse.]

Mr. A was taking his fifth cycle of anabolic-androgenic steroids (abbreviated in this article as "steroids"), and he was "stacking," combining high doses of several different steroids, sometimes referred to by the slang term "juice." The woman working at the convenience store noted his uniform and joked, "You officers use my phone so much, I ought to start charging for it." Mr. A was strangely disturbed by this remark. He felt that the woman had criticized and demeaned him, and he was obsessed by the remark that afternoon and throughout the night. He slept poorly. His wife could not reassure him.

'Roid Rage
Later, he said that he wanted to "scare the lady in return for that remark she made to me." In the morning Mr. A drove back to the convenience store and forced the woman into his car. She fought back, biting his hand and grabbing his revolver which fired through the windshield. Although he subdued her and drove away, when the car stopped she bolted from the car. He shot her in the back as she fled, leaving her permanently paralyzed. Mr. A was later arrested, tried, and sentenced to twenty years in prison. After his arrest and withdrawal from steroids, he developed major depression which resolved in a month.

This case and several other cases of homicide or near-homicide by anabolic steroid abusers are presented in an article by Dr. Harrison Pope, Jr., and Dr. David Katz in the January 1990 Journal of Clinical Psychiatry.

Read more on this subject at Brian's site here (continuation of article)...

Monday, March 10, 2008

Have a Happy Period!

Never know whether these things are true or not. But bwhahahaha. Funny nonetheless! I'm a boy, and even I cringe at the medical marketing.

This is an actual letter from an Austin woman sent to American company Proctor and Gamble regarding their feminine products. She really gets rolling after the first paragraph. It's PC Magazine's 2007 editors' choice for best webmail-award-winning letter.

Dear Mr. Thatcher,

I have been a loyal user of your 'Always' maxi pads for over 20 years and I appreciate many of their features. Why, without the LeakGuard Core or Dri-Weave absorbency, I'd probably never go horseback riding or salsa dancing, and I 'd certainly steer clear of running up and down the beach in tight, white shorts. But my favorite feature has to be your revolutionary Flexi-Wings. Kudos on being the only company smart enough to realize how crucial it is that maxi pads be aerodynamic. I can't tell you how safe and secure I feel each month knowing there's a little F-16 in my pants.

Have you ever had a menstrual period, Mr. Thatcher? Ever suffered from the curse'? I'm guessing you haven't. Well, my time of the month is starting right now. As I type, I can already feel hormonal forces violently surging through my body. Just a few minutes from now, my body will adjust and I'll be transformed into what my husband likes to call 'an inbred hillbilly with knife skills.' Isn't the human body amazing?

As Brand Manager in the Feminine-Hygiene Division, you've no doubt seen quite a bit of research on what exactly happens during your customers monthly visits from 'Aunt Flo'. Therefore, you must know about the bloating, puffiness, and cramping we endure, and about our intense mood swings, crying, jags, and out-of-control behavior. You surely realize it's a tough time for most women. In fact, only last week, my friend Jennifer fought the violent urge to shove her boyfriend's testicles into a George Foreman Grill just because he told her he thought Grey's Anatomy was written by drunken chimps. Crazy!

The point is, sir, you of all people must realize that America is just crawling with homicidal maniacs in Capri pants... Which brings me to the reason for my letter. Last month, while in the throes of cramping so painful I wanted to reach inside my body and yank out my uterus, I opened an Always maxi-pad, and there, printed on the adhesive backing, were these words: 'Have a Happy Period.'

Are you fu*ing kidding me? What I mean is, does any part of your tiny middle-manager brain really think happiness - actual smiling, laughing happiness is possible during a menstrual period? Did anything mentioned above sound the least bit pleasurable? Well, did it, James? FYI, unless you're some kind of sick S&M freak, there will never be anything 'happy' about a day in which you have to jack yourself up on Asprin and Kahlua and lock yourself in your house just so you don't march down to the local Walgreen's armed with a hunting rifle and a sketchy plan to end your life in a blaze of glory.

For the love of God, pull your head out, man! If you just have to slap a moronic message on a maxi pad, wouldn't it make more sense to say something that's actually pertinent, like 'Put down the Hammer' or 'Vehicular Manslaughter is Wrong', or are you just picking on us?

Sir, please inform your Accounting Department that, effective immediately, there will be an $8 drop in monthly profits, for I have chosen to take my maxi-pad business elsewhere. And though I will certainly miss your Flex-Wings, I will not for one minute miss your brand of condescending bullsh*t. And that's a promise I will keep. Always.


Wendi Aarons
Austin , TX

Thursday, March 6, 2008

Medical Quotes #2

More quotes... Some philosphical. Some, er, not...

- - - - - - - - - - - - - - -

Medicine is the only profession that labours incessantly to destroy the reason for its own existence. ~James Bryce, 1914

It is not a case we are treating; it is a living, palpitating, alas, too often suffering fellow creature. ~John Brown

The patient does not care about your science; what he wants to know is, can you cure him? ~Martin H. Fischer

Medicines heals doubts as well as diseases. ~Karl Marx

A physician is obligated to consider more than a diseased organ, more even than the whole man - he must view the man in his world. ~Harvey Cushing

Medicine sometimes snatches away health, sometimes gives it. ~Ovid, Tristia

As it takes two to make a quarrel, so it takes two to make a disease, the microbe and its host. ~Charles V. Chapin

Disease is war with the laws of our being, and all war, as a great general has said, is hell. ~Lewis G. Janes

Until a physician has killed one or two he is not a physician. ~Kashmiri Proverb

No man is a good doctor who has never been sick himself. ~Chinese Proverb

Only one rule in medical ethics need concern you - that action on your part which best conserves the interests of your patient. ~Martin H. Fischer

To me the ideal doctor would be a man endowed with profound knowledge of life and of the soul, intuitively divining any suffering or disorder of whatever kind, and restoring peace by his mere presence. ~Henri Amiel

Medicinal discovery,
It moves in mighty leaps,
It leapt straight past the common cold
And give it us for keeps.
~Pam Ayres

When you no longer know what headache, heartache, or stomachache means without cistern punctures, electrocardiograms and six x-ray plates, you are slipping. ~Martin H. Fischer

It is easy to get a thousand prescriptions but hard to get one single remedy. ~Chinese Proverb

Never forget that it is not a pneumonia, but a pneumonic man who is your patient. ~William Withey Gull

It is said to be the manner of hypochondriacs to change often their physician. ~William Cullen, Practice of Physic

The road to medical knowledge is through the pathological museum and not through an apothecary's shop. ~William Withey Gull

A Short History of Medicine
2000 B.C. - "Here, eat this root."
1000 B.C. - "That root is heathen, say this prayer."
1850 A.D. - "That prayer is superstition, drink this potion."
1940 A.D. - "That potion is snake oil, swallow this pill."
1985 A.D. - "That pill is ineffective, take this antibiotic."
2000 A.D. - "That antibiotic is artificial. Here, eat this root."
~Author Unknown

When a lot of remedies are suggested for a disease, that means it cannot be cured. ~Anton Chekhov, The Cherry Orchard

A half doctor near is better than a whole one far away. ~German Proverb

No doctor is better than three. ~German Proverb

I will lift mine eyes unto the pills. Almost everyone takes them, from the humble aspirin to the multi-coloured, king-sized three deckers, which put you to sleep, wake you up, stimulate and soothe you all in one. It is an age of pills. ~Malcolm Muggeridge, 1962

Man may be the captain of his fate, but is also the victim of his blood sugar. ~Wilfrid G. Oakley

Faith and knowledge lean largely upon each other in the practice of medicine. ~Peter Mere Latham

Each patient ought to feel somewhat the better after the physician's visit, irrespective of the nature of the illness. ~Warfield Theobald Longcope

Who ever thought up the word "Mammogram?" Every time I hear it, I think I'm supposed to put my breast in an envelope and send it to someone. ~Jan King

Never go to a doctor whose office plants have died. ~Erma Bombeck

You may know the intractability of a disease by its long list of remedies. ~Alonzo Clark

Here's good advice for practice: go into partnership with nature; she does more than half the work and asks none of the fee. ~Martin H. Fischer

Varicose veins are the result of an improper selection of grandparents. ~William Osler

If you are too smart to pay the doctor, you had better be too smart to get ill. ~African Proverb

When you treat a disease, first treat the mind. ~Chen Jen

Symptoms are the body's mother tongue; signs are in a foreign language. ~John Brown

The doctor of the future will give no medicine but will interest his patients in the care of the human frame, in diet and in the cause and prevention of disease. ~Thomas Edison

Oh the powers of nature. She knows what we need, and the doctors know nothing. ~Benvenuto Cellini

So many come to the sickroom thinking of themselves as men of science fighting disease and not as healers with a little knowledge helping nature to get a sick man well. ~Auckland Geddes, The Practitioner

Where a man feels pain he lays his hand. ~Dutch Proverb

The doctor is often more to be feared than the disease. ~French Proverb

Despite all our toil and progress, the art of medicine still falls somewhere between trout casting and spook writing. ~Ben Hecht, Miracle of the Fifteen Murderers

The Lord hath created medicines out of the earth; and he that is wise will not abhor them. ~Ecclesiasticus 38:4

A drug is that substance which, when injected into a rat, will produce a scientific report. ~Author Unknown

Cancer is a word, not a sentence. ~John Diamond

The medicalization of early diagnosis not only hampers and discourages preventative health-care but it also trains the patient-to-be to function in the meantime as an acolyte to his doctor. He learns to depend on the physician in sickness and in health. He turns into a life-long patient. ~Ivan Illich

Patients may recover in spite of drugs or because of them. ~J.H. Gaddum

He's the best physician that knows the worthlessness of the most medicines. ~Benjamin Franklin

Physiology is the stepchild of medicine. That is why Cinderella often turns out the queen. ~Martin H. Fischer

The field of Western medicine has become literally nothing but medicine. Doctors are on their way out, to be replaced by self-serve pharmaceutical vending machines. ~Grey Livingston

The fact that your patient gets well does not prove that your diagnosis was correct. ~Samuel J. Meltzer

Man is a creature composed of countless millions of cells: a microbe is composed of only one, yet throughout the ages the two have been in ceaseless conflict. ~A.B. Christie

Our profession is the only one which works unceasingly to annihilate itself. ~Martin H. Fischer

On J-Day our profession will have a lot to answer for! We might at least have withheld our hands instead of making them work against God. ~Martin H. Fischer

The doctor may also learn more about the illness from the way the patient tells the story than from the story itself. ~James B. Herrick

Don't think of organ donations as giving up part of yourself to keep a total stranger alive. It's really a total stranger giving up almost all of themselves to keep part of you alive. ~Author Unknown

Most of those evils we poor mortals know
From doctors and imagination flow.
~Charles Churchill

Men are not going to embrace eugenics. They are going to embrace the first likely, trim-figured girl with limpid eyes and flashing teeth who comes along, in spite of the fact that her germ plasm is probably reeking with hypertension, cancer, haemophilia, colour blindness, hay fever, epilepsy, and amyotrophic lateral sclerosis. ~Logan Clendening

Don't take your organs to heaven with you. Heaven knows we need them here. ~Author unknown, attributed to both Dan and Barbara Hladio and Thomas Boyadjis, Sr.

'Tis not always in a physician's power to cure the sick; at times the disease is stronger than trained art. ~Ovid

And lo, The Hospital, grey, quiet, old, Where Life and Death like friendly chafferers meet. ~William Ernest Henley

For the most part, Western medicine doctors are not healers, preventers, listeners, or educators. But they're damned good at saving a life and the other aspects kick the beam. It's about time we brought some balance back to the scale. ~Claire Todae

A sweating ovary or a sick prostate explains most history. ~Martin H. Fischer

The only weapon with which the unconscious patient can immediately retaliate upon the incompetent surgeon is hemorrhage. ~William Stewart Halsted

The public blabbers about preventative medicine, but will neither appreciate nor pay for it. You get paid for what you cure. ~Martin H. Fischer

To save a man's life against his will is the same as killing him. ~Horace

Nowadays the clinical history too often weighs more than the man. ~Martin H. Fischer

Hypochondriacs squander large sums of time in search of nostrums by which they vainly hope they may get more time to squander. ~Mortimer Collins

One doctor makes work for another. ~English Proverb

Doctors are just the same as lawyers; the only difference is that lawyers merely rob you, whereas doctors rob you and kill you, too. ~Anton Chekhov, Ivanov

Let the young know they will never find a more interesting, more instructive book than the patient himself. ~Giorgio Baglivi

Formerly, when religion was strong and science weak, men mistook magic for medicine; now, when science is strong and religion weak, men mistake medicine for magic. ~Thomas Szasz, The Second Sin, 1973

Wednesday, March 5, 2008

Tooth gives man his sight back


Wat die donder?

27/02/2008 21:16 - (SA). AFP

Dublin - An Irishman blinded by an explosion two years ago has had his sight restored after doctors inserted his son's tooth in his eye, he said on Wednesday.

Bob McNichol, 57, from County Mayo in the west of the country, lost his sight in a freak accident when red-hot liquid aluminium exploded at a re-cycling business in November 2005.

"I thought that I was going to be blind for the rest of my life," McNichol told RTE state radio.

After doctors in Ireland said there was nothing more they could do, McNichol heard about a miracle operation called Osteo-Odonto-Keratoprosthesis (OOKP) being performed by Dr Christopher Liu at the Sussex Eye Hospital in Brighton in England.

The technique, pioneered in Italy in the 1960s, involves creating a support for an artificial cornea from the patient's own tooth and the surrounding bone.

The procedure used on McNichol involved his son Robert, 23, donating a tooth, its root and part of the jaw.

McNichol's right eye socket was rebuilt, part of the tooth inserted and a lens inserted in a hole drilled in the tooth.

The first operation lasted 10 hours and the second five hours.

"It is pretty heavy going," McNichol said. "There was a 65% chance of me getting any sight.

"Now I have enough sight for me to get around and I can watch television. I have come out from complete darkness to be able to do simple things," McNichol said.

Will have to wait for SA Doc to get back from her managed health care world and explain to me the differences between enamel and eyes. :)

Thanks Toby Shapshak for the story...

Monday, March 3, 2008

Medical Quotes #1

I'm in a quotes phase. Don't know why. But found these beauts. Two part series. Original post here.

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In nothing do men more nearly approach the gods than in giving health to men. ~Cicero

My doctor is nice; every time I see him, I'm ashamed of what I think of doctors in general. ~Mignon McLaughlin, The Second Neurotic's Notebook, 1966

The greatest mistake in the treatment of diseases is that there are physicians for the body and physicians for the soul, although the two cannot be separated. ~Plato

Body and soul cannot be separated for purposes of treatment, for they are one and indivisible. Sick minds must be healed as well as sick bodies. ~C. Jeff Miller

In the sick room, ten cents' worth of human understanding equals ten dollars' worth of medical science. ~Martin H. Fischer

It is a mathematical fact that fifty percent of all doctors graduate in the bottom half of their class. ~Author Unknown

Restore a man to his health, his purse lies open to thee. ~Robert Burton

I got the bill for my surgery. Now I know what those doctors were wearing masks for. ~James H. Boren

A hospital should also have a recovery room adjoining the cashier's office. ~Francis O'Walsh

Did God who gave us flowers and trees,
Also provide the allergies?
~E.Y. Harburg, "A Nose Is a Nose Is a Nose," 1965

I learned a long time ago that minor surgery is when they do the operation on someone else, not you. ~Bill Walton

It is a wise mans part, rather to avoid sickness, than to wishe for medicines. ~Thomas More, Utopia [sic]

I wondher why ye can always read a doctor's bill an' ye niver can read his purscription. ~Finley Peter Dunne

You have a cough? Go home tonight, eat a whole box of Ex-Lax - tomorrow you'll be afraid to cough. ~Pearl Williams

To array a man's will against his sickness is the supreme art of medicine. ~Henry Ward Beecher

A doctor whose breath smells has no right to medical opinion. ~Martin H. Fischer

Surgeons must be very careful
When they take the knife!
Underneath their fine incisions
Stirs the Culprit - Life!
~Emily Dickinson

It is a good thing for a physician to have prematurely grey hair and itching piles. The first makes him appear to know more than he does, and the second gives him an expression of concern which the patient interprets as being on his behalf. ~A. Benson Cannon

A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment. ~Author Unknown

One thousand Americans stop smoking every day - by dying. ~Author Unknown

A hypochondriac is one who has a pill for everything except what ails him. ~Mignon McLaughlin, The Second Neurotic's Notebook, 1966

The art of medicine consists in amusing the patient while nature cures the disease. ~Voltaire

A doctor must work eighteen hours a day and seven days a week. If you cannot console yourself to this, get out of the profession. ~Martin H. Fischer

It is sometimes as dangerous to be run into by a microbe as by a trolley car. ~J.J. Walsh

Every disease is a physician. ~Irish Proverb

God heales, and the Physitian hath the thankes. ~George Herbert, Outlandish Proverbs

Drugs are not always necessary. Belief in recovery always is. ~Norman Cousins

I firmly believe that if the whole materia medica could be sunk to the bottom of the sea, it would be all the better for mankind and all the worse for the fishes. ~Oliver Wendell Holmes

There is no curing a sick man who believes himself to be in health. ~Henri Amiel

Doctors think a lot of patients are cured who have simply quit in disgust. ~Don Herold

The only equipment lack in the modern hospital? Somebody to meet you at the entrance with a handshake! ~Martin H. Fischer

The worst thing about medicine is that one kind makes another necessary. ~Elbert Hubbard

When you are called to a sick man, be sure you know what the matter is - if you do not know, nature can do a great deal better than you can guess. ~Nicholas de Belleville

Throw physic to the dogs; I'll none of it. ~William Shakespeare

I recently became a Christian Scientist. It was the only health plan I could afford. ~Betsy Salkind

Poisons and medicine are oftentimes the same substance given with different intents. ~Peter Mere Latham

In the nineteenth century men lost their fear of God and acquired a fear of microbes. ~Author Unknown

Symptoms, then are in reality nothing but the cry from suffering organs. ~Jean Martin Charcot, translated from French

I never read a patent medicine advertisement without being impelled to the conclusion that I am suffering from the particular disease therein dealt with in its most virulent form. ~Jerome K. Jerome, Three Men in a Boat

Diagnosis is not the end, but the beginning of practice. ~Martin H. Fischer

The physician should look upon the patient as a besieged city and try to rescue him with every means that art and science place at his command. ~Alexander of Tralles

Physicians and politicians resemble one another in this respect, that some defend the constitution and others destroy it. ~Author Unknown

A smart mother makes often a better diagnosis than a poor doctor. ~August Bier

When fate arrives the physician becomes a fool. ~Arabic Proverb

Medicines are not meat to live by. ~German Proverb

Treat the patient, not the Xray. ~James M. Hunter

God and the Doctor we alike adore
But only when in danger, not before;
The danger o'er, both are alike requited,
God is forgotten, and the Doctor slighted.
~Robert Owen

Financial ruin from medical bills is almost exclusively an American disease. ~Roul Turley

The hospital is the only proper College in which to rear a true disciple of Aesculapius. ~John Abernethy

A man who cannot work without his hypodermic needle is a poor doctor. The amount of narcotic you use is inversely proportional to your skill. ~Martin H. Fischer

Better to hunt in fields, for health unbought,
Than fee the doctor for a nauseous draught,
The wise, for cure, on exercise depend;
God never made his work for man to mend.
~John Dryden

Saturday, March 1, 2008

All Scrubbed Up - Looking for contributors!

Wanna get under our blog?

All Scrubbed Up is looking for contributors... Drop us a comment with your email address if you're keen to get involved with writing on South Africa's leading medical blog. Share of ad revenue to your posts - part of the package baby!

We want to expand - are you it?