bookofjoe

BehindTheMedspeak: Talkesthesia

The first time I ever saw the word "talkesthesia" was last week when I read an article in Anesthesiology News, a monthly throwaway.

The story was about vibration anesthesia (vibrasthesia?) as an adjunct to reducing the pain of minor dermatologic procedures.

Dr. Kevin C. Smith and colleagues from the department of neurology at Mount Sinai School of Medicine described, in the Dermatology Online Journal, the use of several different commercially available massagers to provide analgesia during a wide range of dermatologic procedures, including:

• Botox injection

• Laser therapy for leg veins

• Laser tattoo ablation

• Collagen injection for facial wrinkles

• Nailfold injections for psoriatic nails

• Incision and drainage of abscesses

• Mild cautery of facial warts

They noted that massager–induced vibration provided useful anesthesia in many patients but noted that their report is anecdotal "because it is clearly difficult to blind or placebo–control patients to the obvious sensation of vibration."

The article has seven video clips demonstating the use of vibration anesthesia.

I won't go into the detailed theory of why vibration anesthesia works: the online paper does that quite nicely and you can read it there if you're interested.

I will note briefly, though, that the general idea is that the conscious brain can only process so much information at one time; therefore, if you overwhelm it with sensation from one source, other sensations won't be nearly as strongly apparent.

The Anesthesiology News report stated, toward the end, "They also recommended so–called talkesthesia (talking during painful procedures)."

Well.

I've been using talkesthesia since I was a resident and find it, along with handholding, among the most useful anesthesia modalities I employ.

You can turn it on and off at any time and there are no side effects that I know of, other than a grateful patient.

I have seen many procedures done under sedation and local anesthesia turn into thrashes because of the use of IV sedatives, hypnotics and narcotics when simply putting a head under the drapes and telling the patient you're there with them, giving them your hand to squeeze and reassuring them that it's almost over — even when that's not so — would have accomplished the same thing without losing the airway and disrupting the surgical field to ventilate the patient.

You see, there is often a conflict between the safest thing to do and what's most comfortable for the patient.

I pride myself on almost never — I say almost because, though I cannot think of an instance I let myself slip in this regard I'm sure it has happened — ever doing what's easier for a patient to tolerate if I think it might increase their risk in any way.

I will make someone very miserable in order to get them through a procedure with the least chance of a complication.

Sorry — but if you're my patient you're doing it my way.

And I don't just talk the talk: when I had four impacted wisdom teeth chiselled out of my mouth back when I was in medical school I refused the oral surgeon's very emphatic recommendation that I allow him to give me a general anesthetic.

He said it would a very unpleasant afternoon if I chose to be awake.

I so chose.

He shot me full of local and proceeded to hammer my teeth out with his big stainless steel mallet and chisel, blood and saliva and bits of teeth flying everywhere.

I saw stars every time he hammered down into my mouth.

And the noise — oh, man, the noise was unbelievable, of teeth breaking and shattering and cracking.

And you know what?

I'd do it the same way tomorrow if I had to undergo the procedure again.

No general anesthesia or IV sedation in the dentist's chair, thank you very much.

My anesthesiology department chairman, Dr. Ronald L. Katz, back in the day when I was a resident, once remarked that when you read a report in the paper about a woman in her thirties who had a heart attack and died at the dentist's you can be sure that the actual events consisted of oversedation, respiratory arrest, inability to ventilate, cardiac arrest and death.

Because, he said, "Women in their thirties don't have heart attacks."

Every few years I read one of those stories in the paper.

Should've had the local.

Bible Key Chain — The Word writ very, very small

1,513 very thin but eminently readable pages contain the entire Old and New Testaments.

"The type is so tiny that you'll need a magnifier to read the passages."

That's for sure.

1.6"H x 1.25"W.

$2.99 here.

I suppose you could make a necklace out of it if you were so inclined.

Why the new New Orleans will be a 21st–century Potemkin Village

It hit me last evening when I read Joe Sharkey's "On The Road" column in yesterday's New York Times.

His topic was the new Clear Registered Traveler Program from Verified Identity Pass, Steve Brill's latest start–up company.

Brill, by the way, is the man who founded Court TV and The American Lawyer magazine.

Here's how you get your Clear Registered Traveler Card:

1) You fork over $79.95 for a one-year pass — money talks or take a walk, in this case to the back of the endlessly long, unmoving hoi polloi airport security line.

2) You give Brill's company your name, address, birth date, Social Security number, and two forms of government–issued ID.

3) You let the company take digital photographs of your fingerprints and irises.

4) The company sends this information to the Transportation Security Agency, which checks it.

5) The T.S.A. either accepts or rejects you — neither you nor the company is told why you were rejected should that happen.

So far they've signed up 7,000 people.

Brill estimates that about eight million people in the U.S. will sign up for a program like his over the next five or six years, and he intends to own at least one–third of the market.

Let's see — that's about 2.65 million people x $79.95 = $21 million a year — not chump change.

This program is a terrible idea, almost as bad as the current policy of separate airport security screening lines for first class and steerage — oops, I meant coach — passengers.

That happened because enough people with money and power used both to get their lives made more convenient.

But that leaves the rest of us to fend for ourselves, without the leverage afforded by the unhappy plutocracy.

That is immense power, lost.

The $79.95 verified identity pass will do the very same thing: leave the unempowered and unheard masses to stew in their lines while those who can pay take the shortcut.

Much better for everyone to be miserable for the reason noted above: them's that got can carry the rest of us along with them on their journey to a better line.

David J. Silbey, a history professor quoted in Sharkey's article, hit the nail precisely on the head: he "said that expediting the journey comfortably for the frequent and, therefore most influential, travelers could 'reduce pressure significantly' to enact necessary changes in standard airport security."

Sharkey wasn't convinced: he said he's already sent his money to Brill's company and signed up.

Money talks — those without walk or, in the case of airports, stand.

Which brings me, finally, to the headline leading this post.

Money is going to rebuild New Orleans — oodles and oodles of money.

But recreating a shell leaves the center hollow.

As Yeats wrote, the center cannot hold — not unless it's anchored by more than hope and wishful thinking.

Any major government initiative invariably comes down to many competing interests, some with excellent, off–the–wall ideas.

But action at the level of rebuilding a shattered major city requires consensus.

And consensus, in the end, is an average which takes into its maw all the great and not–so-great ideas and spits out... well, you and I and everyone in the country know what: back when I was in college we called it "SOSO" — same old same old.

So yes, there'll be lots of nice new buildings and levees and pumping stations and what–have–you but nothing's going to change: not until someone with a vision and the ability to communicate it says something like: from this day forward no resident of New Orleans pays one cent for medical care.

Ever.

For any reason.

The U.S. government writes a blank check to fund all health care forever for anyone who can prove residence in the city of New Orleans.

Just that one measure would bring this great city back to life, bigger and better than it ever dreamed it could be.

But the chances of it happening are zero.

And that's why it's Potemkin time, all over again for the zillionth time.

Oculas — Your own tricked–out 'Private Idaho'

Sometimes you just want to get away from it all.

Now you can — in the comfort and privacy of your own home.

From the website:

Developed over four years by renowned British designer Lee McCormack, the McLaren Formula One™ racing team, computer interface designers, and yacht builders, this is the most complete and distinctly personalized lounging oasis in the world, allowing you to safely and serenely shut out the world with the perfect levels of lighting, sound, seating, and privacy you select.

This private relaxation theater is handmade of fiberglass and integrates advanced audio, visual, seating, and environment technologies, as well as your choice of Macintosh or PC computer, to create a space that allows you to relax completely.

The Oculas has an electronic door that closes silently at a touch, cocooning a sitter inside the well-lit interior, which is upholstered with leather seating for comfort and completely ventilated for continual airflow that prevents stale air without compromising external noise reduction.

An electronic controller allows the user to adjust the light through a complete spectrum of hues and brightness levels for optimal reading, video-watching, or relaxation and sleeping.

The optional built-in massage chair accommodates a single person and has four settings from light to vigorous.

An integral surround-sound system provides clear audio and the flat-panel video screen allows you to watch your favorite DVDs, or you can connect a video game console.

The screen can also connect to the Internet for music and video downloading.

All functions are controlled by an interactive touch screen, and all materials and components have been tested to conform to international health and safety standards.

67"H x 38"W x 75"L.

1,431 lbs.

Like I said up top:

$45,000 here.

bookofjoe Christmas card

It arrived in the email yesterday from down Mississippi way where Shawn Zehnder Lea — among a zillion other things she does — somehow finds time to create wonderful bookofjoe–related (virtual) merchandise.

One day we'll get real.

Cutting Board Knife

Now here's a serious piece of kit.

This whole mashup thing is getting way out of control — just the way I like it.

Add a smidgen of "fast" and a dash of "cheap" and I'm roaring.

From the website:

Scissor Slicer, the amazing new kitchen tool that combines a knife and a cutting board for fast, easy, convenient slicing.

It is so easy to use — just squeeze and slice right into bowls for fresh fruit salad or chopped garden salad.

Slice into pots for delicious homemade stews and soups.

It's great for vegetables, fruits, cheeses, pepperoni and more!

The top blade cuts and the flat–topped bottom blade is the cutting board.

Comfort–Grip handles; stainless steel blade; safety lock; dishwasher safe.

A kitchen in your glove compartment, should you choose to keep it in your car.

$9.95 here.

Not recommended for clipping your nails unless absolutely necessary.

vlogs — if you read any further don't blame me if you don't get anything done today

Fair warning.

A vlog is a video blog.

My nonpareil technical engineer told me a few weeks ago that I could start up bookofjoeTV anytime I wanted, now that vlogs are surfacing from beneath the virtual tar pit.

Ha.

He's the poster boy for Samuel Johnson's memorable remark about second marriages, transposed to me and anything internet–related: "They represent the triumph of hope over experience."

I'm not even close to being able to get bookofjoeTV up and running.

You'll know when it happens, trust me: one day you'll stop by for your fix and there it will be. But enough about me.

mefeedia.org bills itself as "the world's first video aggregator."

Reminds me of my own idiotic styling of myself as "the world's only blogging anesthesiologist." But I digress.

Peter Van Dijck, co–founder of mefeedia.org, told the Wall Street Journal's Becky Bright in a story published Monday that there are currently more than 800 vlogs and the number is growing daily.

mefeedia alone has over 700 registered vlogs at present, encompassing nearly 30,000 individual videos.

Among the most popular vlogs is Amanda Congdon's rocketboom.com, which gets between 30,000 and 40,000 hits a day, according to Van Dijck.

Another aggregator is dvblog.org, curated by a group of artists.

Poker Pen

Finally.

You know how sometimes classes or meetings get boring?

Now you can fight back and no one need ever know.

From the website:

Poker, Blackjack and Slots Pens

Just press the ON button and these pens deal out casino–style fun without traveling to Vegas!

Each features digital display, sound, score and reset buttons.

Don't forget to turn off the sound before you start to play if you're in school or at the office.

Black ink.

5.75"L x 1.4"W.

Battery included.

Your choice of poker, blackjack or slot versions for $7.99 here.