August 15, 2007
BehindTheMedspeak: It is more important to know something is not right than exactly what is wrong
As so often happens, events in the operating room and the practice of anesthesia can be extrapolated to the world outside.
Last week I undertook a what appeared to be a routine anesthetic induction: fentanyl, midazolam, propofol, succinylcholine, oxygenation by mask, endotracheal intubation with my trusty Mac 3 blade and a 7.5 endotracheal tube.
When I did the laryngoscopy things looked funny, with what appeared to be the trachea and vocal cords off the right side instead of midline, but I rationalized the odd appearance as due to the patient's being old (late sixties) and natural human physiologic variation.
When I connected the tube to the breathing circuit and squeezed the bag there was "fog" in the tube (evidence of water vapor, produced in the lungs with each exhalation and evidence of correct tube placement: a tube in the esophagus doesn't show such condensation).
I watched the lady's chest and abdomen and there wasn't much chest movement — in fact, there wasn't any, and the stomach seemed to inflate with each breath I gave.
Well, I rationalized, sometimes that's the case even when the tube's in the right place.
The circulating nurse, sensing my doubt, said, "Oh, I can see the fog in the tube, it's fine," and went off to do what circulating nurses do.
I taped the tube in place, glancing over at the end-tidal CO2 trace for confirmation that the tube was in the trachea (no CO2 = esophageal intubation) — but there was no CO2 trace or numerical value.
Must be, I rationalized, that the thing is still warming up (it was the first case of the day, and sometimes it takes the machine a couple minutes to start working).
Then I reached for my stethoscope to listen to breath sounds, but before I could put it against her chest the high-pressure alarm on the ventilator started beeping.
Okay, I thought, that's four things that aren't right — enough.
I pulled the endotracheal tube out and took another look: this time things looked like they were supposed to, big fat white vocal cords midline (top) — the way they should be.
I put the tube in and guess what?
The chest rose and fell the way it's supposed to, the CO2 trace appeared on the monitor and the ventilator showed 22 cm of inspiratory pressure, again, the way it should be.
Breath sounds were equal bilaterally, as well.
Oh, in case you were were wondering: the events described above — from my initial look inside the mouth until I replaced the tube — took place over a span of about 30 seconds.
But you can see how it can be that you can be fooled — or, rather, fool yourself — into thinking things that aren't quite right are still somehow okay.
It's nice to be the compulsive sort in my line of work.
By the way, I still haven't the foggiest (sorry about that) idea where the initial tube was — but then, that's the lesson, isn't it?
'Recreations from all over the internet'
I'll take it.
Hands-Free Bottle Holder — Episode 2: Add Color
It was over two years ago — May 17, 2005, to be precise — that this clever device made its debut here.
Like Henry Ford's Model T, you could have it in any color you wanted — as long as it was black.
Well, time passes and out back in the bottle acccessory skunk works they've been working night and day, burning the midnight oil in order to, at long last, in response to what must have been overwhelming popular demand, finally produce Blue, Red and Silver versions to accompany the original.
From the website:
- Clip-On Bottle Holder
Keep your water within easy reach with this handy Clip-On Bottle Holder.
No more forgetting to carry your water bottle or searching through your bag or tote to find it.
The sturdy rubber O-ring on this clip-on holder allows you to securely attach a bottle of almost any standard size to your belt, daybag, backpack or carry-on bag for quick and easy access anywhere.
6" long; 1 oz.
Same as it ever was.
Confessions of a French Soy Eater – by Olivier Lichtenberger
A bookofjoe World Exclusive™.
Long essay short: Olivier Lichtenberger believes that he lost his sense of smell as a result of ingesting soy products; the anosmia abated once he stopped consuming them.
Here's his story.
- Confessions of a French Soy Eater
It is two weeks Anne since I dropped this deadly and ultimate food test or experiment. Two weeks I regain progressively my sense of smell. The first week I suffered some sort of hot flushes (or is it flash) but I don't know exactly what is is. And, maybe it was not the lack of my toxic that provoked them, the sudden frustration of my daily oestrogen dose of the four preceding months. I never had felt that. Olfactory distortions lasted up to four days ago, and nothing since. Very neat ghost smells and false odours then nothing. Yes it could come again but I had not had such a truce since February. At the end of the first week my own odour was back, body odour back and nuances and subtleties of all sort of things, tomato, ginger, basil, raw meat or potatoes... Some things are missing as olive oil that I cannot smell through the nose but the fragrance of which I unmistakably identify through the mouth then the nose and in very scarce proportions. Something has changed too in this state of slight nasal congestion when waking-up. It is some very relative congestion nothing as a nasal obstruction, never known that; just a slight discomfort. Since the first days of my new healthy diet, this relative soreness vanishes in minutes after I am up, with this sensation of relief that succeed a voluntary deglutition move we force to balance the air pressure in our ears, passing a tunnel or in an elevator or in a plane an air pocket. A sudden effect and instantly releasing.
So, I at the end of my test I had three days of total anosmia for four days, the rest of the time vague odours faintly consistent with the reality, but mostly discordant smells with or without identifiable stimulus or in connection with a unusual common but real odour or more or less untimely as motor exhaust or fumes down in the street or else the air shaft of a restaurant in the neighbourhood, all odours I interpreted falsely. This impression is often described in the anosmia groups. It is as if the corruption of the smell was provoked by a filter altering the real odour or deafening it as a coloured filters adulterate normal vision of colours. But it has never been a torture for me Anne as it has been for you. And I can very easily hold my smelling appendix without my hands nor any cotton ball. For me it never has been but a eeriness or a dramatic and horrifying loss. Before the day where I found out, it was the hellish abyss of some degeneration in progress.
Bon! Je ne l'ai toujours pas dit, Anne! But the name of the site from where you read this page tells you the name of my toxic, the ex-staple food of mine I identified as THE toxic to be blamed for my anosmia. You see it is very simple. All I had to do was to think of it then try and strike it off my shopping list. And this two years of total anosmia were past history in only ten days. (excepting the multiple tests I ran since... and am finished with.)
This experience of intoxication (beginning fall 2003) I already narrated it to you. I shall tell it here anew, trying (!!!) to be more specific and clear. I told you you all but the name of the poison. It was very difficult, for you too, hard to understand why I did not want to tell it. I tried to explain. I shall do it again. Here. I expect to be the limpidest.
This evening my blue bottle of gin exhale its perfume "d'eau de toilette chic". This evening ginger is no more first of all a burning sting but a fragrant marvel.
Soy. I tried it several decades ago without much enthusiasm. I got back to soy with pleasure perchance, falling in love with a woman who did not like it at all but convinced me to try. It was fall 2003. The soy took the place of my daily ration of milk (3 1/8 oz three times a day; plus all kind of food with soy as a component : "dairy" products, biscuits and confectionery, prepared "meat" ice-creams, beverages...)
I did not make the link with my anosmia/dysosmia, I knew it from long but it was something so labile and in so short lapses that I did not really took care of. It was just enough intriguing to be funny : I never refused having "bizarreries". I blamed swimming or some cold snap for my anosmia, and dysosmia I spoke of as olfactory delusions when I tried to describe it to close friends or family rather astonished or sceptical and afraid or even comforted to hold at last a proof of my latent insanity. I wore that with a sort of sarcastic glee. A painter and slightly colour-blind I was now odour-blind!
It was only several weeks or months later that I began to realise : total anosmia had gradually but surely took place. And then I was very afraid. And much more afraid that browsing the web I soon discovered the identity of my troubles, the names and facts and the grisly reality : nobody knows much or even anything about that ailment and even olfaction to begin with. And nobody is close to know much more. Nothing to be found of great interest else that nobody knows much. But a bunch of charlatans. But some notions relating this impairment with Alzheimer's!!! Ghastliness!
Two years it went dreadfully so. Till the day where I described these gloomy circumstances to my psychiatrist, whining one more time. I told her in the same time that I knew since when it had turned to a complete anosmia. And that I knew the coincidence with the beginning of my new "food" regimen. She told me to stop eating it, very easy... Without her I could have go on and on. After all I had had bouts of anosmia long before this regime. And I really preferred my coffee with soy "milk" rather than with milk. And all these soy foods or soy containing foods were nice enough most of the time.
Thus I stopped eating soy, TOTALLY, or to be exact, almost totally. Because soy is everywhere. Everywhere in prepared food; nearly all that is not raw food is likely to be improved, bettered, enriched, enhanced by or with soy under forms or shapes more or less disguised or hidden but also sometimes glorified, gentrified. So, avoiding soy is all but easy. You should cook all by yourself to be sure not to eat soy : meat, vegetables, bread, pastry, gravies, snacks... But even so, you should absorb soy in a multitude of pharmaceutical stuff, cosmetic stuff, cleaning, sticking, ink and paint stuff, candle and soap stuff... Plus, soon, in your SUV. It is now a century and a half that soy industry flourishes.
I went back to the web where I found very entertaining things about soy and olfaction. And I found too these forum and groups where anosmia is discussed.
And among these findings the most strange thing : there is in French-speaking and English-speaking groups only one other person to have found what I had found. But after his statement. He never spoke of it again. Must be said that nobody appeared to have heard. Or this person did not believe in what he had observed, or he is (as I have been since three years) "lurking around" forum and groups anosmia oriented. But knowing that this person is a plaintiff in one of these lawsuit against Zicam and that lawyers have enjoined their clients not to make untimely statements on the subject, it is not surprising.
I have quickly realised it was an astounding discovery, that I held something about what lots of ENTs, neurologists, olfaction researchers try to find and maybe after try to explain in vain since one (several) century(ies).
Searching the web about soy I think I have understood some things. Some about anosmia, about olfaction but also about soy industry and its following and support by medicine, science and governments.
Soy is a neurotoxic and particularly for the olfactory system.
And The Emperor ? "But he hasn't got anything on" says the child.
PocketDock AV — 'Portable audio/visual iPod solution'
Chris Hunter reviewed it as follows for Steve Leckart's Cool Tools:
- PocketDock AV — Portable audio/visual iPod solution
The PocketDock is the Swiss Army Knife of iPod connectivity. A non-standard compact cable and small dock with several AV connectivity options, it replaces a bag full of adaptors and cables and makes life easier, especially if you spend a lot of time traveling and staying in hotels. Mine lives in my laptop bag and goes with me on regular business trips to Australia, so I can plug my iPod into hotel stereos and even hotel TVs to watch video podcasts via S-Video. I've yet to come across a situation where I haven't been able to output satisfactorily. The key for me — aside from the fact it's significantly cheaper than Apple's AV Connection kit — is how the audio is line-out, rather than from the degraded headphone jack connection. The sound quality, therefore, is higher: I can barely hear the difference between AIFF tracks playing on my iPod through my Linn hi-fi at home and tracks being played via CD on my CD player.
Meet Oliver the Monkey: He's 'The Lockpick Artist' — 'No cage can hold him'
Look at the photo above.
What do you see?
Looks like an ordinary, garden variety capuchin monkey, doesn't it?
But Oliver is no ordinary monkey — not by a long shot.
Breaking (sorry) story short: This 9-year-old capuchin monkey has suddenly acquired a mysterious superpower: for the second time in the past two weeks he's succeeded in picking the locks on his cage at a Mississippi zoo, breaking out into into neighboring yards and gardens to enjoy the bounty of a Southern summer.
Here's Brenda Goodman's story, from today's New York Times.
- Will No Cage Hold Him? Monkey Again Escapes Zoo
For the second time in two weeks, Oliver, a 9-year-old capuchin monkey at a Mississippi zoo, escaped his cage, and this time, his keepers said he proved to be an even more artful dodger.
“I know he wasn’t happy when we caught him the last time,” said Kirk Nemechek, manager of the Tupelo Buffalo Park and Zoo.
“We had a sighting this morning,” Mr. Nemechek said in a telephone interview on Tuesday. “Usually he will come to you. We tried chips, candy, Froot Loops, anything. He wasn’t ready to give up.”
On July 31, the white-faced monkey popped a relatively simple lock on his cage and went on the lam for more than six days before he was spotted looting the vegetable garden behind a nearby home, Mr. Nemechek said.
With his monkey safely back behind bars, Mr. Nemechek said, he spent $300 on new locks for the cage Oliver shares with Baby, another of the park’s five capuchins.
The locks were installed last Friday.
On Monday, Oliver got out of his cage, 20 minutes after his handlers said they had cleaned and locked it. He was seen headed toward the lush landscaping of the Tupelo Country Club.
The new locks were on the ground.
It was unclear if Oliver had shown himself to be a capuchin Houdini or if he had a human accomplice, perhaps an animal rights advocate, Mr. Nemechek said, although he emphasized that that was speculation.
Capuchins are used as helper monkeys for disabled people, he said. “They see a lot of things and they can mimic things.” Oliver, he said, “might have a piece of wire hidden in his cage or something” that he used to open the lock.
Whatever the explanation, the chase could not end too soon for Mr. Nemechek, who said he would be happy never to spend another day trekking through the woods in triple-digit temperatures.
At 2 p.m. Tuesday, a call to a tip line put Oliver in the backyard of a woman’s home about four and a half miles from the zoo.
Mr. Nemechek called for backup.
“Seven or eight police officers and five or six of our staff surrounded him and we nabbed him,” Mr. Nemechek said.
By late afternoon, Oliver was back inside his cage, drinking water to cool off.
Mr. Nemechek said he would try titanium locks.
My Turn To Confess — by Charles Simic
A dog trying to write a poem on why he barks,
That's me, dear reader!
They were about to kick me out of the library
But I warned them,
My master is invisible and all-powerful.
Still, they kept dragging me out by the tail.
In the park the birds spoke freely of their own vexations.
On a bench, I saw an old woman
Cutting her white curly hair with imaginary scissors
While staring into a small pocket mirror.
Inflatable Leg Rest
Inflatable is the new black — or pink, or whatever fits here.
From the website:
- Inflatable Leg Rest
Enjoy first-class comfort for your legs and feet.
This compact Inflatable Leg Rest inflates with just 10-12 quick breaths to raise your feet and support your calves in cushioned comfort.
Made of sturdy vinyl and covered with soft flocked gray fabric, it's ideal for airplanes, offices, or anywhere tired legs and feet could use a little pampering.
Deflates in seconds and stores in its own travel pouch.
• Patented On Air™ allows for easy inflation and deflation
• Elevated feet help reduce fatigue when traveling
• 13" x 5" x 2" folded; 16" x 13" x 10" open
• Makes long flights more comfortable