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October 25, 2004

'Massive Change: The Future of Global Design'

Exhibition_massive_title2

If you plan to be in Vancouver before January 3 of next year, stop by the Vancouver Art Gallery and have a look at this show.

Massive_change3l

It was designed by Bruce Mau (great name, what?), known for his groundbreaking design work for Zone Books in the 1980s and his collaborations with architects Frank Gehry and Rem Koolhaas.

Massive_change13l

The Massive Change project, based at the Institute without Boundaries,

Logo_6

has its own website with much of interest to look at.

October 25, 2004 at 04:01 PM | Permalink | Comments (0) | TrackBack

Electric Fire Bubble Gun

Tn_bubblegun

This continuously firing bubble gun puts out up to 1,000 bubbles a minute.

Spill-proof.

No dipping required.

Just pull the trigger and shoot.

Comes with 4 ounces of non-toxic bubble solution.

Just add 2 AA batteries (included) and you're good to go.

£15.99 here.

That's $28.62 for you gringos.

[via redferret.net]

October 25, 2004 at 03:01 PM | Permalink | Comments (0) | TrackBack

MorphWorld: Jimmie Johnson is morphing into Colin Farrell

Johnson_1

The great NASCAR driver,

Jimmiefan

#48, is looking more and more like the

reigning

Colin_farrell

enfant terrible

232211

of cinema.

October 25, 2004 at 02:01 PM | Permalink | Comments (1) | TrackBack

BehindTheMedspeak: Another Lasik Disaster

Wavefront_graphic

Regular readers know my disdain for Lasik and, in fact, all elective ophthalmological surgical procedures that attempt to correct visual deficiencies that can be remedied with glasses.

Maggie Fox, a Washington, D.C.-based health reporter, drank the Kool-Aid recently, and went under the laser.

She wrote up the story of her surgical fiasco for the October 5 Washington Post.

Read it and try to understand that my approach to medicine and health really is based on Hippocrates' venerable but still valid and highly relevant philosophy of "Primum non nocere." [First do no harm]
__________________

A New Vision For Midlife?

After an Updated Kind of Lasik, She Could Still See Imperfection


It's disturbing to show up for Lasik eye surgery and to be greeted by someone who appears to be blind.

Dark shades, erect posture, unmoving head, the man sits calmly in the waiting room.

Clearly he has just had the surgery.

Eventually I get up my nerve to ask: "How did it go?"

"Fine," he answers serenely.

Later I will learn the secret to his zombie calm.

I have dithered for years over Lasik surgery, asking my ophthalmologist his opinion (he's against it), checking Web sites, questioning eye experts and patients when I meet them.

I believe myself to be a prime candidate.

Nearsighted since the age of 10, I hate glasses, see poorly with soft contact lenses and cannot tolerate the hard lenses that offer the crispest vision.

But I have heard the tales of Lasik patients who wind up with fuzzy vision that can't be corrected with glasses or contact lenses, who can't drive at night, and worse.

And so I waited.

Then I heard about the new technology called WaveFront, or custom Lasik.

It uses a computer and a machine that bounces light off the retina to map the cornea precisely; this provides guidance for the laser that reshapes the cornea to correct the vision.

While ads for the new technology make it sound like a revolution, a closer reading reveals that the mapping only reduces, but doesn't eliminate, the risk of some serious side effects of the surgery, like double vision, halos and glare that can be so bad it prohibits nighttime driving.

Two years after WaveFront's introduction, I made an appointment.

Though I hadn't signed up for the surgery yet, I paid nothing.

I had to peer, without really focusing, at what looked like a video game image of a road stretching into the distance.

This was harder than it sounded.

Meanwhile, the WaveFront scanner bounced light off my retinas.

The technicians also measured my pupil size and the thickness of my corneas.

People with big pupils or thin corneas have a higher risk of poor outcomes.

At the end, the optometrist told me I was a good candidate but warned it would hurt and I would still need glasses for reading.

Still, I waited.

Each company seeking approval for its WaveFront machine submitted to the Food and Drug Administration (FDA) its own studies, carefully selected to highlight the benefits.

Most showed that 85-95% of patients come out with 20/20 vision or better.

One of the few independent studies, done by a team at Ramathibodi Hospital School of Medicine in Bangkok, involved 11 patients who got standard Lasik on one eye and WaveFront on the other.

Researchers found virtually no difference in the rate of higher-order aberrations such as halos or double vision.

A team assessing Lasik for the American Academy of Ophthalmology in 2002 did not find one company's laser better than another's.

But all met the minimum FDA requirements of giving 80% of patients 20/40 vision or better.

In May, I learned that the U.S. Navy had done a clinical study of custom Lasik and claimed a nearly perfect record of success.

Captain Steve Schallhorn, director of cornea and refractive surgery at the Navy Medical Center in San Diego, explained that with conventional Lasik, 88% of patients he treated had 20/20 vision or better six months later, and 30 percent saw halos or had other night driving problems.

With custom Lasik, 97% of 34 patients he treated had 20/20 vision and none reported any nighttime symptoms. Schallhorn has studied more patients since then and said the numbers hold up.

"We don't have 100% 20/20. Probably with custom surgery we routinely get about 95%," he said in a telephone interview.

"There are two caveats. The people that we treat are generally very, very healthy. They are in the military. And they have relatively low levels of nearsightedness."

His patients usually have about three diopters of myopia, meaning their correction is minus-3.

Mine was minus-4.5, which means my vision is about 20/600.

I am so blind without my contacts that I once made everyone get out of a swimming pool when I lost a lens and searched the bottom until I found it.

Otherwise I could not have driven home.

"We don't do aviators or divers because of lingering concerns about the effects of Lasik," Schallhorn added.

It is not clear how a cut cornea will withstand the low-oxygen, low-pressure conditions seen in cockpits and deep underwater, he said.

Experts say not everyone needs the new technology.

WaveFront costs about $5,000 for both eyes (those "$495 per eye" come-on ads notwithstanding).

Standard Lasik is about $1,000 cheaper.

But what if you decide to save the money and get the standard surgery, and then end up with halos at night or the side effect called reduced contrast, which can make faces indistinct when backlit?

You wouldn't know if bad luck or your cheapness was to blame.

I decide to spring for the newer technology.

On the day of the procedure, an optometrist comes to collect me from the waiting room.

It's clear why this is such an expensive deal - there's a cast of thousands here.

I get a final cursory exam and am offered a Valium.

I decline. (Bad decision. More on this later.)

The surgeon enters.

Here is the man whose hands have restored the vision of very, very famous golfers and tennis players.

He is disappointingly lacking in charisma.

He glances quickly at my chart and asks if I have any questions.

He answers them curtly.

Next I am led to the laser suite, where a young, strong technician eases me into the chair, which positions me on my back with my head pointed slightly downward.

He positions a bulky apparatus over my face and puts numbing drops into my right eye.

In a flash my left eye is bandaged shut.

The surgeon comes in and hooks an eyelid holder over the upper and lower lids of my right eye.

Wait! I think. But there is no pausing here - not on a morning where I am patient number 29 out of 30 and everyone is ready to leave for the weekend at lunchtime.

Then the microkeratome, the bladed tool that will slice my corneas, is fitted.

It works like a little guillotine, with a blade that slices a round flap out of the cornea.

This is one of the most fretted-about parts of Lasik, with some experts arguing that if a patient's cornea is too thin, or if the flap is cut too thickly, there is little to work with if more surgery is needed later.

This definitely does not feel good.

"A little pressure," I am told.

Then everything goes black.

I feel nauseated.

I fight the urge to flee.

Why didn't I take that Valium?

Within seconds, the light returns.

I know my cornea has been cut and flipped open, but it does not hurt.

Most of the serious complications of Lasik come from this cutting of the flap - either it wrinkles when it is replaced, or it becomes infected, or the body responds to the incision by growing layers of cells that blur the vision.

These risk are the same for WaveFront and regular Lasik.

The laser begins clicking.

I see nothing but the blurry spot of light that I have been told to focus on from the beginning.

The laser's cool ultraviolet light, guided by the information on a floppy disk carrying my personal WaveFront prescription, has its way with my cornea.

Thirty seconds later it is over.

The surgeon whips off the equipment and wipes my eye.

He is surprisingly rough.

Ten minutes later the second eye is done.

"Look at the clock," the surgeon commands.

I can see that it's 2:30.

I can see the clock!

Without glasses!

"Congratulations," the surgeon says and shakes my hand.

I am escorted to the recovery chair and left alone.

My vision is foggy, as if I had water in my eyes, but I can see close up and far away.

I am given two Tylenol PMs and examined briefly by a brusque optometrist.

I ask her how bad the pain will be. "There will be pain," she says, offering no sympathy.

I feel sleepy when my husband drives me home.

Is it the Tylenol PM?

The stress of the surgery?

I suspect both.

Now I know why Mr. Zombie looked that way.

I climb into bed and have no trouble falling asleep, as instructed, for the afternoon.

When I awake there is a stabbing pain, but it disappears quickly.

The next morning I am able to drive myself to my appointment.

Without glasses.

A technician checks my eyes.

I can see the eye chart and make out the letters near the bottom, although they are not crisp.

"You're 20/20," he declares.

An optometrist explains that my vision will be unstable for a few days and that it is too soon to say what my final vision outcome will be.

She cheerfully advises me to keep my eyes wet with drops.

I work that night, sitting eight hours at a computer screen.

Although I need to put in drops regularly, I can see to read, without glasses, for the first time in years.

I drive home after dark and notice the lights look a bit large and bright, but not enough to be distracting.

But within a week my already-soft vision is softening more.

My eyes feel uncomfortably tight and dry at times.

At a checkup 10 days later the optometrist confirms my fears. "Your corneas are steepening," he says.

In other words, my corneas are reverting to the football shape that made me myopic in the first place.

I am now 20/50 in one eye and 20/60 in the other.

He assures me this can be corrected with a little "enhancement."

That means having the flap lifted - it will not have healed fully - and having the laser shave off a little more cornea.

He wants to wait three months because there is a "slim" chance my vision will improve.

In the meantime he writes me a prescription for glasses - glasses! - so I can legally drive.

I decide not to fill the prescription.

Later, I decide to visit www.surgicaleyes.org, a Web site run by people who have had bad experiences with Lasik.

I am very glad I did not look at this site before getting the surgery.

It features photographs of blurry rooms, blazing headlights that obscure the road, eye charts where the letters are doubled.

"I was unable to read a newspaper or drive at night and whatever my optometrist did he could not correct my vision with prescription lenses," one patient is quoted anonymously on the site.

"Basically I was seeing seven multiple images."

Will the new technology reduce such horror stories?

"The problems of people that come onto SurgicalEyes are not things that are necessarily going to be solved by WaveFront," said David Hartzok, a Pennsylvania ophthalmologist who is executive director of the site, in a phone interview.

"When you lift and cut the flap and then lay the flap back down, you may be altering the topography of that cornea," he added.

The WaveFront technology may make the laser change the cornea more precisely, but the problems associated with Lasik, he said, often have to do with how the cornea heals.

"We do know that we have people coming on our site that have had custom WaveFront treatments and still have some of the complaints than they had before."

Lasik, he said, is very much subject to hype.

It turns out that choosing, not treating, patients is the key to Lasik success.

"My old corneal prof used to say you can teach a monkey how to do eye surgery," Leo Maguire of the Mayo Clinic in Rochester, Minn., wrote in an e-mail.

"The brains are used in preoperative selection and postoperative management."

Still, most people are happy with Lasik, Maguire said.

"Refractive surgery has the highest patient satisfaction rates and highest quality-of-life improvement scores of any operation that is done," Maguire said.

"It does not change the reality that some people have things go wrong from any number of causes including, but not limited to, poor patient selection, machine malfunctions, surgeon error and poor wound healing. These rare things can happen after custom laser just like they can after standard laser."

A month after the surgery I am still slightly nearsighted - about 20/30 in one eye and 20/50 in the other.

Several optometrists tell me this is not unusual.

The optometrist at my one-month checkup tells me they'll adjust their WaveFront logarithms for 45-year-old women to take my case into account - a small comfort.

We talk about the possibility of having enhancement surgery on one or both eyes.

If I do both, I'll have crisp distance vision but will need reading glasses.

Doing one eye will give me "monovision" and allow me to read with one eye and use the other for focusing in the distance.

I should think about this for three months while my vision stabilizes, he advises.

Some days my vision seems very clear and on others I am starting to have trouble reading.

I have an eye gel that wets my eyes better than the drops, so the dry discomfort is gone.

Can I live with that?

The other night I finished a book in bed and reached up to pull off my glasses.

They weren't there.

I think I can live with it.

October 25, 2004 at 01:01 PM | Permalink | Comments (1) | TrackBack

World's most sensational toilet seat

Blaue

It's the Galactika luminous seat,

Galactic

with embedded LEDs that create a truly other-worldly experience in the bathroom.

Grune

The seat's wildly popular, so much so that it's already sold out in red and yellow.

Wcrot

So you'll have to settle for white,

Wcweiss

green, or blue.

Me, I'd go for the blue.

$249 here,

Wc5k

but you better hurry.

Wcgelb

I just love their product pictures: they look like the rings of Saturn on LSD.

[via mcnutts and Gizmodo]

October 25, 2004 at 12:01 PM | Permalink | Comments (0) | TrackBack

Search tricks

B0000auh9501lzzzzzzz

I buy all the books that tell you how to use Google and search and all, and I can't understand any of 'em.

However - I have learned a few things through trial-and-error that might be useful to you.

1) It is much more efficient to simply put a word from the headline or article, an author's last name, and the paper an article appeared in into the Google box and hit "search" than it is to

1) go to the paper's website

2) find the advanced search page

3) put in that same information

4) get no result, more often than not

Very often articles from the New York Times that are over a week old and therefore must be purchased from the Times website for $2.95 a pop can be found by using the trick I outlined above.

Sometimes you get the original Times story, sometimes the same story as it appeared in some other paper but regardless, it's the story you wanted, so who cares how or why it's there?

Even for papers which let you search their sites free for longer periods of time, such as the Washington Post (30 days), using the Google method is much quicker.

059600447801lzzzzzzz

And that's all I have to say about that.

October 25, 2004 at 11:01 AM | Permalink | Comments (0) | TrackBack

Strange ad in a strange land

Nytsmall

Yesterday's New York Times Sunday Styles section was its usual mixture of things, but one thing that was new caught my eye.

It was on page 11.

Page 11 was divided into eight discrete areas.

The two-column-wide section on the left had Bill Cunningham's feature, "Evening Hours," a group of annotated black-and-white photos of posers and poseurs: Al Gore, Bronfmans and Pillsburys, Wynton Marsalis and Ahmet Ertegun, you get the picture.

Under that was the "Letters" section.

The two columns to the far right consisted of an ad for Sergio Rossi shoes, one for Cassina furniture, and one for Jimmy Choo.

The middle section was what got my attention.

Up top was an ad for Steuben Glass; below it was one for Pashmina scarves.

The fascinating thing was just below: an ad for the Genetics & IVF Institute headlined "DONOR EGG" - Immediate Availability"

Egg_rot_txt

Now, I've seen this ad in the Times pretty regularly over the years, but its placement in the Sunday Styles section was new.

Because this section is basically the sports section for girls, as one of the characters on "Sex and the City" once drolly noted.

It's where women go to read about who got married and to whom, and then decide "who won."

The fact that the Genetics & IVF Institute finally broke through, and got the Times to allow them and their message of barrenness and infertility problems into the land of la-de-da and make-believe and happily-ever-after is, I think, significant.

The Times is reeling from the plain fact that newspapers are more and more perceived as part of the Buick/Cadillac crowd's lifestyle, not the hip, 18-34-year-old demographic advertisers so crave.

The Gray Lady, like any institution, will do whatever it takes to survive.

October 25, 2004 at 10:01 AM | Permalink | Comments (0) | TrackBack

BehindTheMedspeak: Curt Schilling's in the wrong sport

24ankle

The stoic Red Sox righthander belongs in hockey, what with his newly-acquired habit of getting stitches put into his right ankle before each pitching appearance.

I couldn't believe what I was seeing last Tuesday night when the Fox TV cameras repeatedly showed Schilling's bloody right ankle during his magnificent seven inning outing in Game 6 of the classic Red Sox-Yankees A.L.C.S.

But I was even more amazed when I read Jack Curry's story in yesterday's New York Times Sports section on what exactly's been going on with Schilling's ankle.

He has a dislocated right ankle tendon.

Its restraining sheath has been torn away, so Schilling's foot won't work properly.

He had to leave Game 1 of the A.L.C.S. after three innings when he injured the ankle while covering first base.

Most people didn't think he'd pitch again this season.

But Dr. William Morgan, the Red Sox team physician, had an idea: he thought he could suture the skin on the sides of Schilling's tendon down to the deep tissue under it, thus creating an artificial sheath to prevent the tendon from snapping against the bone.

He looked into the literature to see if there were other reports of this procedure, but found none.

So he tried it out on a cadaver, then performed the experimental operation on Monday, October 11, the day before Game 6.

He put in three stitches under local anesthesia, but one ripped away early in the game, resulting in the bleeding visible to TV viewers.

Morgan last Saturday performed the operation a second time on Schilling's right ankle, this time using four stitches to make the repair stronger.

After the game is over, Morgan removes the stitches and prescribes antibiotics to guard against possible infection.

Two thoughts:

1) If the series goes that far, Schilling's gonna need the Morgan procedure one more time - before Game 6

2) I'm certain that this surgical procedure will henceforth be termed
"Curt Schilling surgery" in the same way people refer to the now-routine tendon transfer procedure on a pitcher's throwing arm as "Tommy John surgery."

Hats off to Dr. William Morgan for creative thinking under pressure.

And hats off to Curt Schilling for being willing to undergo this procedure.

Remember, you're talking about one of the most valuable properties in baseball.

Schilling's scheduled to undergo reconstructive surgery on his ankle a few days after the World Series, with rehabilitation expected to last three months.

Here's the Times story.
__________________

A Doctor Is Keeping Schilling in Stitches


Soon after Curt Schilling arrived at Fenway Park on Saturday afternoon, he found Dr. William Morgan, climbed onto a trainer's table and underwent the revolutionary medical procedure that should enable him to pitch for the Boston Red Sox in Game 2 of the World Series on Sunday night.

Morgan, the Red Sox' team physician, sutured the skin around the dislocated tendon in Schilling's right ankle down to the deep tissue to form an artificial sheath to prevent the tendon from snapping against the bone.

Morgan devised this remedy before Schilling's last start, and it was successful as he went from pitching like an unknown to resembling the same old ace against the Yankees.

When Morgan first thought of using this method to keep Schilling's tendon in place, he searched for similar case studies and found none.

Morgan practiced on a cadaver before trying it on Schilling the day before he won, 4-2, in Game 6 of the American League Championship Series on Tuesday.

Schilling kept the Red Sox breathing in that series, and everyone in Boston is breathing easier now because the hometown team is in the World Series and the chatty, overpowering pitcher is not worried anymore about the most analyzed ankle in New England.

"This was an absolutely last-gasp, brilliant idea" that the medical staff came up with, Schilling said.

"Because, had this not worked, I would not have been able to pitch Game 6. No way."

So, like a hockey player, Schilling will be stitched again to give him the flexibility and the power he needs to push off the rubber as he opposes the St. Louis Cardinals.

Schilling, who receives an anesthetic before Morgan begins working, said Morgan took about 20 or 30 minutes to finish the suturing.

He will receive another anesthetic Sunday shortly before his start.

Morgan used three sutures on Schilling's ankle Tuesday, but one ripped away and caused some bleeding that was visible on Schilling's white sock.

So Morgan told ESPN that he would use four sutures on Schilling's ankle on Saturday.

Schilling said Morgan removed the sutures after he left game Tuesday to help guard against possible infections.

Morgan prescribed antibiotics for the same reason.

"If something were to happen and they were to get infected, it would put my surgery back four, five or six weeks, and you're talking about missing spring training and the beginning of the season," said Schilling, who will most likely have reconstructive surgery on the ankle a few days after the World Series.

His rehabilitation is expected to last three months.

When Schilling was asked if it hurt when Morgan stitched him, he said: "What do you think? Does it hurt when you get poked in the eye?"

Schilling left Game 1 of the A.L.C.S. after three innings because of the pain in his ankle, and it seemed unlikely that he would be able to return in the series.

But the Red Sox continued searching for ways to get Schilling back on the mound, trying an ankle brace, investigating modified cleats and eventually settling on Morgan's groundbreaking procedure.

"There were a lot of scenarios we looked at, and one scenario was a last-ditch scenario with sutures," General Manager Theo Epstein said.

"Although it sounds extreme and we couldn't find a case of it being done before, it was not that risky."

Although reporters asked Manager Terry Francona about Schilling several times, the Red Sox did not reveal what they had done with him until after he pitched seven effective innings in Game 6.

"It's always nice to have some secrets in October," Epstein said.

If Schilling needs to make a second start against St. Louis in Games 5 or 6, Epstein said the Red Sox should be able to use the procedure one more time.

Schilling, a 21-game winner, is a crucial factor for the Red Sox and could be the difference between them winning, or failing to win, their first World Series title since 1918.

But Schilling emphasized that Morgan had already made a difference for the Red Sox.

When someone suggested that the players might give Morgan a full share of their postseason earnings, Schilling, who is thankful to still be pitching, explained how he offered lavish praise to Morgan.

"I asked him what the highest prize for medicine is," Schilling said.

"I guess they give out a Nobel Prize for medicine. I got to believe that he's on the ballot."

October 25, 2004 at 09:01 AM | Permalink | Comments (1) | TrackBack

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