Buddy can you spare me a cigar?

I was at my local 7-11 store the other day picking up a quart of milk when the line at the checkout was being held up by a man trying to by a cigar; yes buy a single cigar.
The tone of the clerk was harsh; we could all hear him say to the customer "you burned me the other day when you bought your smokes and there wasn't enough on your debit card to cover it. I get fined a penalty when that happens so this time you will have to either pay cash or prove your debit balance first." The man dug through his wallet and his pants and he had no money at all. He swiped his card and his balance came back 2.20. The cigar cost 1.75. However, there is a 50 cent debit card charge which would have put the customer past his overdraw mark. The clerk sent him on his way without his smokes and the line once again moved forward as my milk grew warm.

I am always amazed what an addiction smoking is. This man who hardly has a penny to his name was willing to spend the last nickel he didn't have for one more smoke. That is an impressive addiction!

UW Medicine Research "Sets the Pace"

Today is the thirty year reunion of my medical school graduating class at UW. As an assistant clinical professor I was privileged to participate in the hooding ceremony of the "Class of 2010" followed by a tour of the new "state of the art" UW Medicine South Lake Union research facility. There I visited the stem cell lab where I witnessed "lab grown" myocardial (heart muscle) cells contracting in waves across a Petrie dish. In the not too distant future these will serve as the "building blocks" to restore the heart muscle of heart attack victims. Next we were treated to an explanation by one of the leaders in the new field of epigenitics who hopes to be able to find new biomarkers of disease and unravel disease mechanisms that up until now have remained a "black box" mystery. The new UW facility cannot but help but impress any visitor. Not only are they the "tip of the spear" of scientific investigation, following in the footsteps of their down the street neighbor "The Hutch," they are becoming one of only a few centers in the world to bring the research science to the bedside with their Translational Medicine programs. Makes me darn proud to call myself "a Dawg!"

Only Yellow Easter Eggs for the Cain house next year

What does this have to do with concussion or obesity.....absolutely nothing. It really has nothing to do with Easter either. What happened is I used all my wife's bottles of food coloring, except yellow, in an effort to find the leak in my ski boat. My skiing partner and I got the boat going about a couple weeks ago and noticed that after each outing we seemingly had more water in the bilge than would be expected. This really came to confront us last weekend when my daughter and her boyfriend joined us at the lake and we started out accelerating away from the dock and you could see water welling out of the stern back panel of my 19ft inboard tournament ski boat. Not good. Fortunately I turned on the bilge pump and the water was pumped out in short order. We kept an eye on the water intrusion and it was slow enough not to get in the way of a fun day of skiing for all of us. After one run through the slalom course a piece we took on only 4" of water in the bilge. But this is about 3.5" more than we should. After the day of skiing was done we unscrewed the back floor panel to look at the drive train and fittings from the inside to try and find the leak. From what we could tell the drive shaft coupling was well sealed and that the leak was coming from somewhere on the stern left of the centerline behind the fuel tank where it was not visible without moving the tank.........not a quick job to do. This left two possibilities looking at the outside of the boat. Either it was a leak around the left inboard exhaust seal or it was related to the left speedometer cable or pickup mount. This is where the food coloring come in. We went home and came back two days later with my wife's box of multiple food coloring bottles and pulled the boat up on the trailer. We drained all the water in the bilge and then tilted it so any residual bilge water would run to the back. We looked for a leak with our eyes and none could be readily seen. Next we made up a bucket of water with a dark brew of blue, red and green food coloring and dumped it in the bilge. After a few minutes a slow drop by drop trickle began to show up around where the left speedometer cable exits the hull; leak identified. We didn't have the proper sealant with us at the time to fix it on the spot but that will be today's job. Hopefully we will again be seaworthy soon. Why yellow Easter eggs? Well yellow was the only color in the box we didn't use. I quietly but the almost empty box, save the yellow dye, back on the kitchen cupboard shelf. Unless my wife reads this, she'll never know..... at least until next Easter.

Concussion and Cognitive Exertion

I was recently evaluating a young athlete following a concussion in a sporting event. He was three days out from his injury which involved less than a minute of loss of consciousness. He only had slight symptoms at the time of this evaluation including a very mild headache and slight fatigue. Specifically he said he did not have any light sensitivity. He had a normal physical exam with particular attention to his neurologic exam. His balance testing was not the best but not abnormal. I performed an ImPACT neurocognitive assesment and he was normal across the board based on percentiles. However, what was very interesting is that by the end of the ImPACT test he said he had a terrible headache and his eyes were very light sensitive. He had to turn the lights down in the exam room part way through just to finish the test. This is the second time in recent months where I have had a patient develop a severe headache and photophobia (light sensitivity) when performing the ImPACT test. This phenomenon seems to be a rather interesting marker of the impairment of concussion brought on by cognitive exertion of neuropsychological testing in the recovery phase. This was quite telling as he wanted to know if he could go back to school the following week. I noted that we would have to be careful to craft a list of restrictions and accommodations to meet his temporary diminished "cognitive stamina." Over the last several months I have started asking how the post-injury athlete how they feels after taking the ImPACT test. I have had several who have said they felt a little worse in addition to these two who had a marked increase in symptoms, including photophobia, with testing. This is just one more thing to think about asking in the evaluation of a patient with a concussion. Here is a youtube of a typical concussion patient

Gary Small's Town Hall Lecture - Digital gains changing our brains, especially young ones

http://seattletimes.nwsource.com/html/localnews/2011608655_ibrain15m.html

My son and a colleague and I went to the Town Hall talk by Dr. Small last night. Dr. Small brought out some interesting points: 1) our youth are losing interpersonal and social interaction skills, 2) we sometimes feel anxious when we lose control or access to our technology, 3) we often make more mistakes when multitasking, 4) fMRI studies of brains while websearching show increased activation that decreases with time as we become more efficient at it.

On the other hand Dr. Small did not allude to one very beneficial effect of our technology which was brought out by a questioner in the audience at the end of his talk. Specifically, that modern technology stimulates human creativity by the coming together of ideas to create totally new ideas; that without modern "iTech" these new creations would never have had the chance to come to fruition (at least they would be statistically improbable to do so). Overall the talk was not all that inspiring but I might give his book a try.....when it comes out on Kindle :)

Check this out!

This is my first blog entry. As a healthy living advocate I think this is something we should be aware of. It's hard to eat right with all the wrong foods out there to become "addicted to!"

http://news.yahoo.com/s/hsn/20100328/hl_hsn/junkfoodaddictionmaybereal