Grumpy Grand Rounds

If you haven’t visited the site of fellow blogger Dr. Grumpy (Dr. Grumpy in the House), you should.  Dr. Grumpy is a neurologist whose “. . .patients and practice drive me NUTS!  Some days I’m so sick of patient shenanigans, the stupidity of insurance companies, and just the daily insanity of this field that I write this blog as my gripe forum. I’m a neurologist, and although I practice in an upscale suburban area, I sometimes seem to attract some remarkably “special” folks. I have no idea why. It just seems that weird crap happens to me or my patients. So this is where I vent about it.”

This week, Dr. Grumpy hosts Online Grand Rounds.  He asked for submissions of blog posts about “things that make us grumpy,” and I provided my post about the Blunder Down Under.  Dr. Grumpy found this grumpy enough to be included, and so it landed in the Grumpy Doctors section.  I really appreciate his introduction to my piece:  “Dr. Dalai, a radiologist who specializes in the “I’m tearing my hairs out by the roots” field of IT, sends in his grumpiness over trying to set up a PACS system.”

I would be REALLY grumpy if I had to deal with some of the other issues posted!

The Health Care Law Dissected

Note: Tim Farrell is a radiologist practicing in Virginia. In his own words, he’s “done a lot research on the 2010 Health Care Act for a lecture I’m giving at a medical meeting in a few weeks. It’s taken me several months to complete the research. In preparation, I compiled a lot of notes, put together in outline/text form.

I know that it’s lengthy, but in it I’ve briefly outlined the history of health care reform, reviewed the reasons behind reform and tried to condense the highlights of over 2,500 pages of legislation.The analysis is my opinion, based on my position as an “insider” in the medical profession who has had to deal with the insurance industry and the state and federal legislature for more than 15 years. A lot of it seems like basic common sense to me.

It’s an interesting read, if you’re into that type of stuff. If not, it will be boring as hell, so it’s your decision whether to read it or not. After spending THIS amount of time on it, I know the law about as well as one can (and a good bit of the stuff “going around”, is false).”

Without further ado….

Healthcare Law

Another Correct Prediction

In my February, 2008 post titled “A New Cellphone Accessory”, I requested that someone invent a combined bluetooth headset and video camera, mocked up as below:

On this occasion, I was only a few years ahead of my time.  Behold the Looxcie (Look-see, get it?) wearable camcorder:

Looxcie takes a sound-bite/tweet approach to video.  It is always on, but if you see something you wish to capture, press the button on the back, and Looxcie saves a clip of the last 30 seconds it, ummmm, saw.  It can also function as a bluetooth headset.

Phone app is now available for Android devices, and support for iPhone and Blackberry is coming soon.

All this can be yours for $199.  Visit

RadNet Buys eRad

I seem to have a lot of contacts in the PACS business, so many that they keep turning up in unexpected places.  I received a note yesterday from a friend at eRad to let me know that the Greenville, SC-based RIS/PACS company had just been bought out by outpatient imaging provider RadNet.  About 5 minutes later, I received a phone call from Ranjan Jayanathan, RadNet’s CIO to tell me the same thing.  I met Ranjan a few years back, when he still worked for Dynamic Imaging (and there still was a Dynamic Imaging).  He walked me through one of the best product demonstrations I have ever experienced.  (I wonder if that particular product will ever be seen again, eh, Ranjan?) 

I’ve got an appointment with Mr. Jayanathan next week to discuss this acquisition further, as I think the story is newsworthy for my illustrious readers.  Stay tuned!

Doctor Dalai’s Health Minute

As a physician, I am supposed to help patients, at least periodically. While I would like to think I do so every working day, I have two personal experiences outside of radiology to report, which I think will benefit you, my faithful readers.

First, let’s deal with a bit of technology. In perusing Medgadget a few weeks ago, I came across this intriguing tidbit:

Solar-Powered Toothbrush Supposedly Makes Toothpaste Obsolete

Researchers at the University of Saskatchewan have developed a solar-powered toothbrush that doesn’t require toothpaste. At the base of the brush is a solar panel, which transmits electrons to the top of the toothbrush through a lead wire. These electrons react with acid in the mouth, breaking down plaque without the help of toothpaste. It is an advancement of a model described 15 years ago using a titanium dioxide rod which released electrons when illuminated. The researchers are currently recruiting 120 teens to test the brush. The model is named Soladey-J3X and is manufactured by the Shiken company of Japan.

I had a peek at the Shiken web-site, and my curiosity was really piqued:

After a bit of back-and-forth with the Shiken rep, I was able to purchase a sample version, as full production and distribution of the J3X has not yet ramped up. I’ve been trying it for the past couple of days, and…the damn thing works! I’ve been using a Philips Sonicare brush, recommended by my dentist, for many years. After two days with the J3X, my teeth feel significantly cleaner, with a definite (although subjective) decrease in my perception of film/plaque as compared to the Sonicare. And this clean feeling lasts all day. I’ll keep you informed, but I think we have a winner. I am adding a bit of toothpaste at the end of brushing to keep all my lovely teeth fluoridated, and to keep my breath from lethal levels, but so far, this new toy does what it promises. And it looks really modernistic to boot! (I have the blue one.)

Moving now to the other end of my aerodigestive tract, I finally did something every 50 year-old needs to do: I had my colonoscopy. Sadly, I am actually 51.5 years old, and so this little party was a bit belated. That could have been a disaster, as you will see.

The worst part of the procedure was, of course, the prep. I mean, the induced diarrhea is bad enough, but drinking a gallon of GoLYTELY is sheer torture. This crap has a faintly salty taste and slimy consistency, and by the time I had my last 8 oz. cup of the stuff, I was ready to croak. My green Jello tasted wonderful after that.

The procedure itself is easy as can be. The worst part is anticipation, and the insertion of the angiocath for the IV. After that, a pop of Demorol and Versed sent me off to La-La land, and I awoke in the recovery area with some minor gas pains but no other discomfort. I do have a millisecond-flash of memory from the test itself, in which I think I complained of cramping. That’s it. Well, I did get a little woozy about 48 hours later, probably a delayed reaction to the drugs, which gave me an excuse to bail early on Rosh Hashana services. Fainting in Temple is bad form, you know. But I’m absolutely fine now.

Another famous physician, Dr. Mehmet Oz, of the Dr. Oz Show, just recently had his colonoscopy. Being a TV celebrity, he had to do his on time, at age 50. Rather frighteningly, Dr. Oz had an adenomatous polyp, which is considered precancerous, although the potential for malignant degeneration is rather low. Still, someone with as healthy a lifestyle as Dr. Oz is considered at low risk for development of polyps, and of colon cancer. If he can get one, we should all worry.

And indeed, my encounter with the Big Black Snake yielded a polyp as well:

Behold my sigmoid colon, and a 1.8 cm partially-pedunculated polyp within. My gastroenterologist snared this little sucker, and sent it off to pathology. He then skipped town for a much-deserved vacation. Fortunately, I have access to most of the local EMR’s, and against my better judgement, I checked the path myself. This is, of course, a bad idea, but thanks to God, Dalai’s Polyp was hyperplastic, and this is the most benign variety, with very little chance of ever turning malignant. Still, as the little SOB was over 1cm, I’m compelled to repeat the colonoscopy every three years instead of every five. Since my son has Crohn’s Disease, and must be scoped every year or two, I get no sympathy at home for the increased frequency, and frankly, the procedure wasn’t really a bad experience at all. I do hope, however, that there are some advances in the prep by 2013.

I want you all to learn from my experience. I was very, very lucky. Had Polly Polyp been adenomatous, I would be in greater danger for having been a wimp delayed my colonoscopy 18 months past the point I should have done it. So, if you are close to age 50 (or 45 for African-Americans), call your gastroenterologist and make the appointment ASAP! Don’t fool around with your health. Colon cancer is almost completely preventable, but far more so if the precursor lesion is caught in its very early stages. Don’t die young because you are afraid of the prep or the discomfort. It isn’t that bad, and this procedure could save your life. Literally.

Now, as a radiologist, I have to add one more thing: Based on my experience, I’m going to skip virtual colonography, and go straight to the ‘scope. VC is a good procedure, and it would have found my little friend with ease. But, I would have had to wait for another appointment, and I would have had to reprep.  And, VC involves radiation. Had I come out negative, I might be singing a different tune, but for me, for the moment, the Big Black Snake is my new best friend. Apologies to VC affectionados world-wide.

I suppose my next foray into self-improvement will involve CCTA. Hopefully I won’t fall asleep from the beta-blockers.

The iPad–Radiology’s Sharper Image?

I’m still naive and vain enough to be impressed when something I wrote makes it to a real publication, i.e., a professional operation hoping to sell copy or at least advertising, and not self-published like my blog.

The good people at AdvanceWeb recently asked me to write a piece on the available iPad radiology viewers.  Since their budget didn’t allow them to buy me my own iPad, I stole my son’s while he was in Australia and proceeded to download any and all viewing apps I could find.  At this stage, most are dedicated to the iPhone, but they work adequately well on the iPad.  There were a few pleasant surprises in this little technical odyssey, including the discovery of Calgary Scientific, which seems to “get it” far better than most in this particular venue.

I have to let you know that the title of the piece was selected by the editors over at AdvanceWeb.  Let’s hope the demise of the Sharper Image stores has no bearing on the success of my writing.

To avoid copyright problems, and to keep from having to reproduce the images in the article, I will simply provide you the link to the AdvanceWeb site:

I hope you find it interesting.  Let me know if I’ve inspired you to go out and buy an iPad!

The Actor Playing…ME!!

Chad Einbinder, Image Courtesy
Every so often, it pays to Google ones’ self.  You never know what you might find.  As it turns out, there was a character in Episode 8 of the first season of Grey’s Anatomy which aired on May 15, 2005, named….Sam Friedman!  Sam and his screen-wife Doris were the parents of an Orthodox daughter Devo (played by Lisa Kaminer and Sarah Hagan, respectively), who didn’t want a valve-replacement from an un-kosher pig.  
Chad, has had a fairly busy, if non-descript Hollywood career, with several minor guest-starring roles in several TV episodes, and more recently Neanderthal #3 in “Night at the Museum, Battle of the Smithsonian”.  Playing me, I mean Sam, probably was adequate prep for that one. 
So tell me folks, who is better looking, my alter ego Chad, or me? Don’t everyone shout at once…