taking it like a man

Oh my! I just read some harsh words about Herself. It certainly deserves a “yeah, right” when I write that I often wondered why Herself has never played up or talked about Herself’s role on the Nixon Congressional investigation team. Maybe this is why:

“Because she was a liar,” Zeifman [Herself’s supervisor on the project] said in an interview last week. “She was an unethical, dishonest lawyer. She conspired to violate the Constitution, the rules of the House, the rules of the committee and the rules of confidentiality.”

Oh my! Those are harsh words indeed! The article is interesting reading about how she removed documents from a publicly accessible area and then wrote a legal brief as if the contents of those documents did not exist. Sounds vaguely familiar to what one of her henchman did when he placed documents from the National Archives in his socks in an attempt to steal them.

Is there a there, there? The article again: The [legal] brief [written by herself] was so fraudulent and ridiculous, Zeifman believes Hillary would have been disbarred if she had submitted it to a judge.

Oh my! I am certain these are not good times for Herself. A liar? Unethical? Oh my!

D’jver just want to break out in song?

Mine eyes have seen the glory
Of the coming of the Lord;
He is trampling out the vintage
Where the grapes of wrath are stored;
He hath loosed the fateful lightning
Of His terrible swift sword;
His truth is marching on.

We used to sing that in grade school in the 1960s. Bet they don’t anymore. Where’s the ACLU when you need them most?

I just entered another blogger’s contest. I couldn’t focus on what she wanted, so I randomized my answer. she wrote me! seems pretty cool. she has an iPhone. must be in debt up to her earlobes.

I’m going through my links. Amazing what you find in there, eh? I think these were shorts that amused me some time ago. Seems my link was from a subpage in 2004. Here’s the home page. I just went through 11 pages before my twin popped on line. Didn’t find anything too good. Forget I mentioned it.

When’d I get compromised? Friday? My how time flies when you are trying to rid yourself of being holed by a five-foot camera. Well, I just wanted to share that I seem to be in a repacking mode still. Seems that Fleets stuff emptied the warehouse. Closing off the fourth day without a, a movement thingey. I’ll keep you posted. Yeah, you’re welcome.

I just remembered why I am cranky. In October – maybe even September – I wrote Cyndi Lauper with the full SASE and all that jazz. I nicely asked for a signed pic for my daughter for Christmas. That guy from Dirty Jobs came through. Hell, Drew Carey sent four! Did Cyndi? No. WTF, girl? The link is her address. Somebody harass her. I don’t want to in case she’s just busy and is going to send the pic, and didn’t because I harassed her. I’m smart like that.

rectally speaking

You people think I am exaggerating when I tell you that docs have a butt-insertion fetish. Well, to wit:

“A 60-year-old man with acute pancreatitis developed persistent hiccups after insertion of a nasogastric tube. Removal of the latter did not terminate the hiccups which had also been treated with different drugs, and several manoeuvres were attempted, but with no success. Digital rectal massage was then performed resulting in abrupt cessation of the hiccups. Recurrence of the hiccups occurred several hours later, and again, they were terminated immediately with digital rectal massage. No other recurrences were observed. This is the second reported case associating cessation of intractable hiccups with digital rectal massage. We suggest that this manoeuvre should be considered in cases of intractable hiccups before proceeding with pharmacological agents.”

Now, the guy’s got hiccups. That’s a mouth thing, right? I mean, out the other end, he would be a serial farter. No, it’s his mouth. He won’t stop. What to do? Well, stick your fingers up his ass. Makes sense, eh? Can’t you picture it? Hiccup, hiccup, hiccup, insert, silence, extract, hiccup, hiccup, insert, silence, extract, hiccup …

“Dr. Bob, I think we have something here!”

“Yes, Dr. Jim, I agree. What a novel idea! Tell me, how did you conceptualize of this solution?”

“Well, Dr. Bob, I was reading one of my old Med School textbooks, How and When to Compromise the Anal Cavity. Just for old times’ sake, really. Loved that course. And I noticed that I jotted in the margin, ‘Always,’ and ‘At every opportunity.’ Then later in the book, I found a muse I wrote to myself, ‘The butthole is the gateway to health.’ I started thinking. Remember Extant Physiology Lab, where we tried to push the existing knowledge of biological functions?”

“Yes, Dr. Jim, I do.”

“Well, Dr. Bob, at NYU we tested the hypothesis that a person could not burp and fart at the same time. We were amazed that the historical data was so conclusive. So we began controlled tests among volunteers from the general population, and then later amongst ourselves.”

“Go on, Dr. Jim”

“Alright, Dr. Bob. From a scientific viewpoint, it has to be understood that a ‘fart’ is not something defined purely by auditory cognition.”

“Of course, Dr. Jim.”

“Yes. It is the mere passing of gaseous fecal matter that establishes whether or not a ‘fart’ has occurred.”

“The silent-but-deadly effect.”

“Precisely! So we rigged a sensor line into a Dixie cup and duct taped the device onto the posterior out-door.”

“Brilliant!”

“Thank you, Dr. Bob.”

“You are welcome, Dr. Jim. We then induced a burp effect through the consumption of various soft drinks.”

“Did you also enhance the physiological environment to increase the likelihood of farting?”

“You are following this research closely. I am impressed, Dr. Jim.”

“As am I with myself, Dr. Bob.”

“As well you should be, Dr. Jim. As you anticipated, the original experiment design was fatally flawed. The subjects burped on a recurring and frequent basis, but watch as we did – no farts.”

“What did you do in response, Dr. Bob?”

“We adjusted the testing protocol, after appropriate presentation and approval from the Chief of the Medical Staff, to isolate a subject-preparation phase.”

“Do tell.”

“Before a subject was fitted with the butt-gas capture system, we sat them in a room for thirty minutes and feed them beans and Coke.”

“Brilliant!”

“Thank you, Dr. Jim. We anxiously watched both mouths and butts of the subjects. It usually took no more than 15 minutes post-consumption for the body to respond.”

“And what were the observations, Dr. Bob?”

“The subjects did indeed burp and fart rather intensely, however, never at the same time!”

“Fascinating!”

“Yes. Now we had to figure out why.”

“And did you?”

“No. Funding ran out. But this one subject had such a magnificent ass that I chose to specialize in gynecology.”

“So the research was a success.”

“Yes, it was.”

“So tell me, Dr. Bob, how does that research relate to the patient in front of us now, the one with repeating hiccups?”

“Simple, Dr. Jim, and forgive me for suggesting that I am rather shocked that you do not see the correlation already.”

“I am merely deferring to your expertise, Dr. Bob, and I hope to hear more about the specialty-inducing subject as well.”

“Very well, Dr. Jim. The results of my previous research as applied to the present situation are thus: If one cannot fart and burp at the same time, then there must be a relationship between the two escape hatches. It cannot be avoided. So, if a patient presents with hyper-activity in one of the regions, compromise the other and see what happens!”

“Research in action!”

“Yes!”

“So, tell me, have you ever treated a serial farter by cramming something down their throat?”

“Yes, but the hospital’s legal staff informs me that I cannot speak of the matter until the litigation is resolved.”

“I understand.”

I get hiccups upon occasion. I wonder if my insurance company will pay for a butt plug? “Hello, Blue Cross Nurse Hotline? Can’t stop my hiccups. Any ideas? Hmmm. Didn’t think of that … ok … hhmmmm … alright. And that’s covered? Wow. Ok. Thank you. Have a nice day.”

Hiccup. Insert. Silence. Ut oh! My pants are getting tight!

the doctor is in 6

It’s good to get back into the cyber-office after the Holidays. Trust yours was enjoyable and nobody got hurt too badly – remember, it’s all fun and games until the cops show up.

Today’s case is called, “Swelling and Pain in the Back and Hip of a 35-Year-Old Man.”

Let’s start out with an exterior shot.


Dang! That boy got some butt. No hair, cute little cheeks. Ut oh! What’s that up the top of the ole crack in the china? A little protruding buddy, eh, son? Sensitive to touch? Bet you have to hang up the thongs for a bit.

We need a better look. Have to go inside. No, not the anal-intrusion instrument – I am an internet doc; only “real” docs invade the chubster on any excuse. We’re gonna use one of those machines with letters for a name, whichever one is available. “Hey, tell the tech, top down, 32 degree lateral shots from points A to B, C to F, and X to A1.” I have no idea what that means, but everything I say they write down and these picture thingeys come back, so it must be something.

Let’s see what they found …


YOWO! Lookey here! The boy’s got an ALIEN in his BUTT! AN ALIEN!! This is so cool! It’s got floppy ears! The protrusion out of his butt is its HEAD! It must have parked itself there for the food supply. Smart, them aliens are. Got a bunch of fat to suckle and, of course, the ultimate food supply – the colon – food’s already digested, got that dark chocolate nutty flavor. This is a first in the annals of medical science! A documented alien in the butt!

Another pic? What’s this?


Oh, no! This guy is in trouble. See those two circles? Alien eggs embedded in his butt cheeks. Toast. Better schedule an untimely death and burn this dude’s carcass. He’s got one alien already hatched, ears fully deployed, and two more coming. Them butt cheeks ain’t gonna be so cute in another few weeks. I estimate about 4 to 6 weeks max gestation left. I wonder if we can toss him into coma somehow, then fix the records to show his brain waves isoelectric. That hatched alien decides to exit, it’ll get ugly! They sneak right out the butt when you are aren’t looking! Let’s hope it’s a mama alien and will stay put until the eggs hatch. Man, this is so sad.

Let’s hear the guy’s story …

BACKGROUND. A 35-year-old man presents to the emergency department (ED) complaining of sacral pain and right hip pain (damn straight. Hatched aliens HURT!). The pain is associated with increasing swelling in these regions that began 3 days before presentation (the little alien dude hatched just a little time ago. That’s good news, actually. Not likely to venture out soon.). The patient otherwise denies having any systemic symptoms, such as fevers, chills, nausea, or vomiting (I agree. Aliens don’t like it warm. Anyway, they eat vomit like ice cream before it ever gets a chance to leave). His past medical history is significant for a recent admission to the hospital after an accident with a motor vehicle approximately 2 weeks before presentation (I don’t like the sounds of this). As a pedestrian, the patient was struck by a car and sustained multiple rib fractures and facial lacerations (an alien hit-and-run. Typical. Once he was dazed, this stick the eggs in his butt. Notice the precision with which they placed the eggs – right cheek, left cheek, top of the crack. Very common in alien-egg insertions. This poor guy.). He was discharged to home from the hospital 10 days before presentation and has been doing relatively well, with adequate pain control for his rib fractures.

On physical examination, the patient’s temperature is 98.96°F(37.20°C) (I can tell you right now that everything is normal – aliens cover their tracks well. We’re lucky to have found these), with a blood pressure of 129/67 mm Hg and a heart rate of 89 bpm. His respiratory rate is 20 breaths/min, and his O2 saturation is 95% while breathing room air. The patient is not in acute distress. The head, eyes, ears, nose, and throat (HEENT) examination shows well-healing facial lacerations with intact sutures. His chest is clear to auscultation on both sides, with normal cardiovascular and abdominal findings. The lower extremities have normal sensation and 5/5 strength (on a scale of 0-5, with 0 being no strength and 5 being normal strength) (see? Normal across the board. Aliens in the butt. Man, I hate aliens).

A visible fluid collection is observed in the proximal lateral aspect of his right thigh (aliens gotta pee, too; it’s building up in his legs. We gotta act fast.). The fluid seems to track up (track UP? Idiots. It is flowing DOWN. Alien pee) around the gluteus maximus muscle to the lumbosacral region, with slight crossing of the midline to the left. The fluid appears to be a free-flowing, low-viscosity collection without evidence of erythema or ecchymosis (that is EXACTLY how alien pee presents). No loculation is noted on palpation, and the patient has no thickening or induration of the skin in the overlying and surrounding areas (all normal … see what I told you?).

What is the diagnosis? (One hatched alien distal to the butt crack; two alien eggs embedded one in each of his butt cheeks; accumulation of alien pee in his legs – simple – we’re done here!)

HINT. This fluid collection was not appreciated during the patient’s previous admission to the hospital. (Of course it wasn’t! The dang thing just hatched! What kind of hint was that? Ah, I get it! See, they are telling you they KNOW it is a recently hatched alien! A-HA!)

ANSWER. Closed, internal degloving injury (“degloving” is code for floppy-eared alien): The patient underwent computed tomography (CT) scanning of the pelvis, which showed a large, subcutaneous fluid collection extending from the region of the lumbosacral spine along the right lateral buttock to the thigh and down to the level of the femoral shaft (alien; pee). The fluid collection was not present on a previous CT scan that was obtained 2 weeks before presentation (the time of the motor vehicle collision) (you mean, before they implanted their eggs INTO him? Of course not!). The patient’s laboratory studies showed a white blood cell (WBC) count of 8.38 × 109/L; hematocrit, 0.363 (36.3%); platelet count, 953 × 109/L (953 × 103/µL); and an international normalized ratio (INR) of 1.0 (yep, yep, yep, yep – alien, alien, alien, alien. Wait until the pee starts to accumulate – that’ll crank his white count!).

The patient underwent CT-guided aspiration of the fluid collection under local anesthesia. An 8F catheter was used to aspirate 800 mL of dark red fluid (alien blood – careful, they bite!). Postaspiration CT images demonstrated near-complete resolution of the fluid collection (yeah, do you think they are stupid? It went to lunch! Just parked itself INSIDE the colon for a spell), and the catheter was removed (and the alien came back). A pressure dressing (elastic spica dressing) was applied. An elastic bandage was wrapped around the entire thigh, beginning just proximal to the knee, and continued upward across the proximal thigh and buttock. The bandage was wrapped around the waist several times and then brought back over the thigh to compress the entire lower back, buttock, and proximal thigh. The patient tolerated the procedure well and was discharged to home the following day. He was instructed to wear the compression dressing as much as possible, and a follow-up visit was scheduled. The aspirated fluid was sent for bacterial culture and found to be negative for bacteria (aliens don’t have Earth bacteria! Bet you didn’t scan for non-Earth bacteria, did you?).

(I can’t listen to these idiots anymore. Aspirate, my ass! This dude has a serious alien infestation. Let’s put him under, flat-line his results, fake an autopsy, and burn him. These things lay eggs like turtles – all plop, plop, plop until the hole is filled – and the hole, in this instance, is his two butt cheeks! I’m outta here – office closed!)

A closed, internal degloving injury is a clinically significant soft-tissue injury that is associated with pelvic trauma. The subcutaneous tissue is torn away from the underlying fascia, which creates a potential space that can fill with serous fluid and/or a hematoma caused by the disruption of the arteries that perforate through the fascia mixed with viable and necrotic fat. The condition commonly occurs over the greater trochanter, but it can occur anywhere over the trunk, buttock, or thighs. When a closed, internal degloving injury occurs over the greater trochanter, the condition is known as a Morel-Lavallee lesion. As mentioned, this condition usually occurs in association with pelvic and acetabular fractures, but it can also occur in the absence of fractures. Direct crush injury to the pelvis or a high-speed motor vehicle crash are the most common mechanisms of injury. The importance of this soft-tissue injury may not be initially apparent; some patients present months after the initial event, complaining of soft-tissue swelling or contour abnormalities that are not resolving.

The diagnosis of a closed, internal degloving injury is usually based on physical findings (ie, a soft, fluctuant area over the lesion and a loss of local sensation). Diagnostic aids may include ultrasonography and CT imaging. Various methods or combinations of techniques for treating degloved areas have been suggested, including the application of compression dressings, fluid aspiration or liposuction, injection of sclerosing agents, deep fascial fenestration, prolonged closed surgical drainage, and open surgical debridement (ie, leaving the degloved area open for closure by secondary intention). A review of the available literature, while failing to reveal prospective comparisons, did demonstrate variable outcomes with different therapeutic approaches, ranging from complete resolution to the development of various complications, including infections and skin necrosis or breakdown. The complications associated with closed, internal degloving injuries often require extensive therapy and surgical management.

greed can form loving relationships

There’s something about good ole fashioned greed that brings a smile to my lips, a sparkle to my eye, and that warm hug inside.

Our story begins in the hometown of ALF, that loveable alienable life force from 20 years ago (that’s 8 to 16 lifetimes in sitcom years depending on the week night upon which the show airs), nestled above Los Angeles and along the sea, Oxnard, California.

In this sleepy salt-laden town operates Haas Automation and, operating no more (albeit I get ahead of myself), its owner, 54-year old Gene Haas.

Haas Automotive is a half-billion dollar operation and employs about 1,000 people, as the “nation's largest computerized machine tool maker.”

How much profit can $500 million generate every year? Well, Gene-boy, or as his cellie may soon be calling him, My Wife, is also the owner of a NASCAR team, fielding a car in each of the Nextel and Busch series, operating as “Haas CNC Racing.” So apparently enough to play in an expensive sport. Is that enough for Genette to be happy?

Alas, no.

“Let’s squeeze another $20 million out of this puppy. Ideas?” And so began a course of events that resulted in several indictments, including the king of all horrors to defense counsel: an unindicted co-conspirator (read, rat).

Here’s a great quote: “The owner of Supermill Inc., a nonexistent Nevada company that allegedly issued fake bills to Haas Automation.” Let’s parse that: Owner of a nonexistent company. He owns something that does not exist. Did they really write that? It’s in the linked article above. I own a unicorn – did I ever tell you that? I own this really super-cool plane-car-boat-barberchair-bar-be-que thingey. Takes you anywhere, gives you a shave and a haircut, and feeds you the best grilled tuna. I didn’t get the optional geisha-girl attachment.

The “nonexistent company” issues “fake bills.” No shit. It doesn’t exist – do you expect it to issue real bills?

Where was I? Oh yeah, so this nonexistent company has a name, Supermill (my unicorn’s name is Fred). Seems the non-entity issued non-real invoices for non-real expenses. (I am sensing a pattern here, although clustering can also be attributed to random chance) There was a total $20 million in fake invoices. All the invoices were issued to Hass Automation, who promptly paid them with non-real money but took very real tax deductions. Ut oh! Add a rat to the recipe and you are, well, fucked. And so will be Genette soon enough. Repeatedly, all the while yelling, “Yes, I’m your bitch! Yes, I’m your bitch!”

Initially, Mrs. Gene pled not guilty (everyone does – you can’t plead otherwise at an arraignment. They have separate proceedings for guilty pleas.), and pointed the finger at his financial guy, claiming with all the gusto of a wronged-man, that the “tax issues ‘revolve around’ the company's former financial officer, John Phillips.”

“Revolve around”? What the hell is that? A denial? No. My shower water “revolves around” the drain. My tires “revolve around” the axel. Ms. Gene’s life is about to “revolve around” the shithole. Here’s a denial: “That cocksucker Phillips did all of this. I knew nothing. I sure hope he doesn’t make bail and is found guilty, then does a long, long time in prison. Cuz if I get my hands around his neck, he’ll be begging for prison time. That miserable, lying prick. I never liked him. FUCK HIM AND EVERYONE THAT LOOKS, SMELLS, OR TALKS LIKE HIM! I HOPE THEY ALL GET BUTTHOLE CANCER” A denial?

Alas, no.

As June 2006 left with its indictments (and rat) a dusty trail in the horizon, now arrives November 2007. Has Miss Genette established her innocence in the face of these vicious allegations by an overzealous prosecutor and that cocksucker Phillips?

Alas, no.

“LOS ANGELES -- A NASCAR team owner was sentenced Monday to two years in federal prison after he pleaded guilty to defrauding the government of more than $34 million in taxes.

“Gene Haas … was ordered to begin serving his term on Jan. 14, the U.S. Attorney's office said.
…

“As part of his plea agreement, Haas paid a $5 million fine, plus more than $70 million in back taxes and interests.”

Poor baby?

Alas, no.

royalism dick

Not sure if it is ever a good idea to click through on ads, but this was tucked in my gmail sidebar. It’s for ”Handy Spray” – a hand-held bidet. It’s a hose, people, a HOSE! And they want $30 to $60 for it. It’s a hose. A bidet is something the beautiful people use because they can’t deign to wipe their own ass, not unlike that nose freak Mrs. James “The Janitor” Brolin (who, btw, ranks a pic but not not a word – not even his name on Ms. Nostrils’ personal webpage bio. “Um, BS, baby, um, could you, um, maybe mention, um, you know, we’ve been that M-word for almost ten years. Um, maybe you could put my, um, my, um, my name in your bio – you know, just a passing mention, that’s all. Nothing big.” “WHHAAATT!! YOU FUCKING EGOMANIAC!! [TOSSED MING VASE CRASHES INTO HIS HEAD] GO CLEAN THE TOILET!! MAKE SURE THE ROSE PETALS ARE ALL FACE UP. Fucking dammit, just can hire good husbands anymore. What is wrong with the placement agency?”

I can’t believe that I am going to write about what I am about to write about. I am trying to decide whether to wretch or laugh. Ah, what the hell, let’s do it. This is so pathetic. I have to go put on a clean suit. Brb.

OK. Start here. Left side, reads, “Statements. Read the latest comments direct from Barbra.” Oh, God, clean suit bad idea. Vomit contained. Brb.

Click on “Statements” (man, I hate the chewy stuff left over from vomit. What was that? One sec … oh yeah, I had a bagel. OK.) Let’s see we have for “direct from Ba-ba-bar--” (Oh, God, this is bad. brb. … OK. Pasta for lunch. It was whole wheat penne in this fresh tomato sauce. Not bad.) Her first “direct statement” is interesting. Seems she uses the nom de guerre “Bob Herbert” when writing for the NYT. Let’s look for something which she had the masse testiculaire to publish under her own name.

Here we go, Republican Attempt to Steal California’s Votes. Sounds, um, enlarged-scrotum-ish. Let’s dive in.

Her first paragraph as presented: “Karl Rove may have resigned as the President’s chief strategist, but the dirty and secretive tricks that have characterized the Republican Party in recent years are still here to stay. Leading California Republicans are promoting a dishonest initiative that steals electoral votes from California, a democratic state. Republicans attempting to steal votes in a major election? This smells all too familiar.”

Her first paragraph, annotated: “Karl Rove (I read ahead, darlings – KR is not mentioned again. Use of his name is just a ploy to draw in a common audience – emphasis on “common”) may have resigned as the President’s chief strategist (his title was “Senior Advisor.” A campaign has a “strategist.”), but the dirty and secretive tricks that have characterized the Republican Party in recent years are still here to stay (as opposed to the dirty and secretive tricks that have characterized the Democratic Party?). Leading California Republicans are promoting a dishonest initiative that steals (to take and carry away the property of another with the intent to deprive permanently the holder of its possession) electoral votes from (the topic will become a reallocation; California will continue to have them, sweetums) California, a democratic state (as opposed to, the “socialist” state of __? And California is no more democratic than any other state – they are all representative democracies, buttcheeks; we don’t have democracies in America. The closest was the New Hampshire Town Hall system.). Republicans attempting to steal votes in a major election? This smells all too familiar.” (Why does it not surprise me that you would use an olfactory reference?)

Next paragraph, annotated (lost interest in wasting cyber-inches on both versions). “The initiative, crafted by a lawyer for the California Republican Party and member of the group misleadingly called "Californians for Equal Representation,” (as opposed to your several “Farewell Tours”?) proposes to divide (what happened to “steal” and take “from”?) California's electoral votes based on results in each congressional district, rather than award the entire 55 electoral votes to the winner of the statewide popular vote (funny, I haven’t been around politics for a while, but I recall Algore and his ilk proposing this). Proposed for the California ballot in June 2008, where voter turn-out is extremely low (so much for democracy in action), this initiative would essentially give the next Republican presidential candidate as many as 19 additional votes--almost equal to all the electoral votes from Ohio (20) and nearly all from Florida (27 – so that’s the difference between “almost equal” and “nearly all.” I was wondering. So, 2/3s is “nearly all.” OK. Why not Pennsylvania or Illinois, both with 21?)!”

Next: “For many voters, this initiative upon first glance seems logical and fair. (I am so glad that you are here to protect us from what seem logical and fair!) However, in the context of the rest of the country, where large red (oh, so this is a color thing? Since when do democratic principles get determined by current political winds? Sounds kinda unconstitutional.) states in particular (I repeat my last comment, deary, because your lack of commas offsetting the phrase “in particular” denotes its criticality to the sentence – so the issue is that it is a “blue” or “red” state. Got it.) would still award their electoral votes to the candidate who won the popular vote, this ballot initiative is completely imbalanced and undemocratic (Actually, it would more closely resemble a democratic system – one person, one vote. The inherent problem with the approach is that it would render smaller representative democratic states virtually unimportant as their electoral caches would be divided from five to ten down to just two or three at a pop. Politicians would ignore them completely.). There is no way this initiative would create a more fair and balanced voting system in our country, unless it was uniformly adopted by ALL states. (so this system is democratic if adopted everywhere, but not democratic if adopted by California. Can you say, non sequitur?)”

The rest of it (besides her links): “This initiative shines a glaring spotlight on Republican hypocrisy. Republicans want to continue the same winner-take-all system in other big states that they consistently win, like Texas and Indiana (Indiana? Indiana?!? It’s got 11 EVs, boxhead.). However, they want Democrats to share the electoral votes in California, a big blue state with the country’s most electoral votes. Democrats have been carrying California in recent elections. Even if Democrats were to win the state in 2008, Republicans would still get a substantial number of electoral votes under this new law (nearer thy god to thee).

“If passed, this initiative would make a democratic victory in any major election extremely difficult. We can not let the Republican Party pull the wool over our eyes and steal yet another election. (I actually teach Constitutional Law, and understand the attempt by Gore to steal the 2000 election by recounting only three counties – where W said, “count them all and you have a deal.” Gore said, “no.” SCOTUS said, simply, “No, Gore, you cannot compel a localized recounting when the entire state’s EVs are at stake. That steals votes from the uncounted counties” And everyone knows that the entire state was recounted privately and W won it. So where was the theft? You people suck at history.)”

One last “Statement,” wherein she strongly recommends two books: “I would like to strongly recommend these two books by John Nichols:

“The Genius of Impeachment: The Founders' Cure for Royalism Dick: The Man Who is President (Dick Cheney)

“They both address important issues regarding holding our leaders accountable for their actions.” (Verbatim, folks. Complete and unedited. Four words, full colon, six words, full colon, seven words. I shudder to think what “Royalism Dick” is. Sounds bad.)

I can’t do this any more. I have to shower, then hook up the hose and bidet myself.

the doctor is in

We start this session in the office with a little pissed off attitude. “Why?” you ask. “Let me tell you,” I respond.

I get these case studies and I have real patients with real problems (dicks falling off, aliens in butts (that one is coming soon), etc.), albeit all in my virtual medical practice. I get it – I’m not a “real” doctor, I just play one on the internet. But still, that guy’s dick was going to fall off, that cold butt would be numb by now if I didn’t prescribe a hot shower and a good spanking.

Well, I open this file, jot out my diagnosis, give the guy a script for weed and speed, go to the drug store to fill it, come home, and get toasted and hyped. As while I am scratching the fricking thousands of gnats off of the wallpaper, and also gathering the carcasses to top my brownies that are baking (protein supplement), I decided on a lark to check the “real” answer written by “real” docs – as if they actually know what the hell they are talking about. What I did find? You won’t believe it! I am so pissed! They added more data! A-holes.

I have watched precisely one Hercule Periot episode. One. I am an old Columbo fan. Have seen about every one a dozen times. My hero. So I was curious about this Periot guy. I never liked men that act as he does. Character or not, he makes me want to act out. So the show goes on – the crime, the investigation, the big finale – and what happens? As he is explaining how he “solved” the murder, he added data! He added data! You don’t add information when you give your solution. It’s like a rule. That was 15 or 20 years ago. I am still pissed about it. I can be real anal about some things.

So when I felt like reading the junior varsity’s diagnosis of this guy and saw that they added data I almost quit practicing medicine again. But I have a responsibility to my patients, and I took the Hippopotamus Oath sometime or another, so here I am.

Let’s look at some pics. Here’s the one they shows us in the background.


The guy (presumably, could be a chick), has a problem immediately apparent. See it? The dude’s must be shaped like a grotesque pear! Very thin on top. Can see right through him. Then with his heart in the middle, you can see his butt pushing right up to it! See his cheeks? That’s really gross. Heart looks kinda big, too. Is having a big heart a bad thing? They always say it’s ok, but this one may be swollen because it’s chaffed or something from rubbing up against his butt cheeks.

Note: “Relocate butt.”

His bones look kinda thin, too. Note: “Prescribe calcium supplement.”

And now, the pic they were hiding from us (I won’t treat you, my team of residents, in the same despicable manner as Dr. Periot treated me).


Ut oh! Another misfile? Looks like Joe Camel all dolled up to make himself feel pretty got his booty caught on a night-surveillance camera. Thought no one would be looking, eh, Josephine? You know, pal, there is one rule in this world: When you want to look pretty, and you’ve got a pump-action yogurt chucker sitting atop a mud flap all stuck inside your tummy-tucker pantyhose, you stay inside with the doors locked and windows blocked. It’s like a rule. OK?

I can’t believe it’s another misfile. Let’s look closer. Yep, misfile. Joe Camel. Let’s go to the patient …

BACKGROUND. A 27-year-old man presents to the emergency department with a 3-day history of worsening epigastric pain and nonbilious vomiting (Oh, this sounds bad. I better put on one of this ear things with the cold silver front that the “real” docs lick and then put on a woman’s breast. Note: “Put morgue on alert – incoming.”). His bowel movements were normal until the day of presentation (“until”), when they turned black and sticky (I’m gonna puke.). He denies having any hematemesis (so would I. What kind of pervert to do think I am? Hema-what? WTF is that?), fever, chills, or any other associated symptoms, as well as any history of prior surgeries or medical problems. He has taken no medications recently except for Pepto-Bismol, which made the pain worse (did you check the expiration date? That stuff tastes like shit on a good day; can you imagine after the half-life has expired?). He does not smoke tobacco but consumes 4 beers each day (that’s almost 1,500 beers a year! What was that word up there … oh yeah, “epigastric.” Means, “beer coming out the wazoo”). He denies any illicit drug use (why? He’s thoroughly liquid. This boy spends almost a $1,000 a year on beer! No wonder his ass is so big).

On physical examination, his oral temperature (oh, c’mon, have some balls – stick it up his ass. Oh yeah, you’d have to work your arm up to the elbow just to find the entry point. Oh, dry heaves coming!)is 98.6°F (37.0°C). His pulse has a regular rhythm with a rate of 88 bpm. His blood pressure is 198/88 mm Hg. He is noted to be in mild distress secondary to his epigastric discomfort (hurts having all that beer coming out your wazoo, doesn’t it?). The examination of his head and neck, including a check for icteric sclerae (is that like code for head lice?), is normal. His lungs are clear to auscultation with normal respiratory effort (sure, and remember the homeless guy that they crammed something down his throat to make him gag? Not this guy – he’s got insurance!). A 1/6 soft systolic ejection murmur is detected (“Systolic.” I;ve heard that word before. It’s a medical term of some kind.). His S1 and S2 heart sounds are normal. His abdomen is soft (“fat”) but tender to deep palpation in the epigastric region (the “wazoo” region). The rectal exam (oh no! Going in! Better tie a rope around your waist. Gas mask!) reveals normal tone and black, guaiac-negative stool (I really do not like the sound of “gualac-negative.” It’s like, “we did a scrotum check, and it came back ‘testicular-negative.’ We’re sorry, sir, you have no balls.”). The peripheral arterial pulses in the lower extremities are palpable but diminished when compared to the pulses in the upper extremities (that’s normal, ain’t it? Nearer thy god to thee?).

The laboratory analysis, including a complete blood count and a basic metabolic panel, is normal; however, his serum amylase and lipase levels are elevated, at 240 U/L (normal range, 30-110 U/L) and 2118 U/L (normal range, 46-218 U/L), respectively (Hey, Joe, you got the extension for the morgue? 221? Thanks.). The patient is diagnosed with alcohol-induced pancreatitis (surprise, surprise) and treated in the ED with bowel rest, intravenous fluids, antiemetics, and generous doses of intravenous opiate analgesics (gotta love ERs. Here’s some opium, a generous amount. Who’s leg you gotta hump to get this script?). The patient is to be admitted to the hospital for continued bowel rest and intravenous fluid therapy for complete resolution of his pancreatitis; however, despite having his pain eased, the patient is noted to have a persistently elevated systolic blood pressure in the 190-199 range (she’s gonna blow!) and a diastolic blood pressure in the 90-109 range. When further queried for his past medical history (because we think you lied the first time) and a thorough review of systems, the patient does not recall ever having had his blood pressure checked, although he does report that he frequently experiences cramping in his legs (sure you don’t smoke?) and sometimes feels as if his feet are “cold.” (Got socks?)

A posteroanterior chest radiograph is obtained (Image 1). (Hollow guy, big butt.)

What is the most likely cause of this patient’s hypertension, and what further testing should be performed? (Beer. Put him a treadmill until he drops like a stone, then call the morgue. Should take no more than 7 minutes.)

HINT. The next step should be to check the blood pressure in the lower extremities.

ANSWER. Aortic coarctation: The patient’s hypertension and murmur are likely caused by a previously undiagnosed coarctation of the aorta (Beer-induced heart malfunction. Would have been better off smoking. At least his butt would be a normal size.). The chest radiograph demonstrates an enlarged collateral intercostal arterial circulation that has caused notching of the inferior-posterior rib margins, which is supportive of the diagnosis (JV clowns. The “notching” is because his ass has rubbed his heart. The resulting chaffing has enlarged the cardiac organ to such a degree that it is now affecting his ribs.). Magnetic resonance angiography (MRA) confirms the presence of a postductal aortic coarctation (Image 2). (Joe Camel in a dress.)

(You can read more … I’m done.)

Coarctation of the aorta is a congenital condition that results in narrowing of a segment of the aorta. It was first described by Giovanni Morgagni in 1760. Historically, coarctation of the aorta was classified as preductal (before the origin of the ductus arteriosus) or juxtaductal (distal to the origin of the ductus arteriosus). More recently, the latter designation has been abandoned for the term postductal. The postductal form is the most common type of coarctation of the aorta. Coarctation of the aorta constitutes approximately 6-8% of all congenital heart diseases in infants. It is most frequently associated with other forms of congenital heart disease, such as ventricular septal defects, patent ductus arteriosus, bicuspid aortic valves, and aortic stenoses; however, it may also appear as an isolated condition. It is more common in males than in females; in patients with ovarian agenesis (Turner syndrome), it is particularly common.

Patients diagnosed with coarctation of the aorta in infancy usually have a combination of other heart anomalies that can lead to overt congestive heart failure. Those patients presenting beyond infancy, such as in this case, often have vague symptoms that may include headaches, a propensity to nose bleeds, leg cramps, and cold feet. Hypertension is usually present and leads to further in-depth testing. The hallmark physical sign of postductal coarctation is that blood pressure in the arms is at least 20 mm Hg higher than it is in the lower extremities (normally blood pressure in the lower extremities is slightly higher than in the upper extremities). A systolic or continuous murmur in the infrascapular or infraclavicular area also may suggest the presence of this anomaly. Additional murmurs may indicate the presence of associated anomalies, such as ventricular septal defects, patent ductus arteriosus, or aortic stenoses.

Chest radiography may demonstrate cardiomegaly and rib notching from the compensatory collateral intercostal arterial dilatation. The classic “figure 3” sign seen on chest radiographs occurs in at least one third of patients, and results from prestenotic dilatation of the ascending aorta followed by indentation of the aorta at the coarctation site and poststenotic dilatation of the descending aorta. The “reverse 3” or “E” sign can also be observed on barium swallow studies, resulting from matched compression of the esophagus by the dilated segments of the aorta. Signs of left ventricular hypertrophy are also often seen on electrocardiograms (ECGs). An echocardiogram is usually performed to detect any associated cardiac anomalies. MRA and cardiac catheterization may be necessary to confirm the exact location and the presence of collaterals. A gradient of more than 20% across the stenosis during cardiac catheterization indicates a severe coarctation and requires urgent intervention.

Treatment of aortic coarctation is usually surgical. Antihypertensive medication must be used with caution, as its use may lead to inadequate perfusion of the lower body and renal impairment. The best treatment strategy is admission for early repair. If left untreated, 90% of patients with aortic coarctation die by the age of 50 years, usually from hypertensive complications. Historically, surgical resection of the involved aortic segment has been the treatment of choice, and it has a high success rate. More recently, balloon dilatation and placement of endovascular stents are gaining popularity and becoming accepted forms of primary therapy, especially for patients who may be unsuitable candidates for surgery. Postoperative complications may be acute or delayed and include persistent hypertension, recoarctation, and aortic aneurysms, among others.

This patient had an echocardiogram that failed to reveal any associated cardiac defects. He was referred for surgical intervention and underwent successful resection of the coarcted aortic segment after resolution of his associated pancreatitis, the initial reason for his presentation and admission.