much-needed perspective

Sometimes in life we need a barometer by which to measure if we are doing ok. Events can appear insurmountable; depression can be seen or tasted. It helps oftentimes to view another’s life to put our own in perspective. Maybe with this frame of reference our cloud can have a silver lining, the sun may peak through.

The life and times of Bryan James Hathaway is my perspective for today. As the sports guy Jim Rome says, when a story starts with a guy’s name that includes his middle name, you just know the story is not going to end well.

Bryan, age 21, is from Superior, Wisconsin. Mayor Dave Ross seems like an agreeable fellow. Superior is way the hell up there, beyond Minneapolis. It’s further north than Quebec City! Check the demographics - there were more people living there in 1900 than there is now. It’s been in a population freefall since 1930.

What’s a person to do in Superior? Get in trouble it seems.

His legal troubles began at least as early as April 2005, when he pled guilty to having sexual relations with Bambrick, a 26-year-old horse, which he shot and killed for the express purpose of ensuring the presence of a passive lover. It seems he also pled out at the same time to taking a vehicle without the owner’s consent. Must have needed a ride. Got 18 months in the pokey for that plus a bunch of probation.

Being out of jail on the horse poke, it seems he was driving down the road and noticed – ut oh – a dead deer in a ditch. D-d-d, da-de-de-da, da-deer! Poor Bryan could not contain himself. Pull over, pull down, pull out, and poke in. Busted.

Part of his sentence was a probationary period that included no sexual contact with anything – including humans!

Poor boy, his probation got revoked last month for using alcohol and marijuana, lying to his probation agent, and having unapproved contact with a minor child and sexual relations with another adult.

Must be lonely up there in Superior, Wisconsin.

Feel differently than I do about this pathetic fuck? Then join the 142 people that have signed the Petition to free Bryan!

hippocrates gets dissed

In my never-ending search for truth and wisdom, I decided that as an Internet Medical Doctor, I should take some Continuing Medical Education credits. Since I have absolutely no medical training whatsoever, I decided to start at the beginning, kinda like opening the Bible at Genesis. I decided to start with the Works by Hippocrates. He’s that Oath guy, so if people swear an oath towards or about him, I figured he must be somebody.

He was a pretty important guy, so it seems. They called him the Father of Medicine, and he lived from about 460 BC to 370 BC. Ninety years is impressive for a time before flushing toilets and Dyson vacuums.

Turns out he wrote a lot, and his works are collected into something called the Hippocratic Corpus. I figure strolling through his writings should be worth a handful of CMEs.

I picked one called, Aphorisms. It is presented in Roman-numeral section and then numbered paragraphs within each section. Let’s stroll …

I.21. Those things which require to be evacuated should be evacuated, wherever they most tend, by the proper outlets. (“Evacuated … by the proper outlets.” Man, starts right in with the anal bit. Just remarkable. How did I know that was coming?)

II.11. It is easier to fill up with drink than with food. (This sounds like a proverb. “There is no ‘I’ in teamwork.” “‘Gullible’ is not in the dictionary.” “Orville Redenbacher’s brother is a colonel in the Air Force.”)

II.21. Drinking strong wine cures hunger. (“I’m hungry!’ “Shut up! Get blasted – you won’t think about it as much!”)

II.24. [Concerning acute disease] The fourth day is indicative of the seventh; the eighth is the commencement of the second week; and hence, the eleventh being the fourth of the second week, is also indicative; and again, the seventeenth is indicative, as being the fourth from the fourteenth, and the seventh from the eleventh. (Where’s my slide rule? I know I left it around here somewhere …)

II.48. In every movement of the body, whenever one begins to endure pain, it will be relieved by rest. (“Doc, it hurts when I move.” “Then stop moving.” Brilliant!)

III.10. Autumn is a bad season for persons in consumption. (Back in his day, Consumption/Tuberculosis was characterized by coughing up blood, fever, and was almost always fatal. Seems to me, Hippo, the time of year isn’t dispositive.)

V.3. A convulsion, or hiccup, supervening on a copious discharge of blood is bad. (Good rule. Got it. Thank you.)

V.34. When a pregnant woman has a violent diarrhoea, there is danger of her miscarrying. (“Dear Diary, about two months ago I got pregnant with Spyro’s child. Last week, I began to feel a quivering in my toes that worked its way the entire distance of my legs. I thought it would result in a real howitzer of an orgasm. Alas, to my dismay, the result was explosive flatulence. Now, the flatulence has given way to violent diarrhoea. What could be next? Methinks I am not well. I must stop eating hummus as very often.”)

V.72. Persons disposed to jaundice are not very subject to flatulence. (Um, OK. “Johnny, I haven’t heard you fart lately, and you look a little yellow under the gills. I think your liver is failing. I could be wrong.”)

VI.9. Broad exanthemata are not very itchy. (“Not very”? Rather loose language for a doc, eh? If it’s a rash and it was itchy when it was little, you can be damn sure it will be itchy when it spreads. “Itch” isn’t proportioned to a condition, like you only get so much “itch” per condition. The broader the condition, Hippo, the more it frickin itches.)

VI.13. Sneezing coming on, in the case of a person afflicted with hiccup, removes the hiccup. (Yes, and if you read a few posts below, sticking your fingers in his ass will also “remove the hiccup.” Surprised you didn’t come up with that.)

VI.17. It is a good thing in ophthalmy for the patient to be seized with diarrhoea. (Let’s see … “ophthalmy” is an inflammation of the membranes or coats of the eye or of the eyeball. “I can’t see nothing, doc. My eyes are all inflamed. Big time.” “Yes, they are, Spartacus, I can see that. How’s your butt?” “Hunh?” “I said, ‘how’s your butt?’” “Um, OK, I guess. I could lose a pound or two. You know it is.” “I think we need to aid in the evacuation through the proper outlets.” “Doc, it’s my eyes. My eyes are weirding out on me.” “I know, Sparty. Trust me on this one. We’ll ream you out a good one, give you a tonic to induce violent diarrhoea, and in a few days you’ll be good as new! You aren’t pregnant, are you?”)

VI.28. Eunuchs do not take the gout, nor become bald. (Now here is news you can use! The heck with that Propecia or the Gessippi Whoever with the Beverly Hills salon that hugs all his customers while he charges them $500 for the same product you can now get for $19.99 but wait order now and we’ll give you a second bottle for free who has time for all that nonsense look I don’t own the company in fact I don’t know anything about them they just agreed to give my 20% of gross if I would do this commercial so I am and stop staring at that zit above my right eyebrow I am fully aware the pancake didn’t cover it completely just buy the product you bovine freak. You want to stop hair loss or jumpstart re-stimulation or re-growth? Easy – cut your nuts off! And as an added bonus, if you chop the mud flap off within the next 15 minutes, we’ll guaranty that you’ll never get gout! “Honey, where’s the hedge clippers?”)

VI.46. Such persons as become hump-backed from asthma or cough before puberty, die. (And if it happens after puberty, people will just spend a lifetime being pointing at you and hiding their children from your view. Man, how hard do you have to cough to create a hump on your back?)

VI.53. Delirium attended with laughter is less dangerous than delirium attended with a serious mood. (“How is he, doctor?” “He’ll be fine, Ma’am. Just keep him laughing. Whatever you do, keep him laughing.”)

VII.4. A chill supervening on a sweat is not good. (I know. This happens every time I drink myself into oblivion and evacuate through all the proper outlets. I always hear this voice, “This is not good.” Voice sounds familiar. I think it is me.)

VII.14. Stupor or delirium from a blow on the head is bad. (OK. How long did it take to figure this one out? Did you use live subjects?)

VII.34. When bubbles settle on the surface of the urine, they indicate disease of the kidneys, and that the complaint will be protracted. (I always make bubbles. It’s fun!)

VII.43. A woman does not become ambidexterous. (Whew! Is the next line, “burn the witch!”?)

VII.55. When the liver is filled with water and bursts into the epiploon, in this case the belly is filled with water and the patient dies. (I think you got a little off track here, Hippo. It seems to me that the patient died because of the burst liver. I really do think the water in the stomach is secondary. You may want to look over your data again.)

Interesting guy.

So I figure since “real” docs take the Hippocratic Oath, maybe I should read it. Good rule: Always start with the original text when doing research. Then, silly me and somewhat to be shock and awe, I wanted to find the modern version, and found instead a bunch of “modern” versions. I have three of them following the original.

Here is the original version (yes, translations differ, but that is your problem, not mine).

“I SWEAR by Apollo (wasn’t he a god or sumptin?) the physician, and Aesculapius, and Health, and All-heal, and all the gods and goddesses (smile. Pagan!), that, according to my ability and judgment, I will keep this Oath and this stipulation- to reckon him who taught me this Art equally dear to me as my parents (mentor = daddy. Interesting concept. Sounds like a blood oath, Kemo Sabe.), to share my substance with him (are you selling Amway?), and relieve his necessities if required (mentor = sex daddy?); to look upon his offspring in the same footing as my own brothers, and to teach them this art, if they shall wish to learn it, without fee or stipulation (getting whored out just to learn a trade. Wow.); and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples bound by a stipulation and oath according to the law of medicine, but to none others (was there a secret handshake? I picture Fred Flintstone with his big blue hat while at the Loyal Order of Water Buffalos Lodge). I will follow that system of regimen which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous (OK). I will give no deadly medicine to any one if asked (OK), nor suggest any such counsel; and in like manner I will not give to a woman a pessary to produce abortion (WHAT?!? You will NOT induce an abortion? Um, wait a minute … roughly 45MM abortions since 1972 in the US and the original text of the Oath includes a prohibition? Oh, it is to laugh.). With purity and with holiness I will pass my life and practice my Art. I will not cut persons laboring under the stone, but will leave this to be done by men who are practitioners of this work (Ewww! What pray tell is behind this crack? Cutting the tendons so they cannot escape?). Into whatever houses I enter, I will go into them for the benefit of the sick, and will abstain from every voluntary act of mischief and corruption; and, further from the seduction of females or males (and since docs were all guys, here’s a little gay reference.), of freemen and slaves (don’t go banging the patient – good rule). Whatever, in connection with my professional practice or not, in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret. While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the art, respected by all men, in all times! But should I trespass and violate this Oath, may the reverse be my lot! (whew, it ends like a spell. Eerie!)”

Well, old Hippo didn’t support abortion, did he? He’d get on all fours and let his teacher bang him doggy-style, but wouldn’t do his patients. Gotta draw lines somewhere, I guess. Interesting world.

Let’s see how the Oath was updated. Here’s the first modern version:

“I SWEAR in the presence of the Almighty (down to one god) and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

“TO RECKON all who have taught me this art equally dear to me as my parents (but you’re not going to sleep with them, right?) and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations (all?), so long as (funny, didn’t take long for the “but” to come in)the treatment of others is not compromised thereby (well, cowpoke, there is only so much of “you,” so in order to not compromise this fee-paying patient over here …), and I will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient (the origins of the referral system).

“I WILL FOLLOW that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous (tip of the hat to Hippo). I will neither prescribe nor administer a lethal dose of medicine to any patient (… any patient …) even if asked nor counsel any such thing nor perform the utmost respect for every human life from fertilization (oh my, methinks a prohibition against abortion has reared its head) to natural death and reject abortion that deliberately takes a unique human life (Oh! I should have read ahead, eh? “Reject abortion” coupled with previous reference of “life = fertilization” seems very clear. How interesting. I wonder how fully this position lies with Aristotle’s delayed ensoulment.).

“WITH PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being without the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual. Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient. (There’s that “seduction” bit again! Must’ve been a real problem. Something just dawned on me – in all the usages, it is the doc seducing the patient. Always that form. So if she (or he!) starts it … weird demarcation. Why not just prohibit sexual relations with patients?)

“WHATEVER IN CONNECTION with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.

“WHILE I CONTINUE to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse by my lot.”

Alright, substantially intact. Added a few bits about human research and informed consent. Good issues. Let’s see another “modern” version. Methinks the Indians are discussing leaving the reservation.

“I swear to (now down to zero gods) fulfill, to the best of my ability and judgment, this covenant:

“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. (A little soft around the edges, but still very Fred-like.)

“I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism. (But sometimes the exact appropriate amount of treatment is nihilistic. How do you handle that?)

“I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. (Oh man. How many docs do you know that skipped this paragraph?)

“I will not be ashamed to say "I know not," (ditto) nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery (share the wealth).

“I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life (in theory); this awesome responsibility must be faced (application) with great humbleness and awareness of my own frailty. Above all, I must not play at God. (Capital G? But you axed Him in the opening. Odd.)

“I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. (No comment.)

“I will prevent disease whenever I can, for prevention is preferable to cure.

“I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

“If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.”

That was an interesting shift in the treatment of abortion – from clear to cryptic. Still present, in some carnival mirror sort of way. Notice what is missing entirely? Docs can now nail their patients – male and female – regardless of who initiates it!

Last and, yes, least I found the AMA approved version. The reservation is now devoid of human inhabitants.

“You do solemnly swear, each by whatever he or she holds most sacred (Hunh? “whatever”? Good lord, talk about politically correct): That you will be loyal to the Profession of Medicine and just and generous (read, “make referrals early and often”) to its members. That you will lead your lives and practice your art in uprightness and honor.

“That into whatsoever house you shall enter, it shall be for the good of the sick to the utmost of your power, your holding yourselves far aloof from wrong, from corruption, from the tempting of others to vice. (Is this code for boning patients?)

“That you will exercise your art solely for the cure of your patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it. (Cure = good; criminal = bad. Silent on preventing abortion. Silent on assisted suicide. But neither “cure” do they?)

“That whatsoever you shall see or hear of the lives of men or women which is not fitting to be spoken, you will keep inviolably secret.

“These things do you swear. Let each bow the head in sign of acquiescence. And now, if you will be true to this, your oath, may prosperity and good repute be ever yours; the opposite, if you shall prove yourselves forsworn.”

The AMA sucks. Remarkable how much they changed from Hippo’s first writing. Why do they even continue to use the name?

the doctor is in 5

just learned something about odiogo audio - i need to use different titles. it associated this post with an older one. so i am deleting and reposting. will use doctor is in 5 ... then 6 ...

Today we are presented with a 68 year-old. We’ll get to his story in a few. First, the pics …


Oh my! Looks like the dude swallowed somebody’s scrotum! That’s gross. I mean, nuts still wrapped up like a couple mini-pillows just-for-to-sleep-on-honey-oh-no-thank-you! seem to be lodged in this guy’s throat. Wanna have some fun? Take your browser slider and move it up and down a bit – the old chin strap seems to move around as if it were riding free in a pair of Levi’s and we are frolicking in a meadow feeling free and pretty like those girls that wear panti-liners. Hey, wait a sec … look at that kinda sorta line of white under the scrotal package. Odd. Wonder what it is. Better look at the next pic.


AAHH!! AAAHHHH!!!! AAHHH!!! NO!!! SAY IT ISN’T SO!!! AAAHHHHH!!!! IT IS!!! The dude SWALLOWED somebody’s DICK!! AHHH!! AAAAHHHHH!!! NNOOOOO!!!!! AND IT WAS STILL PUMPING THE LOVE JUICE!!! IT’S RIGHT THERE! LJ’S STILL DRIPPING!! IT’S IN HIM. NOO!!! AAAHHHH!!!!!

This boy better have a good story. Ain’t never no reason no-how to go chomping down on the spanker, and in particular … AAHH!! AAAHHHH!!!! THE DUDE HAD HIS LOVE PUMP LOVING IN SOME OTHER DUDE’S MOUTH AND GOT BIT BIG TIME! AAHH!! AAAHHHH!!!! And then this low-down geriatric sexual purveyor of “Dick: The Other White Meat” couldn’t stop there – he had to take the lil buddies, too? Damn, man, what is you thinking?

You better have a DAMN fine story, or I am going toss HIPAA right out that window, track down your sorry ass, and perform a stomach stapling without anesthesia. You won’t eat another thing, son, for the rest of your days. You done had your last meal!

Alright – cough, I want the story. I’m listening.

BACKGROUND

A 68-year-old (sixty-eight, 68! You should know better, son! Ain’t your dick still attached? You like it there? You tinkle on a regular basis? What is wrong with you?), previously healthy white man (I knew he was white, just by viewing the crime scene – I knew it. Yeah, “previously healthy” until you started chomping. I oughta kick your ass right through this cyber-diagnosis) presents to his primary care physician’s office with a complaint of 2 years of progressive dysphagia (Two years, my ass! That dick still dripping momma’s milk! You lie so bad). He reports that he has lost about 15-20 lb and that he is not following any diet or regimen to lose weight (unsafe sexual practices can lead to weight lose, too, grampaw. I don’t see no rubber on that rascal. You surfing bareback. Why you surprised you losing weight? Probably fit into a size 9 cocktail dress now, don’t you?). Although he can drink liquids without difficulty, he has lately felt a “sticky sensation” in the middle of his throat (it’s still dripping – can’t you people see that? Of course it’s sticky! It’s gots to stick to the egg – it’s designed that way! HEY – THE DUDE BIT OFF AND SWALLOWED SOMEBODY’S DICK THEN WENT AFTER THE MUD FLAP! YEAH – STICKY – SURPRISED? You want to know what is even more sticky? When the now-flapless-and-dickless partner goes home to his WIFE and has to EXPLAIN where his DICK went – and STILL is!) when he eats any solid food (I think our friend has had enough solid food for one lifetime). He also regurgitates food particles from a particular meal for up to 2 days after he has eaten it (I am positive this is true. Yes, whatever he eats comes back up. Yes. I have no problem believing this).

On physical examination, the patient’s vital signs are within the normal range. The examination of the oropharynx yields unremarkable findings. The patient has no neck mass or other abnormality. Examination of the thorax and the abdomen also yield unremarkable results. (Blah, blah blah. The formerly attached dick lost its erection. You would, too, with a good bite-down. So of course you don’t feel anything in there. It’s sticky – but soft.)

HINT
Observe the saclike structure in the esophagus. (Scrotal fun buns, dick. Saw them. Thanks.)

ANSWER
Zenker (so that’s his name. Better write that down. I can find him. No problem. I’ll do the Whistle Test. Little known fact: Dicks lodged in throats prevent whistling. Something about the way air moves in the diaphragm. I’ll find every 68 year-old Zenker in America and make them whistle. When one can’t – I’ll have my man!) (pharyngoesophageal) diverticulum: The frontal (see Image 1) and lateral (see Image 2) barium-swallow images of the upper esophagus demonstrate a large outpouching (what a great medical term, “outpouching.” I prefer “lodged spanker.”) at the posterior aspect of the pharyngoesophageal junction that retains barium (arrows) (I think “barium” is code for “seminal fluid”). This finding is consistent with a Zenker diverticulum (Latin for “pervert.” Zenker, Pervert. Now I have a complete name. This dude is so toast).

A Zenker diverticulum, also called a pharyngoesophageal diverticulum, is a pseudodiverticulum (note, “pseudo” – this answer is full of code only us internet docs can read) consisting of esophageal mucosa and submucosa (read, “seminal fluid”) that herniate (“the buddies”) posteriorly between the cricopharyngeus and the inferior pharyngeal constrictor muscles (like a pirate map to show you where to find your nuts if your wife said, “go back and get them! And don’t return until you do!”) and through an area of potential weakness referred to as the Killian dehiscence (the first clue as to the victim’s identity – a Mr. Killian). The pathogenesis of this condition is not well known (this means that they don’t have much information on Mr. Killian – must have been a chance encounter in a bar, mayeb a glory hole). Patients with a Zenker diverticulum are thought to have a discoordination of the swallowing mechanism that increases pressure on the mucosa of the pharynx (this “discoordination” means that he didn’t want to bite the guy’s dick off – but got the “mucosa” thing happening, which means he did bite the guy’s dick off). Over time, this pressure leads to herniation of the esophageal mucosa through the Killian dehiscence (“Over time … herniation” – Mr. P. Zenker bite off the dick of one Mr. Killian, and then bit off and removed the remainder of the male package).

The condition occurs most commonly in elderly women (this should come as no surprise), with peak incidence in the seventh to ninth decades of life (OK, good information. No wonder older men tend to be so quiet – fear of being Zenkered). The most common presenting feature in a Zenker diverticulum is upper-esophageal dysphagia, which occurs in as many as 98% of patients (this means that the dick get lodged pretty high up). Other common symptoms are halitosis (you’ve got a dick in your throat, probably been there for days – of course your breath stinks), regurgitation of undigested food, aspiration, noisy deglutition, and changes in voice (eg, hoarseness) (yeah, what about the change in voice in the bitee?). Weight loss, possibly resulting from limited caloric intake (tough to get calories around that thing in your throat, eh, grammaw?) and recurrent pulmonary infection from aspiration, occurs in approximately one third of patients.

(Blah, blah, blah. Read the rest of the pseudo-answer if you like. Here’s the bottom line. Diagnosis: Dick and Scotty lodged in throat. Recommended treatment: Shoot him right between the legs, then between the eyes. Put his crime on prune juice containers for all prospective criminals to see – face, facts, final disposition – under the caption, “Don’t be a Zenker!”)

In patients with a Zenker diverticulum, the physical findings are usually normal. Fluoroscopic barium-swallow studies are the mainstay of diagnosis and demonstrate the characteristic outpouching that arises from the midline of the posterior wall of the distal pharynx near the pharyngoesophageal junction. This finding is best identified during swallowing, and it is typically seen on lateral images, on which the diverticulum is observed at the C5-C6 vertebral level. If the diverticulum is large, it may protrude laterally, most often to the left side. After the bolus of contrast agent passes the upper esophagus, the diverticulum is typically seen extending posterior to the cricopharyngeus muscle, and the contrast material that was retained in the diverticulum may be regurgitated into the hypopharynx. The lumen of the diverticulum should be carefully observed for irregularities or filling defects because squamous cell carcinoma can develop in a small percentage of cases.

When incidentally imaged on computed tomography (CT) scans or magnetic resonance imaging (MRI) scans, a Zenker diverticulum appears as a structure that arises posteriorly from the hypopharynx and is filled with air, fluid, or oral contrast material. Zenker diverticula may also be found on endoscopy. Care must be taken during endoscopic procedures, because passage of the endoscope into the diverticulum may result in perforation.

Small, asymptomatic diverticula may be followed up by monitoring the progression of symptoms. Surgical management should be considered in patients with clinically significant dysphagia, weight loss, pulmonary aspiration with recurrent lung infections, and complications related to bleeding. Surgical options for treatment include myotomy of the cricopharyngeus muscle, with or without diverticulopexy, and endoscopic division of diverticular wall with stapling. The success rate (ie, the relief of symptoms as measured in most studies) is approximately 93%.

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

OH YEAH, BABY! The doctor be IN! No intro. Straight to the pic – this just came in moments ago. Here you go:

(Hand raised – bouncing in seat.) Pick me! PICK ME! I got it! I KNOW THIS ONE! Know that with no more data! This boy done got the scratch! He been doin’ some ho’s and shit! Been banging and shit with the nasty girls! See where that is, way up along the top part? WTF wrong with this man? He ain’t using no rubber! He be just banging and banging and banging! Dumb motherf—ker. Serve him right. I hope his dick falls off. Stupid motherf—ker out there making it nasty for the rest of us.

Let’s see what this man has to say for himself …

BACKGROUND. (“Background” shit – this man doing ho’s with no rubber. Get the f-ck outta here. Alright, alright. I’ll shut up. Let the man say his piece, lying motherf—ker.) A 52-year-old man (52! You should know better, stupid motherf—ker. Where you head at, besides buried in some ho’s twat?) with no clinically significant medical history presents to the emergency department with a chief complaint of a “rash” on his penis (A rash? A RASH?!? You dumb motherf—ker, that be the scratch and you know it! You trying to get free medical or sumptin? F—cking lying piece of sh—t you be.). The patient states that the rash first appeared 1 week before presentation. He denies any dysuria, urethral discharge, pruritus or pain in the area of the lesion. This is the first time he has had such a rash (lying piece of shit, you be lying like a motherf—king rug). He admits to having had several recent sexual partners(ho,ho,ho, motherf—ker wit no rubber).

On physical examination, his vital signs are normal (you check for a brain?). The patient has a well-demarcated, ulcerated lesion (always is) on the ventral aspect of his penis (see Image). The lesion is not tender to palpation (never is). No other lesions are noted (better hope not, mofo, else that dick be falling off!), and no discharge is observed from the urethra (just wait.). The findings of his testicular examination are unremarkable (“Hey baby, whachu doin after work? Maybe you and me go steppin’ out. I gots some blow with your name on it.” "Not with that dick you ain't steppin' out wit nobody like me."), with the exception of bilateral prominent inguinal lymphadenopathy (that means sumptin be big down there that ain’t aposta be big, like Swollen Nut Syndrome. This stupid motherf—ker be sick!). The remaining physical findings, including the cardiac and abdominal findings, are unremarkable.

What is the diagnosis, and what empiric treatment is necessary? (The boy gots the scratch. Give him some penicillin and a handful of rubbers. Better check him for The Drip and Crabs. I hopes he’s gots them all. Serve him right. Dumb motherf—ker.)

(I’ll just let the answer run. I don’t care nuttin for this jackass.)

ANSWER. Primary syphilis: Syphilis, an infectious disease caused by the spirochete Treponema pallidum, is usually transmitted by means of sexual contact; the usual route of transmission is the skin or mucous membranes of an uninfected sexual partner coming in contact with the mucosal ulcerations (eg, in the genital area, mouth, or anus) of an infected partner.

In the United States, the rate of primary and secondary syphilis declined by 89% from 1990 to 2000; however, in November 2005, the Centers for Disease Control and Prevention (CDC) reported that the number of primary and secondary cases of syphilis had been increasing, from 2.6 cases per 100,000 population in 2002 to 4.7 cases per 100,000 population in 2004 (an increase of 87%). This rise was partially attributed to increased rates of infection among men who have sex with men, who in 2004 represented 64% (up from 5% in 1999) of all cases of primary and secondary syphilis in the United States.2

Primary syphilis manifests as a nonpainful ulcer (chancre) at the site of infection. The lesion is usually on the genital area, but it may also occur on the lips, tongue, cervix, or anus of the infected person. This lesion usually develops within 3-4 weeks after infection, but it may occur as long as 3 months after. The primary lesion spontaneously heals in 3-7 weeks, and it may go unnoticed, especially if it is on the cervix or anus; therefore, infected individuals may not realize that they have an infection. Unilateral or bilateral regional painless lymphadenopathy is also a characteristic finding of primary syphilis.

Secondary syphilis is the next phase of the disease, developing 4-10 weeks after the primary lesion appears. This phase is marked by nonspecific systemic complaints, such as fever, headache, fatigue, and lymphadenopathy. A characteristic rash that consists of round, discrete, nonpruritic macules on the trunk and proximal extremities and penny-sized, reddish-brown sores, appears on the palms, soles, scalp, and face in this phase. These sores may coalesce to form highly infectious lesions called condylomata lata. Symptomatic secondary syphilis also spontaneously resolves, and the disease then enters a latent period where few if any symptoms are seen; the latent phase is divided into “early” and “late” periods. Symptoms may recur in the early latent stage (during the first 2 years of infection). The disease then goes into the late latent phase, when patients remain asymptomatic and noninfectious.

About one third of patients with primary syphilis develop a form of the disease called tertiary syphilis, which is a chronic inflammatory process that progresses over years and decades and results in varied symptoms and physical findings, including mental illness, blindness, heart problems, and eventual death. Cardiovascular syphilis can cause devastating damage to the heart, including aortic endarteritis with medial necrosis and aneurysm formation. Gummatous syphilis manifests as coalescent granulomatous lesions affecting the bones, joints, skin, or almost any part of the body. Finally, symptomatic neurosyphilis can lead to meningitis, brain parenchymal infection, endarteritis, or stroke.

Standard treatment for primary syphilis or for syphilitic infection <1 year after exposure is benzathine penicillin G 2.4 million U given by intramuscular (IM) injection. Alternate regimens for patients allergic to penicillin are a 2-week course of doxycycline 100 mg given orally (PO) twice daily (BID) for 14 days, tetracycline 500 mg PO 4 times daily (QID) for 14 days, or ceftriaxone 1 g given IM or intravenously (IV) once a day for 8-10 days. A recent study also demonstrated efficacy with azithromycin 2 g PO as a single dose; however, the authors suggested caution in applying this finding to patients in the United States, because the trial was conducted in a geographically limited area outside of the US, and because macrolide resistance has already been demonstrated in the US.1

If the patient was infected for >1 year at the time of presentation, benzathine penicillin G (2.4 million U IM once a week for 3 consecutive weeks), or doxycycline for 4 weeks is recommended. Neurosyphilis requires treatment with aqueous crystalline penicillin G 2-4 million U IV every 4 hours for 10-14 days. Patients with neurosyphilis should also be followed up every 6 months for 3-4 years for cerebrospinal fluid (CSF) and serologic testing.

Given this patient’s allergy to penicillin and current social situation, he was treated with azithromycin 2 g PO instead of a 14-day course of doxycycline. The ulcerative lesion was swabbed and sent for darkfield microscopy. Rapid plasma reagin (RPR) and Venereal Disease Research Laboratories (VDRL) serum studies were also ordered. A urine sample was sent for Neisseria gonorrhoeae and Chlamydia polymerase chain reaction (PCR), and the patient was counseled about concomitant sexually transmitted diseases (STDs), including HIV. He was referred for HIV testing and given a fast-track follow-up appointment for the laboratory results.

haiku you

I go to Darwin Awards every once in a while. The premise is to give awards and honorable mentions to people that die in such a way as to provide creedence for Darwin's "survival of the fittest" concept - that is, truly people stupid always find a way to kill themselves.

I submitted a story one time. Some local was riding in an innertube behind a snow mobile and ate a tree. I thought it was rather unique. Turned out to be common. Oh well.

I was surprised to find on the site this time a forum on haiku. It set the following parameters;

The Easy Type: A total of 17 syllables makes a Haiku.

5 syllables for the line
7 syllables for the line
5 syllables for the line

Harder:

3 syllables
5 syllables
3 syllables.

I pulled these from the forum. I made a few changes because this is my blog and I can do whatever I want to.

My genitals hold
My body high above ground
Now without body

Suspend yourself from
Wire around your genitals.
Ut oh: piñata.

I think for myself
Warning signs do not apply
To an immortal.

Homemade parachute
Not latest technology
Opens on impact

Death happens to all
Some happily wait to go
Some knock on Death's door

Death happens to all
To many, a quite tall wall
To some, not so tall

It looks like a bomb
Naturally I wonder:
What could be inside?

After fools rush in
Where angels do fear to tread
The fools become dead

True wisdom: knowing
That you should insert nothing
Into your rectum

Being inspired by such gifted writing, I took a few shots at it.

5-7-5
Waiting for the knife
To cut deeply once again
My blood lets for her

She runs swift as wind
Chased, hounded every night
By a changeling

There is never time
To love openly, truly
When self is utmost

3-5-3

My best friend
Died a thousand deaths
Then gave up