The Cardiac Exam

We just finished two weeks of Clinical Foundations of Medicine, which included practice with the history and physical as well as two electives! My electives were Health Policy and Video Making for Physicians. In the health policy elective I learned about who's winning (drug companies and device manufactures) and who's losing (everyone else) as health care costs skyrocket. We talked about the idea of a monopsony (single buyer), and how in other countries having the government as the sole buyer of health care helps keep costs down. And we discussed Accountable Care Organizations (ACOs), which are networks of primary care physicians, specialists, and hospitals. These organizations are paid a set amount per person assigned to the ACO by the insurance companies, so there is an incentive to keep costs down rather than ordering unnecessary tests and procedures. There would also be bonuses for health care providers who improve quality metrics while keeping down costs, further incentivizing high-quality, low-cost care. ACOs are a major component of the Affordable Care Act.

In the video making elective, we made a 2-minute video showing some parts of the cardiac exam. The idea was that videos are an excellent way to convey medical information to colleagues and patients. Here are both groups' videos--me and my deranged jugular vein are in the first one.

Greatest game ever?

The Michigan Wolverines beat the Notre Dame Fighting Irish 35-31 last night, after 3 touchdowns in the last 1:12. At 1:12, Wolverine phenom Denard Robinson threw a touchdown pass to Vincent Smith to make it 28-24 Michigan. The Fighting Irish stoically marched down the field and responded to make it 31-28 with 30 seconds left. With 2 seconds left on the Notre Dame 16, Michigan showed remarkable courage by going for the TD rather than kicking a field goal to tie it. Robinson connected with Roy Roundtree to win it for Michigan. This game would have been incredible under any circumstances, but it turns out that it was the first ever night game played in the Big House, with a record attendance of 114,000.

I moved into a new house last weekend with four other med students and 1 undergrad. The place was an absolute mess: there was a hole in the ceiling that leaked water during a storm; the dishwasher is broken; there were leaks in the basement; the kitchen was full of dirty dishes and soggy rags; the refrigerators were stocked with months-old rotting food and were growing mold; the living and dining room were trashed and the carped badly stained; the backyard was buried in old furniture, mattresses, and decades-old desks and chairs; and the front yard was overgrown with bushes and weeds. Last week all of us have put huge amounts of money and effort into the place to get it in working condition. Here are some pictures after we removed all the trash, scrubbed, painted, mowed, and brought new furniture.

Dining room

Living room

Kitchen with new pegboard for pots and pans I installed. Moderately tacky but functional.

New cabinet we installed

Two fridges

My room

Deck

Behind house/parking (we have a shed to the right of this)

Addendum to previous post

Sky Cowboys

Up and Down From Ground Zero

WTC

As the 10th anniversary of 9/11 approaches, I thought I would write a quick post about the new World Trade Center complex. I haven't heard many people talking about it, but as of March 2011 (the last date when updates were available), 1WTC was 56 stories and growing. Here are some neat pictures of the construction.

The new WTC will have five skyscrapers and the 9/11 museum & memorial. 1WTC will stand 1,776 feet tall and will be the world's 3rd highest building when it's completed in January 2013. It will have quite an arsenal of safety features:

In addition to structural redundancy and dense and highly adhesive fireproofing, the building will include biological and chemical filters in the air supply system. To assume optimum egress and firefighting capacity, extra-wide pressurized stairs, multiple backups on emergency lighting, and concrete protection for all sprinklers and emergency risers will be provided, in addition to interconnected redundant exits, additional stair exit locations at all adjacent streets, and direct exits to the street from tower stairs. All of the building's life-safety systems - egress stairs, communication antennae, exhaust and ventilation shafts, electrical risers, standpipes, and elevators - will be encased in a core wall that will be three feet thick in most places.

It's architecture is not particularly noteworthy, but check out the dinosaurian transportation hub:
The rebirth of the World Trade Center cite is inspiring and exciting. I'm glad that 1WTC will be even higher than the old twin towers (although the roof of 1WTC will be exactly the same height as the original 1WTC; only with its spire will it rise to 1,776 feet). Some developers wanted to rebuild the old towers pretty much exactly as they were before 9/11. In my opinion it was better to make a new design representing a stronger, reinforced New York. If only Daniel Libeskind's original design was used, New York's skyline would look like this:

Michigan LP Bike Trip

*Itching madly from mosquito bites*

I'm writing from the Detroit Metro Airport Super 8 Motel, the only major casualty from a 7.5-day bike trip in Michigan. Here's the route:

I started at the Ralph A. MacMullan Conference Center in Roscommon, Michigan on July 31. This was the last day of our MSTP retreat. There were two seminar sessions and one poster session at the retreat, with lots of games and drunken merriment mixed in. The day I started, I must admit I was suffering rather severely from hangover and lack of sleep. Fortunately I felt better once I started riding in the early afternoon after the morning's scientific talks. Here are some notes from the trip, with pictures at the end.
Day 1: Roscommon to Gaylord. Best sight was Lake Otsego on a sunny, breezy Sunday with lots of beachgoers. Spent the night in a motel to be sure I got a decent sleep.
Day 2: Gaylord to Mackinaw. Rode today on the Gaylord-Mackinaw Rails to Trails Project. Gaylord (aka the Alpine Village) is on a "plateau" of something like 1000 feet in elevation so the first part of the day was a gentle downhill. The trail was well-groomed all the way to Mackinaw. I dropped my things at the Teepee Campground a couple miles south of Mackinaw City and then pedaled into town to catch a ferry to Mackinaw Island. There I was amazed to find thousands of bicycles EVERYWHERE and horse-drawn carriages for the heavier loads and lazier tourists (automobiles are outlawed). I had a picnic on the lawn beneathe Fort Mackinac and enjoyed a sunny summer evening.
Day 3: Mackinaw to Fisherman's Island State Park (1.5 miles south of Charlevoix). It rained hard, pretty much all day. I was in northwestern Michigan now, so it was hilly as well. I took a wrong turn and ended up cutting across Michigan's middle finger (don't know any other word for it) rather than hugging the coast as planned. But this allowed my to see some very nice rolling farmland, so no problem. Rolled through the haughty resort town of Charlevoix and spent the night at a campsite on Lake Michigan.
Day 4: Fisherman's Island State Park to Traverse City. Relatively short day down to the surprisingly pleasant town of Traverse City. Had an awesome dinner at the Dish Cafe, and a slice of cherry pie from the Grand Traverse Pie Co.
Day 5: Day trip to Sleeping Bear Dunes. Best cycling day of the trip. Covered beautiful rolling farmland over Michigan's "pinky" finger. Somewhat serious climbs for Michigan, including a hill with a runaway truck ramp (!). Pedaled through Glen Arbor and Empire, the two main towns in the Sleeping Bear Dunes National Seashore. I hiked up the "Dune Climb" and got a superb view of Lake Michigan.
Day 6: Traverse City to Highland Lake Campsite. Long and at times tedious day through unremarkable terrain, but terrific campsite on secluded lake, where I went swimming!
Day 7: Highland Lake to Grand Rapids. Rain again for much of the day. Rode on the White Pine Trail for the last 20 miles into the city, then followed the Grand River to the Holiday Inn in downtown. I felt like splurging a little bit. Most impressive thing about Grand Rapids is the Grand River, which actually is pretty big. I recognized a lot of sites from the entertaining Grand Rapids Lip Dub Video.
Day 8: Grand Rapids Downtown to Grand Rapids Airport. Hardest day of the trip, seriously. I started out by going to the Gerald Ford Museum, where I decided that Gerald Ford was a nice guy but not a particularly good president. Then I rode (in the rain again) through Grand Rapids, and after a couple turns noticed that I was seeing the same street names I had seen a half hour earlier. Mentally I was not prepared for a wet, confusing ride and got somewhat upset with myself before I got my bearings. Eventually made it to the airport where I picked up a rental car and booked it back to Ann Arbor to exchange my bicycle and soaked gear for hiking boots and fresh clothes, because I was planning on meeting my dad in Yellowstone for a few days. Unfortunately, delays that accumulated throughout the day led me to miss my flight, so here I am...stuck in a motel a few miles down the road from DTW, but content to have an extra rest day before flying out tomorrow.

110807 Michigan LP bike trip

Visit to Los Angeles

This weekend I traveled to Los Angeles to visit my Uncle Jonathan, Aunt Julie, Grandma Elise, cousins Rivkah, Dvorah, Hannah, and Akiva. And my dad, step-mom, and brother Alex drove down from Sacramento as well. We visited the Watts Towers, constructed over a period of decades by Simon Rodia, an uneducated Italian immigrant who moved to Watts in 1921. Rodia was a laborer by day and in the evenings and weekends he would work on the towers, which are made of rebar covered in concrete. Rodia covered the concrete with shards of glass soda bottles, broken plates, tiles, sea shells, and other found objects like a boot. He used only simple tools like a hammer and chisel and bent the rebar on the nearby railroad track to make the curved structural elemets. He didn't use any scaffolding either so climbed up the towers to work, until he finished in his late 70s. At one time the city tried to tear down the towers, claiming they were an eyesore and not structurally sound. A truck pulled cables attached to the tops of the towers, but the cables snapped and the demolition effort was abandoned. The towers have not wavered despite many earthquakes and being exposed to the elements. They are truly an amazing piece of artwork.

We also visited the University of Southern California campus; USC has graduated the most Olympians of any university in the country. And we ate dinner at Shiloh, the best Kosher restaurant I've ever been to.

The family, minus Dad.

More pictures:

Summertime!

I just finished the third week of my summer lab rotation. Most of the folks in the lab come from a chemistry background, so I'm learning a lot from them and trying to dust off the cobwebs from orgo. I ran a thin layer chromatography experiment this week and everyone made fun of me because I cut the silica strip WAY too big. It's interesting contrasting a chemistry-based lab with the biology labs I've been in previously. Just as in biology, there are certain generally accepted methods for doing things. For example, when doing chemistry one does not use a pipetman with plastic tips, so ubiquitous in biology labs. Instead, one uses a glass syringe that won't be dissolved by organic solvents. It's funny though, the chemists in the lab often break cardinal rules of the biology lab. For instance, people pore the supernatant from a bacterial culture down the sink. Or they leave the plumbing of chromatography equipment sitting in aqueous buffers, making it prime real estate for bacterial growth. I'm enjoying sharing tips and hints with labmates from different backgrounds.

The weather was warm and sunny the past week, so I got out for plenty of bike rides and runs. Two weekends ago I ran in the Dexter-Ann Arbor half marathon, a beautiful race mostly along the Huron River. I thought it was an impressive show of community spirit, with many of my friends and professors running and a large post-race rally followed by the Taste of Ann Arbor festival. Picture at one representative point on the course:

After taking a two-hour nap following the race, I traveled to the Detroit Institute of Art with a group of medical students and professors as part of a Arts and History in Medicine trip. The museum's most famous piece is a multi-wall mural by Diego Rivera depicting Detroit's history and industry; here is just one wall:

The DIA has many other famous works, including some by van Gogh and Picasso, that we saw only briefly, so I'll definitely need to return.

And finally, I'd just like to note that it's been great to see hordes of bicyclists out and about on the streets of Ann Arbor. I've noticed that only a fraction of bicycle commuters wear helmets in Ann Arbor. Usually people out for long rides wear a helmet, but folks on short trips tend to forgo them out of convenience. The bicycle helmet debate is still raging, with conflicting scientific evidence on both sides regarding the efficacy of helmets. If you were to compare the outcome of a helmeted rider versus a helmetless rider in any given crash, the helmeted rider probably has an increased chance of faring better. However, there's evidence that helmet laws decrease the number of cyclists on the road (increasing the risk for the remaining cyclists due to the "safety in numbers effect," not to mention diminishing the huge cardiovascular health benefits to cyclists in general), cause cyclists to ride faster, and cause motorists to pass cyclists more closely.

On the other hand, the evidence for the efficacy of motorcycle helmets is pretty much irrefutable, yet the state of Michigan is currently looking into repealing mandatory helmet use for motorcyclists:

http://www.mlive.com/politics/index.ssf/2011/06/repeal_of_michigans_motorcycle.html

The argument for repeal is that the helmet law is hurting tourism in Michigan...I have trouble imagining someone canceling their vacation to Michigan because they have to ride with a helmet on their motorcycle. Meanwhile, the health care savings due to helmet use in Michigan are in the many millions of dollars.