Billy Rubin

Matrix Spoof

2007-04-16T08:02:00.000-02:30

June Callwood

2007-04-10T16:06:00.000-02:30

Talk about preparing for death with dignity. Watch June Callwood on The Hour with George Stroumboulopoulos.

Update: June Callwood died early Saturday morning, April 14th. As she requested no funeral a candle lighting service will be held by mourners.

Diagnosis Wenckebach

2007-04-08T13:28:00.001-02:30

real med students of genius

2007-04-08T13:21:00.000-02:30

A classmate introduced me to a series of videos on YouTube entitled "real Med Students of Genius". It's a bunch of videos from the University of Maryland's School of Medicine Class of 2006 that have a little fun with the types of students every med school class seems to have.

Dr. Tran

2007-02-11T00:14:00.001-03:30

A little warning that this video may not be for everyone.

Pills Pills Pills

2007-01-25T00:05:00.001-03:30

http://www.cafeoflifepikespeak.com/Videos/Licensed%20To%20Pill.swf

Six Until Me

2007-01-20T11:31:00.000-03:30

Since I'm currently studying for my endocrinology final on Monday, I found it apt that the blog "Six Until Me" hosted Grand Rounds last week. Kerri Morrone, the author behind "Six Until Me", is a young woman living with Diabetes. At the age of six she was diagnosed and she has been on insulin treatment since. She has a great outlook on life as evidenced by this Pre-Grand Rounds interview. Her perspective of living with this disease is eloquently writen:

Such perspective is gained from a chronic condition, regardless of its complications. It doesn't define me, but the strongest parts of my personality may have been gently shaped by the perspective gained from having it.

Diabetes didn't make me love with such ease, but having tasted my own mortality makes every hug, every laugh, every kiss that much more needed and appreciated.

I hope so fiercely for a cure. I hope for a cure every time I see a press release about new research breakthroughs. I hope every time I test my bloodsugar that the numbers will always be in range. I hope every time I go to Joslin. I hope every day...

When I wake up every morning and test my bloodsugar, when I prime the pump, when I calculate the carbohydrates in a meal, I know it doesn't define me. But when I am feeling anxious or scared about my medical future or just simply overwhelmed, I know it doesn't define me. It just helps explain me.

And she does have a sense of humour about it (see the Pump in Sock entry).

How to Fake it At Christmas

2006-12-11T21:26:00.000-03:30

A little bit premature...

2006-12-11T08:38:00.000-03:30

but Merry Christmas. I cute card from the neonatal intensive care.

To My Pancreas

2006-12-09T21:26:00.000-03:30

Kerri Morrone, a patient with diabetes, writes an "Open Letter to My Pancreas."

Dear Pancreas I’m not sure what the hell happened to you, but you’ve taken it upon yourself to stop working. You did have that job for about six years, where you got up early every day and produced my insulin, but apparently that was too much for you. You were laid off or fired or something. Don’t blame it on that virus again. I think you just slept through the alarm and were let go and you just don’t want to admit it.

Read the rest at Six Until Me. It's good stuff.

Where the sun don't shine

2006-12-06T00:37:00.000-03:30

A friend sent this to me today. It's fitting since we're doing GI right now

Beautiful Mind

2006-11-21T21:34:00.000-03:30

I tried to find the scenes right before this where his wife finally realizes the truth, but this is the best I could do.

And shortly thereafter, as he tries to re-enter society:

And finally:

And just for fun:

Here it goes again

2006-11-19T13:00:00.001-03:30

I believe...

2006-11-11T09:06:00.000-03:30

On the walls of a concentration camp during WWII a prisoner had written:

I believe in the sun, even though it doesn't shine,
I believe in love, even when it isn't shown,
I believe in God, even when he doesn't speak.

Terry Kelly's Pittance of Time

2006-11-11T09:05:00.000-03:30

More on MJ Fox

2006-11-03T16:43:00.000-03:30

Bad day to golf!!

2006-11-01T14:22:00.000-03:30

This head X-ray was presented in our Head Trauma lecture earlier this week. Apparently this guy golfed a little too much for his wife's liking. She found a better place to store his 9 iron.

Why don't we do it in our sleeves?

2006-11-01T14:12:00.000-03:30

This is a humerous video designed to eduate on the proper way to sneeze and cough so as to prevent spread of disease. Visit the site here and watch the video here.

Pumpkins

2006-11-01T11:12:00.000-03:30

I'm on the home stretch for neuro, but before I finish one final post on the brain. These images are from www.pumpkingutter.com in the 2000 gallery:

the Naked Truth

2006-11-01T10:43:00.000-03:30

We always want to hear the truth from our politicians. We want the naked truth and none of this glossy polical rhetoric. But Canadian politicians seem to have misconstrued what we're looking for.

Liberal leadership candidate, Scott Brison, posed nude for a calendar which is raising money for prostate and ovarian cancer research. Apparently he posing nude pretending to look into the refrigerator and, thankfully, the door covers the goods. The Globe and Mail quoted Mr. Brison as saying:

"It's naked ambition for a good cause. My father had prostate cancer. My uncle died of cancer. . . . . We're not unique to Canadians. Cancer research is a cause that's very close my heart."

Bob Rae, another Liberal Leadership candidate, didn't want to be outdone. So here he is on the Rick Mercer Report:

Michael J. Fox on Stem Cells

2006-10-28T09:04:00.000-02:30

Russ Limbaugh accused Michael J. Fox of faking his symptoms in his political ads supporting candidates who favor stem cell research, including Maryland Democrat Ben Cardin. Quoting Limbaugh:

"He is exaggerating the effects of the disease. He's moving all around and shaking and it's purely an act. . . . This is really shameless of Michael J. Fox. Either he didn't take his medication or he's acting."

Russ Limbaugh is a jackass. The writhing you see is dyskinesia, a common side-effect of the medications used to treat the disease. Michael J. Fox was telling the truth when he responded to Russ Limbaugh by saying:

"I’m kinda lucky right now. It’s ironic, given some things that have been said in the last couple days, that my pills are working really well right now."

Google Bomb

2006-10-27T16:08:00.000-02:30

Try entering the words "miserable failure" into a google searchbar. What do you come up with? The biography of President George W. Bush on the White House website.

How is this possible? The answer my friend is the google bomb. As wikipedia explains: "Because of the way that Google's algorithm works, a page will be ranked higher if the sites that link to that page use consistent anchor text. A Google bomb is created if a large number of sites link to the page in this manner." A small number of sites (~32) all having the same link can be enough to create such a google bomb.

And before you ask, no George Bush's website doesn't appear when you search moron or dumbass.

Moments

2006-10-25T17:17:00.000-02:30

Condolances

2006-10-19T17:17:00.000-02:30

I wish to express my condolances to Uncle's family. I'm glad I had the opportunity to see Uncle and his family last Sunday. With his long battle coming to an end, Uncle was at peace. He was happy to have his family around him. In a quiet voice he sang again and again:

"I've got a mansion over the hilltop,
In that bright land where we'll never grow old,
And some day yonder we will never more wander,
But walk on streets of purest gold."

I hope he finds what he's looking for.

With love and condolances,
William Rubin

Postsecret

2006-10-19T17:15:00.000-02:30

Another gem from postsecret.com

Uncle

2006-10-12T19:12:00.000-02:30

My uncle was sitting in a chair holding a garbage bucket. The bit of hair he had was dishevelled. A large bruise stood out on his pale skin. His right leg was badly swollen; with no narrowing at the ankle or knee, it looked like a cylinder. He was nodding in and out of consciousness.

His family sat around his bed. His wife and daughters looked as if they had been crying.

As I walked into the room everyone greeted me. I sat and they began to explain the severity of the situation. My uncle was in renal failure. He had been flown into this tertiary hospital to have an emergency operation, but his platelet level was too low to risk the surgery. Doctors didn't expect him to make it through the night.

The minister, who had been sitting quietly with the family, began to pray. I bowed my head. " 'In my Father's house are many mansions. If it were not so, I would have told you so. I go to prepare a place for you.' "

Sitting in his chair, Uncle began to sing. "I've got a mansion over the hilltop, In that bright land where we'll never grow old, And some day yonder we will never more wander, But walk on streets of purest gold."

I sat with the family, not knowing what to say. When it was finally time to leave, I told Uncle it was good seeing him and that I would see him again soon. He drifted off into unconsciousness. I said my goodbyes to the family and left, wondering if that would be the last time I saw him.

Functional Neuroanatomy

2006-10-12T18:52:00.000-02:30

I discovered this program, Functional Neuroanatomy, at the University of Toronto website. It's an amazing program for learning neuro structures. It has sagittal, axial and coronal images of the brain, angiograms, tracts, and spinal cord sections. Structures light up when you pass your mouse over them and a brief description appears on the right. You can switch back and forth between anatomical features, functional areas, and vascular territories. In each of the views, you can do self tests to aid you in naming things. It's a remarkable program and a great aid for med students who are slogging through neuro. Hope it helps

Animaniacs sing the countries

2006-10-03T20:08:00.000-02:30

And the award goes to...

2006-10-02T17:07:00.000-02:30

Before I began this long journey called medical school, I did some graduate research for a couple years. A large chunk of my research used a technique called RNA Interference (RNAi). It's an amazing piece of technology which allows a researcher to selectively eliminate one gene product. It's like being able to thumb through a phone book and selectively erase one person. All the other names and numbers are left undisturbed except for that one. RNAi is essentially the magnet which allows you to remove the one needle from the haystack.

A simplied mechanism of RNAi is shown here. Put simply short sequences of RNA called small interfering RNA (siRNA) bind to a complimentary region of messenger RNA. This creates a double-stranded RNA which is detected by the cell and "sliced" up. The power of this tool is that the sequence of the siRNA is chosen so that it recognizes only one mRNA sequence. And in this way you selectively remove the mRNA before it is translated into protein/enzymes/etc.

The reason I bring this up is that this year's Nobel Prize in Physiology or Medicine went to Andrew Fire and Craig Mello for "for their discovery of RNA interference - gene silencing by double-stranded RNA". The press release describes their eureka moment:

Andrew Fire and Craig Mello were investigating how gene expression is regulated in the nematode worm Caenorhabditis elegans (Fig. 2). Injecting mRNA molecules encoding a muscle protein led to no changes in the behaviour of the worms. The genetic code in mRNA is described as being the 'sense' sequence, and injecting 'antisense' RNA, which can pair with the mRNA, also had no effect. But when Fire and Mello injected sense and antisense RNA together, they observed that the worms displayed peculiar, twitching movements. Similar movements were seen in worms that completely lacked a functioning gene for the muscle protein. What had happened?

When sense and antisense RNA molecules meet, they bind to each other and form double-stranded RNA. Could it be that such a double-stranded RNA molecule silences the gene carrying the same code as this particular RNA? Fire and Mello tested this hypothesis by injecting double-stranded RNA molecules containing the genetic codes for several other worm proteins. In every experiment, injection of double-stranded RNA carrying a genetic code led to silencing of the gene containing that particular code. The protein encoded by that gene was no longer formed.

After a series of simple but elegant experiments, Fire and Mello deduced that double-stranded RNA can silence genes, that this RNA interference is specific for the gene whose code matches that of the injected RNA molecule, and that RNA interference can spread between cells and even be inherited. It was enough to inject tiny amounts of double-stranded RNA to achieve an effect, and Fire and Mello therefore proposed that RNA interference (now commonly abbreviated to RNAi) is a catalytic process.

Fire and Mello published their findings in the journal Nature on February 19, 1998. Their discovery clarified many confusing and contradictory experimental observations and revealed a natural mechanism for controlling the flow of genetic information. This heralded the start of a new research field.

The Brain on the brain

2006-09-28T21:40:00.000-02:30

Homunculus

2006-09-27T12:03:00.000-02:30

Studying neuroanatomy, I have come across pictures like these representing the relative areas of the brain associated with sensory input or motor output. Our mouth and hands require very fine movements to speak and write. They also have a great deal of sensory input. These Homunculi are essentially how our brains view the rest of the body.

From this image one can deduce that, in sensitivity terms, a large mouth ulcer could be more significant than ones tackle - not a pretty thought.
-- From the Mouth Ulcers Homepage

(sensory homunculus on left and motor homunculus on the right)

Systolic Murmurs

2006-09-23T01:39:00.000-02:30

We sat in a semicircle unsure of how to proceed. Our clinical skills class commonly had us examining volunteers, but this was an entirely new challenge for us. Men and women in various states of undress would allow us to listen to their hearts, bend their knees and percuss their chests. They gave us the opportunity to learn and over time our fumblings became more experienced palpations, our ears became tuned to the sounds of the lungs and heart, and our eyes began to recognize atrophy and distress. As medical students we became familiar with the unfamiliar, but this was something different again.

Seated in the centre of the semicircle was today's volunteer. She had bright blue eyes and golden yellow hair. She smiled brightly as she played with a toy dog. Her name was Sarah. And she was a bright and beautiful four-year-old girl.

Sarah was very outgoing and engaging. She put us at ease quickly as she shook each of our hands, in turn, as we introduced ourselves.

Slowly we began to make our way through the Denver. Sarah was eager to perform the tasks. She hopped on one foot, drew shapes and completed sentences. She correctly answered questions well past her age bracket, reveling in the adoration she received after completely the assigned task.

Finishing the Denver, we moved on to the physical exam. Before listening to her chest, we had Sarah listen to each of ours. Placing the stethoscope on my chest, Sarah mouthed what she was hearing. "Swoosh."

"Really?!"

"Yup. Swoosh." Sarah smiled. My mind flooded with the horrendous possibilities this entailed. I began drowning in thoughts of systolic murmurs. I thought about young relatives who had died or coronary heart disease. I AM TOO YOUNG TO DIE!!

"Swoosh."

My eyes focused on the small girl standing before me. Her small hand held the diaphragm to my chest. Her tiny face was encircled by the larger headset. She smiled at me, looking for approval. She was unaware of the implications of "thump, swoosh, thump". I weakly smiled back at the four-year-old who had just diagnosed by heart valve stenosis.

Sarah checked everyone's heart. "I don't hear anything," she said to the first student. She told the second student she heard, "Bang Bang Bang." The third was informed that she heard "Ka boom!" The worry quickly melted away, as I realized she had just diagnosed my fellow classmates with having no heart, CHD, and, the ever common, exploding heart, respectively.

Image credit.

If I asked you about art...

2006-09-16T19:18:00.000-02:30

I've been in school a very long time. More than eighty percent of my life has been spent in a classroom. Preschool. Elementary School. Highschool. An undergraduate degree. A year of honours research. Two years of masters research. And now a couple years of medicine. It's been a long time. And at moments like this, when it's Saturday night and I have spent the entire weekend studying and there's seemingly no end in sight, it feels even longer.

I want to be doing something. I don't want to be reading about medicine; I want to be practising medicine. I want to be able to feel the lump in a person's neck and not just read about the cytogenetics of lymphoma. I want to diagnose a patient and not just study the tests to order. I want to write a prescription and not just sit here reading about drug-drug interactions. I want to be a doctor and not simply be reading about what a doctor does.

I do realize that studying is a necessary evil. That before I can examine a patient's neck I have to know what I'm looking for. Before I make a diagnosis I have to know what the test results mean. And before I can put pen to prescription pad I have to know the drug, the dose, and the side effects. I understand that the books are necessary before I get to real deal, but that doesn't mean I won't be glad for that day to come. And hopefully all this studying will be put to good use.

So, if I asked you about art, you'd probably give
me the skinny on every art book ever written.
Michelangelo. You know a lot about him. Life's work,
political aspirations, him and the pope, sexual
orientation, the whole works, right? But I bet you
can't tell me what it smells like in the Sistine Chapel.
You've never actually stood there and looked up at that
beautiful ceiling. Seen that....If I ask you about
women, you'd probably give me a syllabus of your
personal favorites. You may have even been laid a few
times. But you can't tell me what it feels like to wake
up next to a woman and feel truly happy. You're a
tough kid. I ask you about war, you'd probably
uh...throw Shakespeare at me, right? "Once more into
the breach, dear friends." But you've never been near
one. You've never held your best friend's head in your
lap, and watched him gasp his last breath looking to
you for help....  I can't learn anything from you I can't
read in some fuckin' book.
   -- Sean speaking to Will in Good Will Hunting

Long Way From Home

2006-09-15T21:44:00.000-02:30

Anne was a long way from her home. She stood on the wharf, suitcase at her feet, and gaped at the three-story building that stood in the center of the small town. The clinic was no bigger than the house in England she grew up in. This couldn’t be all there was. Could it?

She turned back to the water to see if she could catch the boat before it had left. The small dory was already halfway out of the harbour, smoke rising from the fisherman’s pipe as he methodically rowed away. He had been hired to transport her to this town, given there was road access. His job done, he had left immediately. The journey back was a long one and would take the remainder of the day.

Anne picked up her bag and trudged toward the small cottage hospital. She had been trained as a nurse and midwife in London. With senior positions being filled and little room for advancement, Anne began looking for positions outside the United Kingdom. Health boards in Australia required three year contracts, a seeming eternity to a twenty-two year old. Newfoundland was offering 1 year positions. Anne could sign up, work one year, and, having experience, look for positions back home. And now she found herself her, at the God-forsaken end of the Earth. No road access. No amenities. No trees! Just a small group of houses huddling together against the barrenness.

“Hi. You must be Anne. I’m Gertrude.” A plump middle-aged lady stood before her, clad in a white nursing dress and cap. “Would you like a tour of the hospital?” Without waiting for an answer Gertrude turned and began up the steps. The third floor was one large open room housing three beds. The nurses slept there. The second floor contained a small ward. Their clinic was on the first floor. The nurses slept upstairs and worked downstairs. There would be little time for anything else.

Anne lay in her bed, head under the covers, crying silently. What had she gotten herself into? How was she going to get through this next year? This couldn’t be happening. It must be a dream!

Little did she know that this small Newfoundland community would be where she’d stay. She would treat everyone and everything without exception. She would eventually lose track of the number of babies she would deliver. Children would be named in her honour. She would pull teeth, set bones, treat animals, and prescribe medications. Along with Gertrude, she would become the town’s entire medical system. And this town would become her home. She would marry a local man and have two beautiful children. She would become a grandmother. She would retire here, but she would still stay. She had found her corner of the universe. She had found where she belonged. But that first night, lying under those blankets and crying silently, she just didn’t know it. Sometimes life takes you not where you want to go, but where you're meant to be.

Bad news

2006-09-08T18:18:00.000-02:30

They sat in the waiting room, not knowing what to expect. It had been two weeks since he had discovered an egg-sized lump in his groin. He called his family doctor and made an appointment. Upon seeing the physician, the mass did a disappearing act. It had taken a couple of trips back, but the doctor had finally found the mass he had felt. Within a day or two he had been sent to a specialist. Upon examining him, the doctor was obviously shocked. Disquieted by this, he repeated asked what was wrong. But no answer had been forthcoming. The doctor simply said she couldn't be sure until the lab tests come back. And now he sat, wife by his side, in his GP's waiting room, wondering what secrets those lab tests would reveal.

The GP walked out and called them into her office. They sat. The doctor began to cry.

"Tell us what's wrong?"

"You're full of it!"

"I know he's full of it, I've been telling him that for years!" his wife joked.

The doctor sobbed. "You're full of cancer!"

He began to cry. Large tears rolled down his cheeks. He shook as waves of grief rolled over him.

In twenty-five years of practice, she had never had to give someone such a bad report. The prognosis was poor. She was as devastated as he. Together doctor and patient wept. She had had the uneviable job of telling him he had cancer and he had had the uneviable job of hearing it.