Erectile dysfunction after prostate removal for prostate cancer

Robotic Surgery Blog discusses sexual life after prostate removal:

"This post is for all the men who have prostate cancer or are worried about prostate cancer. One of the most feared side effects of therapy for prostate cancer is the impact on sexual health.

Hopefully this will give men a better idea of what to expect and take some of the fear of the unknown away."

The post also includes a video demonstrating a nerve-sparing prostatectomy via the da Vinci robot (picture above).

Role of PDE-5 inhibitors (Viagra, Cialis, etc.)

According to Oxford Bandolier Journal, "recovery of sexual function after prostatectomy is not immediate, and it can take up to 2 years for full recovery even after nerve sparing surgery. Oral PDE-5 inhibitors are usually the first line therapy, with reported efficacy in 10-80% of men after nerve sparing surgery, but probably below 15% after non-nerve sparing surgery."

Related:
Love in the Time of Prostate Cancer. NYTimes, 02/2009.
Image source: Robotic Surgery Blog
Google Video: Saving Sexual Function & Removing Prostate Cancer. HealthTheater.tv.
The small c and the big robot. Jeff Jarvis, 2009.

A patient shares the reality of recovery from prostate cancer surgery: Jeff Jarvis, 2009.

Updated: 12/18/2009

Make Your Own "Medical Journal" with iGoogle Personalized Page

Google.com/IG or iGoogle personalized page is also an RSS aggregator. You can use it to collect the feeds of your favorite journals in one easy-to-scan page. A free Google account is required.

As you can see in the screenshots below, I combined the feeds of NEJM, JAMA, Archives, BMJ, Clinical Evidence and AAFP on Google.com/IG.

You can make your journal page more interactive by by subscribing to JAMA audio summary, Johns Hopkins podcast, etc. There is even a text-to-speech module that works with iGoogle.


Figure 1. Click "Add stuff" in the top corner to add a RSS feeds to your personalized iGoogle page.



Figure 2. Use the search box to find RSS feeds for medical journals.


Figure 3. Entering just "NEJM" in the search box is enough to find the RSS feed of the New England Journal Medicine. Repeat the search for "BMJ" and "JAMA" to find the feeds of the corresponding journals.


Figure 4. You are done -- your personal medical journal has just been created.

Click here to subscribe to the RSS feeds of the "Big Five" medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals.

Click here to subscribe to the podcasts of 4 major medical journals in iGoogle.


How to use iGoogle

References:

Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Backup Your iGoogle Page. Google Operating System, 04/2008.
Create and share "your own bundle" of recommended RSS feeds in Google Reader: http://bit.ly/hkoen
Google ranks the top 100 journals and NEJM is no more the "top dog" according to G Scholar Metrics for Publications http://goo.gl/unTjs

Some of the screenshots above are from an earlier version of iGoogle bu the general idea remains the same.

176-year-old turtle once owned by Darwin dies of MI and CHF

The late Harriet was a 176-year-old tortoise, believed by some to have been owned by Charles Darwin. She died peacefully in a Queensland zoo owned by Steve Irwin, the Crocodile hunter.

According to the zoo veterinarian quoted by CNN:

"Harriet sadly died last night after, thankfully, a very short illness. She'd been sick yesterday with, in effect, heart failure. She had a very fairly acute heart attack and thankfully passed away quietly overnight."

People have heart attack at age 76 (and often much earlier), for Galapagos turtles the risk age seems to be 176...

Read the whole story: 'Darwin's tortoise' dies, age 176. CNN.
Image source: Wikipedia

Related:
Darwin, Britain's Hero, Is Still Controversial In U.S. NPR, 02/2009.

Updated: 02/08/2009

JAMA and Archives Have RSS Feeds Now

AMA Journals now have RSS feeds:

"Each new issue of JAMA and the 9 Archives journals has an accompanying free RSS feed, which is a special Web page formatted for RSS readers. JAMA and the Archives Journals offer feeds for the current issue and for the 3 most recent issues. Each RSS feed includes article titles, abstracts for articles that include them, and links to the full text version."

There is no need to use the Pubmed/Send-to-RSS work-around anymore.

RSS feeds are updates that are delivered by the websites when something new is published.

Its inventor, Dave Winer likens RSS to "a sushi bar where the sushi comes around in boats. When you see something you like, you grab it and eat it." The same is true with RSS content that feeds you news aggregator.

"It's like having a personal assistant who goes through every publication and blog that could possibly interest you and picks out stories to bring to your attention", writes PC Magazine.

References:
Get RSS Feeds for the Major Medical Journals
Web 2.0 in Medicine

Submit an Abstract to the Cleveland Clinic Perioperative Summit

Don't forget to submit an abstract to the 2nd annual Cleveland Clinic Perioperative Medicine Summit. The deadline is July 1. Submission is free and, if selected, your abstract will be published in a supplement of the Cleveland Clinic Journal of Medicine in a citable form.

I am a member of the Clinical Vignettes Committee of the summit, and if your abstract is of good quality, you definitely have a chance... :-)

And, yes, this blog is still the number one result on Google for "Cleveland Clinic Perioperative Medicine Summit", so if you are planning to start a blog to popularize an idea or a project, do not delay it. Search engines "like" content that is up-to-date and rank it high in their algorithms.


Screenshot of Google search results for "Cleveland Clinic Perioperative Medicine Summit"

References:
Cleveland Clinic Perioperative Medicine Summit

In the News

Drug-coated stents triple the risk for heart attack compared to "bare-metal" stents

According to WSJ (subscription required), "a recent Swiss study found 3.3 more heart attacks and deaths per 100 patients with drug-coated stents than with the uncoated, bare-metal ones, beginning six months after implantation and ending a year later. The heart attacks and deaths were mostly attributed to blood clots."

A drug-coated stent costs $2,300 apiece, compared to $700 for an uncoated stent.

WSJ cites a review published in the Annals of Internal Medicine this week: Drug-Eluting Stents for the Management of Restenosis.

References:
Concerns Prompt Some Hospitals To Pare Use of Drug-Coated Stents. WSJ.
Narrative Review: Drug-Eluting Stents for the Management of Restenosis: A Critical Appraisal of the Evidence. Annals of Internal Medicine.


Doctors' income falls over the last 8 years

According to MarketWatch:

Physicians' income fell 7% after adjusting for inflation between 1995 and 2003. Primary care doctors income fell even more than 10% in that time.

During the same period, lawyers and engineers had a 7% inflation-adjusted gain. In a nutshell, while doctors lost 10%, lawyers made 7%...

This decline in income may lead to shortage of primary care doctors.

Last year, the average CEO was paid $10.9 million a year. This is 262 times the average worker yearly salary of $41,000.

Reference:
Doctors' income falls over eight years. MarketWatch.
BIG news for ER docs. AllBleedingStops.blogspot.com
Image source: OpenClipart.org

Road Safety in the UK TV PSA

GruntDoc found these gripping PSA (Public Service Announcements) aired on TV in the UK:

Seat Belt 1

Seat Belt 2

Don't Drunk And Drive

Slow Down Boy...

I'll see you to the door 1

I'll see you to the door 2

Link source: EMT City Online Community, PSA videos are posted on YouTube.

Update 5/28/08:
PSA: "I'm New Jersey Governor Jon Corzine, and I should be dead."

How much time do you spend blogging?

According to a UMass study, 31 % of bloggers spend 1-4 hours per day researching for and writing their posts, 65 % spend less than one hour.



One hour a day is a significant commitment in the busy schedule of most physicians and this explains why so many of them quit blogging purely for time constraints. If a remember correctly, Medpundit wrote that she could see 4 extra patients in the one hour she used to devote to blogging.

Link and image source:
UMass Study Identifies the Traits of Successful Bloggers. Micro Persuasion.
Behind the Scenes in the Blogosphere. Nora Ganim Barnes.

"Why I don't want my daughter to become a doctor"

The Patient's Doctor blog lists a few reasons why he is doing his best to discourage his daughter from taking up medicine:

"Doctors will have to spend half their lives on paperwork; or arguing with clerks about the "medical necessity" of the treatment their patients need."

Don't forget the 10 years of being a medical student/resident/fellow (4+3+3), the 80-hour work week, the night calls without a minute of sleep, and "the art of medical pimping", just to name a few other reasons...

FatDoctor still remembers how she slept 26 hours straight at the end of her night float month: "No waking up to pee, no waking up to eat, all I needed was sleep."

According to Newsweek, every year, between 300 and 400 doctors take their own lives—roughly one a day. No other profession has a higher suicide rate.

According to MarketWatch, physicians' income fell 7% after adjusting for inflation between 1995 and 2003. Primary care doctors income fell even more than 10% in that time.

During the same period, lawyers and engineers had a 7% inflation-adjusted gain. In a nutshell, while doctors lost 10%, lawyers made 7%...

References:
Why I don't want my daughter to become a doctor. The Patient's Doctor.
Young Doctors Learn Quickly in the Hot Seat. NYTimes.
Sleep. Fat Doctor.
Doctors' income falls over eight years. MarketWatch.
It is July and I love to pimp. DB’s Medical Rants.
Et tu, Radagast? Respectful Insolence.
Image source: OpenClipArt.org, public domain.

Related:
The process...how long does it take to become an emergency medicine doctor? EM Physician - Backstage Pass, 11/2007.
Primary Care or Engineer? And the Winner is... The Happy Hospitalist, 12/2007.
Who’s Cuddly Now? Law Firms. NYTimes, 01/2008.
Doctors Who Kill Themselves. Newsweek, 04/2008.
Eyes Bloodshot, Doctors Vent Their Discontent. NYTimes, 06/2008.
Reasons Not To Become A Doctor. Forbes.com.

Updated: 06/24/2008

Clinical Procedure Guides on Picasa Web: Step-By-Step Photos

I have just moved the three procedures guides we created to Picasa Web Albums:

Central Line Placement - Procedure Guide

Central Line Placement with Ultrasound Guidance - Procedure Guide

Thoracentesis - Procedure Guide

Picasa Web works great: it resizes the images automatically to fit the monitor size and pre-fetches them so that the slideshows load faster. Our previous host, Webshots, used to place too many banner ads around the images but I chose it over Flick because it offered a larger resolution of the slideshows.

Andrew Schechtman of MeisterMed contacted me last week with the suggestion to create a free PDA guide for clinical procedures. I hope that this project is completed soon.

Of course, our slideshows cannot compete with the excellent professional NEJM videos but this is not the goal. The idea is to help any health care worker anywhere in the world by offering a quick reference guide to refresh the memory about a certain procedure before performing it. In our informal surveys, many residents at the Cleveland Clinic and Case Western/St. Vincent find the guides very helpful.

Unfortunately, NEJM recently removed their procedures videos from the free area of the website and started to charge $ 10 per video.

Update 06/26/2007:
Picasa Web has a mobile version and map locations.

References:
Procedure Skills and ACLS Refresher
Put your photos on a map, and Picasa on your phone. Official Google Blog, 06/2007.

You have a blog and you're planning a vacation. What to do?

ProBlogger Darren Rowse offers some tips in 7 Things to Do with your Blog when you take a Vacation.

I usually just stop blogging and give my readers (and me) a break. This does not mean that every time I don't blog for week, I'm having a vacation though...

On the other hand, I was guest-blogging for KevinMD a few months ago and it wasn't that easy but it was fun.

Another option is to hire a "blog-sitter."

Medgadget Launches a Wiki About Medical Technology

There is only so much a blog can do. The blog platform is great but it is not really structured, especially if you want to write something in a book format with table of contents, chapters and index. Blogs have categories, I know, but it is not the same.

The authors of Medgadget blog are not entirely sure how they are going to use the newly-launched Medtech Wiki but they would like to have "a nice "base" layer of reference articles on basic medgadgets."

Wikis can be very useful and popular. Almost any search brings a Wikipedia link on the first page of Google results nowadays.

Wikis are a typical example of a social website though, which means that the website is just as good as the people that contribute to it and their desire to expand and correct it. There is also a critical mass of users that are needed maintain a credible and current wiki. For Wikipedia, this mass consists of about 1,000 administrators-volunteers. Millions contribute but these 1,000 people are the "backbone" of the world's largest online encyclopedia.

Medgadget blog has been a great resource for anything new in medical technology. I remember searching for the newly-approved EpiFlo device a few months ago and Medgadget was right there on Google's first page with a nicely-written post about it. The website has already had more than one million visitors. I hope that their new project will be even more successful.

References:
Medgadget Launches Medtech Wiki
Which Wiki is Right for You? School Library Journal, 5/1/2007.
Image source: Medgadget

New Opera Browser with Google Widget

Opera has been my preferred browser for the last 6 years. It is fast, very secure and intuitive to use. Most new features make their debut in Opera before they are adopted by IE and Firefox: tabs, zoom, RSS reader, password manager, integrated mail client, voice recognition and text-to-speech.

Opera 9.0 was released today. Multiple mini programs, called widgets, are included. Google widget is one of them, it covers almost any Google service you would like to use.


Google widget is not just another toolbar. Give it a try and you will see for yourself. How about a Password Generator, Translator or tinyUrl?

The list of features seems endless.

My only complaint as an Opera user is that due to the low market share of the browser (11 millions or so), some web services (like Google Calendar) do not work well in Opera. For regular browsing though, Opera is simply unsurpassed. Hopefully Google and Yahoo will fix the compatibility issues soon.


Video: Opera browser 12-year history

References:
Opera Voice Feature : Talk to Your Web Browser. Quick Online Tips.

Updated: 02/06/2008

This Week's Grand Rounds

Check out Grand Rounds (GR), a weekly summary of the best posts in the medical blogosphere.

GR has become the contemporary weekly portrait of medicine through the eyes of the medical bloggers.

Pre-Rounds is an article series about the hosts of Grand Rounds on Medscape.com. Nick Genes of Blogborygmi, who writes the Medscape column, is the founder of GR and he maintains the archive.


Image source: Dr. Deborah Serani

Medical News

RA Drugs Increase Cancer and Infection Risk Significantly

Remicade and Humira are anti-tumor necrosis factor (TNF) drugs that are effective and widely used and advertised for treatment of rheumatoid arthritis (RA). The problem is that, according to a recent Mayo Clinic study, these drugs triple the risk for malignancy and double the risk for infection.

Source:
Rheumatoid arthritis drugs increase infection, cancer risks. ACP Observer.
Anti-TNF Antibody Therapy in Rheumatoid Arthritis and the Risk of Serious Infections and Malignancies. JAMA.


"Burning Out" the Bronchial Muscle to Treat Asthma

Bronchial thermoplasty is an experimental method for treatment of severe drug-resistant asthma. The best evidence so far seem to be from studies with as few as 16 patients, so it will be a while before bronchial thermoplasty becomes mainstream (if ever).

Source:
Asthma Experiment Removes Lung Tissue. Associated Press, WSJ (subscription required)
The Alair System for Bronchial Thermoplasty. Medgadget.


ACP "Internal Medicine 2007"

ACP changed the name of its Annual Session to Internal Medicine 2007 " to increase the visibility of internal medicine." Interesting idea. With fewer medical student choosing internal medicine as a career each year, let's hope it works.

Source:
ACP's Annual Session gets name change. ACP Observer.


Pulmonary Artery Catheters Not Helpful in ICU Patients

We have been aware of previous research with similar conclusions for a while now. The latest study was done in part at the Cleveland Clinic and adds to the evidence that Swan-Ganz catheters are more harmful than beneficial to most ICU patients.

Source:
Pulmonary artery catheter does not improve outcomes in intensive care. ACP Observer.
Pulmonary-Artery versus Central Venous Catheter to Guide Treatment of Acute Lung Injury. NEJM.
Just the FACTTs (Fluid and Catheter Treatment Trial). Notes from Dr. RW.

Image source: OpenClipart.org

Chinese Menu: Scorpions and Grasshoppers on a Stick

The author of MyMoneyBlog just returned from a trip to China and posted some interesting photos. The Great Wall of China is impressive but so is Beijing's smog (see photos below).


Scorpions and grasshoppers on a stick


Countdown to Beijing 2008 in Tiananmen Square. That's not fog... it's smog!

Images source: MyMoneyBlog, used under Creative Commons license.

BBC Test: What Sex Is Your Brain?

According to BBC:

"Some researchers say that men can have 'women's brains' and that women can think more like men. Find out more about 'brain sex' differences by taking the Sex ID test."

The test has 6 parts and it takes about 10-15 minutes to complete.

Link via Digg.com.

FreeMedMatrix is a Meta Search Engine for Medicine

"Meta Search Engine" means that FreeMedMatrix compiles results from several search engines and services. For example, a Google search provides only web pages available in the Google index.

FreeMedMatrix searches:

Google Powerpoint Lectures
Merck Manual
AAFP Patient Ed Handouts
Family Practice Notebook
National Practice Guidelines
Dermis Skin Disease Images
Medline

Medical meta search is not a bad idea but the interface looks cluttered.

The webmaster of FreeMedMatrix sent an email announcement about the new service to a few medical bloggers yesterday but I did not really pay much attention to it until I saw the link on KidneyNotes.com. Having the email address listed on the blog page has the adverse effect of receiving 70-150 spam emails daily. Gmail generally does a good job forwarding them to the spam folder.

FreeMedMatrix is owned by Medical Matrix L.L.C.

Subspecialty Grand Rounds: Pediatrics, Radiology, Nursing...

The idea of "Grand Rounds" is branching fast. Nick Genes' original Grand Rounds (GR) started in 2004 and until this year there were no alternatives. Not anymore. Suddenly, over the last month or two, we have seen Pediatric Grand Rounds, Nursing Grand Rounds and now, Radiology Grand Rounds.

Does using "Grand Rounds" in the title dilutes the "brand" of the original GR? I don't think so. Nick's GR will (most likely) always be the most popular and visited one. NEJM will always have a higher impact factor than JACC.

It all depends on the number of users, just ask Digg.com competitors who launched similar websites -- what happened to them? Nothing... Exactly. Nothing happened because nobody uses them.

I certainly hope that the faith of the newly-launched specialty Grand Rounds will be different. And most likely it will be -- subspecialization is the natural tendency in modern medicine. I also like the name "Grand Rounds" much better than "carnival" of, let's say, pediatrics. It does not sound serious, does it?

Good luck to the new subspecialty Grand Rounds and don't forget the most important part: submit and read other bloggers' posts.



Image source: Radiology Grand Rounds

Cleveland Clinic Offers New Podcasts

Cleveland Clinic now has both podcasts and videocasts.

The new podcasts are available at clevelandclinic.org/podcast:

"Cleveland Clinic podcasts offer breaking news from the cutting edge of medicine, in-depth information on diseases and treatments, and moving real-life stories. Each podcast is 3-4 minutes. Download them for yourself, your family or friends."

As you can see the programs pretty much follow the headlines of the day but they also offer the opinion of the Cleveland Clinic experts who explain the real issues behind the news chatter:

Is Your mp3 player making you deaf?

Fungal Eye Infections: How to Prevent and When to Worry

Reversing Coronary Artery Disease

Bariatric Surgery: It Can Change Your Life

You can see/view programs directly from the website or subscribe to receive updates in your favorite RSS/podcast player. Videocasts are also available on Google Video.

Image source: Cleveland Clinic

Special contact lenses supposedly give athletes an edge

It does not sound like a good idea to me:

"The 15-year-old wears tinted contact lenses that block certain wavelengths of light and help athletes see better. Oh, and they look cool, too.

"It gives me more confidence because you feel intimidating and bigger and stronger, kind of an ego-booster," said Walters, who plays for Father Ryan, a Catholic high school in Nashville, Tennessee."

Source: CNN

Did we forget about the Moisture Lock-related keratitis so soon?

Using almost any medical product comes with risks and benefits. Doctors document any intervention in the patients' charts with the line "RBA discussed." RBA stands for "risks, benefits, alternatives."

I doubt that the benefits of using "performance-enhancing" contact lenses outweigh the risks. (Don't) use at your own risk.

References:
Contact lens designed to give athlete an edge
Image source: Wikipedia

How Can Academic Physicians Benefit From "Google Office"?

Online Word Processor

We already use Writely.com to collaborate on articles at our section at the Cleveland Clinic and several members of the group (including me) are very happy with it. No more emailing back and forth different versions of one document and you can see all the revisions.

For example, KidneyNotes and me are currently working on an abstract together. He is in New York and I am in Cleveland but if he edits the document at the same time as me, I can see the changes in real time.... And with Writely, all collaborators always have the latest version of the document.


Online Spreadsheet

Google Spreadsheets, which is released today, is the logical next step -- now you can combine the data online and share it with other researchers. Importing or exporting a MS Excel document is easy. Whenever you are ready with the data analysis, just switch to Writely to prepare the abstract and manuscript. HIPAA compliance is a must -- no patient-identifiable information can be stored on Google servers.

Google Spreadsheets and Writely will definitely be very useful to physician researchers around the world. Whether they are called "Google Office" or not, these 2 services will change the way we work.


It Is Good to Share

The key difference between the good old MS Word and Excel, and the new online collaboration tools is that you can "share" a document with other people. They can be invited as viewers or editors.

Currently, Google Spreadsheets is a limited experiment and only the people who signed up very early this morning can use the product. If you are a researcher interested in trying Writely or Google Spreadsheets, send me an email, and I can invite you as a collaborator.


References:
It's nice to share. Google Blog.
Google Spreadsheet? and Inside Google Spreadsheets. Google Blogoscoped.
A look at Google's Spreadsheets. The Unofficial Google Weblog.
Now, Free Ways to Do Desktop Work on the Web. NYTimes.
Image source: Google

This Week's Grand Rounds at The Medical Blog Network

Check out Grand Rounds (GR), a weekly summary of the best posts in the medical blogosphere.

GR has become the contemporary weekly portrait of medicine through the eyes of the medical bloggers.

Pre-Rounds is an article series about the hosts of Grand Rounds on Medscape.com. Nick Genes of Blogborygmi, who writes the Medscape column, is the founder of GR and he maintains the archive.

The Medical Blog Network wants to build "the World's Largest Community of Medical Bloggers" and this Grand Rounds is a good start. There was some controversy about the requirement to register to submit a post to Grand Rounds but the open format contact form was also available to those who did not want to register. The web is the most democratic medium of them all and it is very is important to have a choice.

As per the Medscape Pre-Rounds column, Dmitriy, the entrepreneur who created The Medical Blog Network, is "an ambitious -- and at times polarizing -- figure in the medical blogging community, but he's moving forward and may just change the way people think about medicine."

Dmitriy must be ambitious if he is blogging under the pseudonym of "hippocrates." The original Hippocrates is often called "the father" of medicine, see the picture above... :-)

He also quotes Gandhi: "First they ignore you, then they laugh at you, then they fight you, then you win."

Whatever the outcome of the "battle" is, enjoy reading this week's selection of the best posts in the medical blogosphere.

It is always better to have a lively discussion rather than a boring selection of links, isn't it? It spreads "the buzz" around and it made me write a longer column announcing Grand Rounds this time...

Image source: Hippocrates from Wikipedia, the free encyclopedia, public domain

A Drug-seeking Patient

Graham of Over!My!Med!Body! does a good job of describing a drug-seeking patient:

"“I Usually Get Dilaudid and Phenergan"

Graham is a medical student and his blog is an excellent source for those who want to see the medical world through the eyes of an insider.

There is a selection of Pain Management Cases on ClinicalCases.org.

Toledo Zoo in Photos

See the Tabblo

Related:
There's So Much to Do in Toledo, Ohio

LibriVox Offers Free Audio Books in the Public Domain

"Old books never die. They don't even fade away. Instead, their copyright expires and they are released into the public domain, where hordes of volunteers breathe new life into them. Groups like Project Gutenberg, and Wikisource digitize, preserve and categorize classic works of literature, old encyclopedias, and even periodicals.

Hugh McGuire, a writer from Montreal, decided that he did not only want to read these voices from the past, he wanted to hear them. "On a practical level," he says, "I wanted to download a free audiobook."

In August 2005, LibriVox was born."

Read more in the Interview with LibriVox founder Hugh McGuire from Wikinews.

References:

Free Classic Audio Books
Free Audio Books. Gadling.com.
Investigating the art of the audiobook - Audible founder reports 40% growth in unit sales every year http://goo.gl/q1Iqh

The text and the images above are from Wikinews, available under the terms of the Creative Commons Attribution 2.5.