The authors of “Fournier’s Gangrene Associated with Intradermal Injection of Cocaine” explain:

We sought to highlight the effects of cocaine use within the penis and emphasize the different effects that may ensue.

Disease-mongering comes to masturbation in “Impaired Masturbation-Induced Erections: A New Cardiovascular Risk Factor for Male Subjects with Sexual Dysfunction:”

We now demonstrated that investigating its outcome on erections could provide useful prognostic information, otherwise not captured by other typical (history of CV diseases) and atypical (number of children, response to PGE1) CV risk factors. Hence, as in the story of the Princess and the Frog, the “secret sin” may. become a medical opportunity to live happily ever after.

In “Surgical Solutions for the Complications of the Vaseline Self-Injection of the Penis,” we learn that

Penile girth enhancement by the injection of Vaseline is an existing practice. Many cases develop
severe complications that need surgery.

The authors conclude:

The complications depend mainly on the amount of Vaseline injected, the hygienic circumstances, and the personal tolerability.

I’ll say.

You can learn a lot from the Journal of Sexual Medicine. The problem is that you can’t unlearn it.

A 9/11/12 memorial to those Rescue One firefighters who died on 9/11. Their station is a few doors from my apartment building.

I’m not sure what prompted me to write this today, as opposed to the other ten September 11ths that we’ve observed since 2001. Mine was not even a minor September 11 story. I did not lose any close friends or family in the attacks. It’s the stories of those who died, those of their families — such as this one in yesterday’s Stamford Advocate, just to highlight one example — are the ones to pay attention to, as are those of the first responders who sacrificed everything. In contrast, this is my personal blog, and this was an opportunity to put down my thoughts. I’m planning to treat this as a work-in-progress, filling in and correcting details as needed, and doing some rewrites, so I look forward to feedback.

On the night of September 11, 2001, we got to the front of the line at Mama Buddha, on Hudson Street in Greenwich Village, just as they were taping a sign to their window saying they needed to close for a while. They seemed to be the only restaurant open for blocks. They’d been jammed with customers for hours, and the staff needed a break.

They looked at me, sweaty and wearing hospital scrubs, and then quietly asked how many in my party. I didn’t really think about why they were letting us in despite the sign, just said it was four or five. It was only as we were being seated that I realized I was being faced with an Ethicist-worthy question. Do I tell the hostess that I hadn’t actually been working at the hospital, as the staff obviously assumed from my scrubs, but had shown up only to be gratefully told I wasn’t needed?

We decided to stay. We were hungry, we weren’t taking food away from legitimate rescuers – the crowd looked to be locals who didn’t want to sit in their apartments – and I had tried to volunteer, after all. We figured we’d leave a big tip.

We did, and then we dispersed to various parts of Manhattan, me to Hell’s Kitchen, my friend Gady and the others to their hotels. We weren’t sure what was in store the next day, but we knew we’d need some rest.

***

I live the same building I did in 2001, with the same southern exposure, just in a different apartment ten flights higher up. In 2002, I moved from the 10^th floor to the 20^th. My balcony faces downtown Manhattan.

I was working at home on the morning of September 11, 2001. A friend instant messaged me, and told me to turn on the news. A plane had crashed into one of the Twin Towers.

I spent the rest of that morning alternating between the television and my balcony. It was, as everyone remembers, a gorgeous day, the sort it would have been wonderful to spend on the balcony.

At some point, I spoke to my friend Gady Epstein, a reporter for the Baltimore Sun. He was on an Amtrak train that had stopped outside of Newark Penn Station while workers checked why a hatch was open without explanation. Was there a bomb on board? (There wasn’t.)

You can see the Manhattan skyline from where the train had stopped, and he of course had dribs and drabs of what was happening at the World Trade Center.

Gady told me he was headed to New York that day to cover the primary. The mayor of Baltimore, Martin O’Malley, was supposed to come to help his brother campaign for a City Council seat in Queens. Gady asked me what I knew. I had either just watched one of the Twin Towers fall, or that happened while we were on the phone — Gady’s pretty sure of the latter, and he’s probably right — but I was agitated, and I didn’t know any more than he did.

I told him, knowing he wouldn’t agree, not to come into Manhattan, that I was looking for ways to leave. It wasn’t clear if I would have the option of driving up to my parents’ house in the suburbs, since all the bridges and tunnels were closed.

It looked as though Gady’s train would be the last one let into the city, and he was staying on it. He was coming in to cover what even then people knew would be a story that dominated the decade. I seem to remember him planning on a day trip, so he didn’t have a place to stay. I told him he was welcome to stay at my apartment, and wished him safety getting into town.

Sometime soon after that, my cousin called, understandably close to panic. Ian is basically my brother, the older sibling I never had, just as I’m the younger brother he never had. At the time, he was an attorney at a large Times Square law firm. No one knew if there would be more attacks, nor what their targets might be, and here he was stranded on the island of Manhattan, some 50 miles away from his family. He told me he was coming over.

When he arrived at the door to my apartment, he crushed me with a hug, for a good long time. We caught up on the most current news we had, and opened a bottle of something white. I was desperate for a drink, but abstained, thinking by then that I might head to a hospital to try to help treat any injured that showed up.

Ian started making phone calls so he could work out how to get home, while I called my dad. I had called earlier to let my parents know I was fine, even though they’d know I hadn’t been at the World Trade Center in years. But now I was calling for advice, as I often did.

What should I do, Dad?

I’d really like you to come up here, we know it’s safe here, he said. But just as I knew Gady was coming into Manhattan, my dad, a pediatrician, knew what I was really asking.

You should go to the hospital, he said. I had an MD and had done my internship, but I’d left medicine two years earlier, and I didn’t have a license. You still know enough medicine to be useful, he said, even if it’s just doing whatever someone tells you to. It’s what I would do.

I knew that too. I told him I’d stay in touch, and went to find a pair of scrubs.

It was right around that time that my cousin and I watched the second tower fall. We hugged again. It was all unreal, and that of course is a ridiculous and trivializing understatement.

Somehow, Ian figured out a way to get home. He headed out, and I got on my bike.

***

The ride across town was almost the mirror opposite of the one I’d taken from NYU, where I was a medical student, to the Hudson River ferry to meet Ian and Lisa’s first son just after he was born in August 1997. We laugh about that visit now. I was a sweaty 25-year-old, and I think the new parents were horrified that I’d be touching their baby. I don’t blame them.

This time, I biked eastward across 34^th Street. When I arrived at Bellevue, there were throngs of people. A state trooper was guarding a back entrance to the ER, and said he couldn’t let me in because I didn’t have any current NYU or Bellevue ID – which was true. I thought about asking the deans for some proof I’d graduated, but quickly realized that wasn’t exactly a good use of anyone’s time that day.

I decided instead to bike across to St. Vincent’s, which was actually the closest trauma center to the Twin Towers. There, staff were waiting outside the ER, looking downtown for any signs of rushing ambulances. They thanked me for coming, but said they already had too many hands on deck, and no patients had even arrived yet. Come back at shift change at 8, they said. We’ll have a better sense of our needs then.

We all were of course hoping that hospitals would be full, as gruesome as it sounded. That at least meant there would be survivors.

I biked home.

***

The streets were empty of cars at 7:30 when I biked back to St. Vincent’s. I saw the same crowd of staff amassed outside the ER. It was clear they still didn’t need any help, which I knew before I arrived but was hoping wouldn’t still be true. They again thanked me for coming.

As I was getting back on my bike, my phone rang. It was Gady, who happened to be across the street covering a St. Vincent’s press conference. He had found a hotel, so he didn’t need a place to stay. But he was starving – as Gady often is – and wanted Chinese food – as Gady often does.

So Gady and I, along with a few other reporters he knew covering the press conference, ended up at Mama Buddha, just a few blocks away.

***

The eleven years since September 11, 2001 have been full of changes, some wonderful, some sad, and some mundane.

Mama Buddha is now closed, having merged with another Chinese restaurant. St. Vincent’s has been shuttered since April 2010, the victim of debt.

My father died later that year. But he stood proudly at my wedding in 2004.

My wife was stranded in upstate New York the morning the towers fell. We didn’t meet until the following spring, and were married two-and-a-half years later.

Ian was a groomsman at my wedding. He’s now at a different Times Square law firm as a partner.

Gady couldn’t make it, since he had moved to Beijing as correspondent for the Sun and then Forbes. Today, he does the same for the Economist.

This morning, I worked at home. Cate and I – and our dog Zinny, adopted in April — alternated between watching friends and relatives call out the names of the nearly 3,000 people who died 11 years ago, and staring at the nearly complete Freedom Tower from our balcony.

A casual observer who wasn’t there on September 11 wouldn’t even know that the Twin Towers had been visible from my midtown Manhattan building. But we did.

In one case, titled “A case of self amputation of penis by cannabis induced psychosis,” a group of doctors at Aligarh Muslim University in India

…present a case of a 35-year-old male who self mutilated his penis due to dependence on cannabis for the past few years that led to a condition called cannabis induced psychosis.

Here’s the authors’ evidence for why marijuana was to blame:

Remission of symptoms within weeks and no relapse with poor compliance of antipsychotic medication suggest that the psychosis was primarily induced by cannabis.

But it’s worth noting that this case study appears in the Journal of Forensic and Legal Medicine, which could explain that interpretation, as well as the paper’s stern conclusion:

The consumption of cannabis products other than bhang, have been prohibited in India under NDPS Act, 1985. By doing so he may warrant imprisonment for a term of six months, or a fine which may extend to ten thousand rupees, or both (NDPS Act, 1985).¹⁴ Different amendments of the act tried to prohibit the trading but no stress had been on its use in community. Cannabis is used regularly in different religious ceremonies and other social gatherings have made it impossible to ban in India. A strong policy or act is further needed and rather its implementation is required to avoid chronic addiction or habituation in the society which is prevalent from centuries.

This wasn’t the first such case in the medical literature, it turns out. From a case report by doctors in Morocco and the Netherlands in the Journal of Medical Case Reports last year:

We report a case of a 40-year-old Berber man, who was presented to our emergency room with externalization of both testes using his long fingernails, associated with hemodynamic shock. After stabilization of his state, our patient was admitted to the operating room where hemostasis was achieved.

The authors explain why they blamed pot:

We report here the first case of a patient who self-mutilated his testes with his long fingernails under the influence of cannabis. Many theories consider self-mutilation to be a strategy to reduce distress or tension, an expression of anger or shame, or manipulative behavior. Some authors link this behavior to borderline personality disorder [10] or treat it as a means for the patient of controlling traumatic childhood experiences [11]. Our patient, however, had no history of childhood trauma or any axis II disorder. A high consumption of cannabis just before his act led us to the belief that cannabis abuse was the trigger for testicular self-mutilation. Self-mutilation may also be linked to difficulties in impulse control, as here. In any case, the clinical characteristics of self-mutilation are manifold, and its etiology is a topic for debate [12].

So, are these two case studies Reefer Madness, overinterpretation, or both?

A 2011 meta-analysis in the Archives of General Psychiatry

found that the use of cannabis and other illicit substances was associated with an earlier age at onset of psychotic disorders.

The authors write:

A number of hypotheses have been proposed to explain the association between cannabis use and schizophrenia, including the following: (1) that cannabis use is a causal factor for schizophrenia; (2) that cannabis use precipitates psychosis in vulnerable people; (3) that cannabis use exacerbates symptoms of schizophrenia; and (4) that people with schizophrenia are more likely to use cannabis.⁴³ This study lends weight to the view that cannabis use precipitates schizophrenia and other psychotic disorders, perhaps by an interaction between genetic and environmental factors as has been suggested for cannabis and catechol O -methyltransferase^{21 - 22} or by disrupting brain development, especially during the important neurological maturation that takes place during adolescence.⁴⁴

The study, “A Preliminary Report on the Use of Functional Magnetic Resonance Imaging with Simultaneous Urodynamics to Record Brain Activity During Micturition,” was published last week in the Journal of Urology. Micturition, as you probably guessed, is a synonym for urination. What caught my eye was this, from the abstract:

We evaluated 12 healthy female volunteers 20 to 68 years old. Eight subjects could urinate while supine. Meaningful data were obtained on 6 of these subjects.

Supine, as readers may know, means lying on your back. The mnemonic they taught us in medical school, to distinguish supine from prone, was to think of a soup spoon.

I tried to reach the corresponding author of the study to find out how common it is for women to be able to urinate while supine. (A urologist friend of mine, in what can only be described as an “are you kidding?” email, said it was unclear.) If it isn’t common, how hard was it to recruit subjects for this study? If I hear back, I’ll update.

The authors used a catheter to measure pressures in the bladder, and scanned the women’s brains with the fMRI to see areas were active. They conclude:

fMRI combined with urodynamics shows great potential to elucidate the central neuroregulation of lower urinary tract function. The activation of the frontal lobe, cingulate gyrus, temporal lobe and parietal lobe that we observed during micturition agree with the current concept of central neuroregulation of micturition. Given that our current understanding of brain activity during micturition is based only on animal experiments and PET in humans, the current findings represent a significant contribution to our knowledge. Our data suggest that increasing the number of recordings and monitoring bladder sensation in a more detailed manner are necessary to make this experimental protocol feasible.

So, women, if you can pee while lying on your backs, give Thomayer Teaching Hospital, in Prague, a call. Seems they’ll be doing more of this research.

As my urologist source said: This one is really thinking outside of the commode.

Previvor is what a particular cancer advocacy group would like everyone who just has a risk factor but hasn’t actually had that cancer to call themselves.

Yesterday, I received a letter from Facing Our Risk of Cancer Empowered (FORCE), the advocacy group that coined the term, expressing concerns about how I had used it. (I’ve made the whole letter available here.) FORCE wrote that they intend previvor to describe people with “a very high risk for a deadly disease like cancer.” And in a different version of the letter that they posted online, executive director Sue Friedman wrote:

I feel compelled to correct what I believe is a misunderstanding on your part about the term “previvor,” and the intent of the advocacy group FORCE in coining and using the term.

She also wrote:

We coined the term to refer to individuals who are genetically predisposed to cancer but have not been diagnosed.

I’m very happy to engage in this dialogue, because based on what they write in their letter, I think that FORCE and I actually agree far more than we disagree. Where we disagree, it turns out, is on whether FORCE’s own definition of previvor is consistent with their intent. Here’s that definition:

“Cancer previvors” are individuals who are survivors of a predisposition to cancer but who haven’t had the disease. This group includes people who carry a hereditary mutation, a family history of cancer, or some other predisposing factor. The cancer previvor term evolved from a challenge on the FORCE main message board by Jordan, a website regular, who posted, “I need a label!” As a result, the term cancer previvor was chosen to identify those living with risk. The term specifically applies to the portion of our community which has its own unique needs and concerns separate from the general population, but different from those already diagnosed with cancer.

The medical community uses the term “unaffected carrier” to describe those who have not had cancer but have a BRCA or other cancer-predisposing mutation. The term applies from a medical perspective, but doesn’t capture the experience of those who face an increased risk for cancer and the need to make medical management decisions. Although cancer previvors face some of the same fears as cancer survivors, undergoing similar tests and confronting similar medical management issues, they face a unique set of emotional, medical, and privacy concerns.

If a group of people with a mutation that puts them at high risk for cancer finds it useful to label themselves in some way, I have no issue with that. The problem is that there are hardly any people alive who do not have “some other predisposing factor” for cancer, which makes FORCE’s definition far too broad to be useful. That was my point.

I am deeply moved by the difficult choices that women with BRCA1 and BRCA2 mutations are forced to make. In fact, those difficult choices are some of the reasons why I remain concerned about “pre-diseases.” Many of those definitions are so broad as to put us all into a state of extreme worried well, at far greater risk of overtreatment than of anything else, as I noted in my talk. Labeling everyone “with some other predisposing risk factor” a “previvor” only contributes to that confusion, and makes those choices more difficult. I submit that it is not consistent with FORCE’s admirable goals of helping people make better health care choices — goals we should all be working toward.

Perhaps FORCE will consider my feedback, and rewrite their definition — which I would welcome.

I’ll conclude this post the same way I ended last week’s:

I look forward to more conversation, and feedback.

That’s me with one of my favorite artists, Jill Sobule — and her mom! — backstage at TEDMED (courtesy TEDMED)

In April, I was given the chance to speak at TEDMED 2012, a remarkable gathering of health care leaders, patients, and entertainers, among others, in Washington, DC. It was, as my friend Scott Hensley of NPR put it:

…a way for people who care a lot about health care to get together and make some headway on thorny problems.

In other words:

The smart kids from the cafeteria have grown up and become cool, a geeky kind of cool.

In short, it was a non-stop smorgasbord of ideas, inside and outside of the Kennedy Center auditorium.

TEDMED has just posted the video of my talk, which you can watch below (post continues afterward):

I was very pleased that a number of blogs and news outlets broadened the discussion by writing about the talk. Here’s a sampling:

• Addiction Inbox, “Ivan Oransky on the disease model at TEDMED 2012“
• The Atlantic online, “The preposterous epidemic of pre-diseases“
• The Irish Times, “We all have a fatal condition: it’s pre-death“
• NPR’s Shots blog, “TEDMED takes its big health tent to Washington“
• Scientific American online, “TEDMED: Tougher topics to chew on“
• Time online, “How the power of self identity affects your health“

I’m asked to speak on medical journalism and scientific integrity frequently, but giving a TEDMED talk is something quite different. The format requires a different level of preparation, and TEDMED’s high standards push speakers out of their comfort zones in a really good way. I’m grateful to TEDMED’s Marc Benerofe, Lindsay Potter, Lisa Shufro, Jay Walker, and Marcus Webb for the opportunity, and for sage advice as I crafted my talk. And I also want to thank Denise Graveline, whose advice and suggestions were invaluable, as always.

I look forward to more conversation, and feedback.

Please see a new post on this subject, in response to criticism from FORCE, the group that coined the term “previvor.”

Stanley Oransky

The middle of May can be wrenching for my family. My brother David, who died in a car accident in 1995 at the age of 17, was born on May 12. Mother’s Day usually comes around that time — this year it was the day after what would have been David’s 35th birthday — which is understandably a tough juxtaposition for my mom.

And today, May 16, 2012, would have been my father’s 71st birthday. He died in August 2010.

I’ve been thinking about Dad and David a lot in recent months, wondering how David’s kindness and wisdom, which belied his age, would have developed as he got older, and wishing I could let both of them know how much I miss them. So inspired by Steve Silberman and David Kroll, in honor of my father’s birthday, I’m posting the eulogy I gave at his funeral:

I want you to imagine yourself as a child in an examining room. You’re at least a tiny bit anxious, because while your mother or father sits somewhere nearby, a bear of a man is leaning over you, teddy bears clinging to his stethoscope.

The man asks you to show him your arm, and before you can wonder why, he pinches the skin near your shoulder. Just as the pain is starting to register, he lets go and smiles down at you while rubbing your arm with something cool and wet. “All done,” says the bear.

For some of you, this wasn’t as much imagination as memory. If you were a patient of Bardonia Pediatrics in the 1970s, 80s, or 90s, that was your experience getting a shot. But you didn’t feel the shot, because my father made sure you felt the slight pain of the pinch and didn’t even notice the needle going in.

The way my dad gave shots – and the way he would later teach me to do the same – was to me a metaphor for much of the way he lived his life. Most things that were worthwhile – say, a measles, mumps, rubella shot – took a bit of sacrifice – in this case, the pain of a pinch.

Dad was always the kind of customer salesmen like – he always suggested buying the extended warranty, or more insurance than he thought you needed. But there was a point to all this, whether it was studying harder for a test, or reading the extra book for a class. He honestly believed you’d do better. And he was often right.

My father began life as his older sister Barbara’s birthday present. That sounds like a sweet romantic notion, but it was the most fraught birthday present she would ever receive. Dad was sick for the first few months of his life with encephalitis, and there were tense moments as doctors wondered whether he’d make it.

He did, of course, growing up in Crown Heights in Brooklyn in the house shared by his father’s medical office, next door to the basement synagogue where they davened.

He rooted for the Dodgers as a kid, going to games after the seventh inning, when they let everyone in for free. After the Dodgers left Ebbets Field for Los Angeles, he was heartbroken like every other kid in Brooklyn, and he never really found another New York team he wanted to root for.

But Dad was getting ready to leave Brooklyn for college soon anyway. One school was happy to interview a smart kid from Stuyvesant, but at one point in the interview the admissions officer asked my dad about the synagogue youth group at the end of his resume. When he found out what it was, he politely told Dad that they’d already “filled their quota,” but that he was welcome to apply the following year.

That didn’t quite work for my dad, either timing or anti-Semitism-wise. So he ended up at Alfred University in upstate New York. It was at Alfred that he first read the work of Martin Buber, whose work he would often bring up when conversations turned to philosophy.

My grandfather’s prescription pad — he was also “I. Oransky, M.D.”

Dad returned to Brooklyn for medical school at Downstate. My grandfather was still in practice at the time. One day, one of his patients called my grandmother, frantic because he had collapsed while on a house call. My dad, then a fourth-year medical student, was the first to arrive, and he started CPR – but it was unsuccessful. That was 1964. My cousin Ian and I are named for our grandfather.

Dad signed up for the Berry Plan during his pediatrics residency, which he also did at Downstate, and entered the Air Force in 1968, at the height of Vietnam. Andrew and I have tried to picture him in flight training school in Texas, but it just doesn’t work.

He ended up as a base doctor in Plattsburgh, New York, which was lucky for two reasons. One was that it meant he could spend his two-year stint stateside. The other was that the friend of another base doctor was a high school friend of one Lesley Leavitt, who came out for a visit and needed a date.

He and Mom were married in 1971. They first lived in an apartment in Nyack. One day they had been doing some work around the house, and decided to go house-hunting in New City. They found themselves at a model house in a neighborhood more upscale than the one where they would eventually end up living.

Dad was wearing overalls. The real estate agent sitting behind a desk in the hallway of the house took one look at him and my mother, pregnant with me, and politely told them this probably wasn’t a good fit. They represented other houses, though, and would be happy to show them some of those another time, if they wanted to leave their names and contact information.

My dad was only happy to do that, signing his name with an even larger-than-usual “MD” at the end. The real estate agent’s eyes went wide, and she tried to recover and said she’d be glad to show them around.

No thanks, said Dad; we don’t really want to look at anything you have to offer, actually. He wasn’t going to wait for an anti-Semitic college to decide to let him in, and he wasn’t going to wait for a snooty real estate agent to deign to show him a house.

That was OK, since he and Mom ended up buying a house separated from my Aunt Barbara’s by a patch of grass, a lawn, and a hundred feet of asphalt. When he called my aunt to ask her if she had ever heard of Rugby Road, she figured he meant the one in Brooklyn. He brought the spirit of Brooklyn to New City, though, as my cousin Ian – who was the older brother I never had, while I was the younger one he never had – reminded me yesterday: cousins living close by, able to play at any time.

I arrived about a year after Mom and Dad were married, and then, of course, came Andrew and David. This was back when no one told their kids Mom was pregnant, and I was obviously too clueless to notice. So when Dad brought me to the hospital after David was born and asked me in the parking lot how I felt about a new baby brother, I told him that sounded great, but that I was kind of hungry and could use breakfast first.

For those of you still having flashbacks about shots and my dad’s hands, be assured that patients weren’t the only ones he pinched. His favorite tactic on long car rides wasn’t the usual “if you don’t cut that out I’m going to pull this car over right now.” Instead, he’d reach back and pinch whomever he could reach. That was almost invariably David, who sat in the middle as the youngest.

Dad could be quite stern, but as we got older we realized he really wanted us to be independent. When I was a teenager, no older than 15, one afternoon, a few friends and I were having lunch with him at the Maxi City Deli. We were complaining that New City was terribly boring. Nothing to do, especially without a driver’s license.

So why don’t you go to Manhattan for the day sometime? Dad asked. We looked him as if he had grown a second head. Manhattan? That dangerous place everyone’s parents are warning us about?

Yes, that one, he said. Take the bus from this shopping center some Monday you have off from school, don’t stray too far the first time, and you’ll go exploring. We did just that, eventually taking the bus once a month, and it began my lifelong love affair with Manhattan that lasts to this day.

Dad was an early adopter of technology. Andrew reminded me yesterday that he was one of the first thousand or so people to sign up for America Online in the 1980s, a fact they rewarded him for with a dramatically low monthly fee for decades. We had a Franklin ACE 1200 in 1984, and he also bought one of the first CD players. He insisted it was only to be used for classical music, but pretty soon be broke his own rule with Paul Simon’s Graceland.

Making sure everyone ate dinner together every night was so important to Mom and Dad, even when the phone kept ringing with anxious parents. I learned more about spinal taps and fevers than I did on my pediatrics rotation in medical school.

But Dad’s contributions to the dinner table didn’t usually involve the actual dinner. He really wasn’t a great cook. When Mom would travel, his repertoire seemed limited to codfish cakes, a concoction that would stink up the whole house and make us wonder why we hadn’t just gone out to eat.

When I left for college, Dad was always just a phone call away, offering me encouragement, which I often needed. I remember one night in particular, when I scored so badly on a calculus exam that I was convinced I would fail out of school. Don’t worry, he said, think about this as a good thing. You’ve just realized you’re surrounded by kids just as smart, and many smarter, than you. Some of them won’t have the chance to nearly fail until too late. That was some of the best advice I’ve ever heard.

Sometimes he was just a drive away in a rented diesel station wagon. He came to pick up the contents of my freshman dorm room one day, since I was staying in Cambridge for a few more weeks. He drove up and back in the same day. On the way back, I have no idea how he saw any cars behind him, since I had stuffed the entire car full of my stuff.

Dad often made sure we got everywhere we needed to go, and had whatever we needed once we got there, no matter what he was doing at the time. He escorted me to my first medical school interview, at his alma mater. That may have been the only reason they let me in.

My brother David, as most of you no doubt know, died in early 1995. The community’s reaction gave me an inspiring window into what was mostly an invisible life of Dad’s. Sure, I knew he was always rushing off to board meetings of a non-profit health insurance company, and using his days off to run the Hudson Valley Poison Control Center.

But those were just things he did. They didn’t tell me how much his patients loved him, or how the nurses he worked with would do anything for him because of how he treated everyone.

People I’d never met showed up to our house for shiva and acted as if they knew me and Andrew our whole lives. Dad, we realized, talked about us all the time. One of his Hasidic patients, who even braved the mix of genders at the house to pay his respects, told me Dad had saved his kid’s life.

One of the other things that happened during that terrible time was that I met some of my cousins and got to know them as adults. Family was so important to Dad, and he was so happy that I became close with his cousin Ira’s daughter, Sandy Ashendorf, and others.

As proud as Dad was of Mom, and the three of us kids, I couldn’t help but be proud of him. To this day, whenever I’m talking about insect repellents, I tell people it was Dad who first reported that one of the common ingredients, DEET, was linked to seizures.

But unless he was dealing with a snooty real estate agent, he wasn’t the kind of guy to wander around announcing his accomplishments. Nor was he cowed by others’ credentials or fame. One day, I went to meet him for lunch at Nyack Hospital, after he had become medical director. We were standing in the administrative wing of the building when a tall familiar-looking guy, looking a bit lost, started walking toward us and asked if we knew where one of the clinical units was.

I realized as he started talking that it was actor Bill Murray. Hey, aren’t you…I said. Yes, yes I am, he said. Pleasure to meet you. This is my dad, he’s the medical director here. I’m sure he can tell you where that is.

He and my dad talked for a minute, and my dad sent him on his way with directions. I was a little giddy, still in a little bit of awe at having met Bill Murray. My dad saw the expression and said, Now, who was that again?

Dad and I didn’t talk about Saturday Night Live or other entertainment all that much. We didn’t really discuss sports much either. But we talked about pretty much everything else.

In recent years, he became increasingly frustrated with our health care system, a frequent topic of conversation. He tried to do something about it, volunteering with a non-profit near the house in Becket that he and Mom moved to full-time in 2007.

Some of those conversations happened by text message. It was probably the first time I ever showed him how to use a particular technology. I’m pretty sure I ended up texting him more than anyone else – and I’m as tethered to my BlackBerry as anyone I know.

I’ll miss those texts, as well as his voice. I’ll miss his counsel, which I didn’t always appreciate at the time. After all, it often required a bit of sacrifice, like a shot. But even when I didn’t do what he suggested, it was always clear he wanted nothing but the best for us. It will be heartbreaking, but I know I’ll forever ask myself “What would Dad have done?”

Happy birthday, Dad.

But one veterinarian may have taken the “I’ll just use pet drugs instead” idea a bit too far.

In the American Journal of Medicine, SUNY Stony Brook’s Harmeet Singh Narula reports on the case of a “33-year-old veterinarian with Hashimoto’s thyroiditis and hypothyroidism” — that’s an autoimmune disorder that causes low thyroid hormone levels — who showed up to the doctor’s office with “mild anxiety, jitteriness, and insomnia.”

Lo and behold, her thyroid hormone levels were high. But why?

On further questioning, the patient realized she had recently run out of her prescribed levothyroxine tablets and had been taking levothyroxine “dog tabs” 0.5 mg/d, thinking that would be the same as the 50-
g tablets she had been prescribed, inadvertently taking 10 times the prescribed dose.

Her doctor stopped the dog tabs, and eventually restarted her on her original dose. The vet also got a warning:

The patient was instructed to take her prescribed levothyroxine tablets and not use her levothyroxine “dog tabs” in the future.

A bear cub climbs up a tree:

A cub climbs down, and joins a sibling, as mama bear comes to see what’s going on:

Don’t forget about me, says the third cub:

Photo by doktorspinn via Flickr http://www.flickr.com/photos/doktorspinn/

Those of you who follow me on Twitter have probably seen at least one exasperated rant about PR folks who haven’t bothered to figure out what Reuters Health is interested in, and insist on calling to check whether I’ve received an emailed press release.

When I got a call like that earlier this week, I decided to crowdsource the response I’d give the next time it happened. Here are the results:

• “Yes.” Click. — John Fleck
• “It’s lining the birdcage as we speak.” — Rick Murnane
• “Yes. Did your mom get the fruitcake I sent?” — Joshua Umar
• “Could you fax it to my Twitter? Or email it to my Pinterest?” — CMI Media
• “Oh no, I’m not that guy from Reuters. I write for Adult Entertainment Digest. Happens all the time though. Great release btw.” — Justin Paquette
• “I was wondering who was responsible for this piece of crap!” — Peter Edmonds
• “What’s your email address?” Searches, adds to blocked senders list. — Liam T.A. Ford
• “I would tell you, but then I’d have to shoot you.” — Denise Graveline
• “I wish I could tell you, but we’ve embargoed that information indefinitely.” — Denise Graveline
• “I’ll tell you but only if you promise to never, ever send me anything ever again.” — Denise Graveline
• “Yeah, I’m going to reference it in an article about anal warts.” — John Platt
• “Your call is important to us. Please, continue to hold.” — Charles Bergquist
• ‎”If you sent it, I got it.” Click. — Susan Brink
• Barking: “What? No, What? What’s the pitch make it fast I only have a minute. Oh no. No. No, I don’t think that’s for me. Why don’t you try (someone you dislike).” — Matthew Herper
• “Yes! I got it! And you know, I think it’s just perfect for this piece we’re doing. Can you get your company’s CEO to the side door of the White House in half an hour? I’d like to interview your CEO with President Obama there, to get his reaction to this groundbreaking idea.” — Charles Bergquist
• A variation on this way of scaring telemarketers. — Andrew Holtz
• “You mean the one about (make up an important, novel, incredible idea). Oh, oops, you meant that other one…” — Amanda Urban
• “If it’s not about X, I don’t care.” — Matthew Herper
• “No. Why don’t you send it again?” Repeat as necessary. — Brendan Maher
• “When did you send it? Oh, there is… and ‘delete’. Thanks. Bye.” — Andrew Holtz
• “Oh, yes, indeed. Great addition to the material we’ve been gathering for our investigation into how marketing warps health care.” — Andrew Holtz
• “Oh, yes, indeed. Great addition to the material we’ve been gathering for our investigation into releases that misstate medical evidence.” — Andrew Holtz
• “Please hold while I check.” Place call on hold, go back to work. — Andrew Holtz
• “Can you hang on just a second? (place phone down, but don’t put on hold, pretend to talk to a coworker: “You won’t believe who’s on the line, a PR person from [company]. Sounds like they don’t know anything about the story on them that’s about to hit. Yeah, can you imagine what those poor folks in PR there are going to have to deal with?” (then pick up the phone again) “Hello, still there? Yeah, I’ve got it. I think we’ll be talking again real soon! Have a nice day! Bye.” — Andrew Holtz

Of course, Celeste Young asked: “You answer your phone? So quaint!”

Good point. Maybe I’m still an optimist. Keep these coming, I’ll update the list.