CSI: Hot, Hot, HOT!

CSI, you say? Why on earth would we include CSI on a blog about medical shows? Well, even though CSI is a crime series, the forensic aspect of the show does often involve medical details. Oh sure, they're often included after the fact (like during the autopsy), but they all add to the bigger picture of whodunit and why and often involve clues that might have a different outcome if they'd been discovered before the patient died.

Besides, I've always loved CSI, and last season exceeded my wildest expectations. When it ended with Sara Sidle kidnapped, a miniature scene delivered to Grissom indicating that Sara was to be serial killer Natalie's next victim, and the unmasking of Sara and Grissom's secret relationship, I was hooked and hungry for Thursday's premiere.

I've been curious about Natalie since her identity was revealed last season. She definitely had a past...one that included child abuse, growing up in the foster care system, and an unhealthy attachment to her last foster father. Was it the abuse, the instability of her life, psychosis, or some other condition that caused her to become a serial murderer? Her ability to see and memorize an entire room was interesting, but certainly not a characteristic that leads down murderous pathways, particularly the sinister and premeditated ones that Natalie created. I asked our stress expert, Dr. Patricia Farrell about Natalie and here's what she had to say:

She had what I would term "eidetic imagery" or what is popularly known as "photographic memory" which is usually found in children more than adults. Being raised in the foster care system could have created a personality which attaches to no one and develops little empathy for others. The violence may be from this personality disorder, but none of this is a formula for a serial killer.

In fact, although many seem to present themselves as experts on serial killers, there is no way, outside of a few parameters, to predict serial killers. In fact, even these parameters may not be as predictive as the experts would have us believe.

I think she was created out of "whole cloth" to give the details some an intriguing twist.

Hmmm. Will Natalie slither off into the sunset, or will she return? The scene where Sara tells her she was also raised as a foster child makes me wonder if they have a shared past. Maybe there's more to this story yet to be told.

Overall, the entire episode was a study in extremes. Flash floods turned to high noon in the desert as night turned to day, frustration turned to hope and finally to elation at the end. The portrayal of Sara in that hot, dry desert heat was almost painful to watch. Seeing her struggle for every step at the end was agonizing -- I almost felt like I was walking out there with her. Between being drugged, having a car lowered onto her arm, wrestling herself free just in time to avoid drowning only to collapse with heat stroke definitely left me hanging to the last scene. To the writers' credit, when Sara was finally found (after they teased us with the 'other body'), I was glad to see Nick gently pouring cool water over her entire body to cool her down, which is what the First Aid guide instructs in the case of someone with extreme heat stroke. Now that she was rescued in the very last nick of time, will she pick up her romance where it left off, or will the experience change her and her relationship with Grissom?

I just have one other question. How was that tiny woman able to lower that big, heavy car down onto Sara's arm?

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• Take Cover When the Heat is High
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Technorati Tags: CSI, CBS, forensics, investigation

Grey's Anatomy: Attending Sex

First, let me say if I missed anything important in the first 15 minutes of Grey's Anatomy, please someone fill me in. For instance, how did the writers' work George back into the show since he had all but left at the end of last season?

I'm at an internal medicine board review course in Denver (we have to recertify every 10 years) and Grey's came on an hour earlier than on the east coast.

On a funny - but related - side note, the course speaker today mentioned how he wished he was a resident again given how much sex Grey's residents seem to have with their attending physicians. Of course he couldn't imagine which one of his attendings he would have wanted to have sex with. Let's just say most Hollywood attendings are easier on the eyes than their real world counterparts.

We were talking about the ethics of doctors having sexual relationships with their patients. Despite what happens on Grey's, such a relationship is highly frowned upon. Even relationships between residents and attending physicians aren't usually as in the open as they are on Grey's.

Now onto last night's episode of Grey's Anatomy.

I turn the TV on and see Dr. McDreamy talking to a man whose head was "internally decapitated." Yes, that's possible and very serious as you can imagine. But there was a similar case in a woman a couple of years ago.

But I was shocked when I heard McDreamy say "Find out if he's an organ donor." While that is an unfortunate thing that doctors have to do when a patient is seriously ill, I would hope that most doctors wouldn't be so heartless as to say that where the patient could hear. Did you notice the patient started crying right after he said that? I sure did.

But since we're on the subject, are you an organ donor? If not, you should be. Organ shortages are a big problem and are a significant cause of why deathly ill people have to wait so long to get a life-saving transplant, such as a heart or kidney, if they get one at all.

Talk to your family and tell them that you want to be an organ donor. Agreeing to be an organ donor on your driver's license is a start but really doesn't mean anything unless your family knows your wishes. Your next of kin has to ultimately make that decision should something unfortunate happen to you. That decision could save a life or two.

Lastly, let me apologize for rambling a bit. My brain is a bit like mush after sitting in the course for 9 hours today. But it's been kind of fun. Good thing since I have 3 more days of fun.

Related Topics:

• Organ Transplants
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Technorati Tags: Greys Anatomy, residents, attendings, sex, McDreamy, organ donation, decapitation

Private Practice Procures Sperm

As I watched the season premiere of the new Grey's Anatomy spin-off, two things occurred to me: 1) They've turned Dr. Addison Montgomery into a wimp! And 2) it looks like they're going to continue the tradition of spotlighting fascinating and unusual medical cases.

One of the main characters is a fertility specialist so it's no surprise that the first of these cases involves reproduction. In the season premiere, a man attempting to store his sperm suddenly dies of a stroke. His fiance, however, requests that the docs retrieve sperm from his dead body, which opens up a huge ethical dilemma that's further exacerbated when the guy's estranged wife shows up.

Setting aside the ethical concerns (and yes, they're huge), I wondered if this was even possible. Yep, it's an actual medical practice called "posthumous sperm procurement" that's uncommon but gaining attention:

With advances in reproductive technologies, it has now become possible to harvest sperm using various methods from a newly deceased male for later fertilization. The process, referred to as posthumous sperm procurement, is usually performed within the first 36 hours after death. The first case of successful posthumous sperm extraction was reported in 1980, and the first pregnancy, in 1997 with subsequent birth in 1998, sparking medical, legal, and ethical debates. Although the practice is growing in both the United States and internationally, requests are still infrequent.

One widely reported case earlier this year involved an Israeli solder killed by a Palestinian sniper. His parents had a sample of his sperm taken two hours after his death and stored in a hospital, and a subsequent legal battle ensued when they tried to access his sperm.

So just how is sperm retrieved from a dead man? Not surprisingly, the cameras cut away right before Taye Diggs performed the procedure on Private Practice. I have to admit I'm glad they did that because the mere thought of what he might be doing down there made me squeamish. According to an article published in the journal Human Reproduction, there are at least four different ways to retrieve sperm from a dead man:

1. resection of testis and epididymis
2. en-block excision of testis, epididymis and proximal vas deferens with vasal irrigation
3. electroejaculation
4. epididymectomy
   

Since I'm no surgeon, I don't know all the details of those procedures but it sounds like they involve cutting into the testicles. Ouch. An epididymectomy is the removal of a tube that stores and carries sperm, so my guess is later in a lab they'll harvest sperm from that tube. Electroejaculation, on the other hand, is just what it sounds like: a small electric shock delivered to nerves in the pelvic region, which results in ejaculation. It is primarily used for collecting semen from quadriplegic or paraplegic men who want a child but can't ejaculate because of a spinal cord injury. Apparently, it can be done on a recently deceased man as well.

We'll never know exactly which procedure they performed on Private Practice. But that's OK, at least they got the basics right. Now if only they'll give us back the tough, strong-willed Addison we've grown to love.

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• A Couples Guide: Trying to Conceive
• Getting Pregnant Message Boards

Technorati Tags: Private Practice, Addison Montgomery, sperm donation

America's Next Top Model Says "No" to Smoking

Let me start this post by saying my husband loathes and despises reality TV of any sort. Therefore, it is almost impossible to watch any of those yummy, juicy, totally indulgent shows in our house without having him follow my girls and me around commenting on how they are all just worthless, rigged, and not reality at all. Blah, blah, blah.

Honey, I love ya, but sometimes I just NEED to watch something that is totally fun. And, an hour of America's Next Top Model is a good time to eat chocolate and bond with my teen girls as we choose our favorites and dish the dirt about the ones we can't stand.

But this week, I was pleasantly surprised to find that my wicked indulgence was also packed with a strong health message for my girls...smoking is BAD for you!

Each week, the wanna-be models have a challenging photo shoot where they have to pull off a certain "look" or "emotion". You know, dig down deep to find that inner supermodel.

Tuesday night, the challenge was a mirror image shot. The first part of the shoot was the model togged out in red-carpet glamour in front of dressing mirror holding a cigarette in a sexy, seductive pose. Then, she was whisked off to makeup and came out looking more than a little like one of the orcs from the Lord of the Rings movies.

The latex and makeup was designed to portray each model as afflicted with one of the many diseases and conditions that smoking can lead to. One of the models was shown with effects of cancer and chemotherapy...her sparse hair falling out in her hands. Another had a hole in her neck where a tracheotomy tube had been removed. Yet another was shown coughing up blood (ewwww). The images, once combined, were even more startling. Beauty versus the beast in the mirror.

My teens' faces were filled with disgust.

But it didn't end there. At the close of the show, host (and executive producer) supermodel Tyra Banks always stands, holding a handful of photos of all those girls who are moving on in the competition. One of the contestants is eliminated and must go home.

This time, as Tyra stood before the group, she explained the point of the mirror-image photo shoot. "This is a no-smoking cycle," she said. "So many young girls are fans of America's Next Top Model, and right now so many young girls are fans of you. If they see their idol puffing and smoking a cigarette, what does that make them think? Wow, she's smoking, that's cool. So that's why smoking will be banned. It's over."

She went on to tell the girls who are smokers that if they wanted to go back to the house and enjoy their last puffs they should do that, because there would be no more after that day.

Now, here's my question: Is this going to be cold-turkey? Is the show going to provide some smoking cessation assistance to these poor girls? It's not that I don't think they should quit smoking. I do. But, quitting is hard, stressful, painful. If you want to know more, just visit the wonderful folks on WebMD's Smoking Cessation Support Group message board. They'll tell ya.

I hope that next week America's Next Top Model is going to show even more social responsibility by laying out a quit plan for these young women.

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• How to Quit Smoking (WebMD Video)
• Adult Smokers: State-by-State

Technorati Tags: America's Next Top Model, The CW, reality TV, smoking cessation, smoking, Tyra Banks

Private Practice: East Meets West

Dr. Addison Montgomery is confronted at the beginning of the premiere episode of Private Practice by the chief of Seattle Grey Hospital. She has resigned and announced her intention to move to sunny southern California to join a private practice. He argues with her, "You don't know anything about those people!"

She shoots back, "I know plenty!"

But what does Addison really know? Apparently not as much as she thinks. As she describes each of her new colleagues, we are shown sides of them she hasn't discovered yet. Particularly striking is her description of Dr. Pete Wilder, a physician who practices integrative medicine, combining the best of East and West: "Pete does alternative medicine. As a surgeon I don't believe in that kind of thing, but he's a healer."

How does a self-described "world-class" surgeon (read smart woman) end up at a cooperative medical practice, a wellness clinic where complimentary and alternative medicine (CAM) is obviously a valued component, with an attitude like that? Why is she surprised that she is expected to do deliveries in a birthing suite, that her "staff" is Dell, the nurse/surfer dude at the front desk who is studying to be a midwife, and Pete who she calls an "alternative medicine guru"? Why doesn't an educated ob/gyn know the word "midwifery"?

Her one patient of the day is Lucy, a 17-year-old girl who is going into labor. Pete points out that in Lucy's medical records there is a holistic birthing plan and announces that he'll help with the birth. Addison has been assured that "laboring moms love Pete," so she invites him in to do "your little Eastern voodoo thing you do."

Turns out she needs his "voodoo." The patient goes into congestive heart failure and the baby is distressed due to a compressed umbilical cord. The ambulance can't get there in time - Addison has to do a c-section or risk losing both mother and baby. But there's no time for an epidural and none of the equipment she took for granted in her former hospital, just some lidocaine to use as a local anesthesia. Dr. Pete's Eastern voodoo to the rescue! He uses acupuncture to block pain receptors so that Addison can perform the surgery.

"Are you sure she's not going to feel anything?"
"I'm sure."
"Are you really, really, really sure?"

She doesn't sound like a world-class neonatal surgeon. She sounds like my daughter did at age 6, questioning whether the tooth fairy was really going to come.

For me that is the problem with this new off-shoot of Grey's Anatomy. Yes, there are beautiful people, beach front homes, nude dancing, and sexual energy floating around (which we can assume will only grow) - all lots of fun. But really - did moving to SoCal suck the brains from this woman? How is this surgeon going to reconcile her attitude about CAM with her new environment? Will she wise up and smell the aromatherapy or is she doomed to sound condescending and ill-informed about everything in her new life?

Hey Addison - read Dr. Joe Pizzorno's blog, Integrative Medicine and Wellness. He'll tell you that "The best medicine is that which integrates conventional and natural medicine in the best interests of the patient" and "Health care decisions should be made on the basis of good scientific evidence." Nothing voodoo about that, is there? Need to hear from another surgeon? Read Healing from the Heart: A Leading Heart Surgeon Explores the Power of Complementary Medicine by Mehmet Oz, MD!

Addison moved south, looking to make changes in her life. Let's hope that an open mind and enlightened attitude are among the changes.

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• Hospitals Add Alternative Medicine
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Technorati Tags: Private Practice, Addison Montgomery, Greys Anatomy, CAM, integrative medicine

Kid Nation: Hungry Kids: 1 Chickens: 0

I have nothing but respect for children who live and work on farms throughout the world, and people who kill and prepare and sell meat and chicken to the rest of us. But there is still something about seeing a 15 year old behead two chickens while 38 other kids look on in horror that is not my idea of entertainment.

Who is the audience for this show? Clearly, not young kids. Why else would CBS post a warning on the screen before the beheading:

"CAUTION: The following scene may be intense for young children." This begs the question, if it's too intense to WATCH the scene, what about the fact that kids were actually IN the scene?! Never mind kids, it was too intense for this adult. Watching this show is a strange experience indeed.

On the one hand, it's blatant exploitation for the sake of the almighty rating. On the other hand, the children seem to really be coming together, for the most part, offering what appears to be genuine support for one another; creating camaraderie.

But last night it was a competition between children who loved animals, especially the heart-breaking nine year old Emilie, and those who craved protein. You get the picture.

At the heart of Kid Nation is a contrived sensationalism at the expense of its young contestants. And contestants is exactly what they are. The show is structured to encourage competition, not community. And as far as kids finding a way to make a better world than the one they've inherited, consider this: each week the teams, known as "districts" compete to become the Upper Class. The producers have imposed a caste system on these kids, turning Bonanza City into, well, any city. So much for the lofty promise of a better world. Here the losing team cleans the outhouse. Second to last cook for the entire group. Above that group of "chefs" are the "merchants" and they run the store that sells candy and soda and items you would think useless here, like bicycles. But the group they all strive to be is the "upper class", which is literally described as the group that earns the most money and doesn't have to do anything. If this sounds alarmingly familiar, like say, your life, then you're not alone. The money these kids earn is in direct proportion to their status in Bonanza City. Not much world change going on here.

So is Kid Nation nothing more than mini-me in a dust bowl town?

And what about the long term emotional impact of these events on the lives of these kids? What about Emilie, who wanted so much to leave the show because she was horrified by the chicken slaughter, but remembered her mother's words--for her to be a "rough and tumble cowgirl"--and so she stayed.

But at what cost?

[Editor's Note: Don't miss the views and opinions expressed by several pediatric experts and others about KidNation over on the Safety4Kids blog]

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Technorati Tags: KidNation, CBS, reality TV, stress, family, children, parenting


(c) John Peters. Image from BigStockPhoto.com

House Season 4 Premiere: Do the Math!

Hello Everybody!

I'm excited that WebMD has asked me to post about a TV series I've never seen before. How surprised I was to learn that 'House' is now in its fourth season on Fox. Like, where have I been the past three years?!?

SPOILER ALERT! The episode's surprise ending is disclosed and discussed in this blog. Come back later if you plan to watch this episode.

This show is the classic procedural drama. It appears to follow a predictable storyline that invariably leads to an unexpected ending. The long-running murder mystery 'Perry Mason' remains the gold standard for this genre. If you couldn't solve the case by the first commercial break you were likely brain dead. Nevertheless, you always stayed glued to the end of the program just to make sure you were right and to celebrate your brilliance.

What makes 'House' different is the medical context. Unlike the ordinary whodunit that is based on money, infidelity and revenge, this mystery series exploits subject matter that is generally unfamiliar to most of the audience. In this case the writers have an advantage.

The Medical Dilemma

After a gas line explodes a young, previously healthy woman is rescued from the rubble of the collapsed office building by her live-in boyfriend. A chain of perplexing health crises follows: severe crush trauma, unexplained fever, cardiac arrhythmia, cardiac arrest, alcohol withdrawal, massive bleeding, and multiorgan failure triggered by an antibiotic she had safely consumed in the past. A quiltwork of clinical contradictions. In each scenario Dr. House divines a specific cause for each problem - but that's the problem! Medicine doesn't work that way. It's more like basic arithmetic.

1+1=2! Whenever the sum of 1+1 equals anything other than 2 it is time to take a giant step backwards and analyze the situation because something is out of order.

The Clues

Clues (bad math) were everywhere. It was determined the patient was taking antidepressants but the boyfriend insisted she was not depressed. The patient developed alcohol withdrawal but she didn't drink. The patient had an enlarged uterus and a recent abortion but the boyfriend denied that his girlfriend would have ended a pregnancy.

Newly acquired health problems typically unify under one umbrella diagnosis; however, this trauma victim was wearing far too many divergent diagnostic labels, even for primetime TV. At this point most health care providers watching the program likely figured out what had transpired...the old switcheroo!

Eureka! The Solution

The assumed identity of the rescued woman with severe facial injuries was incorrect. The boyfriend believed it to be his girlfriend when it was her co-worker. The real girlfriend had actually expired in the collapse. The survivor was correctly identified and found to have a thick medical record with a very long problem list that explained all of the earlier crises. Case closed.

Remember, when watching mystery shows of any kind, if 1+1 does not equal 2, take a step back and rethink the whole situation. Perry Mason taught me that!

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• WebMD Symptom Checker
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Technorati Tags: House, Fox, identity, health and wellness