Friday, June 29, 2007


A patient describing her child's erratic behavior:

"He's like Dr. Jack and Mrs. Hive."

Took me a bit to figure out what she was misquoting.

Rest well...

A patient of mine died last night, unexpectedly. She was in her 40s but had suffered from multiple chronic diseases for many years. She had led a hard life.

She was chronically depressed, and had long been unable to escape her social situation. I found her to be humorous, hopeful, and with a big heart.

I will miss seeing her...

Sunday, June 24, 2007

Nursemaid's elbow

I reduced my first Nursemaid's elbow this week.

I've been jealous of my (non-medical) husband who reduced my daughter around when she was three. Our eldest had been through the experience and necessitated a trip to the ER (I was a medical student, and could diagnose the problem, but was too scared to do anything about it.) So he looked it up on the internet and reduced it, then called me and told me about it.

A Nursemaid's elbow is a common condition in toddlers, where the elbow dislocates to some degree. A simple procedure reduces it, and tho the procedure is painful, relief is immediate.

My patient was under a year old, which gave me an advantage: she was not apprehensive about me touching her. It didn't work the first time, but the second (this time with her seated in my lab facing away from me) worked like a charm. I was expecting a "clunk", but it was definitely just a "click".

She immediately began to play with her toys again, ambidextrously. Baby's happy, mom's happy, Dr. Smak's happy.

Friday, June 22, 2007

AAAAaarrrrrr, matey!!

A distant step-relative of mine is "starring" in the new reality show, Pirate Master. It's a sort of spin-off of Survivor, except they're on a ship, not an island. I've never been a big reality show watcher, but Ben is super cute and a great guy, so check him out. He's been sworn to secrecy, so I have NO idea how he did. But he's doing a good job of staying under the pirate radar right now, and letting the personality disorders vote each other off.

Did I mention he's super cute?

Did I mention he's technically a step-relative, so it's not gross that I think he's super cute? (OK, maybe the fact that he's over a decade younger than me makes it gross, but I'm willing to deal with that...)

Go, Ben!!!

Wednesday, June 20, 2007

How doctors think...

In appreciation of a recent hilarious (but disturbingly accurate) post by Ten out of Ten, I'll offer this post.

For all folks outside of the medical field, this is some helpful inside information.

There are a number of things that you can say to any doctor or nurse that will cause us to involuntarily roll our hidden proverbial eyes and take everything else you say less seriously.

Though this list is intended to be humorous, I'm dead serious. If your doctor or nurse is skilled, you won't see or hear the eye roll, but trust me, it's there. I'd strongly recommend avoiding these interchanges if you can help it (unless you really have multiple allergies).

1. "My normal temperature is 97, so 99.1 is a fever for me."
2. Having more than 3 allergies (or anyone allergic to benadryl).
3. Being on a cell phone or getting a call and responding in any way other than immediately getting off the phone.
4. Rating pain anywhere close to 10/10, unless you are in writhing. Trust me, we've seen people in 10/10 pain. We know what it looks like.
5. Talking about your pain threshhold. If I've been your doctor, I already know what it is.
6. Stumbling on names of controlled substances. If you really want Percocet, saying "I think it's called percy-, perco-, perky-something" doesn't make us think you're anything but scamming.

Doctors enter every patient visit with thousands of previous patient visits as guides, and we involuntarily tack baggage onto patients and complaints. Avoiding the above comments may improve your ability to communicate your complaint effectively to your doctor.

PS On a slightly related note, when your doctor asks you "How long?", "a while" is not a useful answer. Neither is "a good while", "a long time", "a bit", or "dunno". We're looking for a number followed by a unit of time. If you answer "3 weeks" your doctor will smile. You may not see it, but it's there.

Monday, June 18, 2007

A pleasant hiatus...

Aaahhh....I'm back. Relaxed, mellow, and tanned. A week at Folly Beach, SC, who can complain?

I can tell my kids are getting older. For the last 2 years I haven't even bothered to bring books to the beach. This year I brought 4, and read 3 of them while there. Heaven...

So, for all you soon-to-be vacationers, here are my abbreviated book reviews:

1. Next, by Michael Crichton. I've read almost all of his stuff, and enjoyed most of it. Being the sci-fi dork that I am, a good Crichton book is like a trashy romance novel to me. This one wasn't great. Next explores the dangers yet to come in a world of genetic manipulation. Fascinating topic, not the most clever presentation. It felt like he thought up all the nightmare scenarios associated with genetic science and tried to fit them all into one story, not very believably. Still, we all love trashy romance novels at the beach, don't we?

2. Portnoy's Complaint, by Philip Roth. One word: wow. OK, maybe not one word, since that doesn't really cover it. Not "wow" as in "the best thing I've read in a while." More like "wow, I didn't know there was such a fine line between literature and porn." I'm a Philip Roth virgin (really, there's no way to review this book without ample sexual references), so maybe all his books are as uninhibited, but this was new to me. A very interesting portrayal of a young Jewish boy's experience of sexual growth. He brilliantly described a mother that made me feel claustrophobic through the book, but that wasn't the main thrust (he he). My take home message was that if all men think about sex as much as this man did, I'd rather not know about it. It was a quickie (really, I can't help myself) so I didn't have to invest much time, but I'm not sure that I'd recommend it.

3. Wickett's Remedy, by Myla Goldberg. I absolutely loved her debut novel (see my list of all time favorites), but this one fell short for me. The story follows a young woman's experience with the death and destruction wrought by the 1918 influenza epidemic in South Boston. The author included some novel literary devices, including converging storylines through letters at the end of chapters, as well as running commentary from dead acquaintances. The former kept the book a bit more interesting, the latter was distracting. An easy read, but not a great one.

The fourth I just started today, Suite Francaise, by Irene Nemirovsky. I'm not very far into it, but so far I love it. The prose is like a Paris croissant, light and flaky but chock full of saturated fatty goodness. "Children slept peacefully...their lips making sucking noises, like little lambs." Like buttah. I'll write a full review when I finish it.

Also, please note my new section, titled Dr. Smak's List of Truths. I'll be adding to it as more strike me.

Friday, June 8, 2007

Meet George...

When my son (who has two sisters) asks me, "Where's my brother?", I point to George. He's technically the youngest, but definitely the least demanding.

Thursday, June 7, 2007


Occasionally, patients present with something they "found", that happens to have been there since birth, but was just stumbled upon. Here's what I've diagnosed in the past:

1. Circumvillate Papillae on the back of the tongue. If you can stick your tongue out far enough, you'll see several dimpled circles. The patient I saw said her husband refused to kiss her until she found out whether they were contagious.

2. Coronal Sutures. This patient was sure she had a brain tumor. Her suture had a little more of a ridge to it than average, but had been that way for several decades.

3. Nasal turbinates. I was asked to evaluate the growth in this child's nose on three separate occasions. At this point it was less humorous and more annoying. If you've ever looked in your own nose, the pink moist rounded things you see are the turbinates.

4. Bony prominence of the cervical spine was visible in the posterior pharynx of a particularly thin patient. Now, this one was a little weird for me too, but you can be sure it had always been there. In english, when she opened her mouth all the way you could see the a bump there from the underlying spine. What was really weird about it all was the fact that she kept reaching into her mouth and pushing on it to show me it didn't hurt.

I'm sure there will be more.

Monday, June 4, 2007

Book review: Animal, Vegetable, Miracle

I'm a big Barbara Kingsolver fan. I've read just about everything she's published, and enjoyed almost all of it. Her writing style is rich, and she is capable of invoking memories that I didn't realize I had.

Animal, Vegetable, Miracle is a non-fictional account of her family's experience with a self-imposed year of "locavore"-ism. Kingsolver is both a gardener and an environmentalist; the combination of those passions lead her to consider her "carbon footprint" for her eating behavior. How much fossil fuel is used to ship California strawberries across the US in January? How much damage did pesticides do to the land used to raise the wheat in our bread? Is it possible to be self-sufficient from a local produce perspective?

She and her family spend and entire year eating either produce (vegetable and animal) from their own farm, or from other local farms, hence "locavore-ism". Her chapters take you through the harvest seasons, and encourage you to return to the natural seasonality of produce (ie only eating brussel sprouts in the fall, fresh berries in the summer).

Kingsolver flirts with getting preachy, and I do wonder how I will ever enjoy a winter strawberry again. But her main point is that if we all did a little more local food (ie farmer's market) purchasing, we would not only support our local farmers, but we would reduce our fossil fuel consumption significantly. It's a worthy goal.

Overall, an enjoyable read, but mostly because I'm obsessed with gardening. Michael Pollan wrote a book with an overlapping theme called The Omnivore's Dilemma, which I found fascinating. For non-gardeners, I'd start there.

Great American Health Check

Check out this function on the American Cancer Society website - I found it to be very user friendly.

Take the quiz, see how you do.

I need to exercise a bit more. Still working on that one.

Now I'm just showing off...

My most floriferous creation yet. For those so inclined, it contains:

1. New Dawn rose (light pink)

2. William Baffin rose (dark pink)

3. Ballerina (little roses)

4. Mock orange (amazing scent, only last 12 hours in a vase)
5. Snapdragons
Not bad, eh?

Saturday, June 2, 2007

May in the garden

Late May is the best time in the flower garden. The roses and the clematis (clemati?) are popping. The annuals don't look too tired yet. I'll post some favorites - bear with me, adding graphics is a developing skill.
This is Henryi, an addition last year. One or two blooms last season, this one going strong.
Thanks to Moof for the inspiration - I'll add more soon.