Thursday, December 31, 2009

Book worms, imperialist nostalgia and the "Stanford 25" - Abraham Verghese

Saturday, December 26, 2009

How to achieve 'planned patienthood' (via @cnn)

Thursday, December 24, 2009

"Here is my log of major interruptions of attempted sleep over a 12 hour period during yesterday’s stay in the hospital..."

Saturday, December 19, 2009

Things I Learned in Medical Training That Have Influenced Me in My Non-Medical Life. (via @intueri)

Monday, December 14, 2009

"The chain reaction turned into a 13-way kidney transplant, during six marathon days of surgery..."

Thursday, December 10, 2009

20 People Who Make Healthcare Better

Wednesday, December 9, 2009

This is my 1st and last appearance in the NYT sports section: our paper on kidney disease in bodybuilders. (Watch the video!)

Tuesday, December 8, 2009

Medical iPhone Apps in Fast Company (brief quote by me).
Dragon Naturally Speaking Dictation on the iPhone. For free. (Wow.)

Saturday, December 5, 2009

Google Now Personalizes Everyone’s Search Results.

Friday, December 4, 2009

Dr. Rob's 6 Rules for Doctors.
Running a Hospital: A Grand Show by e-Patient Dave and Danny

Tuesday, December 1, 2009

The Emotional Epidemiology of H1N1 Influenza Vaccination (from the NEJM).

Monday, November 23, 2009

Saturday, November 21, 2009

"An antimicrobial tie with a graphic design based on the H1N1 virus."
"Something Something Social Media: The Overdue Minority Report" by Merlin Mann (@hotdogsladies)

Analgesic Nephropathy (via The Renal Fellow Network)

"Anyway, after some probing, he admitted to taking a drug called Vanquish regularly (i.e. daily for over 20 years). I had to look it up, but it turns out to be a compound analgesic (acetaminophen, aspirin and caffeine). I was surprised, as I thought these compounds were off the market, as they are in Europe. So beware, analgesic nephropathy is alive and well in 2009!" — The Renal Fellow Network

Thursday, November 19, 2009

“Health gets personal in the cloud ” -@symtym
"Google just released a new research study on how physicians use the Internet. ” -@skypen

Sunday, November 15, 2009

Adventures in Brain Tumors, by Matt Haughey (@mathowie).

Saturday, November 14, 2009

Merlin Mann blogs about Marco Arment, both of whom I like. A lot.

Tuesday, November 10, 2009

“Find locations near you for both the seasonal and H1N1 flu vaccine" -@google

Saturday, November 7, 2009

Today's xkcd (my favorite webcomic): "Organ Donor."

Halloween at the White House

P103109PS-0527, originally uploaded by The White House.

Friday, November 6, 2009

"If Health Care Is Going to Change, Dr. Brent James's Ideas Will Change It" - NYT

Thursday, November 5, 2009

Receiving the H1N1 nasal vaccine is anticlimactic. "Flu nasal drowning" was a misnomer.

Wednesday, November 4, 2009

The Uroplakins (Via the Renal Fellow Network)

The uroplakins form tiny, hexagonal arrays of particles--visualized best by electron microscopy (see figure taken from this excellent recent KI review by Wu et al)--which comprise structures called "urothelial plaques" that overlie the plasma membrane of superficial umbrella cells of the urothelium...
Read more here.
Amazon Best Books of 2009:


Credit: Baard Overgaard Hansen

Friday, October 30, 2009

Bodybuilding with steroids damages kidneys. (One of the more unusual & controversial papers I've co-authored.)

Wednesday, October 28, 2009

WolframAlpha Searches: Potassium in Lime Juice?

Tuesday, October 27, 2009

"Does anyone have any ideas about how to reconstruct my abdomen?" Heart-wrenching necrotizing fasciitis case in NEJM.

Atypical Hemolytic-Uremic Syndrome in the New England Journal of Medicine

Thrombotic microangiopathyImage by roboonya via Flickr

Every physician has diseases they see improbably often. For me, one of these conditions is hemolytic-uremic syndrome. Since writing one of my first papers on HUS as a resident — "De novo thrombotic microangiopathy in renal transplant recipients" — I've seen way more of it than you'd expect.

For kidney fans, this review article on atypical hemolytic-uremic syndrome in this month's New England Journal of Medicine (subscription required) is a must read. It details recent advances in the genetics of atypical hemolytic-uremic syndrome. What was previously a confusing mess of similar-appearing diseases — hemolytic-uremic syndrome, atypical hemolytic-uremic syndrome, drug-induced hemolytic-uremic syndrome, and thrombotic thrombocytopenic purpura — may finally be understandable.

Sunday, October 25, 2009

Wednesday, October 21, 2009

Dr. Brad Berk, University of Rochester Medical Center CEO, discusses his spinal cord injury on YouTube:

Tuesday, October 20, 2009

David Pogue Interviews Dr. Blumenthal, US Electronic Medical Records Czar

Wednesday, October 14, 2009

The Electrolyte Composition of the Dead Sea.

Monday, October 12, 2009

List of Kidney Diseases Updated

Picture of kidneyImage via Wikipedia

I've updated the list of kidney diseases for patients. Please let me know if I missed anything.

“Medical students at UMDNJ required to have an Apple iPhone or iPod touch” -@DrJosephKim
A med/peds hospitalist writes on resources for nephrology:

Saturday, October 10, 2009

8 Ways Physicians Can Use Evernote.

Monday, October 5, 2009

"New York Health Department study shows how blended drinks from coffee chains foster calorie overload."

Sunday, October 4, 2009

HealthGrades makes it difficult for physicians to edit their info. Here's the link:
"The Burger That Shattered Her Life." (Hemolytic Uremic Syndrome in the New York Times) —

Saturday, October 3, 2009

List of Kidney Diseases

BIRMINGHAM, UNITED KINGDOM - (FILE) (EDITORS N...Image by Getty Images via Daylife

Did I miss anything on this list of kidney diseases? (I intentionally left out a few rare disorders.)

If you know of other links to patient information I might include, please post a comment. Thanks.
The New PubMed.

Swine Flu on Twitter (by

Swine Flu

(original here)

Surgery (by


(original here)

Saturday, September 19, 2009

"Is an efficient physician necessarily a good doctor?"

Friday, September 18, 2009

High Potassium and Kidney Failure Due to Matchstick Ingestion

The Renal Fellow Network Blog is essential reading, part 426...

Matchstick heads are comprised of over 50% potassium chlorate (KClO3); it is an oxidizing agent which makes matches flammable and can also be found in many explosives and fireworks. Unfortunately, it also happens to be nephrotoxic. In this interesting case report by Mutlu et al, the authors describe a 21-year-old man who attempted to commit suicide by ingesting 120 matchsticks...

Saturday, September 12, 2009

Hilarious Journal Articles and NCBI ROFL.

Sunday, August 23, 2009

Robin Williams talks about his aortic valve replacement: (Thanks, to Dr. Wes at

Wednesday, August 19, 2009

New favorite fountain pen, 77¢:

Sunday, August 16, 2009

"We have contests in which we decide who is the most beautiful woman in the world... We should be able to have a World's Most Perfect Kidney contest." -- David Cronenberg, in Aphrodites of the Operating Theater: La Specola Museum of Natural History of the University of Florence, BoingBoing.

Friday, August 14, 2009

Someone please prove me wrong: A table of the benefits of common medical therapies (aspirin, statins, etc.) DOESN'T EXIST.

Sunday, August 2, 2009

Ben Franklin in the NYT Pursuit of Happiness Blog (

Tuesday, July 28, 2009

"NIH is encouraging its scientists to edit and even initiate Wikipedia articles in their fields."
Information Overload, the Index Medicus, and PubMed

Sunday, July 26, 2009

Brooklyn Bridge via Moving Car
Brooklyn Bridge via Moving Car

Thursday, July 2, 2009

Brain with Atherosclerosis

NCP 1277, originally uploaded by otisarchives1.

A Mindmap Containing All Major Topics in Biology, Chemistry, and Physics.

Structure of the Kidney.

Saturday, June 20, 2009

Why Doesn't This Catheter Work?

Have I mentioned recently that you must read Nathan Hellman's Renal Fellow's Blog?

Steve Jobs' Liver Transplant

Image representing Steve Jobs as depicted in C...Image via CrunchBase

Via Daring Fireball:

Yukari Iwatani and Joann S. Lublin, reporting for The Wall Street Journal:

Steve Jobs, who has been on medical leave from Apple Inc. since January to treat an undisclosed medical condition, received a liver transplant in Tennessee about two months ago. The chief executive has been recovering well and is expected to return to work on schedule later this month, though he may work part-time initially.

This must be a deliberate, timed leak from Apple. The timing is simply perfect from Apple’s perspective — midnight on the Friday of what appears to be the most successful new product launch in company history.

Friday, June 19, 2009

Sunday, May 31, 2009

Manhattanhenge 2009

manhattanhenge 2009, originally uploaded by mudpig.

© 2009 Steve Kelley, posted using Flickr's "Blog This" feature. Please see the original on Flickr.

Thursday, April 23, 2009

Wednesday, March 4, 2009

Bizarre Devices from Medicine's Dark Past

From the New Scientist Web site. Not entirely safe for work. (Via Warren Ellis.)

Nephrology Calculators for the iPhone

My colleague Joel Topf over at Precious Bodily Fluids reviews three nephrology calculators for the iPhone. He likes Neph CalcMedCalc the best.

Saturday, February 7, 2009

"13 Things I Hate about Nephrology" (by Nephrogirl)

Simplified hemodialysis circuitImage via Wikipedia

In a recent post, "nephrogirl" — who is either a nephrology fellow or younger nephrologist — listed the "13 things [she hates] about nephrology." I appreciate that she took the time to vent her unhappiness. And while her experiences with nephrology aren't mine — which might have to do with differences in our patient populations and many other factors — I understand her perspective. Here's the list, along with my comments.
1) The incessant checking of labs, powerlessly watching the kidney function slowly deteriorate. [I'd say the ratio of patients for whom I make a significant difference to patients that I feel powerless to help is well over 50:1.]
2) Sending patients for the critical intervention which you feel is going to make the difference, only to see them suffer a devastating complication from the procedure itself which was worse than the actual disease. [Interventions for renal artery stenosis and coronary artery disease might fall into this category. I've rarely seen catastrophic outcomes from either of these interventions, and the number of patients that I've seen helped far outweighs any of the complications I've seen.]
3) The self-deception involved in thinking you might be slowing the progression of their kidney disease, when their main problem is the cardiovascular death that’s waiting for them in the next 6-24 months. [Interventions to slow the progression of kidney disease, like improving control of hypertension and diabetes, also have the potential to also prevent or delay cardiovascular disease.]
4) The rampant noncompliance of so many patients. [Agreed, this is frustrating. But I've also seen many patients stop smoking, lose weight, begin taking their medications, and change their lifestyles.]
5) Reassuring the dialysis patient that his labs look better, when he’ll be dead in a year. [Again with the fatalism and therapeutic nihilism, which is difficult to argue against, because the prognosis for many dialysis patients is so dismal. Then again, I've seen plenty of patients survive many years on dialysis and eventually get transplanted.]
6) Relying on the creatinine to determine kidney function, a wildly imprecise measure at best. [Agreed, but the MDRD formula is now mainstream and is a more sensitive — though not a specific — measure of kidney disease.]
7) Watching the diabetic dialysis patient slowly losing his eyes, feet, kidneys, heart, and brain…knowing the outcome will not change despite everything that you try to do…watching the health care system spend tens of thousands of dollars on him in his last year of life. [I agree, this happens, and is frustrating, and many nephrologists feel powerless.]
8) Trying to explain kidney disease to patients and to other doctors – it’s a wild mystery to most people that they usually equate with death. [A cardiologist once said, half-jokingly, that "Everyone understands the heart, and no one understands the kidney." The mysteriousness and non-intuitiveness of the kidney is what gets many nephrologists into the field in the first place.]
9) The joylessness of a nephrologist’s life, especially one who feels it is her duty to try to make a difference, despite constant evidence that her efforts are most likely futile. [Most days, I'm very satisfied with my work, and I don't feel this way at all.]
10) The realization that it is easier and more financially rewarding to put a patient on dialysis than to try to preserve their kidney function. [I've suspected this phenomenon might occur, but I don't practice this way.]
11) Knowing that the promise of a kidney transplant is what dialysis patients live for…and knowing that a transplant can in some cases be worse than dialysis, especially when the post-transplant care is handled by an erratic system more interested in doing surgery than in practicing medicine. [In general, it's better to get a kidney transplant than to be on dialysis, even taking into account transplant patients who do poorly.]
12) Not being able to let go…for fear you’ll miss the acute renal failure, the rapid correction of hyponatremia, the diagnosis of RPGN…then when your back is turned, an unexpected catastrophe happens. [Many medical specialties require a high level of vigilance, nephrology perhaps more than most.]
13) The realization that the bill of goods you were sold when you chose this field is far different than the reality. [Personally, more than five years into practice, I still wouldn't choose any other field.]
Thanks again for taking the time to leave your comments.

Thursday, January 1, 2009

Electronic Stethoscope Oddities

Happy New Year!

If acoustic stethoscopes — the kind physicians have used for over two hundred years — are the equivalent of typewriters, then electronic stethoscopes are like word processors. Okay, this analogy is non-intuitive, but hear me out. Electronic stethoscopes, like word processors, are newer, more expensive than the previous generation, and are — well — electronic, with all the advantages and disadvantages this implies.

The advantages to electronic stethoscopes are many. As I've written previously in my review of the Littman Electronic Stethoscope Model 3000, it's simply easier to hear heart and lung sounds with an electronic stethoscope than it is with an acoustic stethoscope. (For real-world examples of this, see the previous review.) Plus, some models, like the Littmann 4100 Electronic Stethoscope, allow you to record and playback — think copy and paste — heart and lung sounds for reference or teaching.

But anything electronic is prone to failure, and when electronic stethoscopes fail, they fail spectacularly. Don't misunderstand: I'm a fan of my Littman Model 3000, but it's worth pointing out the oddities you should expect if you decide to purchase one of these things. (Some of these observations are taken from my postings on Twitter.)

First — and this might sound obvious — the electronic stethoscope requires batteries. Eventually, these batteries will die. Unexpectedly. At exactly the wrong moment. Almost certainly, when you're examining a patient. At this time, your electronic stethoscope will make a sad little noise, then — silence. An eerie silence. And unless you're walking around with an extra AA battery in your pocket — which you will suddenly realize is probably a good idea — you will then say, apologetically, "I'm sorry. The battery in my electronic stethoscope just died."

Second, if you carry around an iPhone or a BlackBerry, you will experience intermittently the faint faraway static of your mobile device as you're listening to the heart of a patient. And while this doesn't interfere with your physical exam, it's unnerving.

Finally, if you were planning to place another type of diaphgram on your electronic stethoscope — such as the excellent SafeSeal stethoscope covers by DRGdon't. It will cause unbelievable amounts of feedback. As I learned recently, placing incompatible diaphragms on electronic stethoscopes makes your patients' hearts sound like they're being played by Jimi Hendrix.

(Also posted on Tech Medicine.)