Friday, August 22, 2014

Amazing New Technology

I Dog:

The latest and greatest thing in personal companions. The I Dog, along with the built in I Dog app, allows the user to select all the characteristics wanted in a canine pet. Size, personality, shedding, long hair or short hair, are only a few of the attributes available with the latest I Dog. Long for the complete Puppy experience? Turn off the built in house broken feature and your I Dog will Pee and Poop inside, just like a real puppy. And, don’t worry about astronomical food and vet bills; the I Dog is one hundred per cent digital fun. Just plug in and charge overnight and you are ready for hours of playful frolicking.  Finally, scare off those unwanted guests and would be attackers with the I Dog guard dog app.
The I Dog is coming in time for Christmas.

I Bed:

Tired of the same old mattress, sheets and blankets? This April, the I Bed arrives. Completely integrated mattress, box spring, sheets and blankets conform to every sleep habit. Bad Back? The I Bed senses tight, wound up muscles and arthritic joints, automatically adjusting to provide just the right amount of support and cushion to eliminate lower back muscle pain. Husband snores? The I Bed keeps him turned and even gives him a short jolt to startle him awake and stifle the annoying noise. And, for those intimate moments the Romance App (available separately) fills your boudoir with sensuous perfume, automatically sets just the right mood lighting and senses every thrust and roll to provide maximum stimulation.
The I Bed, available this spring wherever fine bedroom furniture is sold.

I Toilet:

The flush toilet has been around for years with very little innovation. Effective, but boring. Now, American Standard presents the I Toilet. Who says the bathroom can’t be fun? From the perfectly warmed seat to the amazing Elimination App, the I Toilet makes your bodily functions not only necessary but fun!! Even while it spares the environment, the I Toilet enhances the bathroom experience. The seat automatically conforms to even the largest buttocks for maximum comfort. Built in sensors monitor the acts of elimination and micturition and immediately calculate optimum sanitation and cleansing. The optional Bidet App cleanses your bottom with just the right amount of force at just the right temperature.  The included toilet paper app allows the pooper to choose strong or soft with infinite choices, including color. The flush sensors detect liquid or solid waste and adjust the amount of water per flush accordingly. No more annoying multiple flushes; studies have shown that this app actually saves water, thus preserving our limited resources. And, for those days when things just aren’t coming out right, there is a built in catalog of books, movies and music to keep you entertained. Look to the future, Look to the I toilet.

I Back Scratcher

Itches on your back can be sooo annoying. And, if you find yourself alone with an itch what can you do? Rub against a tree? Roll around on the ground? Not very effective or efficient. NO!! You need the I Back Scratcher, the latest in body comfort solutions. Adjust the I Back Scratcher to light scratch for that superficial, but annoying itch or program it for deep and long scratching to feel the comforting scratch deep into those tiring muscles. And, don’t worry if it’s a large area or a tiny spot. The I Back Scratcher automatically senses the itch and provides a timely and soothing scratch either with its five finger mode or, for smaller more localized irritation, the single finger nail probing scratcher. The I Back Scratcher, the latest in personal comfort devices.

I Garden

Don’t have a green thumb? Not even a yellow one? Don’t fret, the I Garden will turn the most incompetent farmer into Johnny Appleseed and fill your home with beautiful flowers and fresh fruit and vegetables all without any fuss or effort. Merely set the I Garden post into the middle of your garden and watch it flourish, all from the comfort of your personal I Garden lawn chair (sunblocking umbrella included only with I Garden Premium Edition).
“But I want to get down on my hands and knees and be part of my garden.” Don’t worry. The Green Thumb app allows you to do as much or as little gardening as you wish. Set it to the lowest level and the I Garden only provides fertilizer and pest control. Turn it up a notch and it will water your sprouting seeds to exact specification. Ramp it all the way up and watch the seeds get planted, watered, fertilized, cultivated, and harvested. Add the I Processor and your fresh fruits and veggies are scrubbed and stored to be enjoyed days, weeks, months or even years later. Worried about pesky crows absconding with the fruits of your labor? Have no fear as the I Scarecrow app zaps these pests and keeps your garden pristine. The I Garden, a must have for every outdoor hobbyist.

I Zoo

You go to the zoo, it’s July and it’s ninety five degrees. Your kids pester you to see the lions, which forces you to make the long trek from the cool confines of the snake house to the Lion’s Den. What do you find? A pride of lions sleeping in their caves, doing the smart thing and avoiding the midday heat. You think: I wish I was a lion, instead of a father having to explain to disappointed children why the lions are hiding.
Sound familiar? Well, you can avoid all these troubles with the incredible, intuitive and customizable I Zoo. Want to see lions. The I Zoo puts you right in the middle of the hunt with crystal clear, life size digital lions projected utilizing the latest in holographic imagery. The picture is so clear and lifelike that you’ll swear you can taste the blood of the wildebeest after the kill. And it’s not just images. The sounds, smells and feel of the African veldt are all available with the patented Sensarround app. Now, suppose penguins are your fancy. I Zoo allows you and your kids to slide down the ice flow, battle vicious seals and consume raw fish. You’ll swear you are right there in the Antarctic.
I Zoo let’s you choose the environment, animal and activity that interests you and it’s more alive and life like than the real thing.
The I Zoo, yours for only $599.95. Senssaround app sold separately.

I Shoes

Feet. We’re born with them, we take them for granted forcing them into any old shoe while all the time they take the abuse until…they rebel. Arches fall, bunions form, nails ingrow and then it’s too late. Chronic pain, crippling inflammation rule our lives because, no matter how hard we try, we can’t ignore our feet. What can one do? Like a noble white night the I Shoe comes into your life freeing you and your feet from endless days and nights of podiatric misery. One hundred per cent intuitive and sensitive to individual needs the I Shoe is practical, elegant, sturdy and comfortable. Built in apps include the arch app, nail maintenance app, odor sensing and elimination app and our very popular massage app. The I Shoe can be worn to a night at the opera or climbing Mount Everest. The sole is completely equipped with the latest 3D technology which allows it to go from a pump with 5 inch stilleto heels to a rugged work boot, all controlled from your smart phone or computer.
Live the life of comfort with the I Shoe, now available at Better Buy and Shoes Are Us and other fine clothing and electronics stores.

I Underwear

You’ve heard of Buck Naked underwear, boxers, briefs and boxer briefs, but we now present the revolutionary new I Underwear. I Underwear is guaranteed to be the most comfortable, versatile, durable and stylish underwear ever. Slip a pair on and the first thing you’ll feel is nothing. That’s right. I Underwear feels like your running free and easy. How can that be? Well, starting at the top, this amazing underwear has no elastic, no waist band, no tags, only the softest, smoothest cotton/nylon/linen blend which conforms to your personal body habitus. Built in sensors allow the I Underwear to anticipate every movement so that the fabric moves in perfect concert with all the body parts it is protecting. And what protection!! Not only are your movements anticipated, but every body fold, every nook and cranny is mapped and catalogued so that the I Underwear provides maximum support. Torn between boxers and briefs, but not sold on boxer briefs? No worries. I Underwear will scan for body shape, perspiration index, odor and nineteen other parameters and adjust to provide maximum support, comfort, hygiene and fertility.
I Underwear, slip into a pair today.

I Aquarium

Work, work, work. At least that’s what many fish owners say about maintaining a home aquarium. Clean the filter, clean the water, feed the fish, change the water, check the pH, stop, repeat. Over and over and over. Is there an easier way? Of course, let technology do the work. The amazing I Aquarium will maintain your fresh or salt water aquarium just like the professionals. Water composition, pH level, alkalinity and acidity, copper levels, aluminum levels, arsenic levels and every other level is continuously monitored and adjusted to provide the perfect, optimum environment for your fine, finned friends.
But, the I Aquarium can do even more!! Tired of the same old boring cichlids? The Piscean App can alter the optics of the tank and water so that even the most boring Black Molly can become a bright, colorful virtual Clown Trigger fish or lovely orange and white Clown Fish.
And, if you want to go a step farther activate the virtual fish tank app. This remarkable and free app will simulate an underwater paradise without the need for live fish or water or any cumbersome equipment. But, you’ll swear it’s all real or we will completely refund your money.
The I Aquarium, a must have for every fresh water and salt water aficionado.

I Car

Start with the first time you set your tush down on the seat and begin the amazing journey. The I Car scanners relay data on every nook and fold of your derriere and adjust the seat to maximum comfort. It’s at that point that you realize you’ve embarked on a special voyage in a special and extraordinary vehicle. But, the I Car is not just any vehicle. It’s a fully automated, customized driving experience which will take you to your destination with a mere push of a button and a few softly spoken words. Settle down into your seat, push START, murmur “supermarket” and lay back as the I Car expertly carries you to the market, all the time gently massaging those tired muscles, playing soft, soothing music while doing all the mundane tasks you dread.
Too tired to get up and push a shopping cart? No problem. Merely upload your shopping list and relax. The I Car delivers your list and arranges to have it brought to your car loaded and brought home. It even tips the grocery boy.
The amazing affordable I Car coming in 2015 from Apple Motors.

Sunday, August 3, 2014

I Wonder...


I’ve been practicing surgery for more than twenty five years. Over these many years I’ve had innumerable interactions and encounters with patients, nurses, doctors and other health care professionals. Sometimes I’m left scratching my head in wonder and amazement. This is not always a good thing.
A few years ago Martha, a patient of one of my partners, called on a Sunday morning, which also happened to be July 4th. She had a colostomy created along with what’s called a mucus fistula following surgery for a colon perforation a few years before. A colostomy means that the colon (large intestine) was brought out to the skin level so that stool passes into a bag instead of taking its normal course to the rectum and out through the anus, a common practice when patients require emergency colon surgery. A mucus fistula means the other end of the intestinal tube is also brought out to the skin where a small amount of mucus will drain intermittently. Such mucus fistulas usually only require a light gauze dressing, not a complete stoma appliance.
Back to Martha. She was concerned because she was out of bags for her colostomy and she needed to change it and the medical equipment stores were closed. She gave me a brief rundown on her history and assured me that besides needing a new a new bag everything else was OK.
I gave some thought about what she should do. We don’t keep such appliances at our office, so I couldn’t help her directly and it was true that the medical supply shops were closed. All I could think to do was to send her to the hospital where one of the nurses could fix her up. I advised her to go to the ER and then I called and spoke with the head nurse in the ER, explaining the situation and asking if she could do the patient a favor and find her a colostomy bag to get her through the holiday weekend.
I didn’t give the matter a second thought, assuming the nurses would be able to accommodate the desperate patient without any fuss. But, I was wrong. Three hours later I get a call from the ER doctor informing me that Martha was there and he had just eyeballed her. Now he was asking me about my concerns. At first I didn’t remember her, but the lightbulb went off in my head and I told him:
“Oh, she just needs a new colostomy bag. She called me a few hours ago and I spoke to your head nurse about her.”
There was a long pause and then the ER doctor replied, “She has two colostomies and nothing is coming out of one.”
“Oh, that’s just a mucus fistula. I wouldn’t expect her to have much drainage from it. Just get her a bag and she’ll be fine,” I reassured him.
“Do you think I can talk to your partner who did her surgery? Because if she has a colostomy something should be coming out,” he deduced, again.
“Well, he’s usually not available on the weekends when he’s off, but Martha will be fine if you just fix her up with a colostomy bag.”
“Unless, I can speak with your partner I feel I’m obligated to do a CAT Scan,” he reiterated more forcefully. “Colostomies should have some drainage and I don’t see anything coming out.”
I was beginning to get a little annoyed.
“Did you actually talk to the patient?” I asked. “Did she tell you what the problem is?”
“I did talk to her,” he replied, his frustration also beginning to surface, “and she told me just what you said. But, she could be confused and a colostomy should have something coming out. I really think I should do a CAT Scan.”
I realized I was going nowhere fast.
“OK, OK, do what you have to do. I haven’t seen her and you have. I’ll see if I can get a hold of my partner.”
I realize that once the ER doctor saw poor Martha he was responsible for her care and he was only trying to practice good medicine, at least from his perspective, but he really broke a few rules. He didn’t listen to the patient, he assumed an elderly patient must be confused if she didn’t tell him what he expected to hear, he ignored his consultant and refused to consider anything but his own inaccurate diagnosis. This also is an example of relying too heavily on CAT Scans for diagnosis, while refusing to utilize any clinical judgment.
In the end, Martha got her bags and a completely unnecessary CAT Scan of her abdomen and pelvis. That particular ER physician was fired about a month later, my encounter being only one of many similar episodes. It made me wonder how some people make it through medical school and residency.
I had another incident today that made me stop and think. I was called to consult on a patient at one of the Long Term Acute Care (LTAC) facilities. LTAC’s are hospitals for patients who are not sick enough to be in a regular acute care hospital, but are too sick for a nursing home. I consult at these facilities when necessary to evaluate surgical problems.
Mitch was a complicated patient who had undergone major intra-abdominal surgery and had numerous drains which had been placed to treat abscesses which had developed after his surgery. I had not done any of the surgery and I had never seen him before, but I was called because the patient’s actual surgeons did not go to LTAC’s.
“Dr. P wants you to see Mitch because his drain broke,” the nurse reported.
I did my best to extract as much information as I could from the nurse. Mitch was stable, the drain hadn’t been collecting much fluid and it sounded like a closed suction drain’s tubing had broken off near where it attached to the suction bulb.
“Sounds like you can just cut the tube a little shorter and reconnect it to the bulb,” I deduced.
“It’s broke, I can’t do that.”
“OK, I’ll see him tomorrow.”
“But doctor. The tube isn’t draining into anything; it’s open to air.”
This was not much of a problem to me, the tube would behave like a different type of drain, called a Penrose, but I could tell the nurse was very worried.
“Just wrap it with some sterile gauze and tape it and he should be fine,” I suggested.
I went to see Mitch and found just what I expected. He had an intraperitoneal closed suction drain with plenty of tubing outside his abdomen.
“Where’s the bulb?” I asked the nurse, who was not the same nurse I had spoken with yesterday.
“I told them to save it, but they didn’t listen,” Mitch said. “They threw it away yesterday.”
The nurse was able to scrounge up another bulb, the tube was cut a little shorter and the crisis was averted, but only after I made a special trip to the LTAC to take care of a problem that should not have been a problem.
Then there are the techniques I have observed in other surgeons. I hear stories of surgeons taking two or three hours to do very simple procedures and I wonder what they are doing for so long a time. Sometimes I will ask that very question of the OR staff. The answers are scary:

“He wasn’t sure about the anatomy. He asked me my opinion, but I couldn’t help him,” reported by a surgical technician.
“He made a hole in the bladder and we had to wait for the Urologist.” I know things like this can happen, but not on a cholecystectomy.
“She just dissects very slowly, like she’s not sure what’s what.”

It’s always best to be as sure as you can be during surgery, and never cut anything unless you know what it is, but there is also some truth to the saying that “a good fast operation is always better than a bad slow operation.”
On occasion I assist younger surgeons in the OR. Most are careful and meticulous as they should be, but I have also helped some who can best be described as cavalier and sometimes dangerous.
I was assisting another surgeon on a colon resection for diverticulitis, an inflammatory condition of the colon. The segment of colon which was diseased was adherent to structures posterior to it. These structures are the ureter, iliac artery and iliac vein. Rather than carefully dissect the colon away, this surgeon took a pair of scissors and just cut away blindly, injuring the iliac vein in the process. I had to fix the vein as this surgeon did not do any vascular surgery. The patient lost about a liter of blood, because of this surgeon’s carelessness and inattention to the most basic rules of proper operative technique.

Incidents such as these make me wonder and worry a bit. If a nurse is not familiar with a particular drain, that’s OK. But, it would have been prudent to ask her head nurse what to do, rather than call in a consultant to address what was really a very simple nursing problem. I worry about the judgment, training and basic knowledge of personnel who are in positions where decision making and responsibility are of central importance. I see more and more incidents like these and I worry what will happen as I get older and face the infirmities that always come with age.