history, medicine

The End of an Eponym

It’s interesting when medicine and history intersect (at least I think it’s interesting).  Here’s a quick history lesson that I recently encountered.

An eponym is a medical term named after a person.  Some of these are familiar to just about everyone.  For example, most people are familiar with Alzheimer’s disease and Down Syndrome.  Others are much less familiar, such as Castleman’s disease.  Eponyms are the bane of existence for many first year anatomy students- trying to remember where Hesselbach’s Triangle is, for example.

One fairly common eponymous disease is Reiter’s Syndrome.  I’ve seen it several times.  It is an arthritis that occurs in reaction to a bacterial infections, usually food poisoning or a sexually transmitted infection such as chlamydia.  As I’ve mentioned a few times recently, I’m in the process of studying for my internal medicine board recertification.  I recently completed the Rheumatology module.  When reading the section about Reiter’s Syndrome, I saw that it was always mentioned as “reactive seronegative arthritis, formerly known as Reiter’s Syndrome.”

I thought that was a bit weird.  Eponyms are annoying in that they are yet another term to memorize, but I’ve never seen one apparently being retracted.  About two seconds of Googling told me why.

Hans Conrad Reiter was a German physician born in 1881.  During his time in the army in World War I, he described a case of arthritis in a gentleman with a sexually transmitted infection.  This classic triad of arthritis, uveitis and non-gonococcal urethritis eventually became know as Reiter’s Syndrome.  Following the war, he became a professor in Berlin and was, by all accounts, quite a popular teacher.

However, there is a much darker side.  Reiter was a eugenicist.  He believed that certain people and races carried “inferior” genes, and the removal of these genes from society would create a stronger human race.  It’s not surprising that he became a vocal supporter of Adolf Hitler.  His support of Hitler led to a nice career trajectory.  Eventually, he became a member of the SS.

It gets worse.  He planned and carried out hideous experiments at Buchenwald, leading to the deaths of hundreds.  He sanctioned forced sterilization and euthanasia.  His own testimony at Nuremberg is damning, but he was not imprisoned, possibly in exchange for supplying the Allies with intelligence.  He died at the ripe old age of 88, living out the long, peaceful life that he had denied to so many others.

His war crimes started to come to light in 1977, and a campaign started to change the name from Reiter’s  Syndrome to reactive arthritis.  The wheels of the medical community turn at a glacial speed, however, and it took until 2009 for the name change to become official.

So, it’s the end of an eponym.  Eponyms are meant to honor- we need to make sure that those they honor are deserving of the accolades.



I’ve had a hard time watching the news about the Sandy Hook tragedy. I suspect many people have.  I have a son who is almost six, and it is literally sickening to think about losing him.  So, while on some level I am heartbroken about the loss of those innocent lives, on another level it’s just been too much to even contemplate.

Until yesterday.

Yesterday I got angry.

What finally did it?  It was this.

It’s the press conference given by the NRA executive vice president.  According to him, guns have nothing to do with the massacre at Sandy Hook.  Nothing.  It was video games.  And media glorification of violence.  And lazy law enforcement.  The solution?  More guns.  Got that?  More guns.  Guns for teachers.  Guns for “volunteer guards.”  Guns for the “good guys.”
I’m sorry.  That is sheer insanity.  It boggles my mind.  When a madman goes on a shooting rampage, the response should be, “How do we stop someone like this from ever getting a gun again?”  The response of the NRA was, “How do we get a gun for EVERYONE?”  
It ignores the fact that there was an armed guard at Columbine.  Virginia Tech had an armed security force.  Ft. Hood is a military base, for God’s sake.  Everyone is armed there.
We should have said “enough” after Columbine.  After Virginia Tech.  Ft. Hood.  Aurora.  We didn’t.
Now it’s time.
This is not the Wild, Wild West.  This is America in 2012.  There is no place, outside of the military and law enforcement, for assault rifles, automatic weapons, and extended ammunition clips.  There is no place for the lax, farcical “restrictions” placed on gun ownership.  And the day there are armed guards patrolling outside my kids’ school is the day I pull them out and start homeschooling them.  That is not the free country that I want my children to experience.  That’s a country under siege.
Will it be easy to make a change?  Of course not.  I’ve heard the statistics, just like everyone else.  There are 200 million guns in America.  It will take years, maybe decades to make a difference.  So why wait?  That just means that the time to start is now.  It’s not time to throw up your hands and say, “It’s impossible, so why even try?”
So, please, join me in saying, “Enough.”  Write to the President and your senators.  Write to your state reps and governors.  Don’t let a lobbying organization of 4.3 million gun owners speak for the needs and wants of 300 million people.  


Another Project: Entryway Cubbies

I know. I’m supposed to be studying. And I am, really. Today I learned about anti-NMDA-receptor encephalitis, a disorder that I had never, ever heard of before. Ever. So much so that when I was taking a practice test and saw this as one of the answers, I thought it was a made-up disease. Turns out it is an exceedingly rare autoimmune disorder that wasn’t identified until 2007. Learn something new every day.
However, I decided that our entry way closet needed a serious makeover. We have a large double closet right where you enter the house, from the garage (where we SHOULD have a mud room, but don’t). Apparently, it is too difficult for some people to hang up their jacket on a hanger when entering the house. Therefore, my first solution was to put a bench and some hooks in the closet. That didn’t work. The hooks were too close together, jackets fell off of them, and the closet was still a mess. I’m a bit ashamed to show you what the closet looks like…but hey, people tell me their embarrassing problems all day. I should return the favor.
I told you it was bad. I wanted to take care of this problem before winter truly sets in. My answer- storage cubbies- one for each member of the family. Plans from Ana White, again.
Setting up to cut the plywood:
 Cutting plywood is a big pain in the butt.  Make sure you set up a good straight edge and clamp it down so that you can get accurate cuts with a circular saw.
Finished bases:
Finished hutch:

Putting it all together:
Painted and DONE!!
Alex likes his cubby so much that he wants it to be his “house.”
Roll your mouse over for the amazing before and after picture!

I’d consider that a success!  Total cost for everything- $320 and about 10 hours of labor.  Cost at Pottery Barn– $1400 plus shipping.  Not bad for a day’s work.
insurance, insurance insanity, medications, primary care

Watch an Insurance Company Try to Drive Me Insane

It’s been a while since I posted one of these. Here’s another ridiculous prior approval form. It’s for zolpidem- the generic version of Ambien. Of course, this begs the question of why I need an approval form for a generic drug in the first place.
At the top of the form it says: Drug Name- Zolpidem.
The rest of the form goes on to ask the following questions:
1.  Is the drug Cialis, Levitra or Viagra?
     No, dumbass. The drug is Zolpidem, as written just a few lines above.

2.  Is the requested therapy Zyban?
     No, dumbass. The drug is Zolpidem, as written just a few lines above.

3.  Is the request for Aloxi, ondansentron, zofran, or Kytril?
     No, dumbass. The drug is Zolpidem, as written just a few lines above.

4.  Does the patient have hyperemesis gravidarum?
      What??? Where did that even come from? I write a prescription for a sleeping pill for a 65 year old woman and you ask me if she has uncontrolled vomiting from pregnancy????
And that’s it.  Those are the questions asked. Nothing actually related to the medication I had prescribed.  It was basically like playing a long game of 20 Questions, except I don’t think we ever got to the answer.
medicine, primary care

Hitting the books.

It’s time to hit the books.
My American Board of Internal Medicine certification is up at the end of 2013. Hard to believe that 10 years have gone by since I last enjoyed this experience.
Back then, I was still in residency. All I had to do was complete my residency (no mean feat, that), get certified in a bunch of procedures, and take a 2 day exam (back then, still with paper and pencil). Now I get to experience the joy that is “Maintenance of Certification.” This is comprised of earning 100 points in the MOC program. Some of the points have to be from clinical reading, and the rest have to be from “Practice Improvement Modules.” These are, to put it kindly, a pain in the ass. They involve extensive chart audits.  Then surveys have to be sent to a bunch of patients. Then more and more have to be sent, since apparently people don’t like to fill out surveys. Then you have to come up with all these improvement plans. Then you get to send out even more surveys.
You get the point.  It took about 9 months for me to complete my module.  All of that work had to be done in my “free” time, of which I have approximately none.
Now that I have my 100 points I can register to take the certification exam in April, so I’ve started my studying. Part of me finds this to be just another tiresome chore to do during an already busy day, but another part (the NERD part) finds it to be oddly comforting. Taking out the highlighters, making a study schedule… it’s like slipping on a well-worn pair of pajamas and slippers. 
I know. I’m nuts…but it got me this far!
Alex, Matthew, motherhood

May the Force be with you!

It’s a happy day in the Nicholas household. My kids are finally moving out of their Cars phase and into the Star Wars phase. Apparently, this is a required phase of life for all American males. They boys watched Stars Wars for the first time a few weeks ago. The obsession now has a stronghold on my family.
They are being aided and abetted by Patrick, who is only too happy to support the Star Wars habit. As a matter of fact, he saved all of his old 70’s and 80’s toys in anticipation of this very day. They are all now living in the basement.
Yes, that’s a real, live, complete Ewok Village that you see down at the bottom. Of course, some of those toys from the 70’s can’t compete with 2012 technology. Check out these lightsabers!
As you can see, they are fun for both the under- 6 and over- 40 crowd.  Admit it.  All of you.  You would have LOVED those lightsabers as a kid. Anyway, this Star Wars phase has led to me saying a whole lot of sentences that I never thought would come out of my mouth. For example, “No using the Choke Force at the table!” and “Your brother is NOT a Tauntaun!”
So, anyone in the market for about 50 Lightning McQueen cars?  

My New Kitchen Table- Another Woodworking Project

This will probably be the last project for a while.  It’s getting colder out and the garage isn’t heated…
I also have to re-certify for my internal medicine boards this spring.  Time to hit the books!
I hated our old kitchen table.  And by old, I mean old.  It was left in the house by the previous owners.  It was really wobbly. Its chairs kept breaking, and we were down to two.  Here it is:
Hmmm.  That’s an old picture.  I don’t typically have a cat walking on my table.  Especially that cat.  He died last year.  Anyway, when we took the table to the dump, we saw that the previous owners had nailed plywood to the bottom of the table to hold it together.  Apparently, at some point, I had also shimmed it with my business cards (I KNEW they’d come in handy!!!).  Clearly, the table was on its way out.
I wanted a large table.  I also wanted benches for two reasons: 
1) When not in use, we could slide them out of the way under the table so that there would be more free space, and 2) The table is near the garage entrance (the entrance that we use).  Jackets get slung over the backs of the chairs.  Bags get thrown on the seats of the chairs.  Before long, they are so covered in crap that they look like a big mound of junk.
Soooo, here we go!  My new Farmhouse Table with Matching “Nesting” Benches!
Plans again from Ana White.
I’m totally happy with how this came out.  I used kiln-dried pine.  The finish was 2 coats of Minwax Red Oak stain and 4 coats of polyurethane.  It’s really sturdy and I think it will stand up well to the abuse from the kids.  It’s also incredibly heavy.  Really, really heavy. If you make this, don’t drop it on your foot.
So that’s it for now.  Like I said, this is the last project, at least until after I take the boards!  Oh, by the way, I SWEAR that it’s just coincidence that the same bulb is blown out in the picture from a few years ago and the current pictures.  Really.  I swear, I’ve changed that bulb.  You believe me, right???