Baaaaa, I am a sheep.

I have so far avoided Mafia Wars, Dragon Wars, and other sundry Facebook games. I did do something called Lil Green Patch for a while, but I doubt that any money really went to save the rainforests, and some of the "plants" were decidedly creepy. But when the Incomparable Anne wrote up a post about Farmtown, it tweaked my interest. So I signed up and started farming. It is a slow-going (slow-growing?) game in which nobody gets shot or killed. It reminds me a lot of an earlier version of SimCity, especially the farm section.

I am planning to save up for more land and then a farmhouse. How bucolic of me...



The grapes are especially colorful, and the animals remain contained inside the fence, unlike at Nathan's farm. Anne (aka my own personal Dr. Herriot) had to come over once and help me revive the sheep, because they fainted or got paralyzed and aphasic or developed hoof-and-mouth disease. Thankfully, they were revivable and didn't need to be euthanized. And they now have a chicken and a pig to play with.

TheHusband is mistakenly under the opinion that he will get bacon, ham, fried chicken, and lamb chops out of the deal. If I could grow broccoli, I'd dedicate that field to him.

I do need a few more neighbors, because it's lonely out there, so come on over and play...

Far away and with strong legs

My brother is now in another time zone. On Wednesday, he crossed into Central Time and, by the end of that day, he had biked 1,084 miles! Last night, he was in Sebree, KY, and he should make it to Illinois today. Next is Missouri, Kansas, Colorado, Nevada, and then California. I hope he can find some time to stop and smell the roses.

If you want to read his travelblog, which is updated when he finds a signal, mosey on over and visit him at Handlebar Confessional. You can even read his description of the scary giant bug story here.

Why, yes, I really don't have anything useful to say today. How did you guess?

Neurology 101 -- Find the abnormality

At least it explains the back pain.

Hip-hop for Jesus

A very disturbing thing happened today. Actually, it didn't happen today -- it happened a couple of weeks ago, but I found out about it today. And I am disturbed. ThePinkThing takes a dance class offered by a sort-of local dance school at her after-school program. This dance school also did the ballet class at TPT's preschool last year, and she loved that class. Although it was a hip-hop class, we signed her up without reservations (after the school director said they didn't use "real" hip-hop music). TPT mentioned this morning that today was the "Parent Watch Day", so I emailed to one of the other moms to confirm. Apparently it was Parent Watch Day, but we hadn't been given the fliers.

What is so disturbing about a girls' hip-hop class (other than the music), you ask? Is NeuronDoc making a mountain out of a molehill again? Um, no, I'm not.

The other mom said that the current teacher may not have passed out the fliers because she was fired last week. Fired?!? I hadn't heard that. Well, she was sort of fired -- she would be finishing out the current session (one more class after today), but she will be leaving after that. Why was she "sort-of" fired? She was fired for proselytizing to elementary school-aged girls.

Apparently, it all began when she asked the class what they had done for Easter. When one of the older girls answered, "Nothing. We don't celebrate Easter, because we are Jewish," the teacher (according to that girl) looked a bit shocked. Shortly thereafter, the dance teacher brought in The Story of Jesus for Children DVDs for three of the girls. All three of these girls are Jewish. These DVDs weren't given to any of the other girls, including mine, who probably said (truthfully) that she spent Easter trading Easter baskets with her cousins. One of the girls (M) lost her DVD (how come all six year-old girls do that?), and was then given some sort of pamphlet or tract or booklet instead. This teacher also made several comments to the class about God and religion and Jesus. M's grandmother called up the dance school and spoke with one of the employees. The owner called M's grandmother back after speaking with the dance teacher. The dance teacher agreed that she had done it and was not apologetic about it. She apparently literally couldn't understand why M's grandmother was upset. So she was told that she would be let go at the end of the session, and another teacher would accompany her to her classes. I must admit that I didn't enjoy Parent Watch Day today, mostly because I couldn't stand looking at that teacher.

When I told TheHusband about this situation, he said it explains a conversation that he had with TPT a couple of weeks ago. During that conversation, TPT said that people can be strong. Strong? asked TheHusband. Yes, strong like Jesus, responded TPT. With raised eyebrows, TH asked who Jesus was. TPT's response was "You know, Jesus. He's magical, like Santa Claus." Oh. And the conversation was turned to choosing where to go for dinner.

This woman was handing out religious Christian items to elementary school-aged Jewish girls and saw nothing wrong in what she did. I am still amazed about that. What drives someone to think that this sort of behavior is okay, acceptable, and unworthy of an apology? Being a non-religious sort and having been brought up in a Jewish household (Jews don't proselytize), I suspect that I will and can never understand. And, to be honest, I don't want to. I just want my daughter not to be bothered by people with these types of agendas, at least until she is old enough to defend herself.

And (obviously) this incident makes me even more concerned about who is influencing my child when I am not around. She is the kind of kid who wants to please people, especially adults, and this type of situation may be extra tough for her, for me, and definitely for TheHusband, who might consider poking that teacher in the eye with a sharp stick. I'll just have to keep my eyes peeled and my ears to the ground. (sigh)

The Budding Artist

ThePinkThing thinks it is hilarious to sneak up behind me and scare me. Sometimes I pretend to be scared ("aaaah!") and sometimes she does manage to scare the pants off me ("AAAAAAAAAAAAAH!"). This not infrequent interaction between me and ThePinkThing has been immortalized in her Mother's Day worksheet:


"boo"
"a"

She even got the recliner chair totally right!

I LOVE this picture!

An Easy Fix

Sometimes, my non-doctor coworkers have medical issues and questions. Just like my friends, they never seem to have neurological problems. No, they have gynecological, gastroenterological, colorectal, or otolaryngological issues, amongst others. Lat week, one of my young non-doctor coworkers came up to my office with a question:

Coworker: Do you have any vitamins?
NeuronDoc: No. Why?
CW: I don't feel too good, so I thought I could take a multi-vitamin.
ND (doctor mode engaged): What's wrong?
CW: I just don't feel great.
ND: Well, a vitamin isn't going to fix that. What exactly isn't feeling good?
CW: Well, I passed out this morning while brushing my teeth.
ND (thinking vitamins definitely won't fix that): That's not good. Could you be dehydrated?
CW (who is in her 20's, might weigh all of 100 lbs soaking wet, and probably walks around with a resting blood pressure of 80/60): Yeah, I think am a bit dehydrated.
ND: Are you dizzy or lightheaded? You don't feel like you're going to pass out now, do you?
CW: No. But I just don't feel right in my head.
ND (not touching that straight line with a 10 foot pole, however tempting it might be): Here's what I think you should do... Drink 16 ounces of water and eat a bag of potato chips.
CW (looks very surprised): Potato chips?
ND: Yes, for the salt. You may be drinking a reasonable amount of water, but I suspect that you are low in salts. The salts will help the fluids stay in the blood vessels and increase the blood pressure and improve the perfusion of your brain.
CW: You're a doctor, and you're telling me to eat potato chips?
ND: Yup. Tastier than salt tablets.
CW: There are some Jalapeño Cheetos in the vending machine downstairs.
ND (Jalapeño Cheetos? Yikes!): That'll work. I hope they are the crunchy kind. Puffed Cheetos are gross...

A couple of hours later, I see the coworker in the hall...

ND: How are you feeling?
CW: Totally fine. A bag of Cheetos cures everything.
ND: Well, that was an easy fix!

Thanks to my coworker, I have a new motto: "A bag of Cheetos cures everything".

Scary! (updated)

Spoke to my brother tonight. He's made it to Kentucky!


All under the power of his own legs (and the wheels of his bicycle). He didn't have cell access the past couple of days, so this is our first conversation since Monday.

He is camping in Hindman Kentucky, on the grounds of someone's house or the local Historical Society, or perhaps both; I'm not sure. The person whose house it is has lots of cats, and a couple of times during our conversation, I heard my brother tell the cats to "Be quiet out there." Then he says "What is that?" Like I would have a clue what that is... A lynx? A panther? A Bengal tiger? Then he must have looked out of his tent, because he said "Eeeuuw!" rather loudly. When I asked what it was that had been plaguing him, he said it was a large bug. Which was clearly attracted to the light of his cell phone inside the tent. A bug. I'm in Maryland worrying about my brother in Kentucky being eaten by a bug? Humph. Then I heard lots of zipping sounds as he was shoring up the defenses and barricading himself against the giant bug. Hmmm. Maybe he has accidentally gotten onto the set of "Praying Mantis from Outer Space" -- where a giant praying mantis attacks a small town in Kentucky, wreaking tons of havoc and eating up innocent people. No? Probably not.

Anyway... He has ridden from Bethesda, MD to Hindman, KY in 11 days.

Day 1 -- Occoquan, VA
Day 2 -- Fredericksburg, VA
Day 3 -- Powhatan, VA
Day 4 -- Charlottesville, VA
Day 5 -- Lexington, VA
Day 6 -- Catawba, VA
Day 7 -- Blacksburg, VA
Day 8 -- Blacksburg, VA (rest day)
Day 9 -- Sugar Grove, VA
Day 10 -- Council, VA
Day 11 -- Hindman, KY

Unfortunately, I don't have his mileage, but he will be emailing me some pictures tomorrow or the next day, so I can update his blog.
_____________________
updated Mon, 5/25, 10:15 am

It has been pointed out to me that I was being unkind in this post. Please understand that I am not dissing my brother. I am a total scaredy cat and can't imagine camping out alone in a tent. I would probably expire of fear. Plus, I don't see the point of sleeping anywhere where there isn't a bed...

Other people think Jenny McCarthy is a moron, too!

I am not the only one! Actually, I knew that, but this post cried out for some hyperbole. Y'all know my feelings about Jenny McCarthy -- I think I've been obvious enough, right? Well, the amazingly erudite, incredibly intelligent, and wonderfully wordy docs over at Science-Based Medicine spend a lot of their energy dealing with Jenny McCarthy and her anti-vaxxer friends. Dr. Jones (not Indiana Jones, you idiot!) published a brilliant post dissecting and repudiating Jenny McCarthy's new video. She also does a great job outlining general concerns about this pervasive, under-the-radar, anti-science attitude which seems to be chic in the upper middle class SAHM set. This video contains the most appalling anti-science "information", really misinformation. Remember, it all spews out of the mouth of a former Playboy model and "actress", who styles herself as more knowledgeable about this issue than doctors.

I will not foam at the mouth today, but I did have to wash my eyes out with bleach after I watched the video. And yes, I did watch the whole thing.

I am Borg; resistance is futile

I like sushi, as I have already mentioned. I also am happy when people I like also like sushi. And if given a chance, I will assimilate you into sushi-hood. One of my coworkers, TM, an adventurous sort, has had sushi only once. He had the misfortune to go to a local restaurant and eat at their buffet. The food at that restaurant is okay at best, and their buffet isn't "best". So another coworker (TK) and I decided to expose him to better sushi, in hopes that he would be assimilated into the ranks of sushi-eaters.

Today was the day. All three of us were in a meeting just before lunch. The meeting was dragging on and getting seriously boring. TK mouthed I'm hungry from across the room, and I pretended to eat my pen in reply. Eventually (for the sake of my sanity and my stomach), the meeting ended and we set out. I hadn't eaten at this place, but TK is a regular there. Their selection looked good, and they had some cool, creative rolls to choose from.

TM seemed a bit unnerved, although that is not likely -- he is so not the nervous type. TK and I asked questions, since he allowed us to order for him. While there was the lure of ordering sweet shrimp (which comes with eyes attached [I don't eat things that are looking at me]) or ikura (big fat salmon eggs which are salty and fishy), the point of this exercise was assimilation, not revulsion. So TK and I ordered standard fare (nigiri salmon, tuna, white tuna, yellowtail, and eel). We also got a few crazy rolls. All of the food was good, and the salmon was excellent. TM liked it.

He's been assimilated (second coworker in as many months!)... Bwahaha.

Mumbly Earworm

I am tone deaf. People who know me well ask me not to sing. However, that doesn't prevent songs from getting stuck in my head, and neither does not knowing the lyrics either. My brain just fills in the missing words with "blah" and "something" and Hmm", etc.

Unfortunately, it seems ThePinkThing has inherited my (lack-of) voice (the poor thing). But she likes to sing, and she sings with enthusiasm. And right now it's cute. Anyway, I am not the one to answer any type of musical question. Yesterday morning, while putting her snack in one of the pockets of TPT's backpack, I noticed a note from her kindergarten teacher. It asked TPT to provide a song or title of a song to get the class energized for a big reading test. Here is our conversation on this topic:

Neurondoc: What is this about you bringing in a song?
ThePinkThing: Mrs. S. says I am supposed to bring in a song for the reading test.
ND (to whom this whole thing is completely new, including the reading test): When is the reading test?
TPT: I don't know.
ND: You don't know? Is it today?
TPT: Maybe.
ND: Well, we better get a song for you then.
TPT: What song should I bring?
ND: I don't know. (wracking brain) How about "Twinkle Twinkle Little Star"?
TPT (said in tones of disgust): Mommy, that's for babies.
ND: Oh. Um, how about "Old MacDonald" then?
TPT (now annoyed): NO!
ND: Then you pick a song.
TPT (after some cogitation): How about "The Macarena"?
ND (thinking: aaargh, I hate that song, now it'll be stuck in my head): Fine. Here, you write it out on the paper and don't forget to tell Mrs. S. about it.

As I said, I hate that song. It is one of those songs that I don't know the lyrics to, but it gets stuck in my head anyway. Endlessly. Then it leaves, but comes back again at any opportunity. "Macaroni" you say. My brain translates that into "The Macarena". Aaargh. (I'll have you know it's still in there from yesterday morning because of the above conversation.) And, of course, TPT loves that song and can perform the whole dance routine while (sort of) singing it.

I tried telling this story to some coworkers in the vain hope that the earworm will leave me and go to them. It didn't work. I am hoping that at least it got stuck in the kindergarten teacher's head, because it's all her fault it's in mine.

Maybe I've given it to you and it will get out of my head. And don't you dare offer me macaroni for dinner...

Sleepover Success (updated)

I had meant to post this yesterday, but instead I posted about the Crazy Driver™.

ThePinkThing had her first sleepover at a friend’s house this past weekend. It was at her best friend N’s house. They have been friends since they were “little” -- before they were 4, and TPT is now 6 (actually 6¼, as I am told). TPT refers to N as her BFF (which I find cute).

I wasn’t worried at all about letting her sleep over at N's house. N’s parents are wonderful, caring people, and N is a nice little girl. TPT is well-behaved and not a troublesome kid. But she eats poorly when she is not in her usual element, such as on vacation or at parties. I warned N’s mom (C) that this might happen. The following is the email exchange between C and me yesterday:

ND: The sleepover was a success, as per [TPT]. Thanks so much for hosting (hostessing?) her. She is now looking forward to the next sleepover with N, especially since I said that the girls can both sleep in the big bed in the guest room. She was wiped out, though. When she got in the house, she started an art project in the dining room. When I came up about 30 minutes later, she was sacked out on the couch, drooling onto the pillow. She slept for about 2 hours and was hard to wake up even then.

C: I think it went really well, although apparently all the food we serve at our house is totally disgusting! :-) …They didn’t get to bed until after 9:00. They woke up Sun before 6am (!) and played until it was time to skate. Everybody was wiped out yesterday afternoon—including me!

ND: Did she actually say "disgusting"? If so, then we will be having a discussion on manners. Unfortunately her palate is fairly narrow (like her father's). She likes what she likes and not much else (although that is fairly typical of kids in general). She ate a snack (ice cream and chicken wings!) and a big dinner to make up for it.

C: No, don’t worry about it. My girls started it by saying EWWWWW as soon as I put the plates down. I need to talk to them about manners even to their old Mom! It was baked ziti—noodles, sauce, ground beef, and cheese. I guess my mistake was in mixing the ingredients because they like all of these things in other forms. [TPT] was also suspicious of the cranberry muffins (from a mix) the next morning and wouldn’t eat a bite. She survived on a bowl of cheerios. But you had warned me that this might happen, so I didn’t press.

I have to admit that I find the image of TPT being “suspicious” of cranberry muffins to be hilarious. And TheHusband and I got to eat dinner at a "grown-up" restaurant and see Star Trek. A success all around!
____________________________
updated on 5/21 at 10:19 pm

Here are some pictures of the girls at the sleepover...


After the sleepover, TPT wants a sister even more!

Crazy drivers! (updated)

While I was driving to work this morning, I had an uncomfortable experience. Mine is a "reverse-commute" in that the majority of the traffic is going towards DC, while I head away in the morning, and vice versa in the evenings. So, unlike many of my local compatriots, I actually drive at highway speeds on the highway.

This morning, I moved into the right hand lane about 1.5 miles before my exit into the local lanes. The entrance for the previous exit is about 1 mile before my exit. A silver Honda Odyssey (the quintessential Mommy van) wanted to get onto the highway from that exit into the exact spot where I was. She apparently was coming up at speed and was expecting me to slow down to let her in. The only problem with that scenario was that she was in the entrance lane in my passenger-side blind spot. I literally had no idea she was there. So she stomped on her brakes (which was when I first noticed her) and zipped in behind me.

Big deal, you think. Why are you complaining about this?

Well, she then proceeded to flash her brights at me and beep her horn, which did not make me move out her way, mind you. My exit from the main lines into the local lanes was coming up rapidly, and I got off there. Mommy Van got off right behind me and then tried to cut me off. WTF? Not wanting to get into some sort of vehicular fight with a raving Mommy Van at 8:40 am, I put myself directly behind a big lawn service truck and stuck there. Mommy Van then got in behind me, got off with me at my exit, and turned onto the local street, right behind me. Again, WTF? My office building is basically right off the highway, so I turned into the complex. Mommy Van followed. I really didn't like that, so I drove slowly around in the parking lot in a big circle (with her following me), while I wrote her license number on a piece of paper. I then slowed down even further (with her still following me) and held up the paper (and my cell phone) so she could see it. She got the point and drove off.

I still say, "WTF?"
_________________________
Update 5/19, 1 pm

I had another WTF-driving incident this morning. TPT got on the bus, but I chatted briefly with one of the other mom's at the bus stop. Annoyingly, I then met up with the bus two stops later. The bus has its red lights flashing and stop sign out on the corner of "G" and "H" Street (it is on "H" St) . I dutifully stop, although I am actually on "G" St. A big Mommy Truck pulls up behind me and obviously objected to my stopping. She beeped once, but when I didn't go, she zoomed around me with tires squealing. When I caught up to her at the stop light, she gave me the Hairy Eyeball™. WTF?

Was I wrong? Am I not supposed to stop in that situation? And anyway, it takes all of 2 minutes to load the kids, and then you're on your way. Maybe I am just a Crazy Driver™ magnet. If so, then I will have to demagnetize myself...

Jenny McCarthy = RABIES

I saw two cases of Subacute Sclerosing Panencephalitis, the worst sequela of measles, when I was in medical school. I won't forget either the disease or the two patients who suffered and died of it. I believe strongly in vaccination for the prevention of diseases that are otherwise untreatable and devastating. And the whole anti-vaccination movement literally makes me foam at the mouth ("Neurondoc, do you have rabies?").

I now have a new hero: The Amateur Scientist. I have a total and unabiding hatred of the crap that Jenny McCarthy spews in her quest to rid the world of vaccinations, all because she believes the disproven (time and again) theory that vaccines (or mercury or thimerasol or too many vaccines in too short a time or ...) cause autism. Because of the anti-vaccination movement, people are dying, formerly sporadic diseases are becoming endemic, and we may be losing our herd immunity. So here is a musical thanks to Jenny from her friends Measles, Mumps and Rubella...



H/T to Janiece, my current girl crush
_____________________________________________
update 5/16, 5:20 pm

See it's true!

Which Horrible Affliction are you?
A Rum and Monkey disease.

Cat Blogging Friday

Our cats have an obsession with the "boiler room" -- the room with the furnace and hot water heater. They always want to go in there. Any time of the day or night. Here you see Ajax trying to get in there.

I took pity on him and opened the door.

He was in there for about 5 minutes and then came out all pleased with himself.

This post will definitely get me smacked

One of my good friends is visiting for the next couple of days. He is the husband of my evil twin (or I am the evil twin, I forget), who is my best friend. If you have a best friend, you know that it is extra specially great when your best friend really likes something that you like a lot. Well, I like sushi. It is one of my happy foods. ThePinkThing likes it a lot, too, while TheHusband likes it well enough. My best friend had never eaten sushi before I dragged her to my formerly favorite sushi restaurant in Bethesda (it has since closed). "Try this" (eel), I said. "It tastes like chicken, but better!" She did. "And try this (salmon), too. It tastes sort of like lox, but yummier." Etc. I got her hooked. And in the last 11 years of our friendship, since she has been eating sushi, she has lived in Germany, Belgrade, Bucharest, Yerevan, and now again in Germany (small town in the middle of the country). So sushi is not readily available. Or good, if available at all. But I ate sushi with her stand-in (aka, the ersatz-Claudia) tonight. We shared nicely.

And to top it off, the husbands stopped off at the grocery store and brought back four (4!) freaking pints of Ben and Jerry's. Four different kinds of B&J ice cream that I like. You wouldn't expect me to restrain myself, would you? No? You're right. So I had some ice cream for dessert.

Sushi and Ben & Jerry's with her husband. Claudia will smack me the next time I see her, even if we are on the way to a sushi restaurant... And it will have been worth it. And she is still my best friend.

This new fangled technology

An elderly German man got pissed at his neighbors for playing the same music over and over again. They kept doing it at odd hours and any time of the day or night. Finally, he reported the neighbors to the local police. When the police came to investigate, they found the cause in the man's own home. It was one of those musical greeting cards, which was sitting on his windowsill. Apparently, the sporadic winds would jiggle it, and it would start to play.

I hate those cards, but, of course, ThePinkThing loves them.

H/T to The Washington Post

So long, be careful...

My brother left my house at 10:05 am (EDT) en route to Los Angeles, by way of the rest of the country.

Best of luck, Brother, and have fun!

(And he'll probably be a slight bit annoyed that I posted this before he did. Tough poopies!)

It really is true...

...that if your sinuses are filled with snot, it eats away at your brain cells. Trust me here.

If you remember, I was sick at the end of last week and missed work on Thursday and Friday. This morning I got up (sort of grudgingly, because I didn't get to sleep until about 2 am), did all my usual morning stuff, got ThePinkThing off to school, said goodbye to my brother who will be setting off on his journey this morning, and came to work. When I finally checked my calendar to see what was planned for this morning, I realized that I had scheduled the day off. I had totally forgotten that I took today off to see my brother off. But since I was already at work, I decided to stay. How totally annoying. Maybe I'll leave early...
______________________
update 5/11, 1:35 pm

Yes, I will be leaving early today. My brother will be starting tomorrow due to being underslept. He went to bed about the same time I did last night...

A journey of epic proportions

My brother flew in on Friday from LA, which is always an event in my household. ThePinkThing adores her Uncle Danny and would be happy to throw over her parents to move in with him. Every day for the week prior to his arrival, we counted down the days ("4 days until Uncle Danny...").

I picked him up at Dulles Airport, even though I felt as if I had been run over by a large camper. Thankfully, not only was his flight on time, but his luggage arrived. The cell phone lot at Dulles airport is a godsend -- I just sat in my car reading a book (and blowing my nose) until he called me say he was ready. It took me all of 5 minutes to get to the terminal from the lot. We came home to my house, and I tried to nap, but it just wasn't in the cards.

Then we got a call from TheHusband and had to deal with a bike-problem. Bike problem, you ask? Yup, a bike problem. You see, last week my brother shipped his bike here from LA, because he is bicycling back home. Yes, he will be bicycling across the country, beginning at my house, and ending (hopefully) at his.

I am amazed and awed, and (of course) a little nervous, as any older sister should be. I even bought him a useful gadget for the trip -- a solar powered phone charger, which will allow him to more easily remain in contact with the family. He has promised to text me his location fairly frequently (every day?), and I may post maps of his progress on his blog. TheHusband I promised him that he can call on us for anything (hospital, broken bike, jail, etc) east of the Mississippi. His partner is responsible for any problem west of the Mississippi. I may even fly out to Somewhere, Kansas to meet up with him, providing he can give me enough notice and we can plan appropriately around a rest day.

I can't wait to hear all the stories and see his pictures. And I am proud of him.

If you wish to follow his journey, you can find it at Handlebar Confessional...

Silver lining?

So my cold is better, the family reunion was really fun, and we are staying at my aunt and uncle's house. But now I have a migraine. Bam... bam... bam... goes my right temple. Jim, is this the migraine you kicked out of your house last week? If so, send it somewhere else next time.

All of your good wishes have been great. Now if only the damn migraine will go away...

Whininess, personified

[whine] So I am still sick. Which I find highly annoying and offensive. After all, I have plans this weekend, and the copious amounts of snot that I am producing is not making it very likely that I will be able to participate in these plans. Which, as I said already, I find highly annoying and offensive. We have a family get-together planned for tomorrow afternoon, which has been in the works for like 6 months. And now is when I have to get sick?

We were supposed to collect TheBrother at the airport and drive up to NJ tonight, but there is no way that I could sit in a car for 4 hours. So we are planning to go tomorrow morning at the crack of freaking dawn (8 am) to make it in time for the par-tay. But the way I am feeling right now, I may be sending TheBrother, TheHusband, and ThePinkThing, and I will be stuck here wallowing in my own sinuses, all by myself. And, shockingly, nobody wants us to stay over at their house, so TH, TPT, and will have to get a hotel (if I go at all). [/whine]

And how are you?

Kitty fun

A pseudo LOLcat...

I told you so...

I am home sick today with upper respiratory symptoms, a fever, and a general feeling of crappiness. I told you that I was going to get the Swine Flu, and now I have. I know I got it from the guy two rows up and one over on the plane -- he was coughing the whole time...

What? You don't believe me? You're just telling me to go back to bed, take my decongestants and ibuprofen and I'll feel better? What kind of doctor are you, anyway?

I think I will send TheHusband out to get some OJ, chicken soup, and jello.

Neurology 101 -- Stroke

Acute ischemic stroke has been called a "brain attack" and is one of the leading causes of morbidity (illness) and mortality (death) in the US. I am not talking about hemorrhagic or bloody strokes. I am talking about what happens to the brain when the local blood supply is cut off. Before I talk epidemiology or clinical presentation, I will start off with pathogenesis of stroke -- why it happens at the cellular and tissue level.

Pathogenesis and Pathology of Acute Ischemic Stroke: The process leading from the development of atherosclerosis (deposition of cholesterol and other nasty crap in the arteries) to the occurrence of acute ischemic (non-bloody/non-hemorrhagic) stroke and consequent cell damage is complicated, and many of the intermediary steps are not completely understood. Ischemic stroke is primarily caused by atherosclerosis in large arteries (e.g., carotid, middle cerebral, and basilar arteries) or small arteries (eg, lenticulostriate, basilar penetrating, and medullary arteries), or it may be caused by a thrombus or clot that comes from the left side of the heart and zips up into the cerebral vasculature (cardioembolic). Atherogenesis is the process in which the inside of a blood vessel becomes narrowed by deposition of choleterol, fat, cells, and thrombus material, ultimately to the point of obstruction.

The earliest atherosclerotic lesion is the fatty streak, which was seen in a large autopsy study of coronary arteries and aortas in patients who died between infancy and age 29. (Stary 1989) In this study, approximately 65% of children ages 12 to 14 years had these lesions. Fatty streaks are visible to the eye as areas of yellowish discoloration of the surface of the intimal (inside) layer of the vessel wall. Under the microscope, the lesions primarily consist of lipid-filled macrophages (foam cells). Macrophages are white blood cells that enter into tissue and ingest foreign material. In this study, 8% of children in late childhood or early adolescence had already developed more advanced, focal lesions. These lesions, which occur almost entirely in branch points of the arterial vessels, are characterized by the addition of massive extra-cellular lipids that displaced normal cells and matrix.

By the time people are in their 20’s, some atheromatous lesions have evolved into complex fibrous plaques, which consist of a central acellular area of lipid covered by a cap of smooth muscle cells and collagen. Deposition of platelets and fibrin on the surface appears to be the result of injury to the lining cells of the vessel wall (endothelial injury) and clot-dependent fibrotic organization occurs. Over time, these early atherosclerotic lesions progress to clinically relevant and advanced atherosclerosis; risk factors play a role in the development of these more advanced lesions.

The progression of early atherosclerotic lesions to clinically advanced atherosclerotic lesions occurs with increased frequency in persons with risk factors for atherosclerotic disease (e.g., high blood pressure, high cholesterol, tobacco use). Atherosclerosis is considered to be a response to chronic minimal injury to the endothelial lining of the arterial wall. Interactions among white blood cells (monocytes, platelets, lymphocytes), lipoproteins and smooth muscle cells contribute to and maintain the pathogenic process. Note that monocytes are the circulating blood version of macrophages (in this case, blood cells that eat foreign stuff). Adhesion of circulating monocytes to the internal vessel wall is an early event in the development of atherosclerosis. After adhesion, the monocytes infiltrate between the endothelial cells and enter the subendothelial space and are transformed into lipid-filled macrophages called foam cells.

The proliferation of smooth muscle cells into the intima and over the layer of foam cells then occurs. Normally, smooth muscle arterial cells are present in the media (middle layer) rather than the intima, and it is the thickening of this layer that makes up a significant amount of the atherosclerotic lesion. Another important step in the formation of a clinically significant atherosclerotic lesion is platelet aggregation and thrombus formation. Platelets are the white blood celss that are responsible for blood clotting. Platelet aggregation is an importnat component of the blood clotting cascade and in the case of atheromatous lesions is thought to occur because of toxins released by macrophages and the ongoing intimal damage. Platelets bind to these areas and release growth factors that further stimulate proliferation of smooth muscle and possibly the formation of the outside capsule of these lesions.

Repetitive arterial wall injury of this type with thrombus formation is the major mechanism of atherosclerosis. Once blood supply within a vessel has been compromised, damage begins to occur within the neurons and support cells supplied by that artery. The membrane that surrounds the neuron is damaged and becomes leaky, thus allowing for influx of sodium, chloride, water and eventually calcium. Potassium flows out of the cell. Lactic acid and hydrogen further injure the cell, leading eventually to irreversible cellular injury and cell death.

Not all cells in the region affected by the impaired blood supply die. There are two major zones of injury in the affected regions: the core area of ischemia and the ischemic penumbra. It is within the core area of ischemia that the blood flow is the most impaired (below 25%) and it is here that severe ischemia leads to cell death. However, the penumbra is typically a rim of injured but not dead brain tissue outside of the core ischemic zone. This area is supplied by collateral blood vessels and may remain viable for several hours. However, the collateral circulation is typically unable to supply enough oxygen and nutrients to the injured brain tissue; therefore, unless reperfusion is established these cells eventually die, as well. It is the area of the penumbra that is the primary focus of treatment of acute ischemic strokes. So now you know something about how the cerebral blood vessels become damaged. Now let's talk about what happens to the person.

Clinical Aspects of Stroke: Stroke is the clinical term for a loss of brain function due to a disturbance in the blood supply in a particular region of the brain. Stroke is subdivided into two types: ischemic (in which the blood supply is interrupted) or hemorrhagic (in which a blood vessel ruptures). The WHO in the 1970s defined stroke as a "neurological deficit of cerebrovascular cause that persists beyond 24 hours or is interrupted by death within 24 hours" in order to differentiate permanent damage from a transient or reversible deficit caused by a transient ischemic attack (TIA). The time frame of 24 hours was chosen somewhat arbitrarily. There are many well-defined risk factors for stroke and include age > 55, hypertension, prior stroke or TIA, diabetes, hyperlipidemia, cigarette smoking, atrial fibrillation, and migraine with aura.

Signs and symptoms of stroke are dependent on the area of the brain involved. The area of the brain involved in stroke is dependent on the particular blood vessels affected and the type of stroke that occurred (ischemic vs. hemorrhagic). An ischemic stroke involving the anterior circulation (the area of interest in this submission) may result in a variety of neurological deficits. Left (dominant) hemisphere major or branch cortical infarction may lead to the following impairments: aphasia, right hemiparesis (paralysis), right-sided sensory loss, right-sided spatial neglect, right homonymous hemianopia (right half of the visual field is lost), and/or impaired right conjugate gaze. Right (nondominant) hemisphere major or branch cortical infarction may lead to the following impairments: left hemiparesis, left-sided sensory loss, left-sided spatial neglect, left homonymous hemianopia, and/or impaired left conjugate gaze.

Stroke is diagnosed via history, physical and neurological examination, and neuroimaging; it is most commonly diagnosed in an emergency room setting. It is highly important to differentiate between ischemic and hemorrhagic stroke as the management of these conditions is very different. A recent study comparing the effectiveness of MRI and CT for the diagnosis of acute stroke in a suburban hospital found MRI to be more effective in identifying acute stroke of all types.

Treatment of Acute Ischemic Stroke: Approved treatment for acute ischemic stroke is limited to a single therapy – intravenous recombinant tissue plasminogen activator, or IV-rtPA. Thrombectomy via the clot retrieval devices can be used in the setting acute ischemic stroke, these devices have not been approved or cleared for the treatment of stroke. The significant limiting factor for both of these treatments is the time from known onset to presentation to the ER. IV-rtPA must be administered within 3 hours of onset of stroke symptoms and the neurothrombectomy must occur within 8 hours. Only preventative and rehabilitative therapies exist beyond these two therapeutic options.

Epidemiology of Stroke (primarily from the Heart Disease and Stroke Statistics—2008 Update: A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee): Stroke is one of the most common disorders affecting the American population. The incidence of new or recurrent strokes among Americans is about 700,000, and 87% of these are ischemic strokes. About 500,000 of these are new strokes, and 200,000 are recurrent attacks. At younger ages, the stroke incidence rates in men are greater than in women but not at older ages. The male/female incidence was 1.25 in those 55 to 64 years of age, 1.50 in people 65 to 74 years of age, 1.07 in those 75 to 84 years of age, and 0.76 in those 85 years or greater. African-Americans are at a greater risk of stroke than whites. The age-adjusted stroke incidence rates in those 45 to 84 years of age are 6.6 per 1000 population in black males, 3.6 in white males, 4.9 in black females, and 2.3 in white females. Prevalence of stroke varies according to race: in 2005 it was 2.5% among whites, 3.2% among African-Americans, 2.4% among Asians and 5.1% among Native Americans.

Mortality due to stroke is an important consideration. Stroke accounted for about 1 of every 16 deaths in the United States in 2004. About 50% of stroke deaths in 2003 occurred out of hospital. Stroke total-mention mortality in 2002 was about 273,000 and ranks 3rd among all causes of death (behind heart disease and cancer). According to the ARIC study (NHLBI), 8 to 12% of ischemic strokes and 37 to 38% of hemorrhagic strokes result in death within 30 days, among people between the ages of 45 and 64, although the total rates are probably higher than these. An epidemiological study of stroke in Europe revealed an overall mortality rate (hemorrhagic and ischemic stroke) of 20% at 28 days. (Bejot 2007) A study of patients aged 65 recruited from a random sample of HCFA Medicare Part B eligibility lists showed that the 1-month case fatality was 12.6% for all strokes (8.1% ischemic and 44.6% hemorrhagic). The 2004 overall death rate for stroke was 50.0 (48.1 for white males, 73.9 for black males, 47.4 for white females, and 64.9 for black females). In 2002, the mean age at stroke death was 79.6 years. Males had a younger mean age at stroke death than females, and blacks, American Indians, and Asians had younger mean ages at death than whites.

Stroke is a leading cause of serious, long-term disability in the United States according to a survey of the US Bureau of the Census. In 1999, more than 1,100,000 American adults had some level limitations in function and/or activities of daily living, resulting from stroke. The length of time to recover from a stroke depends on its severity. 50% to 70% of stroke survivors regain functional independence; however, 15% to 30% are permanently disabled, and 20% require institutional care at 3 months after onset. In a study of ischemic stroke survivors who were at least 65 years of age, these disabilities were observed 6 months post-stroke:

• 50% had some hemiparesis;
• 30% were unable to walk without some assistance;
  
• 26% were dependent in activities of daily living;
  
• 19% had aphasia (inability or difficulty in expressing or comprehending language);

More tomorrow, maybe...

Seattle and Whistler

So here are some pics from my recent sojourn to the Left Coast. I got to meet Jeri in Real Life (which was fab), and I have proof. She called me tiny (for which I will forever love her)!

I might be short, but I ain't tiny! :-)

This was the sunset (yes, a sunset in Seattle!) taken from the dock outside the restaurant where Jeri and I ate dinner the first time. She ate oysters. I didn't.

It only rained once the whole time I was there.

These photos were taken in Whistler Village, BC. Instead of doing the touristy thing in Vancouver, we decided to drive to Whistler, because it is a nice drive, and TheHusband likes to drive. I even managed to stay awake almost the whole time, which is unusual for me. The skiing and sliding events in the 2010 Winter Olympics will take place at Whistler. It will be odd to see these places on TV with tons more people...

Notice the difference in behavior. I am normal. He is not. :-P


Here I am looking surprisingly pleasant waiting to cross the border back into the States. It took about 3 minutes to cross into Canada on Wed afternoon and over an hour to cross back around noon on Fri. However, the overhead sign had said 90 minutes, so we felt like we had lucked out.


Yes, it really happened. I went to the top of the Space Needle in Seattle and neither fainted nor puked from fear. Those of you who know me well, know that I have acrophobia -- I am afraid of heights. I understand rationally that the building (walkway, bridge, dam, etc) will not fall down (crash to the earth, break suddenly into pieces) with me on it. Yes, the rational part of my brain understands this perfectly well. However, my hindbrain takes over, and I hyperventilate. And get freaked. But I knew TheHusband would love eating in the sky. So I went (I kept my eyes shut as we were going up in the elevator). And Jeri will attest that I behaved in a quite mannerly fashion. No fainting, puking, or freaking out. I just sat the furthest away from the window and pretended that we were 3 feet off the ground. And it helped that the food was excellent.


Mt. Ranier was really impressive. I want to go visit it someday. They just don't have brooding mountains like that in the DC area....

Home now

We arrived home last night in one piece, with all of our luggage. In fact, our suitcases were the 7th and 9th bags onto the baggage claim belt, and the bus to the parking lot arrived just as we were walking up to the bus stop. We made it from airplane door to car door to front door in 1.5 hours, which is a record.

ThePinkThing was waiting for us and totally excited, jumping all around. You can't beat that kind of greeting. It took her about 60 seconds before she asked what presents we had brought. :-)

I am finally wearing clean clothes (yay!). The packing cube was sitting on my dresser when I looked last night.

However, now I have to figure out what my MiL did to our TV (we only have the one TV). There is sound but no picture. And my new coffee maker is broken. (sigh)

Welcome home.
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Update 5/3, 9:06 PM

Looks like it was a power spike that fried the TV sometime after my MiL last used it on Friday night. I guess that it isn't her fault. An LG technician will be coming out sometime this week to look at it. However, we went out today and bought a new TV for the basement. We had planned to buy one in a couple of weeks anyway (when we finally have a free weekend), so we just pushed up the timetable a little. Next up is a treadmill to go along with the TV (fry my brain while doing useful exercise)...

Travel

Tonight is my last night on the Left Coast. I am ready to get home. I had a great time. I learned a whole bunch of stuff at the AAN annual meeting that I will be able to apply to my work on a daily basis. I got to meet up with some colleagues who I hadn't seen in years. I even avoided one successfully. I got to visit a really cool city in a state in which I had never been. I did my best to stimulate the local economy by buying a bunch of stuff at Pike Place Market, until TheHusband requested that I leave some stuff for other people. We even drove to Vancouver, because neither of us had ever been there...

One of the best parts was getting to hang out with Jeri in Real Life. Tonight, I even went up to the top of the Space Needle, where Jeri, her sons, TheHusband and I all ate dinner. Those of you who know me well will be shocked that I actually did it, and no, TheHusband did not drug me in order to get me to the top. I am seriously phobic about heights. There are pictures to prove it, which I will post once I return home.

All in all, a great trip. Now I have to get home without catching the swine flu.