Advanced civics

Since my last post about DC, I returned and managed to correctly identify the white house. I even took a photo of it (left).

I also hit up the botanical gardens, air & space museum, natural history museum, art museum, aquarium (ninja turtle, right), washington monument and climbed the rocks at Great Falls.

Not of historical note, I had the best tuna and salmon sashimi I've ever eaten (including in Japan) and went to a bar called "sign of the whale." Great name. I also spent a lovely evening eating chocolate chip cookies, drinking wine and watching Sideways. In that vein, I would like to note there are some perfectly good merlots.

Oh, and I saw the Dark Knight in IMAX. Phenomenal.

North, to Alaska!

Completing my North American tour (S: Mexico to N: Alaska, E: NY to W: California) was an active little jaunt through Alaska by boat. The best moment was climbing the Mendenhall glacier in Juneau, hands down, no questions. Yes, that's me to the left. We helicoptered up there (fantastic), trekked around and did a little climbing. We helicoptered back out just as the storms rolled in.

In Skagway we rode a gold rush era train up to the white pass summit and biked back down (cold!). In Icy Straight Point we drove ATVs up a mountain and ziplined back down (that's my brother and I in the photo) from an elevation of about 3000ft. In Ketchican we went salmon fishing, but somehow managed to catch two dogfish sharks. We let everything we caught go- for the karma.

Medical mysteries

Now that I've left one hospital and moved to another, I find myself reflecting on how many cases were left unsolved. Not untreated or unresolved, but without the foggiest clue as to an answer. The following are some examples:

1. Spinal inflammation. Patient presented with loss of propioreception in the feet, ankles and lower legs. CSF showed inflammatory markers. Treatment with high dose steroids provided mild, temporary relief. Five months later the inflammation is still present, though propioreception is now in tact at and above the ankles. High dose steroids, IVIg and plasmaphoresis had no effect.

2. Severe, sudden onset rhabdomyolysis with no concurrent trauma. Rhabdomyolysis is a rapid breakdown of skeletal muscle and is usually seen when there is a trauma. This patient had muscle breakdown products in her blood at levels usually seen only in crush injury (ie part of a building falls on you), but had done nothing more arduous than work out. Best guess... virus?

3. Adolescent onset of type 1 diabetes with concurrent peripheral neuropathy. Usually type 1 diabetes (the autoimmune, insulin dependent one) presents in childhood, so the age of presentation is unusual, but not unheard of. The concurrent peripheral neuropathy however, is rare enough that I was going to write the case up for a journal (but never got around to it). Neuropathy usually takes years of poorly managed diabetes to emerge.

4. An infant had a hemangioma on her sacral spine so an MRI was performed. The scan revealed several round growths in her spinal column. It was unclear whether they were also hemangiomas or if they were tumors. A spinal tap was inconclusive. It was decided to monitor the growths rather than attempt a biopsy at this point.

Boom-de-adda

I posted a couple of months ago about my "love of the whole world." Apparently, xkcd loves the whole world too. Boom-de-adda...

Straddling the Mississippi

The end of June found me down in New Orleans for a few days. Preservation Hall was probably my favorite experience - it's an old wooden room (no air conditioning) in the French Quarter where some old timers play jazz requests. Fantastic.

The strangest moment was definitely when we went inside the cathedral. First, the fire alarm went off. Shortly afterwards, a middle aged man with a cane started yelling at a man in the front pew who appeared to be praying. The middle aged man shouted "you won't speak to me in that manner, not in my cathedral" and waved his cane around. The other man just sat there. A third man approached, to mediate the situation. All three headed outside (we followed). A cop car pulled up and the cops arrested the man who had been sitting in the front pew and drove off with him.

There was no physical altercation and I can't think of anything a person can say that is egregious enough to warrant an arrest. It was all remarkably odd.

Another funny moment was when we ran under a roof overhang to hide from the sudden afternoon shower. Nearby there were several goslings and some grown swans and ducks. I guess the goslings didn't like the rain either because they came towards us. The parent geese were not so keen on that idea however, and we ended up fleeing from a large group of geese who were pooing/running/quacking at us.