Research Blogging Awards 2010

5 03 2010

Research Blogging Awards 2010It is now possible to vote for the winners of the 2010 Research Blogging Awards.

Yet another blog contest, I can hear you say.

Yes, another blog contest, but a very special one. It is a contest among outstanding bloggers who discuss peer-reviewed research.

There are over 1,000 blogs registered at ResearchBlogging.org., responsible for 9,500 posts about peer-reviewed journal articles.

By February 11, 2010, readers had made over 400 nominations. Then, according to researchblogging.org, “the expert panel of judges painstakingly assessed the nominees to select 5 to 10 finalists in each of 20 categories”.

The categories include:

  • Research Blog of the Year  with some excellent blogs like Neuroskeptic (RB page) and Science-Based Medicine (RB page)
  • Blog Post of the Year
  • Research Twitterer of the Year including David Bradley, Dr. Shock and Bora Zivkovic
  • Best New Blog (launched in 2009)
  • Best Expert-Level blog 
  • Best Lay-Level blog 
  • Funniest Blog 
  • Blogs in other languages, like German and Chinese
  • Blogs according to specialty like Biology, Health, Clinical Research, NeuroScience, Psychology etc

I was surprised and honored to note that Laika’s MedLiblog is finalist in the section Philosophy, Research, or Scholarship. Another librarian, Anne Welsh of First Person Narrative is also finalist in this section.

  1. First Person Narrative (RB page)
  2. Christopher Leo (RB page)
  3. The Scientist (RB page)
  4. Laika’s MedLibLog (RB page)
  5. Good, Bad, and Bogus (RB page)

It is now up to you, researchbloggers to vote for your favorite blogs. You don’t need to vote for all categories. It is simply too much and in case of Chinese blogs wouldn’t make much sense either.

You can only cast your vote if you are registered with ResearchBlogging.org.
If you’re not registered (and you blog about peer-reviewed research), you still have time to register. See here for more information. This way you can vote, and most important, can contribute to ResearchBlogging.org. with your review of peer reviewed scientific articles.

Voting closes on March 14, and awards will be announced on ResearchBlogging.org on March 23, 2010.





I’ve got Good News and I’ve got Bad News

26 01 2010

If someone tells you: “I’ve got Good News and I’ve got Bad News”, you probably ask this person: “Well, tell me the bad news first!”

Laika’s MedLibLog has good and bad news for you.

The Bad News is, that this blog didn’t make it to the Finals of the sixth annual Medical Weblog Awards, organized by Medgadget. (see earlier post)

The Good news is that this keeps me from the stress that inevitably comes with following the stats and seeing how your blog is lagging more and more behind. Plus you don’t have to waste time desperately trying to mobilize your husband to just press the *$%# vote button (choosing the right person: me), no matter how many times he says he doesn’t care a bit – (“and wouldn’t it be better to spend less time on blogging anyway?”)

This reminds me of something I’ve tried to suppress, namely that this blog didn’t make it to the shortlists of the Dutch Bloggies 2009 either (see Laika’s MedLibLog on the Longlist of the DutchBloggies!)

The Good news is that many high quality blogs did make it to the finals. Including The Blog that Ate Manhattan, Clinical Cases and Images, Musings of a Distractible Mind (Best Medical Weblog) , other things amanzi (Best Literary Medical Weblog), Allergy Notes, Clinical Cases and Images, Life in the Fast Lane (Best Clinical Sciences Weblog), ScienceRoll (Best Medical Technologies/Informatics Weblog).

Best of all, the superb blog I nominated for Best Medical WeblogDr Shock MD PhD made it to the finals as well!!

But it is hard to understand that blogs like EverythingHealth and Body in Mind with many nominations are not among the finalists. That underlines that contests are very subjective, but so are individual preferences for blogs. It is all in the game.

Anyway you can start voting for your favorite blogs tomorrow. Please have a look at the finalists here at Medgadget, so you can decide who deserves your votes.

Finally I would like to conclude with positive news concerning this blog. This week’s “Cochrane in the news” features the post on Cochrane Evidence Aid. It is on the Cochrane homepage today.

Photo Credit

Best Literary Medical Weblog
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My Little Golden Llama

23 11 2009

Doctor Rob send me
A little golden Llama
Prestigious Price

I did not earn it
by spitting acid musings*
Just wrote this haiku:

Dark when he leaves home,
Dark when he returns from work.
Resident Life.**

Introduced by Rob of Musings of a Distractible Mind as follows:

The final haiku I’m presenting
That Limpens gal who’s unrelenting
She wrote a whole post
But what touched me most
The hours of a life residenting
(5)

Want to read dr Rob’s entire Llamerick  and the haikus of the other price winners, then read this post.

The entire golden pre-selection is mentioned here.

* I now understand this has two meanings ;)
** As indicated in the original post the abovementioned haiku was I
nspired by a tweet by Scott Greenberg, MD

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Health Care Haikus

5 11 2009

Dr Rob Lamberts of Musings of a Distractible Mind is holding a “Health Care Haiku Contest“. The actual contest is at his Facebook page.

Inspired by the beautiful haiku of Dr. Ramona Bates of Suture for a Living, who also inspired T of Notes of an Anesthesioboist to write a Haiku, I started to write my own. Once I started writing, I couldn’t stop.

This is the result: 9 Health Care Haikus.


Haiku #11018284405_db0b517f24 emergency hospital night

Dark when he leaves home,

Dark when he returns from work.

Resident Life.


Haiku #2

Web 2 point ooh tools,

Might help to reform health care.

Change needs people 2.78244074WM004_Supreme_Court


Haiku #3

Health Care Reform.

An unaffordable plan?

A matter of choice.


Haiku #4

One trillion for war.

The poor denied insurance.

U.S. Death Panel.


2910025091_907be70e41 Exam

Haiku #5

P S A screening,

rectal exams, biopsies.

Worries, no less deaths.


Haiku #6

Doctor, Desk, Patient

2868594277_873f67216d doctor patient mural

Questions, silence, not understood,

Frown, shake hands, such pain.


Haiku #7

Fragile hands, white sheets,

Witty old man, nurses laugh.

Shout down silent tears.


Haiku #82898004506_de9f57e836 patient in the next bed

Wishing he was dead,

Paralyzed from neck down,

Nothing he can do.


Haiku #9

The man next to me

discusses end-of-life-wish.

Curtains are closed.


Notes and Acknowledgements

  • Haiku #1 : Inspired by a tweet by Scott Greenberg, MD (and resident)
  • Haiku #2: Own experience, Web 2.0 is more than web 2.0 tools, Web 2.0 is people (see presentation)
  • Haiku #3 and #4: Based on article: “We Can’t Afford Health Care? You Lie!” at Truthorg. (see linked photo below)
  • Haiku #5 A lot of money goes into screening. But is it worth while? Recent studies show that prostate cancer screening may not lower mortality. See older post: Still Confusion about the Usefulness of PSA-screening.
  • Haiku #6, #7, #8, #9 All about loneliness of patients, miscommunication, the lack of being in control and the lack of privacy. Haiku #8 and #9 are based on my own experience: the man lying next to me wanted to end his life, but was not allowed to. He had to take fluid food. I overheard the conversations between him and his doctors, nurses, a psychiatrist, a dietitian and a priest. Quite embarrassing.

Photo Credits:

 

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Laika’s MedLibLog on the Longlist of the Dutch Bloggies!

3 11 2009

dutchbloggies_copy7Laika’s MedLibLog is nominated for the Dutch Bloggies-awards. The Dutch Bloggies is a  yearly contest by the foundation “Dutch Bloggies” that awards weblogs from Dutch-speaking regions.

Besides the overall Most Popular Weblog and Best Microblog, there are longlists for 15 categories. There are 10 blogs on each longlist. Laika’s Medliblog is nominated for best blog in category Best health & sport weblogs.

These are the blogs in this category:

Ajax Life | Catenaccio.nl | De Hardloper | Gezondheid.blog.nl | Green Jump | Laika’s MedLibLog | Marijn Fietst | Medicalfacts | SuikerWijzer | Zorg Beter Maken

I do feel like Tom Thumb amidst the giants. Apart that this site serves a small niche, it is hosted by one person in spare time on a WordPress domain. I’m getting a little intimidated by the professional looks and frequent updates of some of the self hosted blogs. But being nominated is already a great honor.

After publication of the shortlists the final winners will be announced in “het Paard van Troje” in The Hague, December 1th.

Nice to know: Colleague Librarian and fellow blogger Edwin Mijnsbergen (http://twitter.com/zbdigitaal) of the Wonderful blog ZB Digitaal was previous year’s winner in the category Education (see his blogpost)

All longlists can be viewed on http://www.dutchbloggies.nl/2009/?e=16

A better overview (without the need for clicking) is presented at JeroenMirck (link), the blog of Jeroen Mirck, journalist and chairman of the jury.

NRC-next blog (a blog of a Dutch newspaper) -nominated four times itself- also refers to the contest here.

The Volkskrant mentions the Dutch Bloggies nominations here


dutchbloggies2009-jury-totaal

The deliberation of the jury. Originally there were 5000 nominations.

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An Online Birthday Party!

15 06 2009

15-6-2009 18-05-22 BD poes kaart kleinToday is my birthday. And although I stayed home with a headache and other small complaints, and although I don’t really celebrate it any longer (except for the real round figures, like 50-60), the day started out pretty bright just around midnight with all kinds of virtual birthday wishes.

It started with an e-card (left) from Ramona Bates, plastic surgeon and quilter from the USA (hence her blog Suture for a Living), followed by many other birthday wishes.

Robin of Survive the Journey was so kind to send a song via blip.fm and then to organize a “twitter-party” by using the twitter-tool QuoteURL I had just reviewed on my blog (see here).

The start of the Twitter party  is shown below. Here is the link: http://www.quoteurl.com/r1e27

Suture for a Living

  1. rlbates
  2. drval
    drval Happy Birthday to @laikas, our favorite Dutch medical librarian. :)
  3. Ves Dimov, M.D.
  4. Deirdre
  5. Vijay
    scanman @laikas Happy Birthday Jacqueline :)
  6. Laika (Jacqueline)
    laikas @scanman: @laikas Happy Birthday Jacqueline :) Thanks vijay. Wish we could have a Twitter birthday party with cake or so.
  7. Marilyn Mann
  8. Laika (Jacqueline)
    laikas @MarilynMann thanks Marilyn. It is very nice to begin your birthday with all those kind birthday-twishes.
  9. Robin
    staticnrg @Laikas Oh, happy birthday!! Hope it is a wonderful one!! ♫ http://blip.fm/~88du0
  10. Laika (Jacqueline)
    laikas @staticnrg: “@Laikas Oh, happy birthday!! Hope it is a wonderful one!!” – Well the start is all right – thnx! ♫ http://blip.fm/~88e8a

this quote was brought to you by quoteurl (pity that WordPress transforms the style)

Later I received more birthday and get-well wishes from Twitter, Hyves, Facebook, and Fabulously 40 (and beyond). I even received a e-card with “happy birthday” in Chinese!happy-birthday in chinese

Although my friends are virtual (?) and the cards and wishes are virtual, it feels like I’m having a real birthday party with real friends. The only thing that was missing was real coffee, cake or wine. ;)

15-6-2009 18-29-23 tweet rlbates





Martin Bril: the Author, his Death and his Cancer

23 05 2009

Martin BrilMartin Bril is dead.

No “news“, it happened a month ago: April 22.

Martin Bril was a well known Dutch writer, poet and columnist – and the man who invented “skirt day”.

He loved live -and love- in all it’s simplicity. He needed few words to describe the essence of things or as he would say: “The surface is deep enough”. But you know, it is looking at one drop of water and understanding the ocean.

Other expressions: “Good is better than bad” and “You’ve people that bang the guitar really hard for hours, but I rather hear J.J. Cale. Always finished within 4 minutes, but the music stays with you.”

I liked his stories/columns most of the time, they often made me smile.

It is always sad when somebody dies young (Martin was 49), whether a “celebrity” or not. Especially when he leaves two young children and a wife.

I didn’t expect it and it really hit me. Why? I knew he had had cancer, but I thought it had gone. So did he a few years ago. I found a video-interview with him in 2007, where he said: “soon I will be declared “cured” – but then you will see it will return the other day.” In another interview I read: You never beat cancer”, that’s Lance Armstrong-language. Cancer goes away or it stays. It often stays.

I always thought he had colon cancer, but it was esophageal cancer. That’s the trouble with Dutch:Martin Bril Donkere Dagen

  • esophagus = slokdarm,
  • jejunum, ileum = dunne darm
  • colon = dikke darm.

Notice they all have “darm” in them. Mostly colon cancer is called “darmkanker” (or “dikke darmkanker”), and because esophagus is called slokdarm, slokdarmkanker is mistaken for darmkanker, which is quite another disease with other prospects.

Stupid, journalists keep on using the wrong name. Not that it matters a lot now, but still.

More “incorrect” was the fact that I first saw the announcement of his death in a newsletter from dokterdokter.nl (below). It is an online medical information site for patients. I have been getting their newsletter for years now, because -for one thing or another- I’m unsuccessful in unsubscribing to it. Dokterdokter.nl is typically a website that gives very general information, mostly leading to the advise “to check your doctor first”.

dokterdokter Martin Bril geheel

What struck me (besides the fact that I was taken by his death) was that his death was presented as Medical News, next to an enormous “oral sex” headline and the headline “what happens if you die?”. As if it was a tabloid. The message (he died the day before):

Martin Bril finally succumbed to esophageal cancer at the age of 49. Esophageal cancer has a bad prognosis. Why?
(if you click: )

“Martin Bril, the well known author …, died of esophageal cancer at the age of 49. He was a real hedonist. Cigarettes and alcohol were part of his life. Many years he had fought cancer, but Wednesday April 22 he lost his fight. Few people really completely recover from this illness.”

(….) Generally, the disease has to do with your lifestyle. In Western Countries, smoking and excessive alcohol consumption are the most important causes of esophageal cancer.

And then it continues summarizing the brochure of the Dutch Cancer Society (KWF- kankerbestrijding)

Whereas most medical sites (including the Dutch Cancer Society, from which all the information was taken) just neutrally say that the cause is unknown, but that alcohol and smoking are known risk factors for esophageal cancer, -and even more so in combination- dokterdokter puts a direct link between Martin’s lifestyle and his death, as if it was his own fault. Maybe it was, but at that moment I didn’t want to know. It didn’t matter. I found it disrespectful, tasteless. I’m quite interested in health and medicine and mechanisms, but the reason of his death -at this moment- was less important than his death itself.

As a matter of fact, Martin stopped using liquor and cocaine in 1997 after given an ultimatum by his wife (“you have two young kids!”) and after attending a trial of a drug baron (Johan V., de Hakkelaar) (to write about). He also wanted to quit smoking. I don’t know whether he succeeded, but he helped STIVORO (“for a smokeless future”) with their campaign (2002) by writing a beautiful column and making a video about (the difficulty of) quitting smoking. “I stopped smoking, because I didn’t like it anymore. Moreover, my kids didn’t want me to die because of smoking……..”

How much better was the reaction of STIVORO to the death of Martin, saying “we have lost a talented author” and thanking him for his input. Just a short notice and ending with the column Martin had written for them: “Did you ever tried to quit smoking?…I did”.

——————73554771_f75ce49f1a rokjesdag

Bij Nederlanders hoef ik Martin Bril nauwelijks te introduceren. Dat ik hier over hem schrijf heeft vooral te maken met het stukje dat ik in de nieuwsbrief van Dokterdokter.nl las. In feite was het dit bericht, waardoor ik wist dat hij gestorven was. Voor mij een schok. Ik lees de Volkskrant niet meer, dus het was mij ontgaan dat het slecht met hem ging. Het is ook een jonge vent, jonger dan ik, met twee dochters, net als ik. Zo kom het altijd nog een beetje dichterbij. En hij kon mooi schrijven. “De oppervlakte was diep genoeg,” zo zei hij, maar het was bij hem net of je in een druppel de hele oceaan kon zien.

Voor het eerst zag ik trouwens dat hij slokdarmkanker had. De meeste journalisten spraken van darmdanker, waar men in de regel toch dikkedarmkanker mee bedoelt. Slokdarmkanker is een heel andere ziekte, met een heel andere prognose. Vreemd dat het meerendeel van de journalisten het toch steeds over darmkanker heeft

Maar dit terzijde. Ik vond het vreemd, dat het bericht als een “nieuwsaankondiging” stond naast de kop “orale sex” en “hoe voelt het als je dood gaat”. Misschien had Martin er wel om kunnen lachen, maar ik vond het bizar. Het verhaal zelf vond ik ook nogal ongepast.

Wat stond er?

De ziekte slokdarmkanker werd schrijver Martin Bril op zijn 49e fataal. Het is een ziekte met slechte vooruitzichten, mede omdat het vaak laat wordt ontdekt.

“Schrijver Martin Bril, bekend van boeken als De kleine keizer en Arbeidsvitaminen en van zijn columns in de Volkskrant, is op 49-jarige leeftijd aan slokdarmkanker overleden. Hij was een echte levensgenieter, sigaretten en alcohol waren een vast onderdeel van zijn leven. Al vele jaren streed hij tegen kanker, maar woensdag 22 april was zijn strijd gestreden. Maar weinig mensen weten volledig te herstellen van deze ziekte.”De ziekte heeft meestal te maken met de leefstijl van mensen. Roken en overmatig alcoholgebruik zijn in Westerse landen de belangrijkste oorzaken voor het ontstaan van slokdarmkanker.

Andere bronnen -ook de KWF-brochure, waar dit stuk aan ontleend is, schrijven steevast dat de oorzaak niet bekend is, maar dat roken en alcohol (vooral in combinatie) de belangrijke risicofactoren zijn. Mogelijk is zijn leefwijze inderdaad de belangrijkste reden geweest dat hij slokdarmkanker heeft gekregen. Nou en? Is het nodig om dit zo op te schrijven? Een dag na zijn dood? Ik vond het nogal oneerbiedig. Misschien dacht men bij dokterdokter.nl dat het schrikeffect mensen zou weerhouden om veel te roken en te drinken, want “kijk, daar krijg je slokdarmkanker van!!” Behalve dat dokterdokter niet bepaald het juiste publiek (de “zelfkanters” en “hedonisten”) zal bereiken, zal zo’n actie sowieso weinig zoden aan de dijk zetten. Dan was Martin’s bijdrage aan de Stivoro campagne “stoppen met roken” (2002/2003) waarschijnlijk veel effectiever. Hij schreef een column voor ze en werkte mee aan een video.

Martin zei: “Ik stopte met roken omdat ik er geen zin meer in had. Bovendien; mijn kinderen vonden dat ik er niet dood aan moest gaan”. Eerder, na een ultimatum van zijn vrouw en het bijwonen van een zitting tegen de drugsbaron de Hakkelaar, was hij al gestopt met alcohol en coke.

Zo anders was ook de reactie van Stivoro. Niets vingertje wijzen: “zie je wel!”, maar dit:

“Samen met de rest van Nederland treurt STIVORO om het heengaan van een bijzonder mens en groot schrijver: Martin Bril

STIVORO heeft Martin leren kennen toen hij zich enthousiast inzette voor onze ‘Stoppen met roken’ campagne van 2002/2003. Hij was toen bereid zijn persoonlijkheid en zijn schrijftalent voor deze campagne in te zetten.

Wij zijn dankbaar dat we met hem hebben mogen samenwerken. We wensen zijn familie en andere dierbaren heel veel sterkte toe.

Hij schreef voor ons de volgende column:

“Bent u wel eens gestopt met roken?
Ik wel……..”

Photo Credit (CC):





First Anniversary of this Blog

7 02 2009

118424928_1dabcac6fd

This week is my one year anniversary.

I would like to thank all my readers for following along with my blog.

Thanks for your encouragements, comments and inspiration.

I’m glad I entered the web 2.0 world, but it would have been empty without you.

I hope you keep connected!

Laika (Jacqueline)


Foto credit: http://www.flickr.com/photos/charlietakesphotos/118424928/

Response From Twitter

first-anniversary





Laika’s MedLibLog in review: 2008

3 01 2009

This blog saw the light in February 2008, so it is almost time to celebrate its anniversary.

Maintaining this blog has been an enjoyable and fruitful -albeit time-consuming- experience.
I would like to take this opportunity to thank all readers of this blog for their visits, comments and support! I hope that you will continue to find content here that entices you to read and, even better, comment.subscribing-2

If you like the posts at this blog and you’re not doing this already you might consider:

  • subscribing to my blog by RSS by clicking here (You have to install a reader as well) or
  • subscribing by email by clicking here
  • adding this blog to your Technorati favorites here
  • following me on Twitter here

Or you can simply click on the figures in the sidebar:

I wish you all the best for 2009!

——————————————————————————————————————–

Here is a short review of this first year of blogging.

Highlights were:

———————————————————————————————————————-

An overview of (a selection of) blog posts per subject:*

Searching, Biomedical databases.
PubMed: Past, Present And Future, PART II [1]
PubMed: Past, Present And Future, PART I [10]
Finding assigned MeSH terms and more: PubReminer [16]
BMI bijeenkomst april 2008 [19] [Dutch]
PubMed: Past, Present and Future PART III [39]
New Ovidsp Release Planned August 5th will allow more flexible searching [46]

Evidence Based Searching
The best moment teaching EBM-searching skills [31]
Time to weed the (EBM-)pyramids?! [35]
New Cochrane Handbook: altered search policies [-]
Podcasts: Cochrane Library and MedlinePlus [-]
New cochrane handbook: altered search policies [-]

Evidence Based Medicine, Methodology
Nursing Myths (1): Post-operative Temperative Measurements [2]
The Best Study Design… For Dummies [3]
Huge disappointment: Selenium and Vitamin E fail to Prevent Prostate Cancer.[7]
The (un)usefulness of regular breast exam [9]
FREE online course on evidence-based health care [14]
Thesis Mariska Leeflang: Systematic Reviews of Diagnostic Test Accuracy [18]
CC (2) Duodecim: Connecting patients (and doctors) to the best evidence [49]
Podcasts: Cochrane Library and Medlineplus [-]

Clinical practice, Consumer-related Subjects, Addison’s Disease
Changing care (for Addison patients) [11]
The importance of early intervention in an Addisonian Crisis[13]
23andMe: 23notMe, not yet [15]
Anatomy Lesson 2008: Living in Fear [20]
Etiquette-Based Medicine [22]
The OpenECGproject: an admirable Web 2.0 [42]

Science
The Real Sputnik Virus [4]
Randy Pausch Last Lecture: Achieving Your Childhood Dreams [6]
#Sciblog – a bird-eye’s view from the camera
Evolution and Medicine. Cancer and adaptive immune responses as evolutions ‘within’.

Web 2.0 tools
Incorrect Google Incoming Links? [5]
Delicious Google Toolbar [9]
Google Reader and other free (learning) tools [17]
Visualize your blog (words) with Wordle [21]
Locate Your Visitors (2) [23]
Forget Hyves. Go Twitter! [24]
Possibly an announcement about possibly related posts [25]
Locate-your-visitors [30]
Technorati Rank & Authority Dropping[38]
Blog Spam and Spam Blogs (1) [44]
WikiMindMap to Organize Wiki Content [50]

Other
For Palin & Obama, Fun & Photo’s [8]
A really delicious blog …[12]

Dutch Grand Round and other blog carnivals
.: See the category Grand Round
For Spoetnik Course search for the Category Spoetnik (preliminary Dutch)
For Personal matter search for the category Personal

*([nr] indicates the popularity of the post according to WordPress stats, from 1 [most popular] to 50. Not all posts are shown.





Changing care (for Addison patients)

19 10 2008

This post is inspired by the theme for this weeks Grand Rounds at PalliMed, a Hospice and Palliative Medicine Blog: “Changing Goals of Care”. According to Christian Sinclair, M.D. of Pallimed:

It can be changing the goals in any direction, not just the curative towards palliative route, although I expect that is a common touchstone for many in the medical field.

‘Goals of Care’ is a subject that is outside of my area of professional expertise, being a medical biologist and an information specialist.

But as a consumer and patient I can easily see how I would like health care to change.

  • affordable healthcare for everyone who needs it
  • More personal and personalized care
  • And -indeed- more attention for palliative healthcare (my mother in law has a bearable life, since low doses morphine were prescribed)

But those issues can be better addressed by persons in the field. I just simply want to restrict to “changing care in a very specific area, adrenal diseases, simply because I’m a hands-on expert, having secondary Addison’s Disease (Sheehan’s syndrome)”.

Main conclusions:
Healthcarefivers look (and act) beyond your specialty! Try to be a good generalist as well. Please adapt protocols if it suits the patients. Take the patient seriously.

Diagnosis
Primary Addison (damage or destruction of the adrenal cortex) as well as secondary Addison (absent pituitary signal(s)) often have a slow onset and are difficult to diagnose.
In theory this may be different for Sheehan’s Syndrome. According to Google Knol:

Sheehan’s syndrome (…) is a condition in which the pituitary gland is injured as result of heavy blood loss during complicated childbirth. This heavy loss of blood deprives the pituitary gland of oxygen and other nutrients and leads to necrosis (death) of pituitary tissue and therefore pituitary failure (hypopituitarism). Failure to produce breast milk after delivery (due to lack of the pituitary hormone prolactin) may be a presenting sign of Sheehan’s syndrome. Fortunately, Sheehan’s syndrome is now rare cause of pituitary failure, particularly in developed countries as a result of improved obstetric care.

Looking back I’m stunned that Sheehan was not directly diagnozed by the gynecologists themselves.
And perhaps even more surprised why it happened to me in the first place, being hospitalized in Europe, and having a previous cesarean. (For good reason it is: “Once a cesarean, always a cesarean” According to present protocols I had many negative predictors for success (no prior vaginal birth, short stature, age >40, induction of labor, gestational age almost 43 weeks, failed second stage), but worst of all they didn’t take me serious when I said I didn’t feel well and got a sudden neck pain. When standing up I fainted. So I have every reason to believe all this could have been prevented).

I lost more than 3 litres of blood (and had puerperal fever as well), developing all signs of Sheehan (and Addison crisis) in the days that followed: breast milk “disappearing”, loss of appetite, severe muscle pain, fatigue, headache, lethargy, extreme nausea, diarrhea & vomiting and finally speaking with double tongue, feeling like I fell when lying down, sensitive to cold etc. But nurses pressed to try to give breastmilk (till bleeding), reprimanded me in presence of other patients (you have to break the circle, please do your best (!) and eat something; you have to take care of your child, come on!) and a psychiatrist was being ordered. Finally (after 10 days), when I plead them to check whether I was not dehydrated, they did some tests and found out my blood Natrium was dangerously low (106; normal 140), and could apparently not be corrected by giving saline transfusion. I “missed’ this part, but when I woke up the internist told me proudly he found out I had Sheehan (practically no cortisol or any other hormones under regulation of the anterior hypophysis). Normal natrium levels were achieved after giving cortisol-replacement.

I’m by no means an exception. Addison’s disease is often missed or diagnosed late. That early diagnosis can be a challenge is frequently addressed in the medical literature and many poignant examples can be read on patient forums. In fact I know very few prompt and swift diagnoses.

For instance (from the Newsletter of “The Canadian Addison Society”, issue 27, 2002

After being admitted and discharged what seemed to feel like every weekend, I was finally admitted for bronchitis that affected my asthma. I went on Prednisone* to treat the infection. I felt much better to my surprise. After being “cured” of bronchitis, back in the hospital I went. The pain was unbearable; doctors were questioning if I was anorexic, I saw a psychiatrist who put me on Paxil because I “appeared” to be depressed. Demerol became my new best friend and was the only thing that put me at ease.
My mother continued to stay by my side the entire time. Whether it be stroking my hand, brushing my hair, or encouraging me to walk just a few steps a day. This felt like a marathon to me; in reality it was only a few steps.
After every “possible” test was completed my internist had suggested performing one more test. The results had come back positive! Addison’s Disease….**

(*Prednisone is a glucocorticosteroid that can replace cortisol; this patient also had pigmented handpalms, specific for primary Addison.)

well-ville.com/images/adrenalQA2.jpg

The same is true for other adrenal diseases. Cushing’s Disease (excess of cortisol) is often mistaken for (manic) depression. See for instance wrongdiagnosis.com or here (Dutch).

After years of non-recognized Cushing one of my fellow patients was treated by many specialists. One expert (being an orthopedic, I believe) totally missed the Cushing, because she fixated on other causes of the severe osteoporosis and didn’t notice the patient’s bruises, mania, belly fat, striae to name just a few other symptoms, typical for Cushing. Missing her diagnosis means she is mostly in a wheel chair now, and not able to do the things she liked to do (for those interested and able to read Dutch she has written a book about it: “Aftakelen and Ophijsen”)

Action (in case of a crisis)
With hormone replacement therapy, most Addison patients disease are able to lead normal lives. However extreme stress can precipitate an Addison crises, which is a medical emergency. Patients therefore often wear alert bracelets or necklaces, so that emergency personnel can identify them as having adrenal insufficiency and provide stress doses of steroids in the event of trauma, surgery, or hospitalization.

Luckily I don’t seem very vulnerable to crises (still producing aldosterone), but the one time I had something like it (presumably due wrong capsules, thus more insidious), family physicians reacted inadequatly. One gave me a lab form emphasizing twice that lab tests should ONLY be done when I was really, really ill. Very stupid, because determining Natrium costs nothing compared to hospitalization, and my pride prevented me taking the test, afraid that I made a fool of myself. My own physician said a few weeks later that I should consult a endocrinologist, because he found Addison “much too difficult”. I thought that wasn’t bad, but my endocrinologist didn’t agree, because “he would have been too late in case of a real emergency”. (I had a Na of 123, but was hospitalized, because my endo (a wonderful female doctor) found I behaved differently and wasn’t ok – I also lost >18 pounds in 2 months)

But there are far more upsetting stories of other Addison crises. Even in this era there are unnecessary deaths due to  inadequate intervention. What is also worrying is that paramedics often miss the alert bracelets. A Dutch paramedic wrote on the bulletin board of our patient’s association, that paramedics don’t even look at it, because they aren’t allowed to do anything going beyond first aid and stabilization. However, if my husband may give me an intramuscular injection of corticosteroids, why can’t a paramedic? It is the most essential emergency measure that can and should be taken. He advised that we would bundle our forces with other patient groups to change the protocols of the ambulance personnel. Paramedics won’t do anything when they are not legally entitled to.

I also hear from many Addison patients that it takes ages before there is adequate action. Apparantly routine tests have to be performed first. A nurse even told me that glucose is tested first, because it is such an easy and fast test. O.k. an addison crisis is often accompanied by low blood glucose. So what? Get those corticosteroids in!!! Intravenous injection is often difficult, because of the low blood pressure. It often takes too long and often fails, at least that is what I hear from other patients.

Iatrogenic Cushing and Addison

Apart from natural causes, Cushing and Addison’s disease can have a iatrogenic cause (unintended harmful effects by a physician’s activity, manner, or therapy). It is well known that longlasting treatment and/or high doses of corticosteroids can give Cushing-like symptoms as well as Addison-crises in case of sudden withdrawal (because of feedback mechanisms the body can’t make cortisol any longer).
Laurens Mijnders has developed long lasting Addison’s Disease because of his asthma treatment. His letter in Contrastma, a paper of a Dutch Asthma Foundation (Astma fonds) evoked many responses of patients who had used high doses corticosteroids (up to 50 mg/day Prednison per day). The reactions showed that doctors had given little or no information about adverse effects of corticosteroids and had never warned against a possible Addison crisis (see here).
An endocrinologist revealed at a meeting that they still regularly see Addison crises in patients who received high-dose steroids for their asthma, rheuma, dermatologic or other inflammatory condition
Of course some of these diseases can only be controlled by corticosteroids, but the treating physician should try to sail safely between Scylla and Charybdis, and prepare the patient for any (anticipated) danger.

Wasn’t it: “Primum non nocere” (Latin for “First, do no harm”)?!

Thus physicians, look beyond the border of your specialty and always take patients seriously, please?

Addison's disease info (nvacp)




Laika’s Little Party

21 09 2008

It’s time for some reflections on this blog and for a little party. Why?

So for now I will start with the party (with some wine), the reflections will follow when I’m sober.

This week I received an unexpected email from RNCentral (“the place to learn about nursing online”), anouncing that this blog had made it to the “Top 50 Health 2.0 Blogs list ( see here).

The top 50 health 2.0 list is not based on a kind of “objective” ranking like the Healthcare 100 or MedBlogEN lists, which are a measure of how many people link to your site, find your site by searching or have subscribed to your blogposts: thus an indirect measure of “how popular you are“. In such a list I would not make the top-100.
The RNCental site gives a “subjective” top 50 list of blogs, that appear valuable to the authors. The list is introduced with a very nice definition of health 2.0 blogs, that I can subscribe to:

Health 2.0 embraces the idea of bringing health care into the community of physicians, patients, and those in the health care industry together with technology and the Internet to provide the best possible health care environment. What better way for the various parts of this community to share their thoughts and communicate ideas than through their blogs? From corporate blogs to blogs that are a part of social networks to individual blogs touching on technology or health care policy, these blogs will help bring you into the community, provide information and resources, and may perhaps help you find your voice as well.

I’m thrilled that I’m (literally) placed next to David Rothman in the “Health and Technology”-section. Although, to be honest, I see myself as a true beginner in this web 2.0 world and I learn a lot of established web 2.0 experts like David Rothman, KraftyLibrarian, Berci of Science Roll, MD Anderson on Emerging Technologies Librarian, Dean Giustini (UBC Academic Search), Sachet62 on Twitter, symtym from symtym.com, David Bradley from Sciencebase and Dutch colleagues like Wowter (with a dutch and an english blog), Dymphie (Dee’tjes) and many many more. On my blog I try to integrate what I learn elsewhere (articles, posts, twitter messages) with my own knowledge and interest.

The resultant is a rather diverse mixture of subjects in the field of (medical) librarianship, medicine, health (including consumers), evidence based medicine and web 2.0 tools.

Although such a broad mixture might not be appealing to everyone, it is appreciated by some, as is apparent from a recent blog-review in the Library + Information Gazette, 22 August 2008: p5 (UK). The Gazette is only available in print edition and I wouldn’t have known about it if Anne Welsh of “First Person Narrative” had not mentioned it at her blog (see post: “mainstreaming blogs as information sources”). Anne:

“This review is the first in a series “Blog Spotlight” authored by Danielle Worster (the Health Informaticist). It’s aim is to help separating the wheat from the chaff when it comes to blogs in LIS and health informatics.

Any blog that claims to be about information, research, Web 2.0 or health informatics is considered. Each blog discussed is described in terms of its audience, currency, informativeness, authoritativeness / credibility, readability and design, with a brief overview and summary. It’s a nice format, and starts well in this issue with UBC Academic Search , ResearchBuzz and Laika’s MedLibLog.”

With Anne I find it regretful that the gazette is not available online. I surely would like to follow this series.

Luckily I found Keith Nockels (Browsing) willing to make a scan of the Gazette’s review and send it to me.

The Gazette review sketched my blog with very flattering sentences (“colourful, engaging and relevant”, “easy to read and digest”) as well as apt descriptions, which made me grin: “while it does stray to discuss….. Although she writes copious amounts, it is as easy to skim as to read it all…. crammed full of visuals.”

And about Dean’s UBC Academic Blog:

“Very informative: has an uncanny ability to pick up on crucial issue”. …. the blogger’s energy comes through in his shorter sentences….. essential reading.” All true! Dean’s blog is a must in the librarian web 2.0 world!

Apart from these official listings and reviews I got some comments or links that were also heartwarming.

For instance Keith Nockels (a UK Librarian with a nice blog (“Browsing”), apparently familiar with at least a few Dutch words) refers so nicely in his blogpost “More about changes to Ovid”:

“I have since found a posting on Laikas MedLibLog about this, and Laika has obviously looked at this properly! So, I can now report that you (….)
Laikas posting is here (in English and ook in Nederlands) and is gratefully acknowledged. She talks about other things besides, so please read her posting for more!”

And Dr. Shock announcement of the dutch grand round number 1:

Laika Spoetnik presents The Best Study Design… For Dummies (in English).
She writes in English and Dutch so you have no excuse for not reading this excellent post. She clearly explains Randomized Controlled Trials (RCT’s) and the levels of evidence. She uses an example which is easy to follow: Does beta carotene prevent lung cancer.

At Medliblog (the official website of the BMI, Dutch Biomedical Information) Annie (writing about Evidence Based Dietetics refers to the same post, saying:

….handige bijlages met een checklist voor het lezen van wetenschappelijke artikelen en een statistische begrippenlijst, dat laatste blijft toch altijd wel moeilijke stof voor dummies of alfa’s.
Voor die categorie heeft Laika een zeer begrijpelijke blog (zowel Engels- als Nederlandstalig) geschreven, waarvoor mijn dank. Zo’n presentatie zou ik ook wel willen bijwonen.

meaning:

For that category (dummies or alpha people not understanding checklists and studytypes) Laika has written a very comprehensible blogpost (in English and Dutch), for which I would like to thank her. I would have loved to attend such a presentation. (I gave to historians about “how doctors search”).

These comments strengthen me to continue blogging. This is why I blog: that (some) people like to read what I write and learn from some of the posts.

Well that is probably enough shameless self-glorification for now. I do realize that beginners get mild critiques, but as you get more well known the expectations will grow along and the critiques as well.

Next time, at request of Wowter, I will reflect more on the 5W’s of this blog: why, when, who, what, where?





10,000!!

5 09 2008

Dear readers.

An important milestone 4 me.
10,000 hits in ~7 months.
Thanks everyone!

And the 10.000st visitor is from Wageningen, the Netherlands. Wowter? (84.87.26.#??)
Claim your price: a drink, a hug, a post, or a link!!

Laika





Close to 10,000…

3 09 2008

Still >100 to go and we will have a little party over here.
Are you number 10,000 please let me know!

Possible little gifts:

  • Eternal fame, because you may write a post on this blog (via Google Docs)
  • Eternal fame, because I will write about you (if you like)
  • Or If you’re nearby I will buy you a drink/snack or coffee/cake.

———–

Nog maar ruim 100 en we houden hier een klein feestje…
Ben jij nr 10.000 geef me dan een seintje (zelf hou ik het ook in de gaten).

Mogelijke kleine attentie die je ontvangt (naar keuze):

  • Eeuwige roem, omdat je op mijn blog een bericht mag schrijven
  • Eeuwige roem, omdat ik een bericht over jou schrijf
  • Als je in de buurt bent een drankje of koffie (niet uit de automaat) met iets erbij (je mag het ook tegoed houden)
    NL-ers hebben meer kans, dus doe je best!




MEDBLOG NL 5!!

29 06 2008

Just a little note before I leave for vacation.
Maybe you’ve seen these blue and red widgets at the sidebar.

They are here for a month now. It means that I’m number 5 on the MedblogNL-list in May 2008. Rather surprising because this is the first time I’m on the list.
However, I must admit the list is not very long (30).
(….and no 126 on the English list. This list is quite a bit longer and has WSJ.com: Health Blog at top(!)

And since I don’t expect to stay up in the list for long, I just want to put it here… to remember. Yeah, I’m also a bit proud as a newbie in the blogosphere.

My Technorati rate also went up to 30, but now it’s on his way down, mostly because the Spoetnik-collegues dont’link to each other anymore. Most have stopped active blogging.
I miss it. When my vacation is over I will visit some of the Spoetnik pages. See how you’re doing. I promise.

Back to the Medbloglog. You can see the Dutch MedblogNL here. The may-top 5 is below. Most of the other bloggers are physicians, nurses and students.

The MedBlog log is an idea of Jan Martens. He thought it would be nice to have a list of Dutch Medical Blogs. Later he also made a list of English blogs.
Scores are based on a number of parameters, like Google PageRank, Technorati ranking, Feedburner hits, 4) number of posts and 5) number of reactions.

The blogpost of all the NL blogs can be seen at http://www.medbloglog.nl/.

*********

Sorry, heb nog 2 uur voor we met vakantie gaan (max. 2 uur slaap), dus even geen vertaling van deze post. En nog wel nu het om een NL-top25 gaat. :)








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