Archive for July, 2007

kicking my oil addiction  

Posted in Uncategorized at 10:52 pm by Casey KirkHart

my car smells like french fries — badly burnt french fries

Exciting stuff, friends. My little baby “Yelley Elley”, my sunny yellow new-old diesel 240D Mercedes Benz, has made the leap off the grid. Just last week I started filling up with biodiesel. Straight out the pump, can you believe it?

What is biodiesel, exactly? Well, in this case, it’s B99.9 – 99.9% walnut and soy oil, 0.1% diesel fuel. So while I’m not 100% off the grid, I’ll take 99.9% any day. I’m paying a bit more ($3.30/gallon) but that’s $3.30 not going to Big Oil. Plus, my car smells like burnt french fries out the tailpipe (better than than smoky mess that spews from a semi-truck), helps the environment, and runs smo-o-o-oth.

There is at least one other of us at Harbor using biodiesel. Another uses compressed natural gas (and she wants just 5 mo’ minutes of sleep – hint hint). Several – I count 5 – use hybrid gas/electric engines including Su’s ever-recognizable Prius. So I KNOW at least a few of us are taking action on our wasteful use of the Earth’s precious resources, and I’m CERTAIN that we all are at least somewhat concerned. So, below I’ve posted a upcoming conference in LA on biofuels.

You can follow my adventure with biofuels at my blog for more updates on my life driving the fried flyer.

Press Contacts:Rob Reed: 310-399-3659 – rob@conservfuel.comGretchen
Gray: 310-880-3892 –

The first Biodiesel Community Conference will he held August 1, 2007 from 7pm to 10pm at Mt. Olive Church,1343 Ocean Park Blvd., Santa Monica, CA 90405. Los Angeles, CA – (July 16,2007) The Los Angeles Biodiesel Community Conference is open to the general public and will offer action-based discussions on Biodiesel Basics, Legislation, Local Distribution, School Bus and Other Fleet Usage, Biodiesel Education, and more.

The event is being sponsored by Southern California Disposal and Recycling, and will be hosted by The Los Angeles Biodiesel Working Group, the LA Biodiesel Co-op, Socalbug (the Southern California Biodiesel Users Group), and Josh Tickell, author of “From the Fryer to the Fuel Tank” and “Biodiesel America.”

The purpose of the conference is to empower and educate the public, local businesses and community leaders in their efforts to make biodiesel a viable fuel option for Southern California. Collectively we will establish a groundbreaking action plan that will provide the steps to expand biodiesel distribution in Southern California and establish new legislation that promotes sustainable fuel options.We, as a community, can make biodiesel an affordable and available fuel option. It is time for us to unite and take action today!

For more information, visit contact Rob Reed or Gretchen Gray to schedule an interview with the following individuals to discuss the Biodiesel Community Conference agenda and action plan before or at the event: Josh Tickell – Author/Filmmaker; Kent Bullard – Chairman of Socalbug, a 501c3 non-profit organization, and Kris Moller – Owner/Operator of Conserv Fuel (

If you would like to attend the Biodiesel Community Conference please R.S.V.P. to:
– Kent BullardCFO (Chief Founder & Operator)Southern California Biodiesel
Users Group,

from the desk of the Resident Clinic Director – improving patient care and diabetes  

Posted in Education/Curriculum, Field of Family Medicine at 10:51 pm by Casey KirkHart

Hi all. No, not another anti-Pharm diatribe from me. This one is a clinical diabetes case from the Harbor-UCLA family medicine clinic:

You all know that a few of us family med residents have been involved in the diabetes chronic care collaborative with Drs. Snyder and Cheng. We’ve been trying to provide intensive and attentive care (including testing, treatment, education, and self-management) to our most out-of-control (OOC) diabetic patients. As the Resident Clinic Director (aka “RCD”) for the last month (a required and worthwhile rotation as a 3rd year resident), I’ve been on the front line of patient care at the Family Health Center. Here’s an example from today’s RCD experience that shows what we’re up to.

* Please email me if you’re interested in participating in the chronic care collaborative!*

One of our nurses, Mahdi, alerted me to a patient with fasting blood sugar 256. (This is something you have to address in the few spare minutes you have while RCD between triaging urgent care patient, writing for med refills, and putting out the occasional fire (ie someone with chest pain, residents swamped with clinic, etc) that erupts in the waiting room. It’s fun, actually.) This 66 year old Latina lady with her daughter at her side explained that she’s NEVER been in control of her diabetes in the 15 years she’s had it. Her last Hemoglobin A1c in 1/07 was 9.8% (far above her goal of 7%). Her home sugars run 200 to 400. She’s been seen only a couple of times here, but already her meds are maxed out: metformin 2500mg a day (about max dose), pioglitazone [Actos] 30, glipizide 20 bid (max). So, fair doctor, what do you do?!

Obviously her oral meds aren’t doing it. Your choices are: increase the Actos to 45 a day (max dose)? Start a 4th agent – acarbose, Januvia? All of the above? Start insulin? Take a second: based on what you know about this lady’s diabetic control, how can you best help her?

Well, a little bit more of the story helps. First, she and her daughter are asking for insulin. That doesn’t happen too often (many of our patients fear that insulin causes blindness, amputation, etc – Educate patients, people!), but when someone has a chronic, debilitating condition that isn’t helped with maxed oral meds, she knows that only insulin can help her. Smart lady. Fortunately she’s been given insulin in the past so knows the routine. I start her on NPH 10 units (she’s thin, so 10 is a good start. If she’s obese, I might start 16 units) before bed and counsel her on increasing the dose every 3 days by 2 units if her AM fasting sugars are >130. Both she and her daughter understand, but adjusting insulin like this is tough for newbies; she might need more counseling in the future…

Read the rest of this entry »

Human Guinea Pigs — “standardized patients”  

Posted in Uncategorized at 2:53 pm by los anjalis

Emily Yoffe describes in excruciating detail the adventures of serving as a standardized patient to medical students, to evaluate their physical exam skills. I remember the days of medical school when were evaluated in this way. It definitely was awkward, for both the medical students and the “patient”, but it was greatly appreciated. She shares some interesting stories in this piece:

Over the course of three days recently, I had 23 head-to-toe physicals from 23 second-year students at the Georgetown School of Medicine. I was the first person these would-be doctors had ever fully examined on their own. Some were shaking so violently when they approached me with their otoscopes—the pointed device for looking in the ear—that I feared an imminent lobotomy. Some were certain about the location of my organs, but were stymied by the mechanics of my hospital gown and drape. And a few were so polished and confident that they could be dropped midseason into Grey’s Anatomy.

Georgetown allowed me to be a “standardized patient”—that is, a trained person who is paid $15 an hour to be poked and prodded by inexperienced fingers, so that med students can learn communication and examination skills before they are sicced on actual sick people…

The concept of the standardized patient has been around for decades, but only in recent years have medical schools made training with them a regular part of their curriculum. I talked to a 50-ish physician friend about my experiences, and he said when he was in medical school and it was time for the first rectal/genital exam, the students were told to pair off and examine each other. “So, do you pick someone you like, or someone you don’t like?” he recalled. “Either way, it’s lose-lose.”

Now there are standardized patients trained for genital duty (they’re called GUTAs, for genitourinary teaching associates), but I signed up for something less invasive. Mine was the simplest possible assignment. I was to sit on the edge of a padded table in one of those awful, flapping hospital gowns, in a room equipped with recording devices in the ceiling. Each doctor had 30 minutes to conduct a standard head-to-toe physical: from my vital signs, to my nerve function, to my reflexes, etc. Then I was to go to a computer and check off whether they’d done all 45 parts of the exam (“Palpated for fremitus,” “Auscultated carotids”), and write my comments on their bedside manner…

Oh, it gets better. Check out the rest of her piece. Any thoughts on this concept of standardized patients? Any embarassing stories folks have to share?

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