Sat - January 21, 2006
Our Pictures and Video
Here are various pictures and
videos that my wife and I have taken over the last several years.
I have transitioned my old .Mac homepage site over
to iWeb. The movies and pictures can now be found here.
Been Quiet...
The last six months in private practice have been
quite busy. Six months since I started working, I am finally getting into a
rhythm. My clinic slowly rounding itself out with patient handouts, patient
information, and other things which make it function and look like a real
physician's office. Last week I started to transition into an electronic medical
record system. This week I did my first intrathecal opioid trial since finishing
fellowship and it looks like I'll be doing the implants soon. I also got a
chance to go to Macworld again this year...
Who the Hell is Claudio?
I guess I should formally introduce
myself: my name is Claudio Alejandro Palma Caimanque... add "M.D." to it now (as
if my name was not long enough). I graduated in June of 1996 from
Santa Clara
University
with a B.S. in Chemistry and minors
in Biology and Ethnic Studies. I then went to medical school at UC San Diego and
graduated in June of 2000. Afterwards, I did my internship at
Deaconess Medical
Center
in Spokane, Washington. In July of
2001, I began my anesthesia training at UCLA
and finished my training in June 2004. I then went on to do a one year pain
management fellowship at UCLA. Now I am working in San Francisco at St. Luke's
Health Care Center as part of a multidisciplinary spine and orthopedics
group.
My past history in a nutshell: born in Santiago, Chile, then immigrated to the USA at nine; I still speak, write, and read spanish. My roots and my community have always been important to me. They were one of the reasons why I went into medicine. One thing that has always bothered me was that I thought that the only way I could give something back to my community was by becoming a primary care physician. I had the image of opening a "clinica in the barrio." Me vs. the HMO's, or tuberculosis, or diabetes, or anything that was in the way.
After trying to convince myself to be a primary care physician for three years while in medical school, I came to the realization that it was not in my heart. I could not find satisfaction from being in clinics for extended time. I found that I enjoyed procedures...doing something and getting an immediate result. Additionally, the social issues often hit too close to home and I found myself haunted for days when tragic cases came in.
After working the Latino Medicine site, I have realized that I can give something back, and that I have already. Seems silly looking back, but I did not realize that I could use my computer skills to help other Latinos. Once I was able to get my conscience straight, it was easier to find what I enjoyed in medicine intellectually.... anesthesia.
My past history in a nutshell: born in Santiago, Chile, then immigrated to the USA at nine; I still speak, write, and read spanish. My roots and my community have always been important to me. They were one of the reasons why I went into medicine. One thing that has always bothered me was that I thought that the only way I could give something back to my community was by becoming a primary care physician. I had the image of opening a "clinica in the barrio." Me vs. the HMO's, or tuberculosis, or diabetes, or anything that was in the way.
After trying to convince myself to be a primary care physician for three years while in medical school, I came to the realization that it was not in my heart. I could not find satisfaction from being in clinics for extended time. I found that I enjoyed procedures...doing something and getting an immediate result. Additionally, the social issues often hit too close to home and I found myself haunted for days when tragic cases came in.
After working the Latino Medicine site, I have realized that I can give something back, and that I have already. Seems silly looking back, but I did not realize that I could use my computer skills to help other Latinos. Once I was able to get my conscience straight, it was easier to find what I enjoyed in medicine intellectually.... anesthesia.
Thu - August 11, 2005
Must stop to breathe...
The last three weeks have been like a whirlwind. I
have started working as a pain management physician in San Francisco. My clinic
schedule has rapidly scaled up as well as my operating room
cases.
Perhaps the hardest part has been learning the business part of medicine. Frankly, I must admit that I have zero knowledge of business activities. The good thing is that the other partners in the group have been very helpful.
So far so good...
Perhaps the hardest part has been learning the business part of medicine. Frankly, I must admit that I have zero knowledge of business activities. The good thing is that the other partners in the group have been very helpful.
So far so good...
Thu - July 7, 2005
It is done
Finally. After years of work, I have finished this
step in my medical education. Frankly, you really never stop learning and taking
classes. However, I am no longer a fellow. Technically I finished one week ago,
but it did not really hit me till I got up this
morning.
I am now getting ready to move to the San Francisco Bay Area to start working at St. Luke's hospital...
I am now getting ready to move to the San Francisco Bay Area to start working at St. Luke's hospital...
Mon - June 20, 2005
Postoperative Pain Management With a Patient-Controlled Transdermal
Delivery System for Fentanyl
[Source: Medscape Headlines
http://www.medscape.com/]
A self-contained, needle-free, credit-card-sized delivery system that is worn on the patient????s arm or chest.
permalink: comments: feedURL:http://www.medscape.com/cx/rssfeeds/general.xml
Not a bad system for post operative pain control. It does take one of the factors that can cause traditional PCA to malfunction: an intravenous line. It appears to function with very similar kinetics as a traditional PCA. Unlike Duragesic patches, the effects are transient and it does not create a subdermal reservoir of medication.
This might be great in cancer patients who often have difficult intravenous access. Not only for post operative pain in cancer patients, but also in acute states . Also, this does not preclude the Use in conjunction with a long acting opioid. Still, it has not been studied for pain management in cancer states, but there is great promise in this field.
A self-contained, needle-free, credit-card-sized delivery system that is worn on the patient????s arm or chest.
permalink: comments: feedURL:http://www.medscape.com/cx/rssfeeds/general.xml
Not a bad system for post operative pain control. It does take one of the factors that can cause traditional PCA to malfunction: an intravenous line. It appears to function with very similar kinetics as a traditional PCA. Unlike Duragesic patches, the effects are transient and it does not create a subdermal reservoir of medication.
This might be great in cancer patients who often have difficult intravenous access. Not only for post operative pain in cancer patients, but also in acute states . Also, this does not preclude the Use in conjunction with a long acting opioid. Still, it has not been studied for pain management in cancer states, but there is great promise in this field.
I am not Dead
Not quite there yet.
I am currently getting ready to relocate from Los Angeles to San Francisco to start my new job in a private pain management setting. Naturally, I have trying to pack things up, figure out what the heck to with our condo, and finally where to live in San Francisco.
Fellowship is officially done in two weeks. Counting down!
I am currently getting ready to relocate from Los Angeles to San Francisco to start my new job in a private pain management setting. Naturally, I have trying to pack things up, figure out what the heck to with our condo, and finally where to live in San Francisco.
Fellowship is officially done in two weeks. Counting down!
Thu - May 26, 2005
Happy Birthday to Me!
Today I turned 31 years old. As luck would have it,
clinic was chaotic and I ended up leaving around 8:30 pm. I guess that this
weekend I will be celebrating.
Looking back at my medical education, there were many times I put my big foot in my mouth. Let me tell about one of the first time:
First of all, medical education at UCSD is different from other medical schools in that anatomy is not taught till your second year of being a medical student. The rationale is that learning the physiology first will make learning the anatomy more relevant and easier to study.
Now, my background before going to medical was in Chemistry and computers. So, there I was my first time in a clinic, knowing little basic anatomy, about to go into a room with a physician to examine a patient. Things were going pretty smoothly as the physician instructed me on the basics of the physical examination. The patient was very sympathetic as the physician carefully explained important findings.
Then, it all went to hell... He asked the patient to open her mouth.
"What is the name of that little structure hanging in the back of her mouth?" he patiently asked.
I hesitated since I did not remember the technical name of it. I stuttered a bit. Then I blurted out: "That's the vulva!"
There was immediate silence in the room. The patient turned red. A little bead of sweat trailed down my face as I realize what I had said. The physician looked awe struck. It really seemed like an eternity before anyone did anything.
Then he politely corrected me, "No that's the uvula."
Looking back at my medical education, there were many times I put my big foot in my mouth. Let me tell about one of the first time:
First of all, medical education at UCSD is different from other medical schools in that anatomy is not taught till your second year of being a medical student. The rationale is that learning the physiology first will make learning the anatomy more relevant and easier to study.
Now, my background before going to medical was in Chemistry and computers. So, there I was my first time in a clinic, knowing little basic anatomy, about to go into a room with a physician to examine a patient. Things were going pretty smoothly as the physician instructed me on the basics of the physical examination. The patient was very sympathetic as the physician carefully explained important findings.
Then, it all went to hell... He asked the patient to open her mouth.
"What is the name of that little structure hanging in the back of her mouth?" he patiently asked.
I hesitated since I did not remember the technical name of it. I stuttered a bit. Then I blurted out: "That's the vulva!"
There was immediate silence in the room. The patient turned red. A little bead of sweat trailed down my face as I realize what I had said. The physician looked awe struck. It really seemed like an eternity before anyone did anything.
Then he politely corrected me, "No that's the uvula."
May 21: Morphine's 200th Birthday
[From: Medgadget http://www.medgadget.com/]
Tomorrow is without a doubt a notable anniversary of an important medical discovery by Freidrich Wilhelm Adam Serturner. The University of Chicago Medical Center strikes a chord:
There is pretty funny story about morphine that
occurred several years ago at UCLA pain
management:
Somehow, a patient managed to
steal a triplicate prescription, which was used exclusively for prescribing
controlled substances. They were called "triplicates" for the simple reason that
each one had carbon paper so that you could easily keep track of what was
prescribed to the patient. Anyway, the patient took the prescription to his
local pharmacist. The prescription said
"Mofine; half a pound to
go." Without hesitation, the pharmacist called
the police and the patient was arrested.
Video Games May Help Stroke Patients
[From: Medgadget http://www.medgadget.com/]
So video games are not a complete waste of time...
Personally, I believe that having playing video games has certainly made it much easier for me to learn how to place spinal cord stimulators percutaneously. Placing them requires fine controlled movements and good hand-eye coordination.
We find no surprises in this latest study:
When stroke victims played virtual reality games in which they imagined they were diving with sharks or snowboarding down a narrow slope, their ability to walk eventually improved, researchers reported in a small study.
So video games are not a complete waste of time...
Personally, I believe that having playing video games has certainly made it much easier for me to learn how to place spinal cord stimulators percutaneously. Placing them requires fine controlled movements and good hand-eye coordination.
Tue - May 24, 2005
Bush Veto Looms as House Supports Stem Cell Research
[Source: NPR News: Top Stories http://www.npr.org/templates/topics/topic.php?topicId=1002&sourceCode=RSS
]
The House of Representatives passes a bill that would expand federal support for embryonic stem cell research. President Bush opposes research involving human embryos and is likely to veto the bill if it reaches his desk. The vote of 238-194 leaves the bill vulnerable to a Bush veto.
permalink:http://www.npr.org/templates/story/story.php?storyId=4665058&sourceCode=RSS comments: feedURL:http://www.npr.org/rss/rss.php?topicId=2
Bush has already stated that he will veto the bill if it comes to him.
The potential to cure many diseases is tremendous, although realistically, it would not be for many years. Clearly, there needs to be much more research to understand the mechanism for stem cell development. At least California is moving forward with funding research with about $300 million.
The House of Representatives passes a bill that would expand federal support for embryonic stem cell research. President Bush opposes research involving human embryos and is likely to veto the bill if it reaches his desk. The vote of 238-194 leaves the bill vulnerable to a Bush veto.
permalink:http://www.npr.org/templates/story/story.php?storyId=4665058&sourceCode=RSS comments: feedURL:http://www.npr.org/rss/rss.php?topicId=2
Bush has already stated that he will veto the bill if it comes to him.
The potential to cure many diseases is tremendous, although realistically, it would not be for many years. Clearly, there needs to be much more research to understand the mechanism for stem cell development. At least California is moving forward with funding research with about $300 million.
Sat - May 21, 2005
MRI Can Cause Serious Injury in Patients With Implanted
Neurostimulators
[Source: Medscape Headlines http://www.medscape.com/]
Implant safety labeling should be consulted prior to magnetic resonance imaging for contraindications, warnings, and precautions, according to the FDA.
permalink: comments: feedURL:http://www.medscape.com/cx/rssfeeds/general.xml
The powerful magnetic field of the MRI can induce a current which can heat the spinal cord stimulator (SCS) lead(s) and fry all tissue it is in contact with.
Implant safety labeling should be consulted prior to magnetic resonance imaging for contraindications, warnings, and precautions, according to the FDA.
permalink: comments: feedURL:http://www.medscape.com/cx/rssfeeds/general.xml
The powerful magnetic field of the MRI can induce a current which can heat the spinal cord stimulator (SCS) lead(s) and fry all tissue it is in contact with.
Mon - May 9, 2005
Fun with Knoppix
[Source: Ars Technica http://arstechnica.com]
permalink: comments: feedURL:http://arstechnica.com/etc/rdf/ars.rdf
Knoppix is an amazingly useful tool. A Linux distribution that comes on a bootable CD, it can be used to restore partition tables, troubleshoot a system, and even rid a Windows system of spyware.
After booting up under Knoppix, I could mount the hard drive as read/write (NTFS writing is supported) and edit the registry and file system to prevent malware from starting at boot. While I'm at it, I also perform a complete virus scan and download AdAware and all of the latest security patches. Unplug the network cable, reboot into Windows, install patches, run AdAware and reboot. The only thing left is to train my mother-in-law to run AdAware on occasion and warn her of the evils of malware.
It sounds like the last part about the mother-in-law will be the most difficult! Adam Israel has a complete introduction to Knoppix along with a review of Knoppix Hacks, by frequent Linux.Ars contributor Kyle Rankin. In addition there's Developer's Corner, Tools, Tips and Tweaks, and a whole bunch of Linux news.
I have been using Knoppix for quite some time. I simply boot from
the CD and avoid the trouble of trying to deal with all the spyware and viruses
that infect the computers at work. I specifically use the STD (security
tools distribution) version of Knoppix which as the name implies, comes with
many network diagnostic tools, password tools, etc..
U.S. group launches online medical record program
[Source: Reuters: Health
http://www.reuters.com ]
WASHINGTON (Reuters) - Patients will be able to see, change and share medical records on the Internet with a service launched on Monday by a company set up by a coalition of professional medical groups.
permalink: comments: feedURL:http://www.microsite.reuters.com/rss/healthNews
I just hope that there has been thorough testing of their system so that no one will be able to break into their databases to steal information.
WASHINGTON (Reuters) - Patients will be able to see, change and share medical records on the Internet with a service launched on Monday by a company set up by a coalition of professional medical groups.
permalink: comments: feedURL:http://www.microsite.reuters.com/rss/healthNews
I just hope that there has been thorough testing of their system so that no one will be able to break into their databases to steal information.
US Latinos may develop Alzheimer's disease symptoms at earlier age than
white, non-Latinos (EurekAlert!)
[Source: Yahoo Search: Latino Health
http://news.search.yahoo.com/news/search?p=Latino+Health&ei=UTF-8]
CHICAGO: U.S. Latinos develop symptoms of Alzheimer's disease earlier, on average, than white non-Latino people, according to a study in the May issue of Archives of Neurology, one of the JAMA/Archives journals.
permalink: comments: feedURL:http://news.search.yahoo.com/news/rss?p=Latino+Health
This is a fairly well done study. However, it raises more questions about the specific etiologies for the trend observed.
CHICAGO: U.S. Latinos develop symptoms of Alzheimer's disease earlier, on average, than white non-Latino people, according to a study in the May issue of Archives of Neurology, one of the JAMA/Archives journals.
permalink: comments: feedURL:http://news.search.yahoo.com/news/rss?p=Latino+Health
This is a fairly well done study. However, it raises more questions about the specific etiologies for the trend observed.
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Published On: Jan 21, 2006 10:28 PM
Published On: Jan 21, 2006 10:28 PM
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