Polite Dissent

I’ve been playing video games for the better part of ten years, since the glory days of the Playstation . With a few exceptions, the games I prefer seem to fall into three categories: action games, adventure games and roleplaying games. I know the line between the various types of games gets a bit blurry now and then, but it’s my site, so it’s my call.

The following have been my favorite games over the past ten years, in no particular order. Most can be found cheap in bargain bins or eBay:

Action Games:
Ratchet and Clank I, II and III(PS2) – My favorite series of games. Fun and humorous on so many levels.
Jak and Daxter I, II and III(PS2) – a close second to the Ratchet & Clank series.
Medievel I and II(PS) – Humorous horror-inspired series. Lots of fun.
Psychonauts(PS2, XB) – My current game.
Sphinx(PS2) – Play as a muumy and a god.

Adventure Games
Akuji the Heartless(PS) – Voodoo and Richard Roundtree, what more could you want?
Beyond Good and Evil(PS2, XB) – Clever setting with an intriguing storyline.
Nightmare Creatures(PS) – chasing monsters at night in Victorian England.
Ghost in the Shell(PS) – Very (very) loosely based on the original movie. In this game, you get to pilot one of the spider-like Tachikoma tanks around, shooting innocents bad guys.
God of War(PS2) – A recent favorite. Bloody, but fun.
Resident Evil(PS) – The original.
Buffy the Vampire Slayer: Chaos Bleeds (PS2, XB) – Surprisingly good for a licensed game.
Devil May Cry(PS2) – The orginal was haunting and fun. Diluted by the sequels.
Star Wars: Bounty Hunter(PS2) – Another good licensed game.

Roleplaying Games
Skies of Arcadia (DC, GC) – Probably my favorite video game RPG.
Legend of Zelda: Ocarina of Time(N64, GC) – The best of the Zelda series.
Final Fantasy VII(PS) – The best of the Final Fantasies.
Final Fantasy VIII(PS) – Good storyline and good characters.
Final Fantasy X(PS2) – Beautiful, but became too much like a chore at the end.
Final Fantasy X-2(PS2) – Like Final Fantasy X, but with beautiful women and dancing…
Legend of Legaia(PS) – An overlooked classic.
Dungeons and Dragons: Heroes(XB) – The closest I’ve come to my D&D games growing up (we were all about the hacking and slashing).
Baldur’s Gate(PS2) – A little more thoughtful than the above.
Parasite Eve(PS) – A modern day RPG by the makers of Final Fantasy.

One year ago, I started Polite Dissent with a series of rather lame posts. Since then, things have picked up and (I’m pretty sure) improved.

According to WordPress, this is my 680th entry. I’ve been able to post something every day, except for that one day last August when I was in Chicago with no internet access (Damn you, WizardWorld!).

I’ve enjoyed interacting with everyone, from creators to fans to detractors. Most of all, I’ve enjoyed just having the chance to put in my own two-cents worth.

Next year, more of the same!

• Over at Yet Another Comics Blog, Dave is having a Free Comics Month. Check it out and sign up!
• Laura of Bloggity-Blog-Blog-Blog is participating in the 3-Day Walk for Breast Cancer. It’s easy to sponsor her, so why don’t you send little money her way. It’s for a great cause.

Congratulations to Dave Campbell for the mention of his blog Dave’s Long Box in Newsweek.

Free Comic Book Day is mentioned later in the issue as well.

If driving a car, fishing, or leading a cheer can be considered a sport then why not cutting down a tree? And there you have the quitessence of timbersports.

The Stihl Timbersports Seriesis the mainstay of lumberjack competitions. There are a number of regional events — usually held at state fairs — and then a final showdown at the end of the summer. There are six events incluidng the Underhand Chop, the Stock Saw, the Springboard, the Single Buck, the Standing Block Chop and my favorite, the Hot Saw. In this last event, competitors use souped up chainsways (usually powered with a snowmobile motor) to quickly saw three complete cuts through a log.

The ESPN Great Outdoor Games has a series of timbersports events as well. They include everything the Stihl series has, but adds log rolling competitions, speed climbing, relay events, and female lumberjacks. Truly a sight to behold.

Both series can be caught on ESPN or ESPN2.

Med Blogs Grand Rounds XXXII has been posted over at Tales of an MD/PhD Student. There’s some exceptional reading this week so stop by and check it out.

If any retailers have any all ages Free Comic Book Day comics left over after Saturday, I suggest they donate them to their local Family Physician’s, Pediatrician’s or Dentist’s Office.

This is good cheap advertising for the comic shop (provided they put their stamp or at least a sticker on the comic). It provides perfect reading material for children (and many adults) in the waiting room and exam rooms. Because of the combination of words and pictures, comics provide interest for all ages – being able to read is not necessary. Finally, this also increases the exposure of comics to the general public, which can never hurt.

Last year’s FCBD comics have sat in my exam rooms for the past year and they have been the favorites of kids and adults alike. Far from being neglected, these comics are beat-up and nearly worn out, just like a favorite toy. It’s time for some new ones.

There is a big spoiler below, so condsider yourself warned.

At first, this seemed like it would be an excellent episode of House, but by the end it had degenerated into a “Look at us, we’re so clever” hour of television.

At a swim meet, one of the judges drops dead of bacterial meningitis. The hundreds of participants and bystanders are rushed to the local hospitals for evaluation. While examining a precocious twelve year-old highdiver, Dr. House is alarmed by her symptoms. She has a fever, neck pain (with side-to-side movement, not the flexion/extension pain normally seen with meningitis) and a rash on her abdomen. Due to the fact that these symptoms have been present for several days, House is convinced that she does not have meningitis, but is still concerned enough to admit her to the hospital. A spinal tap is normal. Drs. Foreman and Chase notice that she has blood in her mouth, though an endoscopy (apparently performed with a nasopharyngoscope) is fairly normal. The patient has an absence seizure while conveniently hooked up to an EEG. Due to the overcrowding in the hospital, a CT scan cannot be obtained so they have to ultrasound her brain. The ultrasound shows bleeding around the brain so she is taken to surgery. Ultimately the team discovers that the patient has Thrombotic Thrombocytopenic Purpura (TTP) due to being pregnant. House informs her that she needs plasmapheresis and must terminate the pregnancy.

There are two main problems with the medical care presented. First, while it is possible to ultrasound the brain, ultrasound waves cannot penetrate the skull. The procedure must be performed either before the skull bones have fused or on a surgically opened skull. Neither was the case here. Second and more important, termination of the pregnancy is not required in cases of TTP. The goal is to succesfully treat both the mother and the fetus; terminating the pregnancy does not affect the course of the disease.

A few medical nit-picks: Those weren’t absence seizure waveforms on the EEG. There are many more causes of TTP than the ones mentioned, though pregnancy is a major cause. Did they ever get around to explaining why the patient had neck pain?

The soap opera in this episode involved House trying to convince Cameron to come back to work for him. She agrees, but only if he goes on a date with her. This has conflict of interest written all over it.

This episode earns a B+ for the mystery but a pitiful C- for the solution. The medicine receives a barely passing D. The soap opera aspects earn a B.

Reviews of previous House episodes

My contribution to Lefty’s Mixed Bag was sent out today. Based on some of the discs I’ve seen so far, my collection is going to be a little more mellow but no less eclectic.

My musical tastes can probably best be described as that area where country, classic rock, alt rock, and folk meet. Throw in a little punk and an occasional show tune and there you have it.

I have this strange affinity for depressing songs. Have you ever noticed that while male singers and groups can produce some very depressing songs (Billy Joel, Captain Jack; Pink Floyd, The Final Cut; Christy Moore, Ordinary Man), there are female singers who seem to make a whole career of them (Tori Amos, Sarah McLachlan, Kasey Chambers)?

Before you decide that I need some therapy or at least strong medication, I’m also a big fan of upbeat and up beat songs. My mix has a good selection of both (but can you decide which is which?)

For those interested (or those listeners who wonder what the heck I was thinking), here is the annotated version of my playlist, including lyrics.

from Captain American and the Falcon #12
Written by Priest, art by Greg Tochhini and Oclair Albert

And sadly, those are all real words too (well, except M.O.D.O.K.).

One of the biggest and most common medical mistakes in comic books (as well as television and the movies) is the treatment of asystole — more commonly called a flatline.

We’ve all seen the scenario: a patient’s heart stops beating and the cardiac monitor gives off an unrelenting “beep” while a flat neon line traces a path across the screen. The doctor grabs the defibrillator paddles aand places them on the patient’s chest. He yells, “Clear!” and then shocks the patient. Again and again.

This scenario is not only wrong, but may actually work against the patient.

The most common cause of a “flatline” is an accidentally disconnected monitor lead, so it’s best to quickly make certain the patient’s heart has actually stopped before beginning treatment.

If there is a known cause (for example drug overdose, low potassium or low temperature) it is best to treat this abnormality as well as treating the asystole.

The recommended treatment of asystole is IV medication: epinephrine and/or atropine. There has also been some success reported in using vasopressin combined with epinephrine.

Transcutaneous pacing can work in certain situations if performed early.

Electrical defibrillation is not recommended for the treatment of asystole and is not part of the standard ACLS treatment algorithm. There are some clinicians who feel that defibrillating asystole leads to worse outcomes, but there is a difference of opinions among experts about this. (I was taught that “you might as well try it, it can’t do any harm” – but I will defer to the physicians who deal with it on a routine basis.)

Key points:

• Asystole is a very, very bad thing. The vast majority of these patients never survive long enough to be discharged from the hospital.
• Defibrillation may have some use in the treatment of asystole, but is not routinely recommended (and actively discouraged by some experts). It certainly should not be the knee-jerk response to a flatline.

April brought the usual searches for Bwana Beast, Jabberjaw, Hawk and Dove, Wormy, Zatanna and Kim Possible (in various states of dress and undress).

As always, there were also searches by people looking for some specific information. I always wonder how they end up here. Still, I’ll do my best to help:

The voice of Ron Stoppable
Will Friedle

How tall is the Eiffel Tower in France?
324 meters (counting the flagpole)

Stories about nasogastric tube and foley catheter
I don’t have any good nasogastic stories, but I have a doozy of foley catheter story.

Most psychics have rhesus negative type blood
This would be as true as the fact that most Tooth Fairies have Rh-negative blood.

reading cat
I have two

Dr. Chase kidney & liver pills
A common patent medicine from 150 years ago. Here’s one recipe from Dr. Chase’s Recipes, published in 1866*:

Aloes and gamboge, of each 1 oz.; mandrake and blood-root, with gum myrrh, of each 1/4 oz.; gum camphor and cayenne, of each 1-1/2 drs.; ginger, 4 oz.; all finely pulverized and thoroughly mixed, with thick mucilage (made by putting a little water upon equal quantities of gum arabic and gum tragacanth) into pill mass; then formed into common sized pills. Dose: Two to four pills, according to the robustness of the patient.

Star Trek quote of many outweigh

Spock: If I may be so bold, it was a mistake for you to accept promotion. Commanding a starship is your first, best destiny; anything else is a waste of material.
Kirk: I would not presume to debate you.
Spock: That is wise. Were I to invoke logic, however, logic clearly dictates that the needs of the many outweigh the needs of the few.
Kirk: Or the one.
Spock: You are my superior officer. You are also my friend. I have been and always shall be yours.

Proper hand position steering wheel
10 o’clock and 2 o’clock

Bicillin shot in butt
That’s where they go.

Jungian analysis of the Wizard of Oz
I’d check over at Eric’s website.

Clark Kent’s identity Superman
Shhh! Don’t let anyone else know!

Homeopathic medicine for pink eye
Given that homeopathic medicine is no better than water (in fact, it is water), it would be just as effective (and cheaper) to use water*.

Names of the original Globetrotters
Inman Jackson, Lester Johnson, Walter Wright

*Scott and Polite Dissent do not recommend nor endorse the use of any medications that have not been proven effective by modern science.

Bet you can’t guess which day I hosted Med Blogs Grand Rounds…

from Adventures of Superman #632
written by Greg Rucka, penciled by Paul Pelletier (as if you couldn’t tell)

Sure are a lot of generals in that medical tent, aren’t there?

Let’s take a quick moment to look at all the second generation super-heroes whose mother is also a super-hero. I’m ignoring alternate universes and “possible futures” (which is why I’m discounting both Franklin Richards and the Spider-Girl continuum). The pre- and post-Crisis makes it a little confusing too.

Let’s start with the most confusing: Fury (Hippolyta Hall).
First, pre-Crisis:
Earth-2 Wonder Woman (mother of) Fury

Now post-Crisis:
Fury (mother of) Fury
Miss America (adoptive mother of) Fury

And let’s not forget that fury is a mother in her own right:
Fury (mother of) Daniel (Sandman)

Sticking with Earth-2:
Catwoman (mother of) Huntress

Moving on, Golden and Silver Age mothers of current heroes:
Liberty Belle (mother of) Jesse Quick
Merry Girl of a Thousand Gimmicks (mother of) Brainwave II
Miss Arrowette (mother of) Arrowette
Hawkgirl (mother of) Silver Scarab/Dr. Fate*
Black Canary (mother of) Black Canary
Bulletgirl (mother of) Windshear

Uncanny X-mothers:
Jean Grey-Summers (mother of) Rachel Summers
Madelyn Pryor-Summers (mother of) Nathan (Cable) Summers

Image Mothers:
Gaia Noble (mother of) Rusty, Race and Zephyr Noble
Firebird (mother of) daughter without a super-hero name at this point

Doomed mothers now subject to re-written continuities:
Elasti-Girl (adoptive mother of) Beast Boy/Changeling

Grandmothers:
Firebrand (adoptive grandmother of) Atom Smasher

Sure, one aspect of their mom’s personality was evil, but they are (or were in Obsidian’s case) heroes:
Thorn (mother of) Jade and Obsidian

*While Hawkgirl is the mother of the current Dr. Fate’s soul, Dawn Granger (Dove) is the mother of his body. I wonder if he sends two cards?

Addams Family Values is another of those great “Guilty Pleasure” movies. Whenever I run across it while channel surfing, I have to stay and watch the rest of it. Everyone who stars in it was perfect in their roles, especially Anjelica Huston who simply nails the role of Morticia. While the first Addams Family movie was funny, I think this is one of those rare situations where the second movie outshines the first.

There are some wonderful lines. A favorite:

Morticia: Children, do you think that we love the baby more than we love you?
Wednesday, Pugsley: Yes.
Morticia: Do you think that when there’s a new baby in the house, one of the other children has to die?
Wednesday, Pugsley: Yes.
Grandma: Well that’s just not true – not anymore.

The icing on the cake is the “First Thanksgiving” pageant. In my humble opinion, this has to be one of the top five funniest scenes in film ever.

When I was a fourth year medical student looking at Family Practice residencies, I was drawn to a particular residency that was offering a hefty signing bonus. The residency program looked decent, but it was the signing bonus that I found particularly entrancing.

But then I started to wonder why a residency would offer such a large signing bonus. Other residencies offered bonuses (generally used to offset the cost of moving and housing), but this was at least an order of magnitude better. Could it be that they were trying to cover up some deficiencies in their program by diverting the attention with the cash? Or maybe the bonus was the only way they could recruit residents? Did I really want my fellow residents to be the sort of people who are motivately mostly by money?

Eventually I decided that the risk wasn’t worth it, so I took that residency off of my list. It turned out to be a wise decision. I later met a handful of students who had rotated there and several doctors who had spent time there. None of them had anything good to say; serious problems with the program existed at almost every level. I was right to trust my instincts.

A similar situation happened in the office today. A prospective patient offered us a cash bonus to take him on as a patient. This simply can’t be a good sign. What sort of patient needs to bribe a doctor to be his physician?

I think I’ll pass.

As usual, the are spoilers below for this week’s episode of House.

Another week, another episode of House that gave up good medicine for shock value. A young man comes into the clinic and is found to be having a stroke. A CT of the head is normal, except for a metal plate in the jaw from an old accident. Because of this metal plate, the patient cannot have an MRI (MRIs involve powerful electromagnets, and metal is never a good idea in one). Dr. Chase suspects an aneurysm while Dr. Foreman suspects bacterial endocarditis. A vascular study is negative while an echocardiogram shows mitral valve prolapse (MVP). Because of this MVP, the team decides he must have endocarditis and treatment is started. The whole medical aspect gets derailed once it is revealed that the patient is into (gasp!) bondage, domination and asphyxia. Eventually, the medical aspect returns and it is discovered that the patient has neither an aneurysm nor endocarditis, but instead osteomyelitis from the old jaw injury and this is what is causing the strokes.

Both Foreman and Chase were jumping the gun with their diagnoses. Millions upon millions of people have MVP (2-4% of the population) and only a handful of the more severe cases are at risk for endocarditis. While the patient was apparently having some low-grade fevers, Foreman needs to have more evidence before jumping to conclusions. A positive blood culture would be nice, or how about an echocardiogram that actually shows infection on the valves, instead of just MVP. The treatment was a little drastic as well. The antibiotics make sense, but anticoagulants? In terms of a possible aneurysm, with a negative vascular study I seriously doubt any neurosurgeon would take a patient into surgery “just in case” the study was wrong. Neurosurgeons have a high enough malpractice insurance bill as it is without courting disaster. Lest you think I’m just picking on the young doctors, I have problems with House’s osteomyelitis diagnosis as well. Any abscess containing that much pus would show up on the CT scan, even with a jaw plate. I also see no reason an infection of the jawbone would cause a stroke. House’s explanation made no sense. There’s no way that these chunks of “decaying tissue” would end up in the blood stream, let alone in an artery leading to the brain.

The soap opera aspects were well done, with the episode culminating in a date between Dr. House and Dr. Cameron. The exact ending of the date was left open for speculation.

I give this episode a so-so C for the mystery and the first ever F for the solution. The medicine overall earns a paltry D, but at least the soap opera gets a B+.

Reviews (generally more favorable) of previous episodes of House.

We get too many magazines here at the Polite Household. Sure, my wife gets a couple (usually as a grandmotherly Christmas present), but by and large the majority of them are mine. If you think trying to cut back on the number of comics you buy is tough, try cutting back on the number of magazines you get – it’s even harder.

There’s Newsweek and National Geographic, because every household in America is constitutionally obligated to subscribe to both a weekly news magazine and National Geographic. No really, it’s true. I know I read it in the Constitution somewhere.

Then there are the computer and videogame magazines. PC Magazine is honestly useful, though I could do without the in-depth reporting on $3000 business software I’ll never buy. Maximum PC is inexpensive and one of the best resources for updating and upgrading computers.

I’ve cut back to two computer gaming magazines now. For all intents and purposes, they’re entirely identical on the inside. Same reviews, previews and “exclusives.” One provides a more thorough coverage of obscure wargames, and that’s the one I’ll keep – as soon as I remember which one it is (but I’ve been saying that for two or three years now). Does anyone every use those CDs that are bundled with the magazines? They load slowly and rarely contain anything that can’t be found quicker on the web. I wish they would let me renew without the CD (or “beverage coaster” as I like to call them). And to whoever decided it would be a good idea to attach the CD to the middle of my magazine instead of simply including it loosely: you should be shot.

PSM is my choice of videogame magazines. It’s cheap ($12 for 12 issues) and informative, even if it does degenerate to frat boy humor on occasion (but still less often than Wizard).

In terms of comics, I currently receive four magazines. The Comics Journal, Alter Ego and Back Issue are read cover to cover and worth every dime. I also get the Comics Buyers Guide, but the jury’s still out on that one. Let’s just say that I preferred it as a weekly newspaper instead of the monthly magazine it’s become.

I get several woodworking magazines as well. I love woodcraft and would love to spend more time in my workshop. That is, if I actually had a workshop. For some reason, our garage actually contains cars and that limits that amount of industrial-size power tools I can have. I try to throw away the magazines, but then I start thinking: “Wait, that’s the Router Isue! I must keep it!” Or “This issue has that special report on wood staining with linseed oil. You know the minute I throw it away, I’ll have a project that requires a linseed stain!” I think I’ll need to build a bookshelf just to hold my woodworking magazines.

Ironically, we probably receive 2 or 3 trees worth of nature magazines annually. We subscribe to National Geographic, National Geographic Adventure and Illinois Outdoors. The rest seem to arrive whether we want to read them or not. Admittedly, we in the Polite Household tend towards the “green”, so we support a number of nature charities. They are all happy to send a magazine or two (or four) our way. Why is it that environmental charities seem to send the most mail? Isn’t this counter-productive?

I haven’t even touched on the medical journals yet, but that’s a topic for another day (did you know that just by putting an M.D. behind your name you’re guaranteed an additional 4 or 5 magazines a week? And they won’t stop no matter what you do?).

from Batman & Poison Ivy: Cast Shadows
words by Ann Nocenti, art by John Van Fleet

While technically not 100% incorrect, what is not quite right about this panel? (Click on the image for a larger view)

Over at the Absorbascon, Scipio takes a look at the latest issue of Aquaman and raises some intriguing and important questions. Personally, I haven’t read the issue yet, so I’m withholding speculation until I do so.

I will point out a couple of previous Aqua-posts here at PD:

1. In which the subject of air bubbles, medical gowns, light, the Bends, and Atlantean hair are considered.
2. In which the question is raised that if the people of Sub Diego gained their water breathing from Aquaman’s DNA, why do they have gills when he does not? The concept of functioning gills in humans is then briefly discussed before being quickly dicarded.

I think it’s safe to say that I’m looking forward to this issue of Aquaman now…

Speaking of the Absorbascon, I am going on the record and siding with Thanagar over Rann. Let’s face it, Thanagarians are just much cooler what with the wings and helmets and medievel weapons and all (well, except that whining “artist” Thanagarian who showed up in Grant Morrison’s Animal Man. Adam Strange could have defeated him with both hands and both legs tied behind his back.)

I just noticed this tonight: in addition to changing the title art and increasing the price, DC apparently figured the secret was out and made no attempt to obscure the identity of the corpse in the second printing of Countdown to Infinite Crisis.

First Printing

Second Printing

(I really don’t like the way Wonder Woman is drawn on the cover. She looks like she’s recovering from brain surgery with one side of her head shaved)

• If you’re coming to see me complaining of a sore throat, don’t be surprised to find out that I actually need to look at the back of your throat. Don’t give a huff or exasperated sigh and slowly remove the gum you’ve been chewing. Why are you chewing gum in a doctor’s office anyway? You know I’m going to look in your mouth, I always do. Do you chew gum when you go to the dentist?
• If you’re coming in to see me complaining of a sprained ankle or a sore foot, please take your shoe and sock off so I can get a good look. I don’t have kids so I’m not good at dressing and undressing other people. If I have to take off your shoe myself, it’s undoubtedly going to hurt a lot more than if you do it yourself.
• For heaven’s sake, turn off your cell phone! At the very least don’t answer it and start a drawn out conversation while I’m trying to talk to you or perform an exam. It’s not that my time is any more important than yours, it’s just damn rude behavior.

After a brief hiatus, I am proud to announce the return of Lois Lane Friday!

Adventures of Superman #632 “Time Elapsed”
Greg Rucka, writer
Paul Pelletier, artist

Lois has been shot while covering the war in Umec. Hearing the gunshot from half a world away, Superman rushes to her side. He scoops her up and flies to the nearest field hospital.

The physicians rush Lois into surgery. She’s suffered a gunshot wound to the chest which “clipped the aorta and then ricocheted off a rib.” She also sustained a pneumothorax. After the military doctors stabilize her, Superman and the JLA fly her to the Watchtower on the moon where Dr. Mid-Nite is able to perform definitive surgery.

The medicine as written by Rucka is pretty good (except for the use of whole blood. Please, a field hospital in the desert would not have whole blood. In reality, whole blood rarely used in any circumstance.). The injuries described are consistent with the wound she suffered and the operating team seems to do a good job. I will point out that the injuries are most consistent with a low velocity projectile; I don’t have the previous issue so I don’t know if this fits the story.

The art by Pelletier isn’t nearly as accurate, which is a shame because he is usually one of my favorite artists. There’s nothing horrible, just a lot of little mistakes. For instance, the surgeons aren’t wearing gowns or caps, and they’re using some sort of bizarre surgical mask. I assume they’re wearing gloves, because everyone in the hospital is drawn wearing them. Speaking of the soldiers in the hospital, Pelletier draws every single one as a general with a star on their lapel. Then he makes the common mistake of showing two needles going into the same IV site in the hand. You can run multiple fluids through the same IV, but the tubing is connected well above the IV site and only one needle is ever used.

The book contains a couple of interesting scenes:

• Over at Suspension of Disbelief, Loren does a good job covering Superman’s “super-hearing” and the speed at which he flew to rescue Lois. I’ll only add that if Superman can travel that fast, why does he stop at the nearest field hospital instead of taking an extra second or two and flying her to a fully stocked hospital?
• The scene when Superman enters the hospital tent is very New Testament. The injured soldiers are all clustering around him as he walks him, begging him to touch them and cure their injuries. Personally, I prefer my Superman a little less Messianic.

• Flash shows up undercover to help Superman transport Lois. Why is he undercover? Because Batman told him so. Why? It’s not like the soldiers haven’t figured out that costumed heroes are involved; Superman’s been standing there for several minutes at this point.
• When Pieter Cross (Dr. Mid-Nite) is called at his clinic, he asks who was injured. The response: “One of ours.” That’s a nice answer, but it still doesn’t tell him the important fact of who it actually was. Technically, I think Lois is a superhero-in-law, not a real superhero, but it’s nice to know the perks that come with marrying in to the JLA.
  Still, I can just imagine the scene in the Cross Clinic waiting room…

  Patient: My appointment was at one o’clock. It’s four fifteen now!
  Nurse: I’m sorry, but Dr. Cross is in emergency surgery on the moon. How about some more coffee?

On the far edge of town is a park known as the Dog Park. I drive by it frequently, and I always wonder about it. What secrets does it hold? Not owning a dog (only two strong-willed cat), I’ve never had the chance to discover the secrets — until now.

There’s a small parking lot that sometimes contains one or two cars or trucks, but it never seems to be the same ones. There is a large well-kept grass field next to the parking lot. This field extends for about two hundred yards until the tree line, where the forest begins. In the far corner of the park, where the field meets the tree line, is an open gate leading back into the dark forest.

What is back behind the gate? How come we never see any people, let alone dogs at the Dog Park? Why are there never any repeat visitors, or why are the repeat visitors so rich that they can afford a new car every time they visit the park? These are just some of the mysteries of the Dog Park.

My own suspicion is that there is some kind of vast conspiracy involving the park. Possibly a cult or aliens, though my main suspicion lies towards some sort of dark Lovecraftian horror. I suspect that people (and possibly dogs too) enter the forest through the gate, never to return. Somebody then tows their cars and sells them, probably to Canada.

Any day now, the Polite Wife and I will find out the truth behind this park. The Polite-Sister has a research project this summer and will not be able to take her dog along. Thus my wife and I find ourselves the temporary owners of mostly-Springer Spaniel named Suman (and the cats are definitely not happy). Soon, we will put on our hiking boots, clip a leash on Suman’s collar, hop into the Explorer and head for Dog Park. Its secrets will soon be mine (unless they’re really nasty, then the park can keep them).

Legion of Super-Heroes #5
Mark Waid, writer
Barry Kitson and Art Thibert, finishes

Imra Ardeen (Saturn Girl), Garth Ranzz (Lightning Lad) and Brin Londo (Timber Wolf, though he is not identified as such here) are trapped on the remote (and unimaginatively named) Rimworld 19. Along with a group of potential Legion recruits, they attempt to repel an attack by super-powered invaders.

During the battle, the telepathic Imra uses her telepathic powers to counter the fear the recruits are feeling.

Imra: This is precision work. The amygdala is a very delicate portion of the brain to have to alter.

The amygdala is a small area found in the brain that is indeed involved in the fear response. It also has a role in aggression.

• This is the first time I remember seeing a telepathic character specifically refer to brain anatomy.
• “Amygdala” is also the name of one of Batman’s villains, most recently appearing as a supporting character in Nightwing.

Amazing Fantasy #8 “Posion Tomorrow, part 2: Motherless Country”
Fred Van Lente, writer
Leonard Kird, penciler

The Scorpion (the young female one) is in Madripoor tracking down her birth mother. At the orphanage she runs across the 4T’s, a gang involved in kidnapping and prostitution As to be expected, a fight follows. During the melee, the Scorpion is injected with a syringe.

SHIELD Agent: Sir — this is bad — her vitals are going haywire! These readings — that needle must have been filled with curare — it’s a muscle relaxant — 4T’s can use it to sedate the girls – Scorpion’s been given a lethal overdose! First comes respiratory paralysis, then –

Curare is a poison derived from a South American plant. The natives used it as an arrow poison when hunting monkeys.

Medically, curare is a type of muscle relaxant. Not the type the doctor might prescribe for a strained back, but a one that paralyzes muscles. It works by blocking the communication between nerves and muscles. The facial muscles are typically affected first followed by the muscles of the neck. The patient suffers an inability to hold the head up or swallow. In lethal doses, paralysis of the respiratory muscles (including the diaphragm) comes next which leads to death by respiratory failure.

The agent has it wrong: respiratory paralysis is last, not first. Also, despite what the art suggests, curare has little effect on the heart. Still, it can be a particularly nasty poison.

• Curare (or more correctly, its derivatives) are an important part of surgical anesthesia.
• “Curare” is also the name of one villains from Batman Beyond.

I can’t be the only one who thought of Tom Smith’s “307 Ale” in the scene in Ultimate Secret #1 when Johnny Storm and Ben Grim are building a still out of some of Reed’s equipment.

(For those of you unfamiliar with the song, it’s about some M.I.T. students who got bored one day and built a still out of the cyclotron, resulting in a rather unique beverage. It also has one of the best pun endings of any song*. Lyrics are available here.)

Aquaman #30 “Kiss of Death, part 1: The Nine”
Marc Guggenheim, writer
Andy Clarke, penciler

This comic has so much that is scientifically and medically suspect that I’m going to take two days to discuss it so as not to drown everyone in a sea of science. For the first post, I’m just going to focus on the autopsy.

The scene: Eight people have apparently been murdered in Sub Diego. Aquaman brings the victims to the surface for examination and autopsy at the County Coroner’s Office. He really shouldn’t have bothered as the autopsies are substandard and the pathologist doesn’t seem to understand basic physiology.

To start with, the incision is wrong. Pathologists use a Y-incision, not the straight stern-to-stem incision seen here. (As an aside, what happened to the her skeleton? You know, the ribcage that protects the lungs. It seems to have disappeared.) Second, the pathologist is passing judgment on the condition of the lungs and it doesn’t look like he’s removed them to take a close look.

Pathologist: “subject’s alveoli are swollen and lacking surface surfactant, suggesting hypoxia…in layman’s terms, all of these victims suffocated. Specifically they inhaled too much oxygen.”

There is so much that is wrong here. The lungs of the people of Sub Diego no longer function, so they can’t inhale any air — let alone oxygen. Next, the findings he mentions are not signs of hypoxia. If anything they are consistent with non-working water-logged lungs. Every resident of Sub Diego (except maybe Aquaman) would have lungs that looked exactly like that. Recall that hypoxia means “low levels of oxygen reaching the body’s tissues.” Thus the pathologist is suggesting that high levels of oxygen are causing low levels of oxygen. Admittedly, he’s talking about high levels of inspired oxygen leading to low levels of blood oxygen, but it still makes little sense.

He goes on to say:

“Oxygen’s as toxic to the Sub Diego survivors as carbon monoxide is to you and me.”

Wrong. Carbon monoxide is toxic because it binds to hemoglobin and displaces oxygen. This leads to reduced oxygen levels and ultimately death. Here, the pathologist is saying that the oxygen is toxic because it replaces…oxygen.

I’ll give the pathologist’s comments about premortem bruising the benefit of the doubt. His interpretation is certainly correct, given what we the reader already knows about the crime (though to me the bruising seems more consistent with someone holding the mouth shut, but I’m no pathologist). I’ll also admit that he is right in stating that surface air has a different composition than air in SCUBA tanks (or apparently the air “exhaled” by Sub Diegoans). Next time, Aquaman should just call Dr. Mid-Nite. He’s not the best pathologist, but at least he’s better than this guy.

In short, this autopsy was better than the infamous alien autopsy…but just barely.

My Pete and Pete Season One DVDs arrived today, so I’m going to put them on and join Pete, Pete, Petunia, Mom, Dad, Artie, Ellen and Endless Mike for a nice evening (or two) of relaxation and surreal humor.

Do I really have to say it? There are spoilers below for this week’s episode of House.

An intriguing and at times surreal episode of House that not only introduces the “love of his life” – now married to someone else – but also provides more information about his leg injury. This episode did not try to be as sensationalistic as the last two weeks, and the result was a much better show.

Dr. House is coerced into teaching a Medical Diagnosis to the medical students. He presents three cases, all starting with leg pain. The first case is a middle-aged farmer. Examination of his leg reveals an inflamed puncture wound consistent with a bite. At first, the bite is felt to be from a poisonous snake. The patient doesn’t respond to the antivenin, and in fact develops a life threatening allergic reaction. Different antivenin is tried with no success. After reminding the class that “every patient lies,” House discovers that the patient was bitten by his dog. The dog was a carrier for the strain of Group-A Strep known as “Flesh Eating Bacteria”, and the patient ends up having his leg amputated, but at least he survives.

The second patient is a sixteen year-old volleyball player who comes to the clinic with leg pain. Dr. Cameron examines her and diagnoses muscle strain. On a complete physical exam she notices a small thyroid nodule. The patient undergoes a fine-needle biopsy of the thyroid and thyroid testing, revealing that she was deficient in thyroid hormones. Later, she develops an unusually high calcium level and an MRI is obtained which shows an osteosarcoma of her leg. This was successfully operated upon and she returned to playing volleyball.

The third patient was another middle-aged male. This one developed severe leg pain while golfing. At his first presentation in the clinic, he appeared to be a drug addict. Later, when he returned to the office he was still having pain and had now developed discolored urine. He was misdiagnosed with muscle trauma when in reality he had a blocked artery in his leg. By the time the blockage was diagnosed, a great deal of muscle tissue had already died. An amputation was recommended, but the patient chose to have the blocked vessel surgically reopened instead. Due to worsening pain after the procedure, the patient opted to be placed in a medically induced coma until the worst of the pain was over. While he was in this coma, his significant other used the terms of his power of attorney to send him to surgery – not for the amputation, but for a removal of all the affected tissue. This left him with a limp and constant pain (and a serious beef with his girlfriend) – but at least he was alive. About two-thirds of the way through the episode, it became clear that this patient was House himself.

I really don’t have too much to say about the medicine this episode. For the most part it was decent; however I find it hard to believe that the doctors couldn’t tell a dog bite from a snake bite. Also, the idea of Drs. Foreman and Chase going into the farmer’s field, tackling the dog and swabbing its mouth is just ridiculous. The volleyball player’s diagnoses were more straightforward, though I will point out that thyroid testing and biopsies are generally done as an outpatient and don’t require admission to the hospital.

In terms of House himself, it sounds like his doctors screwed up if they just sat on an elevated creatine kinase without investigating further. A muscle infarction would be very low on my list of possibel diagnoses, but at least I’d look closer. Apropos of a previous post of mine, they were a little quick to shock a flatline this episode (and notice that they defibrillated the poor farmer through his shirt). I recommend a little more research on cardiac emergencies for next season. The medicolegal aspects of the episode I leave up to the lawyers, but it seems like an abuse of the concept of power of attorney to me.

Despite the introduction of Sela Ward as House’s ex, there was precious little soap opera inthis episode (it was basically a set up for next week’s season finale). The scenes where House was teaching the class were particularly clever and well done, especially those that featured Carmen Electra.

This episode deserves a B+ for the mysteries and an A- for their solutions. The medicine was mostly well done, and earns a B. The soap opera aspect also earned a B, but the classroom scenes earn an A+.

Reviews of previous House episodes.

In Part 1, I took a look at the autopsy scene. This portion of the review is going to look at the rest of issue, particularly the scene where Aquaman confronts the semi-mad scientist Geist.

Geist: Well…because of the genetic mutation, everyone in Sub Diego breathes water – and they exhale air. It’s a…a byproduct of underwater breathing.

Geist: Y’know how you breathe oxygen and exhale carbon dioxide? Well, Sub Diegoans breathe water and exhale oxygen.

First, I’d like to remind Geist (and more importantly, the author) that due to his genetic manipulation, the people of Sub Diego breathe underwater using gills, not by using their lungs. There is no inhaling or exhaling at all.

How do gills work? They are very complex structures made up of thousands of tiny filaments which create a great deal of surface area for the water to flow across. They also contain many capillaries near the surface of the gills. As water flows across the gills, oxygen diffuses into the blood flowing through the gills. At the same time, carbon dioxide in the blood diffuses out into the water. Note that gills work constantly; there is no inhalation/exhalation cycle.

Pretty much everything Geist is saying is wrong and/or contradicts previously (and fairly recently) established “Sub Diego facts”.
1. The Sub Diegoans have gills, not lungs.
2. There is no inhaling/exhaling, no breathing in or breathing out.
3. Through their gills, Sub Diegoans extract oxygen from the water and return carbon dioxide.
4. As Scipio pointed out, if they are inhaling water and exhaling carbon dioxide, then they must be swelling up with hydrogen. Good thing nobody can light a match down there (oh, the humanity)

A few final thoughts:
1. If the Sub Diegoans were exhaling oxygen, they’d be very buoyant. In fact, the human body is quite buoyant naturally. How is everyone staying at the bottom of the sea without weight belts?
2. Why isn’t everyone’s skin all pruney?
3. While the Scrabble board is a neat trick, pencils work fine underwater; the trick is finding waterproof paper.

I would like to thank the Polite Sister, a SCUBA certified marine biologist for her help with this review. See what happens when you visit…you get pulled from your world into mine.

From the very beginning, super-hero comics have had their share of poorly designed costumes (has their ever been a more color-challenged costume than the original Green Lantern?). Here’s a look at the top 10 fashion design disasters since I’ve been reading comics, and 10 ideas that shouldn’t work, but somehow do. Some of these are ugly costumes, but most are stupid designs and re-designs that should never have been done in the first place.

Fashion Design Ideas that Simply Don’t Work
1. Superman with a long hair. This never worked for me; even worse was the flip-side: Clark Kent had his hair pulled back in that poseur ponytail
2. About half of Infinity Inc. (Fury, Silver Scarab, Star-Spangled Kid/Skyman, Dr. Midnight, Hourman II).
3. Armor (not counting Iron Man and other characters whose schtick is armor).
4. The Olive Newton John-esque headband-wearing Supergirl of the 1980s.
5. The bare-midriff Huntress.
6. The Beast’s Osh Kosh B’Gosh outfit. He’s never really had a good costume. His original X-Men costume was ugly, but this latest Whedon/Cassaday design looks like a pair of farmer’s overalls gone bad.
7. Dazzler. Even in the Disco era this was overkill…and this was after the Disco era!
8. The new “metrosexual” Riddler.
9. Aquaman’s blue costume
10. The Image re-design of Marvel’s core characters (most blatant in Portacio’s Iron Man and Hulk and Liefeld’s Captain America)

Design Ideas that Shouldn’t work, but Somehow Do
1. Deathstroke (Orange and blue? But he makes it work.)
2. Kitty Pryde’s homemade costume in X-Men #149. Sure it’s horribly ugly, but it’s just the sort of costume a 14 year-old girl would design.
3. Big-Hair Wolverine (from Wolverine/Havok: Meltdown)
4. Jade. The green skin should make her look like a Star Trek reject, but she pulls it off.
5. Warlord.
6. Kraven. What is that on his chest? Is it a lion? A horse?
7. Mr. Bones. A skeleton, wearing a skull and crossbones and a big cape? Yet it works.
8. Dr. Strange. Orange spotted gloves? Big cape? Baroque amulet?
9. Man-Bat. He’s a bat! He’s a man! He’s both!
10. Zatanna. Her fishent and top hat original costume is great. Her black, white and red JLA costume and the horrible outfit from her Special count as “Bad Ideas”.

Hidden deep in the swamps on the remote planet Dagobah is one of the greatest physicians in the universe:

Dr. Yoda: I am wondering, why are you here?
Patient: I’ve had this sore throat for a week. It feels—
Dr. Yoda: Feel like what?
Patient: It feels like I swallowed a lightsaber.
Dr. Yoda: Help you I can. Yes, mmmm.
Patient: Do I need antibiotics?
Dr. Yoda: Already know you that which you need.

Patient: Dr. Yoda, I want to try to quit smoking.
Dr. Yoda: No. Try not. Do… or do not. There is no try.
Patient: OK, OK, I’ll quit! But I’ve smoked for so many years.
Dr. Yoda: You must unlearn what you have learned.
Patient: There are days I’m not sure that I even want to quit.
Dr. Yoda: That is why you fail.
Patient: (sigh) I might as well just accept the fact that I’ll be smoking two packs a day for the rest of my life…
Dr. Yoda: So certain are you. Always with you it cannot be done. Hear you nothing that I say?
Patient: So you will be able to help me quit smoking?
Dr. Yoda: You will know… when you are calm, at peace, passive.

Patient: Doc, I’m here for my test results.
Dr. Yoda: I sense much fear in you.
Patient: I’m scared it might be cancer. I know I should have come in when I first saw the spot, but I just kept putting it off. Finally my wife made me come in.
Dr. Yoda: Now, matters are worse.
Patient: Is it really that bad?
Dr. Yoda: Impossible to see the future is.
Patient: Is it…fatal?
Dr. Yoda: Difficult to see. Always in motion is future.
Patient: Please Doc, I gotta know…
Dr. Yoda: Pain, suffering, death I feel.

Patient: I’m looking for Dr. Yoda.
Dr. Yoda: Looking? Found someone, you have, I would say, hmmm?
Patient: Doc, I’ve kinda got this embarrassing problem. And I was wondering if those e-mails I’ve been getting really work…
Dr. Yoda: Size matters not.
Patient: Seriously, can’t you do anything, you know, to make it bigger?
Dr. Yoda: Strong am I with the Force, but not that strong.

Postin will be light today. The Polite Wife and I are jaunting down to St. Louis to meet some friends and see a production of The Producers. More tomorrow.

The Producers was very funny and had several great songs but it definitely suffered from Huckleberry Finn Syndrome*. After the hilarious “Springtime for Hitler” scene the show just limps along until the final curtain. Lots of Mel Brooks humor, much of it way too blatant, which works best in small doses. Still, it was an enjoyable musical and it’s always a treat to see a show in the Fox Theater.

The man sitting in the row behind me apparently considers “Oy” the funniest word ever.

Character on stage: Oy
Man behind me: Oy. Oy! OY!! [uproarious guffaws laughter]. Oy! Oy.

It was very nice to have a relaxing weekend since I know the coming week is going to be a guaranteed headache (it’s JACHO time). Only five days until a three day weekend! With lots of good racing (the Indy 500 and the Coca-Cola 600)! And barbecue!

Just…five…more…days

It was nice to finally see a new episode of Justice League Unlimited after months of waiting. This episode, Task Force X, was unusual in that it focused on the villains much more than the heroes.

Colonel Flagg has recruited a handful of villains to help him sneak onto the JLA satellite and steal the Annihalator armor. His team is made up of Deadshot, Plastique, Captain Boomerang with the Clock King planning the operation. Flagg and his team (except the Clock King) sneak onto the satellite. While Plastique and Deadshot cause a distraction (by blowing up the nucelar reactor, of course), Flagg and Boomerang sneak into storage and steal the armor. As the team makes their way to the bridge to teleport back to Earth, they have a fight with Vigilante (the cowboy one), the Shining Knight and Atom Smasher. Once they make it to the bridge, they have to fight Jonn J’onzz as well. By using Atom Smasher as a hostage, the villains make it to safety, prize in tow. At the end of the episode, John and Jonn realize that they can’t trust anyone anymore.

This episode had some good action sequences, but there wasn’t of a plot — which is understandable as it’s clearly more of a set-up episode.

I do wonder why the JLU teleporter, which can teleport someone anywhere in the world can only pick-up people from a remote cornfield? And wouldn’t it be smarter to check ID before they arrive on the station — they don’t check your ID once your on the airplane, do they? No, they do it well before. Just a hint for the JLU security guys.

Speaking of the JLU, how about the new action figure 3-pack of Wonder Woman, Hawk and Dove? Finally, the Hawk and Dove collectibles the world has been clamoring for!

Growing up in Virginia, my favorite show to watch after school was The Krofft Super Stars. This was an hour show that was really two random half-hour shows from the prolific Sid and Marty Krofft. There seemed to be no rhyme or reason to the episodes shown. It could be two episodes of the same show or episodes of two different shows. Even if the episodes were from the same show, they were undoubtedly shown out of order.

The Krofft Super Stars included the following shows:

• Land of the Lost. The best of the bunch, and therefore shown rarely. The sleestaks were still creepy, but not as scary as when I was five. Chaka though, he (it?) was scary.
• Far Out Space Nuts. Stupid but funny.
• The Lost Saucer. With Jim Nabors and Ruth Buzzi as androids. Again, stupid but fun. Probably my favorite show, as the humor was perfect for a nine year-old.
• Electra-Woman and Dynagirl. This one only showed up in the rotation rarely and I think only three of four episodes were made. I tried to like it because it featured superheroes, but it was hard not to be astounded by the low production values and inane scripts.
• Sigmund and the Sea Monsters. Or was it Sigmund the Sea Monster? I can’t remember. It was about a couple of boys who lived near the beach, their sea monster friend, and his family of less-than-friendly (though very inept) sea monsters. It was funny with the above average Kroft production values (second only to Land of the Lost).
• H.R. Puffinstuff. Huh? What were thinking? Even as a nine year-old I knew this was a drug show and I had no hope of understanding it.
• The Bugaloos. My least favorite. Tiny whiny hippies with wings — but that’s not all: they sing!

I know that Land of the Lost is out on DVD, but I haven’t seen any of the others.

UPDATE (24 May):
Other Krofft shows I forgot (some I can barely remember at all): Wonderbug (kind of a live action Speedbuggy), Bigfoot and Wildboy, Dr. Shrinker, and Lidsville.
Here’s the TV Tome link for the Krofft Supershow/Krofft Superstars

It’s Tuesday and that means that it’s time for the best of the blog…well, the best of medicine at least. Grand Rounds XXXV is hosted at Iatremia: The Chaplin.News. There are some great articles and posts, so give it a glance when you have a minute.

There are plenty of spoilers below, so don’t say I didn’t warn you.

In the season finale, Dr. House is asked to treat Mark, the husband of his former live-in girlfriend Stacy (played by Sela Ward). Stacy is the only one who thinks that something is wrong with Mark. He denies being ill and blames his abdominal pain and mood changes on stress. All tests to date have been normal.

For one reason or another, House believes her and ultimately discovers some subtle neurological abnormalities in Mark. The team’s hypothesis is that Mark either has encephalitis or Alzheimer’s Disease. A huge battery of tests are all normal. The next suspect is Guillain-Barre Syndrome, but those tests too are normal. Finally, House realizes that Mark has some subtle delusions and is avoiding sunlight. With this information he decides that the patient has Acute Intermittent Porphyria (AIP). He confirms this diagnosis through a blatantly unethical test (unethical because the patient had explicitly not consented to it) and in the end, Mark has survived and is apparently cured.

In reality, Mark’s symptoms were never consistent with a diagnosis of Alzheimer’s, though encephalitis was a possibility. Encephalitis was properly excluded by laboratory testing, but — despite what this episode suggests — there are no easy laboratory markers for Alzheimer’s.

The symptoms do fit a diagnosis of AIP. However, urine levels of a chemical known as porphobilinogen are elevated all the time in patients with AIP, even between attacks, so checking the urine during an attack is not required (and although the suprapubic tap appeared technically proficient, I prefer my procedures to be performed using sterile technique). Also it’s important to note that AIP is not a curable condition, although its symptoms can be treated.

The soap opera aspect was good, with some nice clashes between House and Stacy, House and Mark, and Stacy and Dr. Cameron. Plus there were some great one-liners in (my favorite: “That’s her Indian name. On her driver’s license it’s ‘Stacy’”).

This episode earns a B for the mystery and an A- for the solution. The medicine was fair, and earns a B (points were deducted for Alzheimer’s and the urine-during-an-attack scene). The soap opera aspect earned a solid A. Extra credit for ending the episode with “You Can’t Always Get What You Want,” the best Rolling Stones song ever.

Reviews of previous House episodes.

What’s wrong with this picture? You’ll probably need to look at the larger version.

from Daredevil #72
words by Brian Michael Bendis, art by Alex Maleev

It may not be an error — it may be that Bendis and Maleev are trying to make some sort of point, but I doubt it. It’s probably a mistake.

Let’s say that you’re caught as an innocent bystander in a super-hero/super-villain fight and badly injured. You need an immediate blood transfusion and the only possible donor is one of the super-heroes. Should you consent? What are the odds?

Go for it. The odds are clearly on your side (unless you’re a nearly senile octogenarian):

More information on the individual comic books can be found here.

This is an interesting story where the Reverend Jerry Falwell is suing a man who owns a website critical of Falwell – a website that happens to be a common misspelling of Falwell’s name. The following quote caught my eye:

A lawyer for Falwell maintained Lamparello’s use of a variation of the preacher’s name bordered on theft. “It’s been wrong to steal since Moses came down from the mountain,” attorney John H. Midlen Jr. said.

Somebody needs to remind the Counselor that it was wrong to steal long before Moses came down from the mountain.

While others are dealing with the political and social ramifications of the Thanagar/Rann war, I’ve been busy investigating another aspect of the conflict. I think the following speaks for itself:

As everyone prepares for the summer, here’s a little hint from an old DC Comics ad:

The language is so over the top it’s nearly poetic: “You’ll be filled with pride as you see husky muscles grow and ripple over your body in paths of power.”

The anatomy’s a little off, especially the abdominals (they’re called “6-pack abs”for a reason, not “8-pack”).

Just send $1.00 and you can look like a new man (or woman, I suppose).

The Sunday before Memorial Day is one of my favorite days of the year.

Why?

Eleven-hundred miles of car racing excitement, that’s why!

It started off as a nice mild day. I was able to spend a couple of hours fixing up my herb garden and butterfly garden, both of which are coming along very nicely. I also started up the grill and slow smoked two racks of short ribs that I had slathered with a curing rub the night before. By noon, they were ready and perfect. A light smoky flavor added to the hint of spices from the cure, combined with fall-off-the-bone tenderness. I only cook ribs once a year and savor every bite.

The Indianapolis 500 was a good race. Most of the excitement was on Danica Patrick, a female racer. There have been other female Indy racers before, but never one as highly touted as Patrick. She did well and even led a few laps, but a couple of rookie mistakes cost her and she ended up fourth (but a very respectable fourth). England’s Dan Wheldon ultimately won the race. This gave Michael Andretti his first ever Indy 500 win (though as an owner, not a racer).

An hour or so later the Coca-Cola 600 started in Charlotte. This is the longest race of the NASCAR season and generally one of the most exciting. This year was no exception. Tonight’s race set the record for most cautions in a NASCAR race — ever. There was a time with about 150 laps to go where the Polite Wife and I would bet how long it would be before the next caution. She kept guessing 15 or 20 laps while I went with 8. It never made it past five laps before another caution came out. After three rounds of this, we gave up trying to guess. All the cautions did put Bobby Labonte in good position and with 9 laps left he was leading the race. Unfortunately he was passed in the very last turn by Jimmy Johnson and lost by two hundreths of a second. Still, it was Labonte’s best showing of the year.

And the best part is I still have tomorrow off!

It’s a holiday so I’m taking the day off. Yesterday I realized that I never finished Dungeon Siege, so I think I’ll play that today (and mow the lawn too, sigh).

Today is Memorial Day, and despite what the television networks would have you think, it’s not a holiday set aside for the sole purpose of watching old war movies. Today’s the day when we remember those who went before us, particularly those who gave their lives for our country. Dave Campbell has my favorite Memorial Day post this year (and Laura does a good job rounding up other Memorial Day posts).

Tomorrow I’ll return to the dog-eat-dog world of comic book medical reviews with a long look at Batman: Jekyll & Hyde.

Batman: Jekyll & Hyde #1
Paul Jenkins, writer
Jae Lee, penciler

Batman: Jekyll and Hyde #1 spends half the issue focusing on Harvey Dent, who is better known as the villainous Two-Face. Once a promising District Attorney, Dent had his face scarred with acid thrown by a mobster. As originally written, having half his face horribly scarred drove Dent insane. More current interpretations of the character suggest that Dent always had a darker side and the trauma of the acid burn brought it to the surface.

1. THE DIAGNOSIS OF HARVEY DENT

Arkham Asylum Doctor: Harvey Dent, also known as Two-Face. Paranoid schizophrenic with homicidal tendencies. Secondary diagnosis is a borderline personality disorder, or perhaps multiple personality – we can’t be certain.

Arkham Asylum Doctor: Mister Dent experiences frequent hallucinations as a result of his psychosis. He’s convinced that he shares his body with another person. In effect, he has literally become two people.

It’s no wonder nobody ever gets better at Arkham: the doctors don’t have the slightest idea what they are talking about.

While there are no simple blood tests for mental illness, there are specific diagnostic criteria. The patient is evaluated for the presence or absence of certain symptoms. These symptoms are then used to diagnose the patient. The most commonly used diagnostic reference is the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV TR).

Harvey Dent does not meet the criteria for Paranoid Schizophrenia (or even Schizophrenia in general). He may be delusional at times (which is certainly up for debate), but he has no hallucinations, disorganized speech, disorganized behavior or negative symptoms.

Similarly, he does not meet the criteria for Borderline Personality Disorder, though he does seem to have some borderline traits.

Multiple Personality Disorder (now known as Dissociative Identity Disorder) fits Dent best. It’s not an exact match, but it’s the closest.

Other thoughts on Harvey Dent’s diagnosis:

• Not every expert is convinced that there is such a thing as Dissociative Identity Disorder.
• It’s interesting that the doctors are not sure that Dent has Multiple Personality Disorder, yet spend two pages talking about his “second personality.”
• In regards to the second quote, the belief that Dent is sharing his body would be a delusion, not a hallucination. It would also be a shared delusion since most of Gotham believes it as well. That’s very unlikely. It’s much more likely that Dent actually has a second personality.
• Based on my reading, I would diagnose Harvey Dent with Dissociative Identity Disorder. His second (mostly dominant) personality has a severe Antisocial Personality Disorder with strong Narcissistic and Histrionic characteristics. He also has Obsessive-Compulsive traits, particularly in regards to the number “2” and his coin. (Though I will happily admit that I am neither a psychiatrist or a psychologist).

2. THE MEDICAL TREATMENT OF HARVEY DENT

Arkham Asylum Doctor #1: Medication?
Doctor #2: Just about every combination we can think of – heavy sedatives to keep his mealtimes manageable…a combination of antipsychotics such as dopamine and antidepressants to relieve the agitation.

Antidepressants, antipsychotics and sedatives are all commonly used in the mentally ill — sometimes we seem to use them too much, sometimes not enough.

The chemical dopamine is a neurotransmitter found in specific areas of the brain. In other words, certain nerve cells release dopamine to communicate with other nerve cells. Research has shown that these dopamine-using cells play a role in schizophrenia.

However, dopamine itself has no use as an antipsychotic medication. There is no way of getting the drug to the brain, let alone to the proper nerve cells. When dopamine is used as a drug, it is used as a cardiac drug to raise the blood pressure in critically ill patients (dopamine has different functions in other parts of the body).

3. BRUCE WAYNE – PARTY ANIMAL
When examining the house of a man who killed his family, Batman finds a prescription bottle from a Dr. Rousse. As Bruce Wayne, he visits the research lab where Rousse works. Pretending to be a party boy, Wayne asks Rousse if he can prescribe him some relaxants such as Valium or Ritalin. Rousse turns him down by pointing out that such prescriptions would be illegal and that he no longer prescribes drugs.

He probably also should have pointed out that Ritalin (methylphenidate) is a stimulant, not a relaxant.

UPDATE (1 June 05):
Several readers have informed me that in the past Two-Face has experienced hallucinations, delusions and disorganized speech — depending on who’s writing him. Some of this is open to interpretation given that most psychological diagnosis is based on subjective criteria. Still, based on those past appearances, a diagnosis of Schizophrenia may not be inappropriate, though I continue to doubt the diagnosis of “Paranoid Schizophrenia.”

I’m still going to stick with my diagnosis, which is based on the more recent and more stable (though no less menacing) Two-Face.