Polite Dissent

Unfortunately, hearing damage is a common side effect of one particular class of strong antibiotics: the aminoglycosides. These drugs are infamous for causing ototoxicity (ear damage) and nephrotoxicity (kidney damage). Generally, very careful monitoring of the dosing can avoid these side effects, but not always. It turns out that there is a genetic mutation in about 1-2% of the population that makes them more susceptible to these side effects. The damage from aminoglycosides usually affects the higher frequencies of hearing, but can cause a total hearing loss. The damage is frequently permanent though sometimes — after many years — partial hearing can be regained.

Many of the early aminoglycosides are not used anymore except in a very limited capacity because they had an extremely high rate of these side effects. These included Neomycin (now seen primarily in topical ointments that aren’t absorbed by the body, such as Neosporin) and Streptomycin (used only for treatment of tuberculosis).
Gentamicin is the most commonly used aminoglycoside (in the hospital, anyway). It causes vestibular problems (inner ear damage resulting in dizziness and balance issues) more commonly than hearing loss, though there are some reports that children tend to be resistant to the vestibular problems.
Other similar drugs include Amikacin and Tobramycin.
There are other non-aminoglycoside antibiotics that can cause ototoxicity (however these just cause a temporary hearing loss), but for a hospitalized child as sick as Lulu, an aminoglycoside antibiotic seems the most likely culprit.

On one hand, this doctor is wearing his head mirror correctly…but on the other hand what he’s recommending is simply atrocious (admittedly, this ad was from before the Surgeon General warning was placed on cigarette packs — but not before there was strong evidence that cigarettes were dangerous). I’m just going to assume that he’s an ethically-challenged oncologist trying to drum up future business.

Hawkeye & Mockingbird #1 “Ghosts, Part 1″
Jim McCann, writer
David Lopez, Penciler

Hawkeye’s not the only one who’s confused. I’m not entirely certain what Bobbi (Mockingbird) is up to in this scene and why she punctured the wounded man’s chest with an arrow shaft. As I see it, there are three possibilities, with the last being the most likely:

1. Bobbi actually meant to say “Cricothyrotomy.” The victim could have had his upper trachea or mouth injured and be unable to breathe through it, so she performed an emergency cricothyrotomy (an excision through the cricothyroid membrane to establish an emergency airway). Of course, the only injury we saw the victim sustain was to the chest, the tube is in the wrong place for a cricothyrotomy, and that arrow shaft is way to long and narrow to be effective for air exchange (as I’ve discussed before).

2. The victim could have developed a tension pneumothorax — this is a type of collapsed lung (pneumothorax) where the air trapped in the chest cavity is under pressure and starts pushing against the other organs in the chest — including the heart, the other lung, trachea, etc. It is considered a life-threatening condition.
In the field, one way to treat a tension pneumothorax is with a needle thoracostomy. A small needle is inserted into the affected side of the chest, just below the mid-section of the collarbone. This will relieve the pressure, but bear in mind that it actually doesn’t fix the pneumothorax, it just converts it from the life-threatening tension pneumothorax to the less dangerous open pneumothorax. Some kind of seal needs to be placed on the end of the tube because all it’s doing now is letting more air into the chest cavity.

3. The most likely scenario is that the victim developed a hemothorax (or a hemopneumothorax) from the bullet wound — the chest cavity is filling with blood on the injured side causing the lung to collapse. Bobbi has inserted a make-shift chest tube (a “tube thoracostomy”) to drain the blood. I give her full credit for improvising in the field and using the hollow shaft of an arrow for a chest tube is clever. However, there are some flaws in her technique:
The tube needs to be positioned so that the blood can easily drain out. With the tube straight up in the air, there’s no way the blood can drain, even with whatever meager positive pressure the patient can provide.
Placing a chest tube is a risky procedure at the best of times. Placing it at the top front of the chest is just asking for problems as there quite a number of important structures in that area (trachea, aorta, multiple large arteries and veins, etc.) that could be easily injured during the procedure — especially one using an improvised rigid chest tube. The best place for a chest tube is on the flank, about 1/3 of the way down.
Even if she has managed to drain the blood, she hasn’t sealed thetube so the chest cavity remains open to the air, leading to a pneumothorax. Water seals are the most common as they allow trapped air to escape, but nothing to enter.

A comic-book cover psychic nosebleed this week. As far as I know, this is only the second time a psychic nosebleed has been considered cover worthy (and the first time was Maxwell Lord too, go figure)

I finally got around to listing all the psychic nosebleed posts I’ve done — and the numbers were more than I expected: so far, I’ve cataloged 140 different instances. You can find the list here (it’s a little sloppy because it’s such a long list. I’ll clean up the CSS in the next day or so when I get a chance)

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed maxwell lord justice league

With summer officially here in the United States (thank you, Memorial Day), it seemed the perfect time for a summer-themed public service ad. Today, Buzzy, his girlfriend Susie, and his “friend” Wolfie teach readers about water safety.

It seems to me that a big flaw in Wolfie’s plan is that few women would find the “ability to almost drown” a positive.

TRUE STORY: It was at this point that Buzzy stated administering a battery of tests to those who wanted to be his friend –no more of this having to rescue a drowning acquaintance. Subsequently, all his previous friends moved over to the Binky strip, except for Wolfie, who was able to grandfather in as Buzzy’s only remaining friend.

This PSA appeared in various DC comics from September 1952, and then was reused 10 years later in comics from September 1962. The script and art are by PSA stalwarts Jack Schiff and Win Mortimer.

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A mysterious Sleeping Sickness strikes Gotham City, yet strangely it is affecting only the contestants in the “Queen for a Day” beauty pageant. The doctors who examine the patients confidently declare that the women have contracted a “rare but harmless” disease that will cause them to sleep for three or four weeks before recovering. They place each victim in a glass case so that the “medical profession can observe this rare malady.”

Batman is instantly suspicious as the first victim was none other than Selina Kyle, better known as Catwoman. He believes she is faking the illness, but the guard watching over her case swears she has been asleep the whole time.

With all the contestants asleep, it looks like no one will win the Queen for a Day contest, but luckily, Selena Kyle manages to recover from the sleeping sickness in time to win. Batman stops her just before she is about to claim the prize – a bottle of perfume that just happens to be full of smuggled diamonds

It turns out that Catwoman was behind the Sleeping Sickness (I know, quelle suprise!). She had discovered a chemical that caused the Sleeping Sickness; she gave herself a small dose, and then in a display of pure Scooby Doo science, she rigged a couple of movie projectors in her case to make it look like she was still inside when she sneaked out to give the other contestants larger doses of the chemical. Her convoluted plan was to win the Queen for a Day contest so she could claim the perfume bottle where her overseas associated associates had hidden stolen diamonds.

Batman, of course, was too clever for her.

Me, I wonder what kind of quacks they have in Gotham City: they can’t identify a disease (but are quick to claim it is “harmless”), never realize their prime patient is faking (or even absent!), and yet voyeuristic enough to place their patients in glass cases. My advice: never, ever seek medical care in Gotham.

So not only is the head mirror worn wrong (as usual), but:

1. The doctor is a psychiatrist, so why does he need a head mirror anyway? (Other than peering into the deep recesses of the human soul, that is).

2. The head mirror is unexpectedly giving off light (Remember a head mirror only reflects light, it does not generate light itself. Anyway, the mirror focuses light, so any light reflected would be narrowed, not spread out. And even if the head mirror was flipped over so the convex side was showing, while that would almost explain the spreading light, that side’s not reflective).

And yes, that is Batman in a straitjacket — but that’s a story for another day (basically, one of Batman’s villains rigged the bat-radio to give Batman bad enough nightmares to make him think he was going insane. Insane in that goofy 1950’s way, that is: laughing maniacally. It only took two days in the asylum for the “world’s greatest detective” to figure it out. Read it yourself if you can track down a copy of Batman #84. On the other hand, don’t — it’s not a very good story. In fact, the Batman of the late ’40s/early ’50s had very few good stories).

Exelon (rivastigmine) is a drug that is used to treat dementia when it is associated with Alzheimer’s disease or Parkinson’s disease. It is not a miracle drug by any stretch of the imagination, but it has shown some modest success at delaying the progression of dementia, and some patients experience significant improvement of their symptoms.

Note that Exelon is only approved for Alzheimer’s dementia and Parkinson’s dementia, not for other causes of dementia. This is not to say that it isn’t being prescribed for other kinds of dementia, it is, but these uses are strictly off label and not approved by the FDA.

In this scene from Cable #105, Cable is fighting in an underground mutant fight club when he gets a little overzealous with his psychic blast. He not only K.O.s his opponent –and the referee — but he also manages to take out most of the audience that was sitting behind them. Oops.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed cable psychic blast

Things have been tough for Buzzy and he’s had to take a job as a baby-sitter (I guess he got fired from his job at the grocery. Who knew there were continuity concerns in Public Service Ads?) He turns to his girlfriend Susie to learn how to be a good sitter.

Sadly, Buzzy was in such demand as a baby-sitter that he never had time to go out with Susie again — not that she’d date him anymore, since all her baby-sitting clients switched to Buzzy.

This PSA appeared in DC comics from February 1956, credited to PSA stalwarts Jack Schiff and Win Mortimer.

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Tags: comics psa buzzy susie baby-sitter safety jack schiff win mortimer

In this story, Namor’s kingdom is ravaged by a plague that can only be cured with radium. Unfortunately, according to Namor, there is no radium available under the sea, so he swims up to the surface world to find some. At the same time, a group of Nazi spies has stolen all the radium from the (one and apparently only) New York hospital. Namor captures the thieves and hands them over to the authorities, but keeps the radium for himself.

This story was written back in the days when radium was believed to a wonderful drug and a cure for just about anything. It was added to creams, lotions, ointments, toothpastes, and other medicines to make them “healthier” and “better for you.” As marketing, that may have been genius, but medically, it was disastrous. Radium could certainly certainly cure some medical conditions (and it has limited uses in medicine today), but back in the day it was just as likely — if not more likely — to cause cancer or a painful death of one sort or another. By the 1940s, when this story was written, the truth about radium was finally starting to become known, but it was still felt by many to be a wonder drug.

As for the doctor, he is wearing his head mirror more or less correctly. It’s just pushed up out of place a little, but one can easily assume he nudged it up when the telegram arrived so he could read it better.

Flying through space, Krypto is exposed to the radiation from two strange meteors. One is Kryptonite, but the second is emitting some weird rainbow rays. Together, these two exposures cause him to develop Super-Rabies.

Super-Rabies is fatal, and progresses through three stages:
Stage 1: Uncontrolled super-growth.

Stage 2: Uncharacteristic anger and aggression.

Stage 3: Permanent muscle rigidity.

Once Krypto reaches stage two of the disease, Superboy realizes he’ll have to put him down. He works with the Army to develop special Kryptonite artillery shells. They knock Krypto down, but he’s not out. He tunnels out of range of the missiles, and then uses his super-heat vision to destroy the Army base. It’s at this point that the third stage of the disease strikes and Krypto is paralyzed. Realizing the end has arrived, Superboy then sets up a shrine to Krypto — using the permanently rigid giant dog as his own shrine’s statue (which is wrong in so many ways).

Heartbroken, Superboy flies into space to grieve. He stumbles across the strange meteors Krypto was exposed to and realizes what has happened. Exposing himself to the emanations of the meteors, he gains the same super-growth and increased super-powers Krypto developed. Before the disease can progress, he turns his now more-powerful x-ray vision on Krypto, and it miraculously cures him. Using a pair of mirrors, he then uses his own x-ray vision to cure himself. Both boy and dog live happily ever after, at least until Ma Kent rented Old Yeller.

In today’s comic book public service ad, Binky lectures his younger brother Allergy — and by default us — about how to be a good team player (and, ironically, manages to get in a little ego-stroking of his own — making sure everyone knows that he scored the winning basket in the big game against Beaverville).

As for Allergy’s teammates, they seemed to have missed the obvious answer: stop giving him the ball (and no, I don’t for a minute believe that he’s the quarterback).

You’ve got to admire Allergy’s style: even playing football he’s sporting the bow tie.

Hokey or not, this should be required reading for all professional athletes.

This PSA appeared in DC comics from March 1952 — this particular copy comes from Action Comics #166. The script is by Jack Schiff with art by Bob Oksner.

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Tags: comics psa binky allergy team sports jack schiff win mortimer

The inhabitants of the Lost Valley of the Bird-Men have learned how to surgically attach giant wings to humans, allowing them to fly. All it takes it a few stitches and a large supply of the miracle drug Serum Alpha. Unfortunately, the evil Gravio family has cornered the market on Serum Alpha so they are the only ones in the Valley who can fly, a fact they use to their advantage by raiding and robbing from the remaining ground-bound populace.

All hope is not lost! A dissident member of the Gravio family has smuggled out enough Serum Alpha for one person. The villagers decide that Batman is their best chance, so they kidnap him and bring him to the Lost Valley.

He agrees to the surgery and a large pair of bat wings is grafted onto him.

He proceeds to take on the Gravios and defeats them all by executing an undeniably awesome plan which consists of: 1) divebombing with giant bat wings, and 2) gas capsules from his utility belt. In the end, it really wasn’t much of a fight — but then, this is Batman we’re talking about. In the end, the villagers thank Batman, surgically remove his wings, and return him to Gotham City.

This ad certainly didn’t age well, unless Luden’s still endorses:
1. The shooting of an endangered species (in the back, no less).
2. Bringing drugs to school.
3. Sending young kids on picnics with strange men who carry guns and provide them with drugs.

In Superman #700, Superman is devastated when a woman accuses him of letting her husband die because Superman didn’t use his powers to cure his fatal brain tumor. She believes that Superman could have used his x-ray vision and heat vision to identify and safely eradicate the tumor.

Now, assuming Superman’s heat vision could cure the tumor without any significant side effects* and he wants to make sure no one else dies of a brain tumor:

There are expected to be 62,930 new primary brain tumors diagnosed in the United States in 2010.
If Superman were to work a 24 hour day, 7 days a week, he would have a little over 8 minutes to spend on each brain tumor patient.
If he were to work a slightly more humane 18 hour day (6 hours for sleeping, eating, bathroom breaks, and saving the world), then he would have 6 minutes to spend on each patient.

But why just stop at brain tumors? Why shouldn’t Superman use his abilities to treat all cancers? In that case, there are expected to be 1,539,560 new cancers diagnosed in the United States this year alone (and that’s not counting non-invasive tumors and certain skin cancers that account for another 2+ million cases).
Now Superman has just 20 seconds to see each patient (or 15 seconds if he wants to sleep).
And why not go worldwide? Then Superman would have just 2 seconds per patient.

(And these numbers all assume the patients with cancer have already been identified before Superman even sees them. If you add some sort of screening program into the mix, then the time-per-patient drops even lower.)

I think it’s also important to remember that for all his skills and smarts, Superman is not trained in medicine — particularly radiology and surgery. How many false positives (he thinks it’s a cancer but it’s not) or false negatives (he misses a cancer) will there be? Is a single treatment of heat vision enough? Is 8 minutes, let alone 15 seconds, enough time to correctly diagnose a patient and treat them?

The Bottom Line: The plotline you thought was ridiculous gets even worse when you take a minute to look at the numbers.

*Which I seriously doubt, but that’s another post.

In this scene from X-Man #63, Mr. Glass, a murderous telekinetic, tries to take on Nate Grey, the eponymous X-Man. Things don’t go so well for him.

All previous Psychic Nosebleed Zen posts.

Tags: comics medicine nosebleed cable psychic blast

Another swimming theme for this week’s comic book public service ad — the second this month — basically because it’s summer and “summer = swimming”. Unlike the lighthearted antics of Buzzy and Wolfie, and the loose linework of Win Mortimer, this PSA features the more moody art of Bernard Baily.

I think Bill needs lots more swimming lessons if he finds himself stuck just 20 feet from shore.

This PSA appeared in DC comics from September 1959. The script — as always — was by Jack Schiff with art by Bernard Baily.

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Tags: comics psa swimming water jack schiff bernard baily

Here’s a nice bit of useless historic trivia brought to you by More Fun Comics and Dr. Fate (in his ludicrous “half-mask” period):

Dr. Fate finally manages to track down master criminal (and I use the term loosely) “The Clock” to his hideout, a clock store. Fate realizes it is a fake clock store because the clocks aren’t all set at 8:20.

I don’t know if this is accurate or not, but it has the ring of truth to it. This story was published in the 1940s, before electrical clocks became commonplace. The clocks of that era needed to be wound regularly to work — and it would be a full day’s effort for a clock store owner to wind every clock in the store — so it makes sense that they would just leave the clocks all set to the same time. As for 8:20 — why not? (Though it makes me wonder what they set the clocks for before April 15, 1865 — and what time they were set for in other countries).

Just as much of Marvel continuity is based on characters trying to rediscover the Super Soldier Serum, a large chunk of DC history is based on people trying to reinvent or otherwise improve upon the wonder drug Miraclo. This, frankly, is a mistake. It’s not that Miraclo is a bad drug — it’s not — it’s just that there’s a much better option — the original deus ex machina drug: Solution Z.

Solution Z was the secret drug the villain known as Mr. Who used to bedevil Dr. Fate back in the Golden Age.

Mr. Who was a 98-pound weakling who was constantly bullied by the other kids. Once he got to college, he spent his time learning biology and chemistry so that he could develop a drug which would allow him to turn the tables and bully those who used to pick on him*. Thus was born Solution Z.

So what can Solution Z do? Pretty much anything:
In Mr. Who’s first appearance, drinking Solution Z gave him increased stamina, strength, and invulnerability. It also improved his looks and shaved a good twenty years off his age. Later in the same issue, the drug allows Mr. Who to turn invisible and then grow to 15 feet tall.

In the next issue, Mr. Who uses Solution Z to grow gills and replace his hands with fins so that he can swim faster. Later, the solution allows him to become paper-thin and two-dimensional so that he can fit through a thin crack. After that, he uses the drug to change his face and appearance to look just like the city’s mayor.

In his third appearance, Mr. Who uses Solution Z to escape from custody by growing again, this time to 120 feet tall. He also uses the drug to shrink down to a mere 1 inch tall so he can escape a police manhunt. Solution Z also allows him to become intangible and pass through solid walls.

So once again, why waste time with Miraclo, which only does a fraction of what Solution Z does, and only for an hour at a time?

*but you’ll notice he didn’t spend enough time to actually earn an advanced degree, so he stays poor “Mr.” Who.