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It is included

You may wish to pick up the microphone you dropped.

LabCorp, for example, is happy to take your money and have you order (and pay for) your own lab tests. Along with third parties using LabCorp and Quest.) Then you can bring in the results to your family physician, and spend 40 minutes browbeating them if you like about your insignificantly elevated white cell count and the normal thyroid level that the naturopath says is actually abnormal and your asymptomatic but positive rheumatoid factor because your feet are achy.

Your blood tests results aren't like the indicators from your car's OBD 2 port; people are complex meat machines with varying genetics (really amazing the more you think about it), and normal value ranges get interpreted as part of a broader clinical picture.

Not only doctors can give tests, but in my experience the more thoughtful ones order fewer tests and barely any "routine" bloodwork (whatever that is), and instead rely on a fairly complex set of heuristics from clinical experience, lengthy education, and a good understanding of underlying normal and abnormal physiology. The $40 I get for listening to your theories about chronic yeast is supposed to pay for a learned professional opinion, and hopefully you'll let me get in a word edgewise about how Panda Express doesn't really constitute 5 servings of vegetables and walking from your parking spaces isn't going to save you from diabetes and hypertension. Instead of having to order more tests to "prove" your potentially, well, crackpot theory. Not you personally of course. Just that guy who thinks reading the Internet and ordering his own blood tests == 7+ years of training.

On the other hand, there is potentially a fair amount of good you could do, if you had to, reading UpToDate and a few basic med school textbooks, and taking a little more care with the idea that a home pregnancy test is in the same ballpark as diagnosing lupus. Oh, and a statistics course — if I had my way, they'd be teaching that in high school instead of trigonometry.

You may wish to pick up the microphone you dropped.

LabCorp, for example, is happy to take your money and have you order (and pay for) your own lab tests. Along with third parties using LabCorp and Quest.) Then you can bring in the results to your family physician, and spend 40 minutes browbeating them if you like about your insignificantly elevated white cell count and the normal thyroid level that the naturopath says is actually abnormal and your asymptomatic but positive rheumatoid factor because your feet are achy.

Your blood tests results aren't like the indicators from your car's OBD 2 port; people are complex meat machines with varying genetics (really amazing the more you think about it), and normal value ranges get interpreted as part of a broader clinical picture.

Not only doctors can give tests, but in my experience the more thoughtful ones order fewer tests and barely any "routine" bloodwork (whatever that is), and instead rely on a fairly complex set of heuristics from clinical experience, lengthy education, and a good understanding of underlying normal and abnormal physiology. The $40 I get for listening to your theories about chronic yeast is supposed to pay for a learned professional opinion, and hopefully you'll let me get in a word edgewise about how Panda Express doesn't really constitute 5 servings of vegetables and walking from your parking spaces isn't going to save you from diabetes and hypertension. Instead of having to order more tests to "prove" your potentially, well, crackpot theory. Not you personally of course. Just that guy who thinks reading the Internet and ordering his own blood tests == 7+ years of training.

On the other hand, there is potentially a fair amount of good you could do, if you had to, reading UpToDate and a few basic med school textbooks, and taking a little more care with the idea that a home pregnancy test is in the same ballpark as diagnosing lupus. Oh, and a statistics course — if I had my way, they'd be teaching that in high school instead of trigonometry.

Good, this indicates that doctors and people who think they should take antibiotics like vitamins haven't completely screwed up our natural immunities and that most of the world still fights off this infections even though drugs no longer work on them.

The problem with Staph Aureus is that it's omnipresent in the respiratory tract and skin. It seems to have spent a long time evolving with immune systems, because it has two lines of defense (producing catalase and carrotenoids) which neutralise two of the chemicals that white blood cells use to break down foriegn bodies (superoxide and singlet oxygen). Additionally the protein A in the cell wall confuses the shit out of white blood cells, making them difficult to detect.

Add that to producing some really nasty toxins, and that's why a Staph Aureus bacteremia, even MSSA has about a 30% kill rate, even if you're in a modern hospital.

So it would be nice to have some antibiotics to fall back on, at least in the case of golden staph.

Can we please get back to the point where we take antibiotics when we're in need of them, not just because we might have an infection or have a mild infection?

Your favourite ID doctor, and mine, posted about this today. He has a solution:

The solution? We do not want to make antibiotics more toxic to the patient, so I suggest that every time there is an order for Zosyn and vancomycin (or whatever your decerebrate choice is at your institution) the ordering physician receives a short, painful shock from the keyboard. If you really think the patient needs the antibiotics you will take the shock. That would likely solve a lot of issues with inappropriate antibiotic use and be simpler than a stewardship program.

Although in this case the problem is prophylactic antibiotics given to livestock.

Actually, we UptoDate, but we don't rely on our increasingly fallible memories except for stuff we use all of the time.

Active alcoholism is a contraindication to transplant, however, damage due to alcohol related diseases is not:

Except from UpToDate (requires subscription)UpToDate.com

INTRODUCTION — After initial reluctance to transplant patients with alcoholic liver disease, it is now clear that transplantation offers an excellent survival advantage in appropriately selected patients, equal to that for other disease indications. The original reluctance stemmed from the perception that the disease was self-inflicted and from the possible presence of alcohol-mediated damage to sites outside the liver [1,2]. There was also concern that compliance with postoperative recommendations would be suboptimal and that recidivism would lead to graft failure. Opposing opinions and accumulated data have addressed these reservations [3]. Liver transplantation appears to be cost-effective for alcoholic liver disease, albeit possibly less so than for transplantation for some other indications such as primary biliary cirrhosis and primary sclerosing cholangitis [2,4-6].

snip

Alcohol abstinence and psychosocial factors — Sobriety and adequate social support are essential. No absolute interval of sobriety is required because some patients who are otherwise suitable candidates will not survive a six-month period. However, a period of six months of sobriety is used widely for predicting recidivism and also allows for hepatic recovery from ongoing alcohol-related injury [31], but accurately determining which patients are abstinent can be difficult. One study that included 40 patients with alcoholic liver disease who were admitted for an assessment for liver transplant found that 38 percent of patients had urine tests that were positive for alcohol (20 percent) and/or illicit drugs (30 percent) [32]. However, only 3 percent of the patients admitted to using alcohol.

Cancers would generally disqualify you

Not entirely. You can have HCC (hepatocellular concinoma) and get a transplant:

Also from UpToDate

INTRODUCTION — Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis. (See "Epidemiology and etiologic associations of hepatocellular carcinoma".)

The only potentially curative treatment options are resection and liver transplantation Among patients who are not candidates for liver resection, some who have cirrhosis and HCC are candidates for potentially curative liver transplantation. Unfortunately, the majority of patients are not eligible for either resection or transplantation because of tumor extent, underlying liver dysfunction, and lack of donor organs.

(extra link mine)

The liver makes a good candidate because it is a "nice" organ to transplant. It is very tolerant of ABO incompatibility. It also has a decent survival outside of the body, IIRC, it is exceeded only by the kidney for durability outside of the body.

My concern is that this "liver-in-a-box" makes bile. Bear with here.....

RBCs (red blood cells) are primarily broken down in the spleen, not the liver. The hemoglobin is then broken down in macrophages (which do exist in the liver, but typically aren't involved in this part) into bilirubin which is transported to the liver by binding with albumin. Once in the liver, it is conjugated (chemically linked) to a sugar to increase its solubility, it is then excreted into the bile (which gives the bile the golden brown coloring). If there is no spleen in this circuit, what's breaking down the RBCs(now granted the liver can assume some of this function in asplenic patients, but I'm not sure it can take over this quickly)? This sounds like a fundamental problem with their system....guess if they can solve that they can keep a liver on the shelf for a week or more.

Could just imaging the Monty Python skit coming out of that!

Active alcoholism is a contraindication to transplant, however, damage due to alcohol related diseases is not:

Except from UpToDate (requires subscription)UpToDate.com

INTRODUCTION — After initial reluctance to transplant patients with alcoholic liver disease, it is now clear that transplantation offers an excellent survival advantage in appropriately selected patients, equal to that for other disease indications. The original reluctance stemmed from the perception that the disease was self-inflicted and from the possible presence of alcohol-mediated damage to sites outside the liver [1,2]. There was also concern that compliance with postoperative recommendations would be suboptimal and that recidivism would lead to graft failure. Opposing opinions and accumulated data have addressed these reservations [3]. Liver transplantation appears to be cost-effective for alcoholic liver disease, albeit possibly less so than for transplantation for some other indications such as primary biliary cirrhosis and primary sclerosing cholangitis [2,4-6].

snip

Alcohol abstinence and psychosocial factors — Sobriety and adequate social support are essential. No absolute interval of sobriety is required because some patients who are otherwise suitable candidates will not survive a six-month period. However, a period of six months of sobriety is used widely for predicting recidivism and also allows for hepatic recovery from ongoing alcohol-related injury [31], but accurately determining which patients are abstinent can be difficult. One study that included 40 patients with alcoholic liver disease who were admitted for an assessment for liver transplant found that 38 percent of patients had urine tests that were positive for alcohol (20 percent) and/or illicit drugs (30 percent) [32]. However, only 3 percent of the patients admitted to using alcohol.

Cancers would generally disqualify you

Not entirely. You can have HCC (hepatocellular concinoma) and get a transplant:

Also from UpToDate

INTRODUCTION — Hepatocellular carcinoma (HCC) is an aggressive tumor that often occurs in the setting of chronic liver disease and cirrhosis. (See "Epidemiology and etiologic associations of hepatocellular carcinoma".)

The only potentially curative treatment options are resection and liver transplantation Among patients who are not candidates for liver resection, some who have cirrhosis and HCC are candidates for potentially curative liver transplantation. Unfortunately, the majority of patients are not eligible for either resection or transplantation because of tumor extent, underlying liver dysfunction, and lack of donor organs.

(extra link mine)

The liver makes a good candidate because it is a "nice" organ to transplant. It is very tolerant of ABO incompatibility. It also has a decent survival outside of the body, IIRC, it is exceeded only by the kidney for durability outside of the body.

My concern is that this "liver-in-a-box" makes bile. Bear with here.....

RBCs (red blood cells) are primarily broken down in the spleen, not the liver. The hemoglobin is then broken down in macrophages (which do exist in the liver, but typically aren't involved in this part) into bilirubin which is transported to the liver by binding with albumin. Once in the liver, it is conjugated (chemically linked) to a sugar to increase its solubility, it is then excreted into the bile (which gives the bile the golden brown coloring). If there is no spleen in this circuit, what's breaking down the RBCs(now granted the liver can assume some of this function in asplenic patients, but I'm not sure it can take over this quickly)? This sounds like a fundamental problem with their system....guess if they can solve that they can keep a liver on the shelf for a week or more.

Could just imaging the Monty Python skit coming out of that!

Rakaur, you need to calm down and take a deep breath. Sure you're passionate about the topic, but you need to stop insulting those who disagree with you and trying to insult me in every post. Ad hominem attacks only hurt your own case.

Go call any local CVS Pharmacy in your area and ask the pharmacist what they'd recommend. You sound like a medical professional, so you should be well-aware that not all antiemetics have severe side effects as you claim. Meclizine (brand name Antivert) or Benadryl (diphenhydramine) for example are generally considered to be a safe drug and is sold OTC. The first-line antiemetics are Compazine and Zofran, as well as scopolamine, along with meclizine, promethazine, and hydroxyzine then you can go down the list to Reglan (Metoclopramide) and if those still aren't working then you move into the controlled medications like Marinol, and benzodiazepines like lorazepam.

I'd give you sources in the medical literature, but I don't know if the links like UpToDate's will work for you if you do not have access to a medical library's subscriptions.

If a machine could do a better job than me, I'd be no better than Mengele for preventing it from doing so.

Yeah, its all fine and dandy to say that. But doctors are human and thus, by definition, you can't expect them to be rational, especially in the face of a perceived threat. See the Checklist Manifesto for an example of some doctors doing precisely that - refusing to use a checklist because they think its beneath them, a reflection on their competency. Funny thing, of the minority of doctors surveyed who said they would never use a checklist themselves, almost all said they would want a doctor operating on them to use a checklist.

As for machines which can do a better job - there's UpToDate - for some doctors its like crack, but in a good way.

A study published in the International Journal of Medical Informatics found that there was a "dose response" relationship between use of the decision support tool and quality indicators, meaning that the more pages of the database that were accessed by physicians at participating hospitals, the better the patient outcomes (lower complication rates and better safety compliance), and shorter the lengths of stay.

Google my plagiarism for more info.

I work in medicine, and I can tell you that these databases are commonly used in practice. Doctors probably don't like being forced to use them because there's a tremendous amount of clinical intuition involved in diagnosis, and these databases don't take into account things like age, IV drug abuse, recent trips to South America, etc. There's also a saying that "common diseases happen commonly," so doctors often avoid costly tests to rule out obscure diseases unless initial treatment fails.

Example databases are UpToDate, Isabel, and MD Consult. If you're interested, you should go down to your local medical school library and look at their resources. Since they're written by experts and often evidence-based, they're far better than anything Google can provide.

We do. On the web: MD Consult and Up to Date Just a couple I've used regularly to stay current in medical practice. I would never use Google to guess at a diagnosis in a tough case. Better to have a differential diagnosis, a working diagnosis, and hit the textbooks or the journals for clues.

Do you think if I took a few screen shots and posted a little blog about trying to use dillo, I too could get posted on slashdot? As I write this, dillo is currently show 18 html errors on this page...you should see it !work on the main website I actually use for work: http://www.uptodate.com/ (not /. silly!)

I've got to get over to yahoo and get that blog setup before anyone else gets the same idea!

I rip all my Audio Digests (http://www.audiodigest.com/) to ogg vorbis and play them through my Dell Axim with GSPLayer. Why spend the extra MB on mp3 or rip with the B-man's player? No flames on the Winodows device - I can't convince UpToDate (http://www.uptodate.com/) to make a Palm version... martalli

Dead Trees are NOT just the way to be... ...at least in the medical professions.

Several medical studies have shown that physicians that use medical online databases such as UpToDate, provide better patient care. The medical literature changes so quickly that many books are outdated before they are released to the public.

In residency it was amazing how many "rare" diagnoses were made based on the ability to quickly look up a condition or situation on an online database. Plus, if you can't find it in uptodate or similar online consult references, you can always access PUBMED and review all the medical journals for the latest and greatest information on a disease process.

If you are a patient, you want your doctor going to the online databases and journals for information...

Davak