It is Saturday. Here is a recap of the day thus far. I awoke at 0625. Bathroom duty, shave, shower, and getting dressed took 20 minutes. I left the house and arrived at Memorial Hermann Hospital at 0720. I spoke with, examined my patient, and wrote a progress note by 0745. This patient has chronic wound and urinary tract infections. This will become important later. Rounding with Dr. Farnie began at 0800 and ended around 0900. The next 30 minutes were spent on the phone trying to figure out which radiology attending could read my patient's CT scan. My patient has bilateral decubitus ulcers of his hip. Decubitus ulcers usually arise in hospitalized patients who don't move around much. My patient is paralyzed from the waste down following a gunshot wound in 1991, which has left him rather immobile. Apparently there are still bullet fragments in his body which makes it impossible for us to get an MRI of his hip. So instead we got a CT (computerized tomography)scan of his hip. Why do we need to scan this patient's hip? Because he gets chronic infections of his decubitus ulcers which have apparently burrowed deep into his soft tissue and have now touched the bone causing what's called osteomyelitis. Anything that ends in "itis" refers to inflammation in medical speak. So hepatitis means inflammation of the liver and arthritis means inflammation of a joint. Osteomyelitis means inflammation of the bone--in this patient as a result of his infected decubitus ulcer. The ulcers are currently infected with gram negative rods, which are a type of bacteria. I originally took a look at the CT scan with Dr. Farnie and Dr. Hall (my Intern, which is a first year resident), and the scan shows obvious changes in the bone. 
If you look at the images, you can see the progression of bone deformity. When you read a CT scan, imagine you are sitting at the computer staring at the patient's feet as he lies on his back. Each image is a horizontal cross-section of the body. Keeping this in mind, the left side of the screen would be the right side of the patient. The first image you see is a cross-section of the pelvis, which is basically normal bone with the very beginning of inflammation on the left side of the screen. In the following images, notice how the left side of the screen (the patient's right hip) gets progressively worse. The last few images are of the hip joint which is where the femur (the large bone in the leg) connects with the pelvis. Notice on the patient's left, there is a nice joint space and no inflammation. Contrast that to the patient's right which is completely obliterated. (thanks to Mark Boyle for sending those pictures to me from the hospital) So I went down to radiology and confirmed this information with the attending which will be relayed to my patient's doctor who is private (not on the faculty at UT). Basically, since this patient has osteomyelitis, his antibiotic therapy will last six weeks instead of two. I got home around 1000 and then proceeded to check e-mail, drink coffee, call my parents, call my grandmother, call my sister, and study. At 1300 Ryan's friend Larry (and my friend too) from Austin arrived in town. We went to Kenny and Ziggy's New York Style Deli in the Galleria area for lunch. I had an excellent Ruben sandwich, potato salad, iced tea, and some Oreo Cheesecake. We discussed the movie Troy with Brad Pitt and the epic The Iliad upon which the movie is based. We then proceeded home. At 1625 we drove to the Landmark Greenway 5 Theatre in Greenway Plaza. Originally I thought we were going to the Edwards Theatre (which is huge), but we learned there is a smaller theatre a block away. This smaller theatre is more of an independent film house sort of like The Angelika or Magnolia Theatres. It was here that we observed the movie Super Size Me, which is one of the best independent film/documentary-type films I have ever seen. Apparently the filmmaker, Morgan Spurlock, spent $65,000 to make the movie and has now made over 6.5 million. He basically eats McDonald's fast food three times a day for thirty days. The chronicle of this escapade includes interviews with nutritionists, physicians, food distribution lobbyists, his girlfriend, and people on the streets. We learn that Texas is the fattest state in the country and that Houston (where I live) is the fattest city in the country when the film was made. (Houston has since been replaced by Detroit.) A Memorial Hermann System hospital is featured, showing us how gastric bypass surgery is performed (I have assisted during one of these procedures). It also turns out that 8 of the 15 fattest cities in America are in Texas. Hurray for us. Anyway, the guy basically goes into the first stage of liver failure after eating McDonald's for 20 days. He finishes the course and teaches us a great lesson about fast food. PLEASE GO SEE THIS MOVIE! It is absolutely fantastic not only for the documentary/educational part but also for the great entertainment value the movie provides. After the movie, I watched the Aggies lose to LSU in game 1 of the Super Regionals. Then Chris and Carla came over and had dinner with Ryan and Larry while I read. Then we decided to say in for the night "party" a little and watch a movie. The selection was Wes Anderson's Bottle Rocket, which is excellent of course. Wes Anderson is from Houston and attended the university of Texas. There he met Owen and Luke Wilson, both of Dallas. Eventually they made Bottle Rocket together and went on to make Rushmore and The Royal Tenenbaums. I went to sleep around 0130.
Dad has been smoke-free for 17 days.
If you look at the images, you can see the progression of bone deformity. When you read a CT scan, imagine you are sitting at the computer staring at the patient's feet as he lies on his back. Each image is a horizontal cross-section of the body. Keeping this in mind, the left side of the screen would be the right side of the patient. The first image you see is a cross-section of the pelvis, which is basically normal bone with the very beginning of inflammation on the left side of the screen. In the following images, notice how the left side of the screen (the patient's right hip) gets progressively worse. The last few images are of the hip joint which is where the femur (the large bone in the leg) connects with the pelvis. Notice on the patient's left, there is a nice joint space and no inflammation. Contrast that to the patient's right which is completely obliterated. (thanks to Mark Boyle for sending those pictures to me from the hospital) So I went down to radiology and confirmed this information with the attending which will be relayed to my patient's doctor who is private (not on the faculty at UT). Basically, since this patient has osteomyelitis, his antibiotic therapy will last six weeks instead of two. I got home around 1000 and then proceeded to check e-mail, drink coffee, call my parents, call my grandmother, call my sister, and study. At 1300 Ryan's friend Larry (and my friend too) from Austin arrived in town. We went to Kenny and Ziggy's New York Style Deli in the Galleria area for lunch. I had an excellent Ruben sandwich, potato salad, iced tea, and some Oreo Cheesecake. We discussed the movie Troy with Brad Pitt and the epic The Iliad upon which the movie is based. We then proceeded home. At 1625 we drove to the Landmark Greenway 5 Theatre in Greenway Plaza. Originally I thought we were going to the Edwards Theatre (which is huge), but we learned there is a smaller theatre a block away. This smaller theatre is more of an independent film house sort of like The Angelika or Magnolia Theatres. It was here that we observed the movie Super Size Me, which is one of the best independent film/documentary-type films I have ever seen. Apparently the filmmaker, Morgan Spurlock, spent $65,000 to make the movie and has now made over 6.5 million. He basically eats McDonald's fast food three times a day for thirty days. The chronicle of this escapade includes interviews with nutritionists, physicians, food distribution lobbyists, his girlfriend, and people on the streets. We learn that Texas is the fattest state in the country and that Houston (where I live) is the fattest city in the country when the film was made. (Houston has since been replaced by Detroit.) A Memorial Hermann System hospital is featured, showing us how gastric bypass surgery is performed (I have assisted during one of these procedures). It also turns out that 8 of the 15 fattest cities in America are in Texas. Hurray for us. Anyway, the guy basically goes into the first stage of liver failure after eating McDonald's for 20 days. He finishes the course and teaches us a great lesson about fast food. PLEASE GO SEE THIS MOVIE! It is absolutely fantastic not only for the documentary/educational part but also for the great entertainment value the movie provides. After the movie, I watched the Aggies lose to LSU in game 1 of the Super Regionals. Then Chris and Carla came over and had dinner with Ryan and Larry while I read. Then we decided to say in for the night "party" a little and watch a movie. The selection was Wes Anderson's Bottle Rocket, which is excellent of course. Wes Anderson is from Houston and attended the university of Texas. There he met Owen and Luke Wilson, both of Dallas. Eventually they made Bottle Rocket together and went on to make Rushmore and The Royal Tenenbaums. I went to sleep around 0130.
Dad has been smoke-free for 17 days.
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