News
Eleventh John Butler Lung Conference
On October 1, 2004, the Pulmonary/Critical Care Medicine section of the Boise VA Medical Center will present the 11th Annual John Butler Lung Conference. This year's conference hosts Marvin Schwarz, M.D. from the University of Colorado Health Sciences, Robert Schoene, M.D., University of California-San Diego and the best of University of Washington pulmonary staff, Drs. Glenny, Hudson, Lakshminarayan, Pierson, and Swenson.Idaho's premiere pulmonary conference will be held at the Red Lion Downtowner from 8:00 - 5:00 p.m. There is no registration fee for this conference however, registration is requested.
Welcome McCall
As of this printing, McCall physicians can now join both the Wednesday, 8:00 a.m. Grand Rounds and the Friday, 8:00 a.m. Grand Rounds via teleconference. This new connection allows McCall physicians access to two accredited CME programs weekly. ACMEC thanks all of the administrators and techies involved in making this happen. Next on deck, Mountain Home.
St. Luke's Meridian Works!
Last year ACMEC broadcasts to St. Luke's Meridian were so hit and miss that we quit advertising our presence. New equipment and trained staff has resulted in consistent delivery of the Grand Rounds every Wednesday at 8:00 a.m. The broadcast is available in the Lemhi Room, downstairs in the main building.
ACMS Annual Membership Dinner
Just a reminder of the Ada County Medical Society new-member dinner coming up on October 12 at the DoubleTree Riverside. This year's Physician of the Year will be jointly shared by Drs. Rodney Herr and Kirby Orme. Call Don Bich at 336-2930 for reservations..Advance Notice: Family Practice Residency 30 year reunion - May 13-15, 2005. Contact annicurr@sarmc.org.
Quality Improvement in Primary Care, Thursday, November 4, 2004, 8:00 a.m.-4:40 p.m. Diabetes Alliance of Idaho: The Future of Diabetes Treatment, Friday, November 5, 2004, 7:30 a.m.-43:00p.m. MK Plaza, Morrison Knudsen Auditorium & Executive Dining Room Register by October 15. Contact 389-5039 or nikkis@qualishealth.org
Anderson Center - Wednesday, 8:00 a.m.
Mercy Medical Center - Wednesday, 12:30 p.m. - Winter Room
McCleary Center - Friday, 8:00 a.m.
The following members were voted in:
If you have questions about any of our up-coming events, call Don Bich, ACMS executive director at 336-2930
When they return with the expert, the Fifth Symphony is playing, again backward. The expert notices that the symphonies are being played in the reverse order in which they were composed, the 9th, then the 7th, then the 5th.
By the next day the word has spread and a throng has gathered around the grave. They are all listening to the Second Symphony being played backward. Just then the graveyard's caretaker ambles up to the group. Someone in the group asks him if he has an explanation for the music.
"Don't you get it?" the caretaker says incredulously. "He's decomposing."
November 2004
December 2004
I have always believed that morphine has been the drug of choice for acute renal colic given the fact it can be one of the most severe types of pain. Non-steroidal anti-inflammatory drugs "NSAIDS" by virtue of inhibiting prostaglandins might well have a role in this setting. A recent systematic review identified 20 randomized controlled studies in over 1600 people with acute renal colic. In the majority of studies, patients favored treatment with NSAIDs and those treated with NSAIDs reported reduced need for rescue analgesia within the first four hours of receiving their study drug. NSAID users were significantly less likely to have adverse side effects, especially vomiting which was quite common with the opioids. The authors maintain that NSAIDs achieve slightly better pain relief, reduce the need for rescue analgesia, and produce much less vomiting and recommend them as first line therapy in patients with acute renal colic. (BJM 2004 Jun12;328:1401-4)
When I started out in medicine it was not uncommon to see the majority of physicians smoking at medical meetings. Now its prohibited or virtually unheard of and I am proud to say that physicians have practiced what they preached concerning discontinuation of smoking. An interesting study in the British Medical Journal followed 34,439 male doctors since 1951. Among men born from 1900-1930, smokers who continued to smoke only cigarettes died an average of 10 years earlier than did lifelong non-smokers. The probability of dying in middle age before age 70 was twice as high for smokers than for non-smokers. The probability of surviving from age 70 to age 90 was three times higher for non-smokers. It's always impressive to see a study of this duration and it once again shows just how bad cigarette smoking is for ones long term health. (BMJ 2004 Jue26;328:1519-29)
Telithromycin (Ketek/made by Aventis) is the first in a new class of antibiotics, the ketolides, derived from the macrolide erythromycin. It's been approved by the FDA for community acquired pneumonia, acute exacerbations of chronic bronchitis, and acute bacterial sinusitis in patients over age 18. The drug is given as an 800mg dose, once-a-day at a cost of $114.00 for 10 days of treatment. It is rapidly absorbed achieving peak serum concentrations in one hour and is not affected by food. The most common adverse side effects are GI disturbances including diarrhea. It causes interesting visual difficulties especially in women under 40 years of age who had a 1% incidence. Blurred vision, diplopia, or difficulty focusing was seen. It probably has the potential to prolong the QT interval like erythromycin or clarithoromycin but it has not been observed in clinical trials. The big problems are drug interactions. It is potent inhibitor of the CYP3A4 pathway and can increase serum concentrations of many drugs metabolized by 3A4. Simvastatin (Zocor), lovastatin (Mevacor) and atrovastatin (Lipitor) should be stopped while taking this antibiotic. It also markedly increases serum concentration of the short acting benzodiazepine midazolam (Versed) which is used commonly in anesthesia. The Medical Letter states it would be a reasonable alternative to fluroquinolone for the treatment of indicated infections however, the drug is expensive and because it's a potent inhibitor CYP3A4 pathway it can cause potentially dangerous increases in some drugs.
(The Medical Letter, Vol 46; Issue 1189, August 16, 2004)
John J. Mohr, M.D.
St. Luke's Regional Medical Center - Wednesday 8am, Anderson Center
Mercy Medical Center - Wednesday 12:30pm
VA Medical Center - Thursday 8am, AW Horsley Learning Ctr.
St. Alphonsus Regional Medical Center - Friday 8am, Centennial Room
6 Mark Pimentel, MD, Assistant Professor, David Geffen School of Medicine, University of California, LA; Director, Gastrointestinal Motility Program and Laboratory, Cedars-Sinai Medical Center.
8 E. Michael Gilbert, MD, Professor, Internal Medicine, University of Utah; Director, Heart Failure Treatment Program, Associate Director, UTAH Cardiac Transplant Program.
27 Sanjay Agarwal, MD, Associate Professor of OB/GYN, University of California-Los Angeles; Acting Director, Division of Reproductive Medicine, Cedars-Sinai Medical Center.
6 Mark Pimentel, MD, Assistant Professor, David Geffen School of Medicine, University of California, LA; Director, Gastrointestinal Motility Program and Laboratory, Cedars-Sinai Medical Center.
8 E. Michael Gilbert, MD, Professor, Internal Medicine, University of Utah; Director, Heart Failure Treatment Program, Associate Director, UTAH Cardiac Transplant Program.
27 Sanjay Agarwal, MD, Associate Professor of OB/GYN, University of California-Los Angeles; Acting Director, Division of Reproductive Medicine, Cedars-Sinai Medical Center.
1 Ali Khan, MD, Chief of Urology, VA Medical Center, Northport, NY; Professor of Urology, SUNY and Stony Brook, NY.
15 Allen Bott, MD, Assistant Professor of Internal Medicine/Neurology, Western University of Health Science.
Tumor Boards
Mercy Medical Center - Tuesday, 12:00 noon
St. Alphonsus Regional Medical Center - Friday, 7:00 a.m.
Breast Care Panel - Saint Alphonsus RMC - Tuesday, 7:00 a.m.
St. Luke's Regional Medical Center - Tuesday, 12:00 noon
Breast Tumor Board - St. Luke's RMC - Thursday, 7:00 a.m.
MSTI Pediatric Tumor Board - 2nd & 4th Wednesday, 12:00 noon
Provisional Membership: Dr. Daniel Allen, Dr. Julie Gendler, Dr. Nancy Jo Elsbury, Dr. Olivia Galvez, Dr. Suzanna Hubele, Dr. Bill Laitinen, Dr. Kelly Cushing, Dr. Anthony Gonzales, Dr. Angie Pellant, Dr. Willian Taylor, Dr. Darby Webb, Dr. Donald Morris, Dr. Jacob Kammer.
Annual Meeting and New Physician Dinner:
The ACMS Annual Meeting and New Physician Dinner will be held Tuesday, October 12, at the DoubleTree Riverside. This year's event is a Polynesian Luau. The Society will recognize Rodney H. Herr, M.D. & S. Kirby Orme, M.D. as Physicians of the Year.
Legislative Night:
The ACMS and IMA will co-sponsor a Legislative Night on Tuesday, October 26, at the Red Lion Downtowner. This will be an opportunity for physicians to discuss pertinent issues with their State Legislators.
Winter Clinics:
The Winter Clinics will be held February 18-21, 2005 in Sun Valley. Mark these dates in your calendar!
A tourist in Vienna goes through a graveyard and all of a sudden he hears some music. No one is around, so he starts searching for the source. He finally locates the origin and finds it is coming from a grave with a headstone that reads: "Ludwig van Beethoven, 1770-1827." Then he realizes the music is the Ninth Symphony and it is being played backward! Puzzled, he leaves the graveyard and persuades a friend to return with him. By the time they arrive back at the grave, the music has changed. This time it's the Seventh Symphony, but like the previous piece, it is being played backward. Curious, the men agree to consult a music scholar.
3 Management of the Re-Bound Headache, Fred Scheftell, MD
5 Epilepsy Update, Speaker TBA
10 Intensity Modulated Radiation Therapy, Stephen Smith, MD
12 Stroke Protocol, James French, MD
17 Antibiotic Resistance, Sky R. Blue, MD
19 Teaching Parental Skills in Primary Care: Kids Don't Come with Instructions, Jody McVitte, MD
24 Fad Diets, Kristin Ritzenthaler, PhD
1 Best of AHA, J. Brent Muhlestein, MD
8 Best of Thoracic Society, Richard Barbers, MD
15 Adverse Transfusion Reactions, Annie Strupp, MD
6 Irritable Bowel Syndrome, Mark Pimentel, MD
13 Congestive Heart Failure, E. Michael Gilbert, MD
20 Smart Growth Solutions for Obesity and Chronic Disease, Laura Tirrell, MD, Elaine Clegg
27 HRT and Cardiovascular Disease, Sanjay Agarwal, MD
6 Irritable Bowel Syndrome, Mark Pimentel, MD
13 Congestive Heart Failure, E. Michael Gilbert, MD
20 Photobiology and Photo Protection, Gavin Powell, MD
27 HRT and Cardiovascular Disease, Sanjay Agarwal, MD
7 Intracranial and SAH, Dale Hoekema, MD
14 Early Identification of PAD to Prevent Stroke and MI
21 Brahms: Medical History & Music, David Lee, MD
28 Evidence Based Approach to ACS, Eric Vanderbrush, MD
1 Male and Female Sexual Dysfunction, Ali Khan, MD
8 BPH, Wilfred Watkins, MD
15 Use of Anti-depressants in Management of Chronic Pain, Allen Bott, MD
22 Implications of Current HTN and Dyslipedimia Trials, Wayne Levy, MD
29 Acne Update, Steven Mings, MD
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