Tom Heston

A reader recently sent me this book to review and share with you:

Sunshine and Vitamin D: A Comprehensive Guide to the Benefits of the “Sunshine Vitamin”

This book is 234 pages with 26 chapters.

It primarily covers relationships between vitamin D and various medical conditions, but for me one of the most interesting chapters was at the end, titled “how safe is vitamin D” in which the author presents evidence for higher but safe limits of vitamin D consumption, with the author concluding that many if not most of us get inadequate levels of vitamin D.

For nutrition enthusiasts, this is a great book and worthy of reading. It is inexpensive and an easy read, and highly referenced. But for those interested in how to improve your diet, this likely is too focused on a single topic. Overall I give this book a “B”.

This article by Berman et al advocates a combined role for perfusion imaging along with coronary artery calcium scoring.

2009 BERMAN screening for CAD in diabetics

Here is how to setup a domain to use a self-signed certificate using Simple Control Panel, a free control panel for a dedicated linux server hosted by GoDaddy. This way you can setup your domain to use http secure (https) using SSL. The process is different using the Plesk control panel, and very simple.

In spite of this entire process being incredibly easy (once you figure it out), I couldn’t find a step-by-step guide on how to do it, in spite of an extensive Google search. But after experimenting around a bit, it was amazing to find out how easy it was. Here’s the step-by-step guide:

1. Login to your simple control panel.

2. In the “System Configuration” section, click on “SSL Certificates”

3. Create a self-signed certificate, and assign it to the domain you which to access via https.

4. Now, once again in the “System Configuration” section, click on “Domains”

5. Edit the domain you listed in #3 above.

6. in the “SSL Certificate” drop-down list, select the self-signed certificate you created in #3 above.

7. Upload your files to “public_html” via FTP.  In Plesk, you would upload files to the “https” directory, but using Simple Control Panel, just upload your files to the regular location.

8. You can now access the files from both http:// and https:// for example, say you uploaded the file “test.txt” to your domain, in the “public_html” directory. Then, you can access “test.txt” via:

http://<yourdomain>/test.txt

- or -

https://<yourdomain>/test.txt

There is no need to SSH to your server, mess around with httpd.conf or ssl.conf or .htaccess or to even restart apache. Simple!

The Painted Veil

This book explores the difference between a life of friviolity compared to a life of character and meaning.

The movie is excellent, for me, I liked it better than the audiobook. But both really worthwhile. This is a great story. If you like, download an audiobook from your library, like I did.

Grade: A

The Painted Veil

Clinical Question: Can we assess a myocardial perfusion and renal function simultaneously during 99m-Tc gated SPECT myocardial perfusion scanning?

Background: Cardiac function is closely related to renal function. Decreased function of one system often leads to decreased functioning in the other. The assessment of renal and cardiac function during a single study is thus appealing from a clinical standpoint. In addition, since both would be assessed after a single injection of the radioisotope, there would be a significant socioeconomic value.

Objectives: the objective of this study was to see if 99m-Tc tetrofosmin renal scintigraphy could be performed accurately (compared to Tc-99m DTPA renal scintigraphy) when don in conjunction with gated SPECT myocardial perfusion imaging. The study also looked at renal function after adenosine stress as compared to rest renal function.

Study Design: prospect evaluation of a cohort.

Participants: there were a total of 30 patients referred for clinical reasons for myocardial gated SPECT imaging. Of these, there were 24 with hypertension (including 7 with renovascular hypertension), 7 with diabetes, and 6 with dilated cardiomyopathy.

Methods: Gated SPECT stress-rest myocardial perfusion imaging was performed in standard fashion utilizing a two-day, single isotope protocol with Tc99m tetrofosmin. The next week, 24/30 patients had a standard dynamic Tc-99m DTPA renal scan for comparison with the rest Tc-99m tetrofosmin study.

The rest acquisition started out with planar dynamic and function renal imaging for 30 minutes. Then, gated SPECT myocardial perfusion images were obtained. Patient dosage of the Tc99m was about 10 mCi (370 MBq).

Stress cardiorenal imaging utilized adenosine stress testing. Renal images were acquired over 30 minutes, starting at 3 minutes into the adenosine infusion. Gating was performed using 16 frames per cardiac cycle.

The renal scans consisted of dynamic and functional imaging over 30 minutes. Values obtained included split renal function, time to peak uptake, and the uptake index for the radiotracer.

Results: On visual analysis, the renal images from Tc99m tetrofosmin were of higher quality due to the higher uptake index of tetrofosmin compared to DTPA. The split renal function as determined by 99m-Tc tetrofosmin was comparable to that obtained by Tc99m DTPA. Time to peak activity also was comparable for the two tracers.

Patients undergoing adenosine stress renal imaging overall had a statistically significant (p less than 0.005) drop in their 99m-Tc tetrofosmin uptake index as compared to the uptake index which was obtained by at rest.

Conclusion: renal function can be accurately assessed when done in conjunction with 99m-Tc tetrofosmin gated SPECT myocardial perfusion imaging and only requires a single injection of the isotope.

Source: J Nucl Med. 2009 Jul 17. [Epub ahead of print]. Single-Shot Cardiorenal Scintigraphy with 99mTc-Tetrofosmin: A Dynamic Characterization at Rest and During Adenosine Infusion. Fommei E, Bruselli L, Ripoli A, Gimelli A, Ghione S, Giorgetti A, Kush A, Tagliavia ID, Passino C, Marzullo P. “Gabriele Monasterio” Foundation, CNR Institute of Clinical Physiology, Pisa, Italy; Department of Internal Medicine, University of Pisa, Pisa, Italy. Abstract.

NuclearWiki

Just Launched:

NuclearWiki.com – the molecular imaging encyclopedia. This will be discussed at the 2009 SNM Annual Meeting in Toronto, Ontario

Over the past couple of weeks, it has become more and more clear that the world wide obsession with the swine flu is driven by an insane fear. Here are some common arguments, with rebuttal:

1. “But look at what happened in 1918! We’re all gonna Die ! ” – well, 2009 ain’t exactly 1918. Guess what has happened since then. #1 – we now have antibiotics. We have antivirals. We have antihistamines. We have inhalers for people with asthma and COPD. We now know much better the importance of hand washing….. and we now have wide availability of indoor plumbing ! !

The world is much different now. It’s time to stop pretending it’s 1918.

2. “But it might get worse! We’re all gonna Die ! ” – this brings to mind a great Yogi Berra’ism: “It’s difficult to make predictions, especially about the future.” So, yes, it “might” get worse. But we know that right now people are dying everyday from the common flu, from cancer, from gunshot wounds, from suicide, from heart attacks….. and yes, from a lack of clean water and a lack of the basic necessities. We are spending now millions of dollars on something that “might” happen and ignoring what is happening.

Just last week at a cancer conference at Johns Hopkins that I was attending, it was mentioned that a patient couldn’t get a PET/CT scan, which they really needed in order to help with their cancer. They had no health insurance. About 20 physicians at Hopkins spent their time at this meeting trying to figure out how to get this patient the care they needed. The problem was solved, but why did it ever arise in the first place? Maybe because of screwed up policies and priorities by our federal government. They are spending millions on what might be, and ignoring what is. Heaven help us if we get “universal” i.e. politician run health care. It will be full of idiotic fantasies that boil down to a single thing… getting the politicians more power.

Obviously, these politicians have never volunteered in a community free health clinic, where those without insurance can get at least some access to medical care. The politicians have no idea about the preventable diseases, the unnecessary deaths, and the pain and suffering that exists, right now. The politicians are too focused on the fear of what might be.

Remember the words of FDR: “There is nothing to fear but fear itself.” This fear mongering by the politicians is out of hand.

3. “The swine flu is a pandemic ! We are all gonna die !! ” – OK. This is partly right. Pandemic means a disease has spread around the globe, and isn’t just regional. It doesn’t mean that a large percentage of the population is affected. Typically, it refers to contagious diseases as opposed to chronic or genetic diseases. But we are not “all gonna die” from the swine flu. Much more likely is that you and I will die from the routine, boring, and unexciting diseases of cancer, stroke, and heart disease. These diseases don’t make global headlines, but they are millions and millions of times more important than the swine flu.

4. “That person sneezed. We’re all gonna die ! We’re all gonna die ! ” – guess what. Sneezing isn’t going away anytime soon. Start using a handkerchief or tissue. Wash your hands. And stop scaring everyone to death. Yes, we’re all gonna die, most of us in the western world at about age 75 or so. So prepare for being around for that long and start exercising, eating right, and even having a laugh or two at someone else’s expense (ha, ha).

20090504-we-are-all-gonna-die

Us men often don’t like to express our feelings, but we have ‘em. And sharing them with mom, your wife, or your partner is great. So, here are some highly recommended movies and music videos that will be sure to please.

1. Once – a touching movie about a relationship between two musicians. Beautiful music in unlikely places – http://bit.ly/14Ce5R

2. The Notebook – the power of enduring love. http://bit.ly/51VJV

3. 50 First Dates – a romantic comedy about devotion and destiny. http://bit.ly/nu1pT

4. The Concerts by Barbara Streisand – o.k. to be honest, I’m not a big Babs fan, but she has a great voice and women love to hear her sing. http://bit.ly/18M1Sf

5. Hit Man – songs performed live by one of the greatest contemporary composers and producers of hit music. http://bit.ly/Brrsa

Tom Heston, MD

1 dozen eggs
1 quart heavy cream
1 quart light cream
1 pint bourbon
1 quart rum
nutmeg
sugar to taste (1/2 – 3/4 lb)

Beat eggs, add bourbon and rum slowly with stirring to prevent precipitation of egg proteins. Beat heavy cream separately until it peaks and add to the egg/bourbon/rum mix.

Add the light cream with stirring. Add the sugar to taste with mixing (1 pound/batch), then add nutmeg to taste.

Leave standing at least overnight with lid slightly ajar in refrigerator. Serve after 2-3 weeks in the cold.

Thanks to: NPR News

BOOKS: The best way to shop for books that I’ve found is on Amazon.com

Just add this gadget to your iGoogle home page. This lists the top selling books and the best prices.

COFFEE: find the best selling gourmet coffee, instantly, with the best prices.