cool cases

We had a really interesting week of patients. It all started simply enough. We had a case of a vesicular rash on a Marine’s neck that was causing a burning sensation. It was in a dermatome distribution. He was diagnosed with herpes zoster (shingles), started on acyclovir and is doing much better. (pic below)

Next up was a young Marine who sustained a foot injury as a child. Being that his family was poor and lived far from health care his father latched a 2x4 to his foot for a couple of weeks in an attempt to set it. You can see below the repercussions.

Soon after we got a call about a Marine having a seizure on the flight line. He was noted to have a fever and thus thought to have possible meningitis. He had to be medivac to the hospital where he had a normal head CT and normal lumbar puncture (thus not meningitis). He is now getting evaluation in Germany.

Right after that fellow, we had a fellow get a superior dislocation of his shoulder. I can relate to his pain and suffering as I too have had a shoulder dislocation. At least I can give him good info on rehab.

The past few days have been even better. We had someone show up with chest pain and a history of congenital dilated cardiomyopathy. He was quickly treated and evacuated to the hospital for possible early myocardial infarction. He is doing well, but will soon be in Germany as well for a catheterization.

Then there was the guy who has been impotent for the past 26 months. I know it is common, but not at my age (I hope not) which he happens to be. Apparently he has had this problem since completing a 100 mile long bike race. He had 6 weeks of bilateral lower extremity numbness for 6 weeks after the bike ride as well. He has some subtle neurological changes on exam. So he probably will end up in Germany as well.

But my favorite is the guy with right sided chest pain. Usually, this is not as concerning, unless your heart is on the right side. That’s right, he has situs inversus which means your heart and stomach are on the right side of your body instead of on your left. There is a condition called Kartagener’s that is associated with some of these individuals where you get recurrent sinus and pulmonary infections (due to ciliary defect) and also have high chance of infertility (same defect). Anyhow, he does not have Kartagener’s and thankfully had normal EKG. He instead had a history of recent chest trauma and on CxR I found a cracked rib. If the CxR was able to load, then you can see for yourself below.

I am going to rest my noggin now.

I included a picure of the clouds after a morning rain here. It just goes to show that you can even find beauty in a dustbowl.







Nice party trick.












I itch just looking at it.

Aaaahhhh.

hump

So yesterday I did a hump. Now even though it involved more than one person, let me assure you that it is not the type of hump you may be thinking. This one requires not only clothes, but a 50 lbs pack load. As I mentioned in previous blog, I am striving to get my FMF pin and part of the requirement is doing a 6 mile hump. This is a waved requirement while in a combat zone, but I am a motivator.

So my partner and I decided to do this hump 24 hours prior and we let some of the Marine officers know our intentions. We got 6 of them actually wanting to go along and another few bummed out that their schedules would not permit. That’s the Marine Corps for you (BTW in TBS which is their officer school they do plenty of humps that culminates with a 15 mile hump with near 100 lbs load).

I paced off a route with our vehicle which encompassed the perimeters of both British bases. We had to wear our uniform, our flak, our weapon and have a 45 lbs pack with our Kevlar attached. The rules were that we had to stop for a gear check and for a 10 minute break midway through and we had to complete the 6 miles in less than 2 hours.

Eight of us left on our mission. Everyone did pretty well through first half. At 4 miles I looked at my watch and made a decision that we would split into 2 units since time was pressing and Mike and I needed to finish within the 2 hours. My group finished with plenty of time to spare. I had been told through the grapevine that one particular Marine 1st LT boldly stated that he was going to drive the Navy officers into the ground. Let’s just say that he was marching off my pace all afternoon and he was a bit more sweaty than I :)




All smiles before the hump.

Leader of the pack.

Madatory break.

black friday

Well today I got up early to see what kind of 'black Friday' deals I could get. Unfortunately, there are just 2 places I can go to shop the MCX (Marine Corps Exchange) and the local Afghanistan market. I put a couple picture below of some of our finds. Of course at the little market they always have 'a special price for you'. I did price out those swanky suits that I blogged about earlier. I just might have to buy one for future events.

We have recieved a lot of boxes from AnySailor.com recently and have been able to give a lot of the Marines snacks, toiletries, blankets... We also received a lot of Christmas decor. A few of our corpsmen had any evidence of Thanksgiving down and all the Christmas decorations up before I was up this morning. It should be festive.

You will notice a hat theme below.







Got your hokas here.










LT Crandall, Chief and I with an assortment of hats. I especially like the leopard hand warmer.














Tactical Santa.

Psycho.

Thanksgiving

So today is our Thanksgiving. It is still in essence a workday around here, but we had part of the morning off. I was able to go to Thanksgiving mass followed by the obligatory meeting. I got a chance to run my clothes over to Sadish the laundry guy. Then it was time for football.

Yes we got this idea in our heads that there needed to be a staff NCO and officer football game. I was ‘volunteered’ to play. I suppose it should be a complement that they wanted me to play. I showed them the error in their ability to judge talent by throwing the game deciding interception that was returned for a touchdown.

When we play football, or any other sport, on this field, you are just hoping to come out alive. We have had numerous strains from sliding along the gravel in running shoes as well as many skinned knees, hands, name your body part. I had the further disadvantage having participated in the Marine PFT the previous day which has left my back a little stiff.

I took the Marine physical fitness test yesterday as part of my FMF pin. The fleet Marine force pin consists of being attached with the Marines for a set amount of time, pistol qualification, PFT, 6 mile hump with all your gear on and an oral board about the Marine Corps. The PFT is actually waved while in a combat zone, but we decided to do it anyhow. The PFT is not that difficult. It consists of pull-ups (20 to max points), situps (100 to max points) and a 3 mile run (18 minutes to max points). You are judged on a 300 point total and there are 3 different categories. The most difficult part was the run because we are having some rather fierce winds currently and on certain legs of the run I felt as if I were running in place. You will be happy to know that I got a first class score. If I were to take the test 4 months from now, I would be in a different age category (40+) and would have had to put in a lot less work to get the same class score.

Things that I am thankful for today….

- My health
- My family
- My friends
- My ability to serve my fellow man and my country as both a Navy officer and as a physician
- My faith
- The Marines that keep me safe
- Skype
- Peanut Butter
- Warm clothes
- The fact that this deployment is finite and thus there will be a day soon where I will be able to see all your faces and share laughs with you once again.

May peace and happiness find you and your family. Happy Thanksgiving!




I am in this picture, can you tell which one?















Running a route.












Da Players.

The food resembled and tasted like a Thanksgiving dinner (despite the pumpkin pie being frozen).

updates

So, I thought today I would just update you on some things.

The British chow hall turned over their contract to an independent contractor. This has resulted in much less authentic British food and rather bland menu choices. It has also resulted in a lot of people behind the counter who cannot speak English. On the flip side, my young corpsmen and their novice taste buds actually prefer the more Americanized menu.

I am still doing yoga 1-2 times a week. Rodney Yee is still my man :) However, I have branched out a bit and now am trying some pilates. So far, I have only done abdominal pilates by Ana Cabana and she kicks my butt! I do not have the flexibility or control of my balance to get into the positions that that girl does. It mixes up my routine though and for that I am grateful. Namaste.

I had read the ‘The girl with the dragon tattoo’ by Stieg Larsson which I really liked. I just finished the sequel ‘The girl who played with fire’. It was also good, but not as good as the first. Next book is ‘A bold fresh piece of humanity’ by Bill O’Reilly.

This past Friday, we had our first inaugural cigar club meeting. Gil would appreciate the fact that Marines like their cigars and it is no exception out in the field. One of them has been ordering interesting cigars online. Another Marine has made his own humidor. So a pay $10 for 3 cigars and presto I am in the club. I got quite an education about how cigars are made and how they come by their names. Now, I do not condone smoking, but I figure that if I am in an area where I get ‘hazardous duty pay’ and ‘imminent danger pay’ then I should be able to justify smoking a cigar once a week.

Speaking of smoking, my mom asked what they did with all the trash here. Well, they burn it. In fact they burn everything including plastics (sorry Madeline). Heck, in the outlying areas they even burn their @#$%. They have big incinerators on base for the burning. Below is a picture of the BAS with the smoke rising behind it from afar.

Lastly, I mentioned prior that I was asked to play guitar in church despite only knowing pink panther and bluebird at the time. I had been practicing, but had not been able to get a hold of a guitar this week to ‘fine tune’ (like the pun) my strumming. I was stoked today that I was not going to be able to play guitar and thus avoid embarrassment at mass. Only to be tasked to be the Eucharistic minister. My only qualification is that I am probably the most consistent mass attendant at this camp. So I doled out the Blood of Christ today. I can only imagine Ellie beaming with pride and tears welling up in Liz’s eyes at the thought of me at the altar. I can also imagine Cissy thinking ‘he is only doing it because he gets to drain the cup at the end of communion’.

Till next time…






Lot of hot air in this club.











The roof, the roof, the roof is on fire. Naaahh, just them burning stuff behind the BAS.

The last 2 books I read. Overall, I recommend for both.

research

So, one would think that you would not need too many allergists in Afghanistan (or even one for that matter). That being said, my first two patients were seasonal allergic rhinitis and asthma. There has been a good amount of asthma exacerbations due to the irritant effect of the constant dust. Maybe this is why we will have 3 of the Navy’s 5 allergists serving in Afghanistan by February (which leaves 2 allergists to cover 3 major hospitals).

I have also had some other interesting cases such as food-associated, exercise-induced anaphylaxis to oatmeal. We have had numerous interesting skin cases which my partner is salivating over since he wants to do dermatology one day. Urticaria (hives) is always present as well. I have been able to do some drug challenges to rule out drug allergies and even considered desensitizing a patient to doxycycline for malaria prophylaxis needs.

I was due to go to the American College of Allergy, Asthma and Immunology this month, but could not due to my vacation to Afghanistan. I had 3 abstracts accepted. We had a poster presentation on the ‘evaluation of FeNO and the subsequent diagnosis of asthma in military basic trainees’. We had a poster presentation on ‘anaphylaxis to neoprene’. Lastly, I had one accepted for oral presentation and luckily one of the co-authors was able to present the ‘diagnostic value of limited skin prick test panels’. She did an awesome job and the presentation was well received.

I have brought research to work on out here, but finding more interest in pleasure reading and guitar at the moment. I did read the first volume of the new Middleton Allergist text (pic attached). This was only 700+ pages (unfortunately, volume II is 1000+ pages). I currently am reading a chapter of vol II in Middleton’s and a chapter out of a contact and occupational dermatology book each day. Another favorite professional read has been the new edition of the Red Book on infectious diseases. Hey it helps with insomnia!

I know that this blog was not quit as exciting, but once-in-a-while Mark can be a dull boy. Hopefully it will portray me as being somewhat intellectual…..naaahhh!

I would like to point out that this blog entry was spell checked. Liz was quit perturbed at the fact that I misspelled ambulance in recent blog entry. I told her that I am more interested in what arrives in the ambulance and not being able to spell it correctly. Nonetheless, grammar and spelling should be at least above that for a graduating high school senior which is not saying much these days.





Volume I is in the books so to speak.

















Vol II of an allergy text and a book on contact dermatitis. Who needs ambien for sleep?













This is me strumming the guitar with new hat in tow.













Helicopters on the flight line.

Pacquiao

Is Pacquiao the man or what? I found out that we would get an AFN (armed forces network) broadcast of this HBO match last night. The whole BAS plus some Marines huddled around a TV to see this boxing master pick apart Cotto. I am not a boxing afficiando, but I can appreciate that this man is a bad#$%. It just made my Filipino-in-law pride swell.

We had some Marines playing softball on our wonderful rock field that is surrounded by barbwire. Below are some pictures of what happens when you reach through the wire to try and retrieve a softball. This Marine must have not donw well in the game 'operation' as a child.

We did our H1N1 shot exercise this week. Everything went well. Below is a picture of me getting my vaccine.

I put in a picture of an ambulence that was in front of our BAS recently. With all the IED blasts occurring they have really up-armored all vehicles. This ambulence is no exception. They all V the bottoms of many of these vehicles to help deflect a lot of the blast. These beasts get very low gas mileage, but are probably going to be exempt from the newer mileage regulations that our current government is demanding for the future :)

Last picture is a new tailor shop that opened with the other vendors in past few weeks. I am soooo tempted to get one of these suits with a felt hat. I could be the pimp daddy of them all!







Before.














After.














HN Stein (or Stein-o-mite as we call him) giving me my H1N1.














An ambulence that even Rambo would love.











Style in Afghanistan.

Marines 234th Birthday

So yesterday we had a birthday celebration for the Marine Corps. They were officially born on November 10th, 1775 at Tun Tavern in Philadelphia where 2 battalions of Marines were raised under the Capt Samuel Nicholas. Their mission was defined in the National Security Act of 147 (amended 1952). Today the Marine Corps is 234 years old. We celebrated yesterday, the 11th, to correspond with it being the 10th in the U.S.

Other important dates one should remember are that the Marines came under the Department of the Navy in 1834. Marines will retort that they are part of the ‘men’s department’. I will often remind them that the men’s department is often found in the basement.

In the Battle of Belleau Woods in France during WWII the Germans were so impressed with the tenacity of fighting from the Marines that they called them Teufelhunden which translates to ‘Devil Dogs’. Marines use to hear this name with pride and call each other ‘devil’. Now in our politically correct society Marines are encouraged to refrain from using this nickname in case some may find it derogatory. I don’t know about you, but I like our Marines to have an edge.
So, they have a very formal cake cutting ceremony followed by a BBQ. Some of us had cigars, some participated in pull up contest and yet others participated in football. It was a very important occasion with the Marines with everyone going around wishing each other ‘happy birthday’.

Semper Fidelis!

Happy Veteran's Day!






BBQ setup.















Having a cigar with some Marines.













Participating in the pull-up competition.











Taking a break from festivities.

Marines playing football on dirt lot.

HiMARS

Yesterday I went over to look at the HiMARS attachment that is adjacent to our camp. We often see their Marines in our BAS. HiMARS stands for High Mobility Artillery Rocket System. They use to be an artillery company that shot 155mm Howitzers (M198). I know this because I was a GMO with 1/11 from 1998-2000. 1/11 is an artillery battalion and we use to go to 29 Palms to shoot our very loud and impressive artillery. Back then this company was also traditional artillery, but in the past few years has switched to the HiMARS role.

HiMARS are a rather impressive weapon. They are constantly on standby waiting for calls to provide artillery support for troops engaged in combat or to target buildings. The rockets they shoot can travel up to 80-100 Km (50-60 miles) and are very accurate in their impact zone. They are obnoxiously loud when they launch, but apparently are silent as they approach the target. They can carry various munitions rounds that serve various roles.

We were able to talk to the command element of this company, tour their command center, and look over the vehicles. Their training sergeant decided to have them demonstrate a dry run for us and roused up the ready crew. They basically get geared up and roll the vehicles just out the gate to a firing position. Pictures below.

Movie Reviews:

Kingdom of Heaven - would highly recommend. Good acting, get a little history, decent battles.
Taken - would also recommend. Lots of good violence.
Gamer – don’t waste your time.
Currently watching season 2 of Seinfeld. It is so funny looking at the hairstyles and clothing from the early 90’s.

Book Review:

The Girl with the Dragon Tattoo by Stieg Larsson. Kind of like a Silence of the Lambs who done it. I thoroughly enjoyed and have since bought the sequel The Girl Who Played With Fire.







LT Crandall, HMC Stubbs, Myself, HN Stein posing in back of HiMAR vehicle.













LT Crandall and HMC Stubbs taking pictures of HiMARS outside gate.


















In firing position.

Looking down a missle tube.

food for thought

I thought that I would talk about food today. I have promoted the British chow hall in past blog entries, but I have new distressing news. They turned over the chow hall to KBR which is a contractor through Russia. Now we have a lot of foreign nationals (Indian and many different Asian countries) who are trying to mimic the British cooking techniques. There has been a slight noticeable difference thus far. The main problem currently is proper communication. In other words, there is a lot of finger gesturing at food to try and relay what entrée you would like. Time will tell.

One of my favorite lunch dishes has been the ‘dream’ sandwich which is ham and tasty cheese which is dipped in egg and then fried. I have had it with jam on top ala Monte Cristo and have also lathered it in ketchup and Tobasco when I am feeling a little adventurous.

One of my favorite food activities is to look at the shelves at the Danish and English PXs. I have attached some pictures of interesting foods or interesting names.

It is starting to get cold here and very windy. I know that it is cold because when I pee in the urinal of the port-a-potty there is steam coming off of it. Unfortunately, the cold is not suppressing the stench in there. The wind is kicking up a lot of dust which is affecting visibility at times as well. I am often wearing my sunglasses in these conditions whether it is sunny or not to avoid the crust that develops in your eyes.

I did want to say something about current news. You probably have gathered that I am more a conservative thinker. I am also, as you know a physician. This may skew my opinions on health care a bit. I do believe that health care in this country can be modified for the better. However, I do not like how it is being addressed by this Congress and administration. When you are talking about a big issue like one’s health and an industry that is about one sixth of the GNP, you should not try to bulrush an outrageously large bill through on a Saturday night vote. You should also not be able to pass this type of legislation with a simple majority vote. I think that big change like this should require a super majority vote or a vote to the people (since Congress rarely represent the people these days). I hate the fact that there was limited time for Representatives to look at this bill, I think it is bull**** that the public had even less time to look at this behemoth document and I hate that the vote was almost purely partisan. I can only hope that it collapses in the Senate so we can really have a long healthy debate about what would properly help Americans and also be fiscally responsible. Lastly, I want a health bill that has health as the main topic and not have other agendas as its main driving force as I think is currently happening.

Thanks for tolerating my ranting.






Look, its got milk in it, it is good for them. Besides, he looks happy.













Monster Menthos packs. But look at the people it attracks!


















A perfect snack for an old sailor.














The name says it all!













The Dream.

job description

So I was asked by my son today ‘dad what is your job there?’ I thought that I would answer this in three parts, why our unit is here, what my job description is, and then what I actually do.

I am an augment to MWSS-372. They are a support squadron out of Camp Pendleton. Our job is to make and maintain runways, give fire rescue support to aircraft, give medical and logistical support, provide messing (food) support, and do all kinds of other projects for the Marine Air Group. We are really focused on the airfields during this deployment.

My job is that of senior medical officer (SMO) of the battalion aid station (BAS). I inherited this job because I have the most gray hair and a higher rank than anyone else at the BAS. I ensure that everyone else in the BAS are doing their jobs. I do see patients, but for the most part they are not very complex. My most important job seems to be making power point slides for daily briefs to the CO. Words just cannot describe the excitement and intellectual challenge this brings me. Lastly, I have to deal with local politics of other medical officers. Thankfully, I usually only have to introduce myself with my rank and this resolves most situations since they are mostly LTs.

To really give you an idea of what daddy does at work in Afghanistan, I will describe my day yesterday.

0630 – wake up
0630 – 0700 – brush teeth, make oatmeal and tea (switched from coffee recently)
0700 – 0730 – Talk to family back home
0730 – 0800 – Take 30 minutes on our computer to check about 3 e-mails
0800 – 0815 – Go to daily mass (got to feed the soul too)
0815 – 0830 – Make power point slide for brief
0830 – 0845 – See a couple of patients (maybe it was one patient with 2 diagnosis)
0845 – 1000 – Read medical text, journal articles
1000 – 1030 – Battle Update Brief or BUB (that is really the acronym they picked for brief)
1030 – 1130 – Work out (sit-ups, push-ups, pull-ups, dips, chest and triceps)
1130 – 1200 – Chill / light reading
1200 – 1330 – Lunch (10 min walk, 20 minutes to eat, 50 minutes chat, 10 min walk back)
1330 – 1400 – Patient (possible food-associate, exercise-induced anaphylaxis)
1400 – 1530 – Read, write letter, eat M&Ms
1530 – 1615 – Yoga
1615 – 1645 – Run to other base to play basketball
1645 – 1800 – Play basketball on a court that Brits made from material used for air strip
1830 – 1845 – Shower
1845 – 2000 – Dinner
2000 – 2100 – Sit around and talk smack about people
2100 – 2345 – Watch ‘Conspiracy’. Horrible movie. Name one good Val Kilmer movie other than ‘Top Gun’ or ‘The Saint’. That’s right, you can’t.
2345 – Sleep

I wanted to give a shout out to Greg Utz, former neighbor and Navy colleague who is going to take over as CO for Navy Health Research Center. Lily, we know that this is more from your hard work than his :) I also give Liz all the credit for my current position and stature…………in Afghanistan.



V-22 Osprey have arrived.

Warrior pose(er)?

This one is for you uncle Greg!

gym

Today I thought that I would talk about our local gym. The Marines usually have decent gym equipment on their bases (of course never as nice as that which the Air Force bases will have…different blog). Our gym is about a hundred yards from the BAS which is definitely an advantage. However, it is, like everything else, housed in a tent with a plastic floor. I am sure that at one time (i.e. first month of use) the gym was great. Now the weights are mismatched, the pulleys on machines non-functional, and the pins needed for the machines non-existent. That is not even the worst of it. I have included a picture of the bench which is now more duct tape than fabric (remind you of anyone Liz?). I also added a picture of the treadmills. The treadmills only occupy space at this juncture as they do not work. All they do is collect sand. If you look closely, you will see that a lot of the ‘tread’ from the treadmills has been removed by some industrious Marine.

Mostly my routine these days is series of situps, pushups, dips and pull-ups. I am really starting to pump out some numbers. I have taken up running while out here. I use to run about 5 times a year. Now I am running 5 days a week, 4 miles a day. My goal is to get my weekly miles up and hopefully run the Rock N Roll marathon in June 2010. Anyone want to run with me? That’s right I threw down the gauntlet!
Talk to you all later.

Side notes:
1) I was a bit perturbed when I heard it reported that Obama would not decide on possible troop increases in Afghanistan until after November elections. Goes to show you where politician priorities are these days. They are more interested in political clout (winning local elections for their party) then they are about the welfare and safety of U.S. troops. Maybe we will have an answer after the next poll results are in.
2) I found it interesting that it is speculated that the first eco-billionaire could be Al Gore. He is sure profiting from his agenda. His financial interests stand to make millions off us common folk when things like cap-and-trade programs go into effect.

Just like Venice beach.

Where's the beef?

Yet another use for duct tape.

Slightly used treadmills. Actually never used because they no longer have tread...or monitors....or electricity to run on.