Why are Heberden and Bouchard’s nodes named after 2 different people?

(In osteoarthritis, enlarged DIP joints (knuckles closest to the end of your fingers) are called “Heberden’s nodes” and enlarged PIP joints (knuckles you use to knock on doors) are called “Bouchard’s nodes”.  And yes, I really am going to complain about it.)

Medicine is moving away from most eponyms, since they’re generally undeserved and were also inevitably given to some sketchy doctors who didn’t deserve to be immortalized (case in point: Wegener’s granulomatosis.  He was, it turns out, a nazi.

So that led to a 50-year-long awkward moment in medicine.  A moment which has only been extended by trying to rename the disease “granulomatosis with polyangiitis”).

To be fair, some people will try to tell you that, actually, medicine is moving away from eponyms because they’re “so difficult to memorize” – a viewpoint that’s, at best, pretty damned optimistic.  (Fun game:  Go find a physician, resident, or M4 and ask if they think organic chemistry was helpful.  Then, after they finish laughing, ask them if they’d be in favor of dropping it as a pre-med requirement.

… Yeah.  Spoiler alert: they’re not for it.  Neither am I. “Medical education” is practically synonymous with “Sure, some of it’s inefficient, but if my generation had to do it anyway, so do you.”   People who say that “medicine eats its young” aren’t kidding.)

Heberden’s and Bouchard’s nodes seem even sillier than most other eponyms.  Getting credit for seeing some weird manifestation of a disease, I understand.  Getting credit for some weird “you can only see this part of the anatomy if you cut a person open and squint at them sideways” piece of organ anatomy, I understand.

But getting credit for the fancy notion that sometimes when your knuckles are inflamed, they’re enlarged?  That’s ridiculous.  You may as well call a sore throat “Heberden’s throat”.  In either case, regardless of how fancy the pathogenesis is, I’m pretty sure people already knew the symptom was directly related to the disease.

So I looked it up.  Heberden was a fancy London physician from a good family, who wrote a chapter on arthritis in the medical book that was most in vogue at the time.  So they gave him the DIP-joint-is-inflamed eponym.  Okay, fine.

But nearly one hundred years later, the PIP -joint-is-inflamed symptom was – it appears – randomly assigned “Bouchard” as an eponym.  Bouchard was a French pathologist who studied under Charcot and doubtless did a lot of interesting things, but none of them seem to be related to arthritis.  I guess medicine felt like he was such a stand-up guy he deserved an orphan eponym?

If that’s a legitimate action to take when confronted with an awesome pathologist and an unnamed disease, Wegener’s Granulomatosis should just be renamed Goljan’s Granulomatosis.  TWO BIRDS. ONE STONE.

Goljan is a champion arm-wrestler. Hand over the eponym and no one gets hurt.

Bouchard’s nodes are less common than Heberden’s nodes, so maybe we should give Heberden a pass on not noticing that the swelling sometimes happened on the PIP joints. But I’m honestly not convinced that Heberden didn’t notice the “Bouchard’s nodes”.

You know what I think?  I think he was just like, “meh, it’s exactly the same thing in a location just centimeters away, no need to write about these nodes like they’re any different.  It’s not like they’re going to give it someone else’s name.”

Well, the joke’s on you, Heberden.

Joke’s on you.

Shoes.

When I was a kid, Mom took me to Payless once a year to buy shoes.  Specifically, to have me pick out a pair of sneakers and sandals.  The idea was that I could then buy nicer shoes – church shoes – with my allowance money.

Unfortunately for her, she severely miscalculated just how little I cared about the niceness of my shoes or their appropriateness for church.  So towards the end of every year she’d have to argue me down on a variety of issues I found extremely debateable, such as “Why can’t I just wear my sandals to the Christmas Eve service?” and “But if I jump from the car to the sidewalk, I might not get any snow in them!” and “BUT I DON’T WANT TO GO SHOPPING.“

In fact, up until last week, I’m pretty sure I didn’t own any shoes that weren’t either a) from Payless, or b) a gift.  (Usually from my mother. With a vaguely threatening note attached.)

But after my last pair of flats gutted themselves tragically on a sewer grate (whyyy?), I realized that I should probably just accept that I need to actually go invest my money in A Pair of Forever Shoes, made out of real leather or something.  A Pair of Forever Shoes would’ve survived that sewer grate, damnit.

So I did.

And they cost two hundred dollars.

Oh god, I nearly passed out when I clicked “submit” on their website.  I feel incredibly guilty spending more than $50 on any one thing (thanks a lot, mom!)  (<– that may or may not be sarcastic!  I have not decided!)

Anyway, they came, and they are truly awesome.

Things to Do In $200 Shoes:

1.  Wear them to a day at the clinic – because they’re ridiculously comfortable and professional.  Sensible!

2.  Lie on your bed watching half a season of Arrested Development and eating nachos, and think to yourself, “I am watching Arrested Development and eating nachos while wearing $200 shoes.” and marvel at the direction your life has taken.

… Guess which one I’ve been using them for?

WORTH EVERY PENNY.

(Technically, if you want to follow in my very expensive footsteps, today you can get a 20% off coupon for liking their company on facebook.  I feel like a shill telling you guys that, but like – what if one of you decided to buy a pair?  And I didn’t tell you about the 20% off thing, so you spent an extra $40?  That would definitely be worse.)

Holiday Mistakes

No, I wasn’t exactly awake while showering, why do you ask?

I hope my OSCE patient is feeling festive.

A couple of things

1.  Sometimes people are the absolute best.

I just.. hold on.

Allergies. I just... allergies. I'M ALLERGIC TO LOVE.

2.  Sometimes I come up with multi-million dollar marketing plans in the shower.

Remember when you used to be able to just use face wash?  But now “facial care” is a 3 step process:  1. Exfoliate, 2. Clean, 3.  Moisturize.  You need 3 products.  (We’ll ignore the fact that I’m pretty sure Dermatology has taught me that exfoliating is a gigantic waste of time, money, and protective layer of stratum corneum cells.)

(Oh, also, I totally have my Dermatology test in 2 hours.  You can tell it’s real important to me.)

We could do the same thing for the haircare industry – increase profits by 33%.  After all, does anyone only buy shampoo, or only buy conditioner?  No.  We need a 3rd product everyone has to buy. (And by “we”, I mean “the haircare industry, if I was involved and got a payday out of this”.)

My ad campaign.

The Commercial:  “If you’re only using Shampoo and Conditioner, you’re missing out on a crucial 3rd step.  Take a look at any shower in France, and you’ll find a 3rd product – Pre-Conditioner.”

The actual name of the product isn’t important.  It just has to have a vaguely plausible sounding scientific gimmick like “providing a surface for conditioner to fully enter the hair shaft – because without it, conditioner only sticks to the outside and is mostly rinsed away!”  (Since 90% of the scientific stuff in hair commercials is made-up, this should be legally ok.)

If I were in charge of this ad campaign, I’d pin this “secret” on the French, because – at least in America – we seem to be willing to believe anything about the French, including that they’re all skinny and effortless.  Perfect hair goes with the territory.

If the hair-care industry successfully plant the seed of doubt in people’s mind that shampoo and conditioner are not enough, they could get $6 out of most of the women in the USA, and probably half of the men.  Millions of dollars.

No, I don’t know how tongue-in-cheek this idea is.  I hope you don’t either.  

The Science of Babies

Tonight’s Netflix suggestion:  ”The Science of Babies”!

6:50pm:  Fantastic. I had no idea this existed. With a title like “The Science of Babies”, I expect a 3 year neonatalogy fellowship condensed down to 30 minutes. Do not disappoint me, Netflix.

6:51  WILL SOMEONE PLEASE PICK UP THIS POOR CHILD.

"Babies: They come into this world alone."

6:55:  … No?  No one?  We’re still narrating things over a lonely baby?

Correction!  A lonely, CRYING baby.

7:00:  ”A human will likely take over 6 million breaths in a lifetime.  But the first is by far the most difficult – AND DANGEROUS.”  Shit is getting real.

7:05:  ”Two thirds of baby deaths occur in the first month – a rate not equaled again until the 7th decade of life.”  Poor babies!

7:07:  ”A newborn’s vision is cloudy, and therefore limited to about 12 inches.”  POOR BABIES.

7:10:  ”Babies know intuitively to hold their breath under water.”  Poor ba- wait, what?

And then there was a bunch of stuff about neurons and synaptogenesis and synaptic pruning, which is all well and good, except facebook.  (Don’t worry, I periodically checked back into the Netflix tab to see if anyone ever picked up the crying theater baby.)

7:30:  (They didn’t.)

I don’t think I got a neonatology fellowship out of this, so in that sense, the documentary was a disappointment.  However, a counterpoint:

Vowels!

… I think the counterpoint wins.

And we’re back

In 7 weeks, I’ll be on the wards!  Rotating!  … Clinically!

Okay, so – no, I have no idea what being on clinical rotations is like. I like to imagine it involves looking very serious while holding a clipboard and walking briskly.  And then you also get yelled at a lot, but at the end of the day you remember what it’s all for because you hear Zach Braff’s voice spelling it all out in painstaking detail.

(… In related news, I may have mistaken “clinical rotations” for “Scrubs”.)  (Bonus tip to pre-med interviewees: always pretend like you don’t know the difference between those two.  Interviewers love that stuff.)

(Extra bonus tip to pre-meds interviewees:  never take advice from a med blog.)

Anyway, I’ve had a traumatic couple of weeks, but I think I’m finally on the up and up.  Which is exactly why this was a jerk move, Netflix.

NETFLIX. THAT'S NOT NICE.

In case you have better things to do with your time than read the tiny text up there: my top rated “Witty Romance” choice is not witty.  Nor does it look romantic.  Instead, it is a cartoon about a snow day at the mall where everyone is preparing for the upcoming school dance.  Because it’s legally required that any movie that bills itself as “teen” must include a school dance for which the characters can prepare.

Now I don’t know about you guys, but all of my “preparations” for school dances in high school went something like this:

Step 1:  Make fun of school dance.
Step 2:  Reluctantly deign to make an appearance because “there’s nothing better to do”.
Step 3:  Wait for Freddie Prinze Jr. to show up, extend his hand, and shyly ask me to dance to a Cranberries’ song.
Step 4:  Make fun of school dance.

Which is to say: … yes, I will probably watch this.

But I’m going to be disappointed if Zach Braff doesn’t appear at the end to explain the moral.