A to Z

MYCHONNY!!!

Adu sumpah tuh cowo kok bsa ada di dunia ya? wkwkwk kocak bgt!! Bagi yang ga tau mychonny, langsung aja ke :

http://www.youtube.com/mychonny

salah satu videonya yang bikin geli adalah video pertengkaran dia dgn bokapnya;

*sudah di translate*

bokapnya: Nakal amat sih lu nak, gw tendang jg lo pake anu gw!

mychonny: ha ha ha

bokapnya: jangan ketawa lu, panjang anu gw, kalo lu ukur dri keyboard, itu dari A sampe Z *sambil kasi gambaran panjang bgt, dia ga pernah main keyboard*

mychonny: wah gilaa panjang bgt...eh....tunggu sebentar......*liat keyboard nya dan ukur*

mychonny: cma 2 cm??

bokapnya:......

P.S: mulailah menghapal keyboard

NGEPEL DI GEREJA TENGAH MALAM

INI ADALAH KISAH NYATA!

Hari ini gw kesel bgt sekaligus seneng bgt. Bagian keselnya cuma satu yaitu salah seorang alien di kelas gw (yg menurutku mahluk ini aneeh bgt, ud suaranya aneh, ga jelas pula, males sebut namanya) gw tugas di skul buat poster, nah ni mahluk comment2in semua tugas orang. Kirain punya dia bgs, ternyata dia yg paling hancur dan kampungan, najis bgt.

Gw sampe ketok2 kayu dinding sambil kata2in dia, itu sih saran temen gw, katanya biar anak gw nanti ga kayak dia. AMIT-AMIT! WASPADALAH! WASPADALAH!

Nah bagian senangnya, gw denger byk bgt cerita lucu dri tmn2 college:

Fui: Gila gw punya temen ce cakep, trus dia webcam-an ma org luar gitu, trus si cewe mem print-screen webcamnya karena si cowo cakep. Merasa bangga, dia meng-upload gbr webcam-an tersebut. Eh pas di publish di facebook, tmn2nya komentar;

"Kamu ga salah publish itu? Kamu lagi baca hentai sama buka porn site???"

Gw ngakak pas liat gbr webcam-an nya (sygnya ga bs gw masukin disini demi bangsa dan negara) gile tulisan hentai gede bgt di atas webcam (jadi kaya si cewe lagi buka hentai, trus buka webcam, diatasnya masi ada porn site tersebut) xDDDD

Fanny: Gw jga kemaren, tmn gw ketemu co cakep di mall, trus senyum2 gitu. Si cowo langsung senyum lebar membalas si cewe. Si cewe kaget, nyaris keceplosan, 

"Aduh ni cowo, nyengir lebar bgt! Ga sadar apa ada sayur ijo2 nyangkut di giginya???"

((Gw guling2))

PS: senangnya hari ini tugas2 sudah selesai, saking senengnya gw sampe ngepel di gereja tengah malem jem 10... its true story!

Go Gators! An interesting use of "sovereign immunity" in Florida's medical malpractice reform

It's been an awful week or two for medical malpractice reform with state supreme courts in Georgia and Illinois striking down award caps on the vague category of "pain and suffering". (Missouri's supreme court reaffirmed that state's caps this same week ~ Rob)Such caps have been one of the most effective ways of discouraging frivolous or borderline lawsuits as it disincentives such proceedings unless the cases are truly egregious.

Florida has a bill being considered in it's legislature that would extend the concept of "sovereign immunity" to providers in the Emergency Room. Such status makes providers de facto ``agents of the state'', and consequently immune from medical malpractice lawsuits. In that setting the state would administer any successful claim, which would be subject to the sovereign immunity cap of $200,000. To recover more, victims would need to file a claims bill in the Florida Legislature. This turns the malpractice system into more of a no-fault worker's comp type of arrangement.

You can't help but think that would be a more efficient and fair way to administer such claims. Of course, trial lawyers are screaming bloody murder, but keeping them happy is low on society's to-do list (unless you are a Democrat politician accepting their bribes err... campaign contributions). If physicians are going to be involuntarily obligated by hospital credential committees or federal and state licensing issues to provide emergency services, they should at least enjoy some protection from these high risk (for malpractice exposure) duties. Kudos to Florida for experimenting with some real world solutions to tort reform!

Read more at the Miami Herald about this interesting idea.


Rob

New conflict of interest (COI) rules could decimate academic plastic surgery

The potential of conflicts (COI) for physicians who accept stipends or consulting fees has led some medical schools to formally prohibit their clinical faculty from accepting such compensation. This movement led to the resignation of a number of distinguished doctors who participate in industry sponsored research, consulting arrangements, and educational events. While not universal among medical schools at this point, this trend is likely to keep some of the best and brightest out of academics. Some consultants and speaks make tens or hundreds of thousands of dollars annually to supplement their clinical practice. As academic overhead tends to run high, this opportunity to make alternative income allowed some people to stay in academic surgery who might otherwise leave for pure private practice setups.

Stanford University has now (read here) taken the dramatic step of restricting even volunteer clinical or "adjunct" faculty from this as well. This type of restriction could have a potentially devastating effect on Plastic Surgery training as a number of the most prominent programs in plastic surgery (NYU, University of Texas-Southwestern, Emory, Johns Hopkins, Georgetown, Michigan, etc...) feature many active and adjunct surgeons whom recieve industry support or give educational seminars. The loss of access to these surgeons for training for real (or imagined) COI would be a big blow to the field. In January, the issue was highlighted in a when Boston doctor and well known Allergist-Immunologist, Dr. Lawrence DuBuske, resigned his Harvard medical school position rather than give up his speaking engagements. DuBuske got almost $99,000 from pharmaceutical giant GlaxoSmithKline in three months last year, more than any other doctor in the country.

While most speakers don't score that much in fees, it can add up to a substantial supplement to someone's clinical practice. COI have been managed in recent years by more stringent required disclosures by speakers at meetings and in our medical journals. The FDA has made efforts to remove panel members from hearings with any potential COI from drug and medical device hearings, including the hearings over silicone gel breast implants earlier this decade. The loggerheads with that idea is that many of the experts in these specialized fields inevitably have some COI from funding, speaking fees, stock holdings, or even intellectual property (shared or owned patents). Scott Spears (chief of plastic surgery at Georgetown University) is one of the world's experts on breast implants, but his testimony before the FDA during the hearings on silicone breast implants was attacked by activists trying to prevent the reintroduction of those devices by any means necessary because he is involved with dozens of companies in R&D, educational endeavours, and speaking sessions.

IMO, as long as clear disclosure by physicians is made these COI issues are manageable as long we always maintain some skepticism about what we are told and review data critically.

Rob

Plastic Surgery 101's "Mythbusters" on the health care debate

As a physician, I have a vested interest in following the debate on reinventing the American health care system. Listening to these discussions, I find there is a distinct lack of candor about where the costs are in the system and little insight into where true potential savings are.

• MYTH: Electronic medical records (EMR) will save money

FACT: No one can plausibly explain how any money will be saved. EMR does offer portablility of records, but does nothing to control cost in and of itself. The costs for physicans and hospitals to purchase equipment and pay ongoing subscription and IT costs will be a HUGE burden.
WINNERS: EMR vendors, IT companies, database miners and researchers
LOSERS: productivity of an office
OFF THE RECORD: Why should I be expected to subsidize a national EMR system through my office overhead when it's uncompensated and will surely be used down the road to squeeze providers?

• MYTH: Primary Care Providers (PCP) are the sacred cow in reform and hold the key to holding costs down

FACT: The PCP workforce is under and ill-equiped to treat a mass influx of patients into the system. It will take years to retool the training infrastructure to handle the volume of patients. Massachusetts experiment in universal care for it's citizens has been crippled by an insufficent number of participating PCP MD's.
WINNERS: PCP will be getting a small increase in fees for routine office visits per the federal government at the expense of some specialists (Cardiologists, Radioloists, & GI docs mostly)
LOSERS: specialists physicians
OFF THE RECORD: Medical students will continue to avoid primary care because they percieve it tedious and they realize that nurse practictioners can do 85%+ of what they do for 50 cents on the dollar. It's also intuitive that specialists who work more and have trained 2-3x as long would be expected to earn a good deal more then PCP's.

• MYTH: It's hard to find savings in healthcare!

FACT: There are some big savings in proceduras that could clearly be achieved with little affect on quality of care. Rigidly restricting (thru evidence based indications) the use of knee/shoulder arthroscopy and joint replacement surgery by orthopedists, upper/lower endoscopy by Gastroentreologists, coronary catheterization and stents by Cardiologists, lumbar spine surgery by Neurosurgeons, and the overuse of CT/MRI scans by all of us are the low hanging fruit in cost containment.
WINNERS: whoever's paying the bill (the feds or insurers)
LOSERS: whichever doctor's procedures are restricted and the idea (endorsed by my mother, wife, and many non-thoughtful doctors) that procedure or study "x" should be done "Just to be safe."
OFF THE RECORD: There's no way to make the numbers work without doing these kinds of restrictions. BTW I would not want to be a radiologist who expects to make big bucks in the next few years as they're about to get scalped.

One thing that makes me shake my head is the disconnect in the popular press when they talk about how individual doctor's practices are coping or planning to cope with whatever's coming. My favorite is the young PCP who is featured just out of residency boldly proclaiming things about how they're going to reinvent the doctor patient relationship by their use of technology.


http://www.businessweek.com/magazine/content/09_27/b4138034173005.htm


rob

INSIDEN POM BENSIN

LAGI KEBELET, MALAH NYARIS DI KENCINGIN

Insiden ini terjadi pada saat gw kebelet mampus (saat itu gw lagi pergi brg bokap dan adek gw). Bokap gw langsung aja berhenti di pom bensin terdekat dan cukup bersih.

Bokap: Jadi sekalian nih, Papi mau isi bensin

Gw: Iye Pi, apa habis isi bensin aja, baru aku pipis?

Bokap: Ga usah, papi kencingin kamu dulu, baru isi bensin.

Gw+Adek gw: *ngakak*

Ga habis pikir, tega bgt ya bokap gw mau kencingin gw, apa gara2 gw makanya byk bgt?

Trus habis pipis, gw balik ke mobil, gw liat muka bokap gw marah gitu

Gw: Kenapa Pi?

Bokap:Sebel sama nih motor *tunjuk motor mogok yang dritadi ga jalan2*

Gw:Tabrak aja!

Bokap Gw: Bakar aja! <-- gw sempet shok 2,5 detik

Ade Gw+Gw: *ngakak*

Bokap gw: *langsung jalan, cuekin si motor*

Gw+Ade gw: *sudah tenang dan kalem*

silang beberapa menit kemudian...

Bokap gw: Bener kata Papi tuh, motor mogok kaya gituan harusnya DIBAKAR!

Gw+Ade gw: .....

P.S: hri ini gw beli anjing mini pom LUCUUUU BGT...bingung kasi nama apaaaa....masi bayiiii imudd bgtt! mana ga bsa gede2!!! namanya sudah brubah beberapa kali dari : muerte, top, g dragon, fluffy, dan akhirnya honey karena fluffy ssh dipanggil sama mbak gw.

NANNY's PAVILLON

Hari ini gw makan siang di Nanny's Pavillon bareng Fui & Cindy, nah disitu gw adalah satu2nya org yang paling bokek. 

Fui=> pesen pancake dengan cokelat trus disirem saus maple + es krim +minuman cookies and cream

Cindy=> pesen pancake pisang + es krim + maple + es teh manis

Gw=> Pancake+ maple

disitu gw ngiler liat punya Fui secara gw gag pernah demen pisang.

Gw:Fui..hm hmm hmm..

Fui: ambil nih (bagi seperenam)

Gw: hore, bae banget lo! ^^

Fui: kalo lg ada maunya lu blg bae, kalo biasa aja, gw dikatain Bangka Belitung trus

Cindy: *ngakak*

Gw: *cuek,makan eskrimnya)

beberapa menit kemudian dtg cookies and creamnya yg enk bgt! mata gw langsung kedap kedip

Gw: itu..hmm..hmm

Fui: nih..

Gw: *ambil sedotan lain trus nyeruput minumanya, bahkan dia blm sentuh*

Fui: *bodo amat, makan*

Cindy: *bengek, cengengesan*

Gw: *kedap kedip ke pancake nya*

20 menit kemudian dia blm habis

Gw: Lu blm habis Fui? mau dibantuin ga? nanti kamu kencing manis lo!

Fui: Gpp, gw rela jantungan sama kencing manis demi lu, jadi gw yg makan aja

Gw: GA! GW GA MAU LU MATI BRO! GW AJA, GW AKAN MENGORBANKAN DIRIKU UNTUK MAKAN PANCAKE ITU!

Cindy: *lagi2 bengek*

Fui: siss....

Gw: Broo...hiks...terharu...ternyata lu bae bgt....lu rela kencing manis demi gw

Fui: *lanjutin makan*

10 menit kemudian..

dia GA HABIS PANCAKENYA! 

Cindy: ayo sis kita mesti balik ke kelas

Gw: *bengong, main es batu*

Fui: Yuk keatas *ninggalin pancake yang sangat amat menggoda*

Gw: aaaaa....*suara bayi ngerengek, sambil kasi aba2 buat nunjukin ke Fui & Cindy kalo gw mau pancakenya*

Cindy: Yukk *dia ga ngerti*

Gw: *pasrah, ke kelas*

Fui: *ngakak*

P.S: aku pengen makan pancake dengan eskrim diatas :'(

SAYA BUKAN ORANG JEPANG! HAIK!

MENGEJUTKAN?HAIK! 

AISHITERU? HAIK!

ANU ORANG JEPANG KECIL2? HAIK!

Sumpah, gw bukanlah orang yang sangat tergila2 Jepang, dan juga bukan orang yang sangat mencintai Samurai jaman dulu dengan rambut diikat mengerikan. Ditambah dengan goresan pedang yang kadangkala menambah kejantanan sang Samurai. (contoh: kenshin-Samurai X)

Dulu, MUNGKIN gw bsa dibilang freak anime yang namanya Cloud Strife, pasalnya gw bersedia dengan ikhlas dan wajah berbinar membawa2 poster Cloud kemanapun gw pergi. Tapi sekarang, GAK SUDI deh.

Malangnya, sejak Minggu2 lalu gw mendengarkan band2 Jepang secara ketidaksengajaan yang menyedihkan, akibatnya tugas sekolah yang harusnya normalpun menjadi ajaib, adeganya saja, Samurai.

Hari inipun,gw mendengarkan LAGI lagu2 Jepang yang diputar secara biadap oleh temanku yang juga biadap. Its stuck in ma head!!! HAIK!

Akhirnya, sepulangnya dari kuliah gw menyanyi, menari, dan menarikan gaya orang2 Jepang dalam Youtube yang kutonton tadi. Bukanya indah, malah lebih mirip orang kesurupan nari minta hujan....

Ditengah tarian gw teringat kata2 tante gw, "Kamu orang bule campur Jepang ya?" otak gw kosong sejenak, perlahan gw berkata sambil menahan lapar,

"Tidak, saya bukanlah es campur, Tante, saya CINA, HAIK!"

Woman Sues Plastic Surgeon For Giving Her "Four Breasts"

In a dramatic five million dollar lawsuit filed by Maria Alaimo of Staten Island, the 47 year-old patient accuses her plastic surgeon  (Dr. Keith Berman) of implanting her with "four breasts."

YES, FOUR BREASTS.

But put the brakes on that freaky visual that just popped into your head!

What Maria is actually referring to is a breast augmentation complication called "double bubble."

Double bubble happens when an implant falls down BEHIND the fold of the breast instead of forward INTO the breast. As a result, the breast ends up with two folds that make it look like one breast is stacked on top of the other.

You might need to read that again to really "get" what I mean about how it's caused.

Here's a photo set to illustrate what I mean. Note that this IS NOT Maria Alaimo - it's a patient of Mountlake Terrace, Washington Plastic Surgeon Dr. Richard A. Baxter. The top set shows the double bubble, and the bottom set shows Dr. Baxter's amazing post-corrective surgery:

Photos: http://www.implantinfo.com/

Now back to the lawsuit.

Maria had the first failed boob job in 2003, and she claims that two corrective attempts by Dr. Berman left her no better off - with breasts that "appear flattened on the bottom with severe swells the size of a softball on top," causing her to suffer from "pain, disability, loss of self-esteem, humiliation and embarrassment," - as reported by consumerist.com.

But that isn't all.

Maria is also blaming her divorce on the failed surgeries, saying that she could no longer be intimate with her husband after her disfiguring surgery.

Interestingly enough, the lawsuit states that she paid $2,999 for the breast augmentation in 2003, plus a $500 referral fee. That's such an eyebrow-lifting bargain basement price, that I would have immediately questioned why the steep discount; breast augmentations in the New York area average about $7,000-$9,000.

But a search on the American Board of Plastic Surgeons website shows that Dr. Spencer was board-certified for the first time in 1999 (4 years before Maria's surgery), and was just re-tested and passed board certification again in December of this past 2009.

So is this a case of a hysterical patient who may not be revealing the whole story behind her complications? Or is it a case of poor plastic surgeon skills?

It's impossible to tell with only the little sensational nuggets the public has of the story. It doesn't seem right that three surgeries later, Maria's breasts are still not fixed - but it's also pretty ridiculous that this woman seriously thinks a breast augmentation is the sole reason her marriage ended. (That's what she states in court documents.)

But I can't leave you without a moral to this tale of woe!

If you have very saggy breasts, your risk of double bubble is higher.

Be sure to ask your plastic surgeon if double bubble is something you should be concerned about. Most often, a lift to remove the excess saggy skin when you get your breast augmentation can all but eliminate the risk of this complication, if you've hired a skilled and properly credentialed surgeon.

Breast Implant bombs - Can you weaponize an implant? Unfortunately yes.

I saw a story today which touched on something I'd been thinking about for years. Apparently Islamic terrorists have been working on a way of turning a breast implant into a way to smuggle explosive liquids onto airliners. While that may sound like a joke headline from The Onion, it's really a scarry idea.

From relatively simple and innocuous ingredients, a highly explosive liquid can be produced.

This link to a BBC story demonstrates the devastating effect on a plane fuselage that such a liquid explosive could have:
http://news.bbc.co.uk/2/hi/uk_news/7536167.stm

I'm not exactly sure how you would trigger it, but presumable you could stab into the implant with a wire or pin and wire it to a celphone or battery (this type of liquid material can be ingnited with an electic charge)