Go Retire Psychiatrist

Rounding At Iowa Podcast: “The Promises of Artificial Intelligence in Medicine”

I listened to the recent Rounding@Iowa podcast “The Promises of Artificial Intelligence in Medicine.” You can listen to it below. Those who read my blog already know I’m cautious and probably prejudiced against it, especially if you’ve read any of my posts about AI.

I was a little surprised at how enthusiastic Dr. Gerry Clancy sounded about AI. I expected his guest, Dr. Jason Misurac, to sound that way. I waited for Gerry to mention the hallucinations that AI can sometimes produce. Neither he nor Dr. Misurac said anything about them.

Dr. Misurac mentioned what I think is the Ambient AI tools that clinicians can use to make clinic note writing and chart reviews easier. I think he was referring to the company called Ambience.

I remember using the Dragon Naturally Speaking (which was not using AI technology at the time; see my post “The Dragon Breathes Fire Again”) speech to text disaster I tried to use years ago to write clinical notes when I was practicing consultation-liaison psychiatry. It was a disaster and I realize I’m prejudiced against any technology that would make the kind of mistakes that technology was prone to.

But more importantly, I’m concerned about the kind of mistakes AI made when I experimented with Google Bard on my blog (see posts entitled “How’s It Hanging Bard?” and “Update to Chat with Bard” in April of 2023.

That reminds me that I’ve seen the icon for AI assistant lurking around my blog recently. I’ve tried to ignore it but I can’t unsee it. I was planning to let the AI assistant have a stab at editing this post so you and I can see what happens. However, I just read the AI Guidelines (which everyone should do), and it contains one warning which concerned me:

“We don’t claim any ownership over the content you generate with our AI features. Please note that you might not have complete ownership over the generated content either! For example, the content generated by AI may be similar to others’ content, including content that may be protected by trademark or copyright; and copyright ownership of generative AI outputs may vary around the world.”

That is yet another reason why I’m cautious about using AI.

88: Modifiable Risk Factors for Breast Cancer – Rounding@IOWA

In this episode of Rounding@IOWA, Dr. Gerry Clancy sits down with breast cancer experts Dr. Katherine Huber‑Keener and Dr. Nicole Fleege for a discussion of modifiable and non‑modifiable risk factors, modern screening tools, and practical strategies clinicians can use to guide prevention and early detection. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?P=0&EID=82146 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Nicole Fleege, MD Clinical Assistant Professor of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation University of Iowa Carver College of Medicine Kathryn Huber-Keener, MD PhD Clinical Associate Professor of Obstetrics and Gynecology – General Obstetrics and Gynecology University of Iowa Carver College of Medicine Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 0.75 ANCC contact hour. Pharmacist and Pharmacy Tech: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this knowledge-based activity for a maximum of 0.75 ACPE contact hours. Credit will be uploaded to the NABP CPE Monitor within 60 days after the activity completion. Pharmacists must provide their NABP ID and DOB (MMDD) to receive credit. JA0000310-0000-26-035-H99 Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.)

Empty Pants Running Away! How Did They Do That?

Last night, I was watching the TV show Strange Evidence and noticed that they were going to show what’s been called the ghost pants video from a few years ago. I went to bed because I saw it on a similar show a few years ago. I doubted that it was solved yet. The clip shows a pair of white pants running down a street. You can’t see anyone wearing them.

There are a few interesting video-based paranormal TV shows. The one I think is pretty well done is The Proof is Out There, hosted by Tony Harris. I saw one which showed a photo of a girl whose image was different from her reflection in a mirror. The question was whether it was evidence for something paranormal, maybe proof of simulated reality.

Tony and the group of experts finally settled on it being unexplained. However, on a subsequent episode, Tony explained that someone had notified him that the photo was shot simply by using the panorama mode on a smartphone camera. It was relatively simple. Sena and I made a couple.

That was about the same time the YouTube video about the white ghost pants was circulating on the internet. Today I found a YouTube short video that shows essentially the same thing made by a couple of guys who also made a 10-minute video explaining how to achieve the effect. It’s below the short video. Of course, I don’t understand the technical explanation, but I think it might account for the ghost pants video.

The Greatest Christmas Record of All Time

Last Friday night on the Big Mo Blues Show on KCCK radio, I heard Eric Clapton sing a song that I later found out was a cover of a song originally co-written by William Bell and Booker T. Jones, “Every Day Will Be Like a Holiday.” A Wikipedia entry about it reports that it has been called the greatest Christmas record of all time by Hot Press magazine in 2017. It has been covered by many musicians.

That song is still in my head. I had never heard of William Bell. He’s been a top rhythm and blues performer for decades. He’s 85 years old and is still going strong. I hope he has a lot more Christmases to go.

We Tried Wendy’s Salted Caramel Frosty

We finally got over to Wendy’s and tried the salted caramel Frosty. It was available in mid-November but it was so cold then, we didn’t feel like heading out in the weather for it. Today it was in the mid-50s so it was a good day for it.

There are very long web articles written about it by those who can somehow find a lot to say about the flavor and say things like, “It tastes more like butterscotch than salted caramel.” I had to look up what the difference is between butterscotch and salted caramel. It boils down to cooking caramel to 340 degrees with white granulated sugar vs cooking butterscotch with brown sugar to 289 degrees.

That doesn’t tell me how they would taste different.

That reminds me of the controversy about Miracle Whip, which many people say just doesn’t taste right anymore, which tends to give mayonnaise the edge. They claim Kraft Foods changed the recipe. Maybe. But if they’re comparing how Miracle Whip tastes now compared to what it tasted like in their childhood, the main explanation might be that if you’re past the age of 50, your taste buds have probably fizzled a little.

We think the salted caramel Frosty tasted enough like how it’s billed than not. So maybe our taste buds are burnt, but we’ve been around the block with the Frosty flavors enough to say this one comes pretty close to tasting like what Wendy’s advertises.

Whatever, Sena says the salted caramel replaces the pumpkin as her favorite Frosty flavor. I still prefer vanilla.

Cataplexy and Catalepsy in the Movie “The Comedy of Terrors”

We watched the Svengoolie TV movie last night, “The Comedy of Terrors.” It was my third time seeing it. I wrote a blog post about it in March 2024 partly because the condition of catalepsy is mentioned. Mr. Black’s butler points out that Mr. Black had periods of catalepsy. Much to my surprise, I didn’t write anything about distinguishing cataplexy and catalepsy, but last night I thought about the differences. I finally found a summary of the plot today on the Svengoolie website and you can see it on Turner Classic Movies. You can still see the movie on the Internet Archive.

You see Mr. Black have his “cataleptic” attack about 39 minutes or so into the film. It appears to be triggered by shocked surprise upon discovering Mr. Gille in his house. A bit later, after the butler fetches the doctor, the first scene is that of Mr. Black’s wide-open eyes, which the doctor closes, at the same time saying that he’s dead. In that same scene you hear the butler asking for confirmation because it’s well known that Mr. Black has had fits of “catalepsy” before. The doctor obliges only to confirm, in his opinion, that Mr. Black is dead. However, he wakes up in the funeral parlor, where he has a fight with Trumbull and Gillie, then suffers another abrupt collapse, one of many that occur, always reciting lines from Shakespeare presaged by asking “What place is this?” often from inside a coffin.

This movie made me think about the clinical differences between catalepsy (specific to catatonia) and cataplexy (specific to narcolepsy). Because I was a consultation-liaison psychiatrist, I saw many patients with catatonia. However, I can’t remember ever seeing patients with cataplexy. I had to review them by searching the web. I think the most helpful links are:

Catalepsy: Burrow JP, Spurling BC, Marwaha R. Catatonia. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430842/

Catatonic patients often will be mute and immobile vs purposeless agitation. Waxy flexibility can be one of many features. Catatonia can occur in the context of variety of psychiatric or medical illnesses. They may wake up and talk within minutes if given a Lorazepam challenge test, which is given intravenously. It can look miraculous.

Cataplexy: Mirabile VS, Sharma S. Cataplexy. [Updated 2023 Jun 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549782/

Cataplexy occurs in narcolepsy and is the sudden onset of muscle weakness, often precipitated by strong emotions, usually positive but can occur with negative emotions like fear. Eye movements can be normal, and episodes usually resolve within minutes.

Mr. Black’s episodes look like a strange mixture of catalepsy and cataplexy. His episodes are precipitated by fear or anger. Quoting Shakespeare doesn’t occur in either catalepsy or cataplexy.

At the end of the movie, he is impervious to bullets—a feature not seen in either condition.

The Hippeastrum Flop Crisis

Our Hippeastrum/Amaryllis flowers are doing the flop. Whether you want to call it a Hippeastrum or an Amaryllis, they both flop. I think it’s because they both have hollow stems and heavy flowers. I read that Tulips flop for the same reason. They’re doing pretty well; the tallest one is up to nearly 30 inches.

The flower as it grows starts to bend in one direction or the other. We saw this a couple of years ago with our first Hippeastrum. In the beginning, we thought turning it one way or the other towards or away from the sunlight or the space heater would make a difference. Looking back on it now, I don’t think it did. We ended up staking it using a zip tie and a wooden dowel.

Sena stakes our new flowers using zip ties and long metal rods topped by a Christmas tree ornaments you stick in the dirt. The effect is comical, and it makes both of us laugh out loud.

I checked around on the web and found articles and YouTube videos about how to fix the Hippeastrum flop. One even suggested using a wire coat hanger. You can do this if you’re handy with tools. Or you could get a Christmas cactus.

We’re not doing wire coat hangers.

Addendum: Sena tried to replace the zip tie on the biggest plant because she’s ambivalent about the look of them. OK, so she’s not ambivalent; she was “bent” on finding a different staking method. So, she cut the zip tie and, wouldn’t you know, that’s a good way to tell if the stem is really hollow. She accidentally cut it open. It started to leak fluid. She quickly applied a Christmas tree ribbon bandage, one with blood red cardinals on it in fact. We hope the wound is not fatal.

Another Addendum: OK here’s the last adddendum. It’s a set of crude drawings meant to show how to pronounce “Hippeastrum.” I’ve previously pointed out there seem to be two ways and I don’t know which one is preferred. If you know, shout it out. This is a trick I got from Svengoolie, the star of his TV show of the same name. You draw cartoons that are clues which are supposed to translate to a real word. Sound it out. Hint for the first picture; it’s from the 1960s.

Amaryllis or Hippeastrum Trio?

The Amaryllis trio are reaching for the stars, and “star” may be the operative word because I just found out the name of the flower may be in dispute.

It turns out that the actual name of the Amaryllis is probably Hippeastrum due to a change in the genus classification of this striking bloom. My word processor kept highlighting Hippeastrum, so I had to add it to the dictionary.

The usual name, which has been Amaryllis, sounds pretty and has a romantic story behind it based in Greek mythology. The short version is that a maiden named Amaryllis fell in love with a shepherd named Alteo. Alteo insisted that he would fall in love with a girl only if she brought him a new flower he’d never seen before. She went to the Oracle of Delphi who advised her to literally bleed for him—which she did by stabbing her heart every day and spilling her blood on the ground outside his house. On the 30^th day, a gorgeous red flower bloomed out of the blood. After that she and Alteo were definitely an item. You can find this story on many gardening web sites.

On the other hand, the unromantic name Hippeastrum (it seems there are two ways to pronounce it, both of which sound like a sneeze) was given to the flower by someone named William Herbert. You can find the complete and erudite story about it on a WordPress blog called Professor Hedgehog’s Journal in the post, “Plant of the Month: February 2018.” The name means something like Knight’s Star.

I’m betting that stores are unlikely to change the name on the boxes, out of which the flowers burst impatiently on to the shelves.

Svengoolie Movie: “The Crawling Eye”

I saw the movie “The Crawling Eye” last night. Sena gave up after about 15 minutes. It was almost 2 hours into the film before you see any of the giant eyesores—and they were in dire need of Visine treatment.

The movie was made in 1958 and it’s about an alien invasion of a fictitious mountain in Switzerland called Mount Trendelenburg, no wait, that’s an inclined position of a patient on an operating table; it’s actually Mount Trollenberg.

The aliens are giant eyes with pinpoint pupils. The hero, United Nations employee Alan Brooks (played by Forrest Tucker) manages to stab one with a secret weapon called a sty-letto. Brooks is apparently heavily invested in pushing cigarettes and booze on the various other characters, a few of whom for some reason get transformed into zombies, probably because they get so stoned on cognac. Brooks deals with them by blowing his whiskey breath in their faces.

Brooks has to be pretty stern to get others to cooperate to a new battle plan against the eyeballs after it becomes clear that dilation drops won’t work. I can’t remember exactly what he barked at them but it was something like, “Keep your eye on the highball!” Maybe it was “Do as your told!”

Brooks also directs them to make bombs, which look like Molotov cocktails, and that was a nice break from drinking the regular cocktails at the hotel bar. Brooks orders them not to fire until they see the whites of their eyes, but by now everybody ignores him. At first, they have a hard time hitting the creatures, I guess because they were eyeballing the distance.

When the crawling eyes get hit with the bombs, they get a severe case of floaters, which makes them realize that they’re now up against something even more irritating than the cigarette smoke Brooks blows at them. Unfortunately for the eyeballs, they left their safety sunglasses on their home planet.

The best part of the movie was the Sven Squad; their jokes were so cornea they saved the day.

Amaryllis Progress and Other Notes

I have a few messages to pass on today. This is the last day of November and the Amaryllis plants are doing so well Sena had to brace the tallest one using a Christmas tree stake and a couple of zip ties. It’s over two feet tall!

I’m not sure what to make of almost a dozen comments on my post “What Happened to Miracle Whip?” Apparently, a lot of people feel the same way I do about the change in taste of the spread. So, maybe it’s not just that my taste buds are old and worn out.

Congratulations to the Iowa Hawkeye Football team last night! They won against Nebraska by a field goal in the last 3 seconds of the game. I had to chuckle over the apparent difficulty the kicker had in answering a reporter’s question, which was basically “How did you do it?” There are just some things you can’t describe in words. There’s even a news story about how thinking doesn’t always have to be tied to language.

Along those lines, there might be no words for what I expect to think of tonight’s 1958 horror film on Svengoolie, “The Crawling Eye.” This movie was called “The Trollenberg Terror” in the United Kingdom version. I can tell you that “Trollenberg” was the name of a fictitious mountain in Switzerland.

I’m not a fan of Jack the Ripper lore, but I like Josh Gates expedition shows, mainly for the tongue in cheek humor. The other night I saw one of them about an author, Sarah Bax Horton, who wrote “One-Armed Jack”). She thought Hyam Hyams was the most likely candidate (of about 200 or so) to be Jack the Ripper, the grisly slasher of Whitechapel back in 1888. He’s a list of previously identified possible suspects. I found a blogger’s 2010 post about him on his site “Saucy Jacky” and it turns out Hyams is one of his top suspects. Hyams was confined to a lunatic asylum in 1890 and maybe it’s coincidental, but the murders of prostitutes stopped after that. I’m not going to speculate about the nature of Hyams’ psychiatric illness.

There’s another Psychiatric Times article about the clozapine REMS (Risk Evaluation and Mitigation Strategies) program. I found a couple of articles on the web about the difficulties helping patients with treatment resistant schizophrenia which I think give a little more texture to the issue:

Farooq S, Choudry A, Cohen D, Naeem F, Ayub M. Barriers to using clozapine in treatment-resistant schizophrenia: systematic review. BJPsych Bull. 2019 Feb;43(1):8-16. doi: 10.1192/bjb.2018.67. Epub 2018 Sep 28. PMID: 30261942; PMCID: PMC6327301.

Haidary HA, Padhy RK. Clozapine. [Updated 2023 Nov 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK535399/

The paper on the barrier to using clozapine by Farooq et al is very interesting and the summary of the barriers begins in the section “Barriers to the use of clozapine in TRS (treatment resistant schizophrenia). I think it gives a much-needed perspective on the complexity involved in managing the disorder.

So what do you think about Miracle Whip?

Svengoolie Hosts the Film “Abbott and Costello Meet Frankenstein”

Last night I watched “Abbott and Costello Meet Frankenstein” (released in 1948) for the first (and probably the last) time on Svengoolie. I thought I’d be able to watch it while wearing my new Svengoolie Holiday Sweater that Sena ordered for me, but it arrived too late in the evening for me to make the trip down the street to the mailbox pod. There are not enough street lights down there and who knows, the Wolfman could have jumped me. I got the sweater today and it looks great.

Sena watched a few minutes of the movie and gave up on it. I stuck it out all the way to the end in which you hear the voice of Vincent Price but don’t see him lighting up a smoke because he’s reprising the role of the Invisible Man.

Now for some comments about the movie, for which you can find information on Turner Classic Movies (TCM) and many other websites. I’ll admit, Costello playing the part of the hysterical Wilbur got too slap sticky for me. On the other hand, the bits between him and the Wolfman (played by Lon Chaney Jr, who also reprised the role of Larry Talbot) were pretty comical.

Frankly, what I really got a kick out of was Svengoolie’s recurring doodling riddle game, “Too Drawn Out” in which he rapidly sketches a few cartoons which, when you put them together in your mind translates to the name of a character in the film or a cornball joke about it.

Some people missed the Sven Squad in this show and in last week’s show. The Sven Squad includes Gwengoolie, Nostalgiaferatoo, and IMP (Ignatius, Malvolio, Prankenstein). Importantly (or not) I found out from a web search that the film is actually rerun annually (according to Svengoolie’s summary from the 2021 airing of the movie) because it’s the most requested film by fans. Since the Sven Squad was just put together last year, new scenes were not taped for this movie and the one last week, presumably also a rerun by the same assumption.

As an aside, my Svengoolie sweater has all the members of the Sven Squad on it, and it even includes Kerwyn.

At first, I mistakenly got the idea that Lon Chaney, Jr played Larry Talbot but refused to play the Wolfman because it involved slapstick humor. And somehow, I misread the Svengoolie summary about Glenn Strange playing “the Monster”—which of course meant the Frankenstein monster, not the Wolfman.

But I’m not the only one who’s ever thought that because other fans (I got this from the web) mentioned that Chaney didn’t like how the Wolfman was portrayed in clownish stunts in the film. I thought his sober portrayal of Larry Talbot contrasted sharply with Abbott and Costello’s constant screwball acting. Svengoolie pointed out a goof (which I missed) in the film where Dracula (played by Bela Lugosi) has his reflection clearly showing in a mirror. Nobody’s perfect. And that includes me trying to make up a drawing riddle: