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Tue, 26/07/2005
Vancouver - incrementally becoming a place to avoid

I've lived in Vancouver for 23 of the last 26 years and if you asked me if I was interested in moving 20 years ago, the answer would have been a definative NO. After all, Vancouver had everything one would want and I couldn't think of a better place to live. As it turns out, it is quite possible to spoil paradise and I am now in the process of moving out of Vancouver to Kamloops.

This has been an incremental process as one personally significant location after another disappeared. The final straw in this process will likely be the closing of Granville books, one of my favorite bookstores for over 10 years. With its closing, there is now nowhere local to buy books and it looks like amazon.com will be my primary bookstore when I'm not in Kamloops. I'm sure that people who live in Vancouver would immediately try to refute my statement by mentioning the existence of a huge Chapter's bookstore a few blocks away from the grave of Granville books. As far as I'm concerned, Chapter's does not exist. I have been boycotting this store for years as they refuse to stock gun magazines. This is their right and it is my right to refuse to shop there. Even if they sold gun magazines, it is unlikely I would buy much there as the amount of interesting material they stocked was miniscule. Granville books used to have a huge computer book section as well as an equally well stocked general science section as well as their "esoterica" section. It was not uncommon for me to wander into the store and come out with several hundred dollars worth of books. As I look around at my bookshelves, probably half the books on them came from Granville books.

Prior to Granville Books demise, another favorite magazine store, located at the corner of Robson and Denman burned down last fall. This store used to be a favorite stop on my way back from a walk in Stanley park and one of the reasons I frequented it was because it stocked Soldier of Fortune magazine as well as a huge assortment of gun magazines. It had the best and most eclectic magazine selection I have ever seen in so small a space.

I could go on for quite a while about the bits of Vancouver that have disappeared over the last 10 years; Pepitas restaurant on Denman and Davie, R&P Electronics on 4th Ave, the Aristocratic restaurant on Granville. . . What has replaced these locations is not something better, but a place I have no interest in frequenting.

There was a time when Robson street had interesting stores but now it is a vast wasteland with rare oases such as London Drugs and a few restaurants that have remained behind. It appears that the only placed to go left in Vancouver are restaurants. (I don't have to go through a metal detector to get into a bar in Kamloops so I don't go to any bars in Vancouver). I've decided that when I live downtown in a large city and order most goods over the internet, or drive out to Kamloops to shop, then obviously it is time to move on. Kamloops awaits.


by Boris Gimbarzevsky  Comments

Wed, 20/07/2005
Freescale wireless design challenge update

This is an entry from 27/4/2005 which blog program didn't seem to want to publish so trying again.

A few hours ago I emailed my project code and writeup to the Circuit Cellar contest coordinator with mere hours to go before the deadline. It was probably one of the most satisfying things I've done in a while as when the project was over, I had a very useful system which I'm just starting to use on a regular basis to further characterize physiologic variables during sleep.

Now that my project is in the hands of the judges, I can freely discuss it. In my previous blog posting I described what I was doing so I don't have to repost the material. RSN I will be putting the full source code and schematics for the units I have built on my web site, but this entry is less about the details of the project than it is about how neat it is to have actually pulled this off.

The above material was written last week, and then I went off on a long tangent that really had nothing to do with the project. Hitting delete solved the problem.

Now that I have had a week to think about what I've done, I've concluded that doing this project was a really good thing as it has gotten me back into quantitative medicine. Medicine, as it is practiced for the most part today, is very qualitative. It was one of the things that really bothered me about medicine when I first became a medical student, but then I began to realize that an experienced physician was a very good diagnostic instrument that utilized unique data acquisition methods, performed calculations in non-deterministic algorithms buried in wetware and produced surprisingly accurate diagnoses. I was suspicious at first, but eventually these diagnostic algorithms were programmed into my wetware through the process of internship and residency.

I've practiced qualitative medicine but it bothers me to do so. My scientific background is too strong and I have a need to measure things as I don't believe you know anything about an object or process unless you have quantitative data. Medical expertise is very nice, but what has finally convinced me to get back into quantifying things is patient responses to my diagnoses. What I've found is that patients like quantitative data, the more the better.

Where qualitative medicine still reigns is in psychiatry. I really enjoy psychiatry, but what turned me off this path was the perverse satisfaction that many psychiatrists had with their specialty being non-quantitative. During my psychiatry rotation as an intern, I commented about the lack of measurable variables in psychiatry and the psychiatrist who I was working with at the time tried to stress the advantages of psychiatry over other specialties; no equipment aside from the psychiatrists brain, a pad of paper and a pen. He didn't convince me although I did learn a lot of psychiatry from him.

The most difficult task I've had as a physician is trying to convince patients that they have a psychiatric diagnosis. To me, the diagnosis is obvious and when I am able to get patients in to see a psychiatrist, they almost always concur with my diagnosis. The main criticism I hear from patients is: "what evidence do you have that I have this diagnosis?". Actually I have plenty, but patients have a rather low opinion of the psychiatric evidence I have carefully collected from them using a structured psychiatric interview. A gastroenterologist would have the diagnosis of a gastric ulcer based on history alone, but they will then perform an endoscopy and provide patients with high resolution color photographs of their ulcer. Patients love photographs of their GI tract, readily share them with family and friends and post them on personal web sites. Showing a patient a picture of their ulcer, or other dramatic GI lesion, makes them much more ready to accept a physicians diagnosis and suggested treatment.

There are quantitative tests in psychiatry such as HeartLink monitoring which has high sensitivity for diagnosing major depression based on the results of 24 hour heart rate patterns. A HeartLink report consists of a graph of minute averaged heart rate data over 24 hours as well as movement data. When I've performed HeartLink monitoring on a patient, I can show them their heart rate graph and representative graphs of various psychiatric conditions. This approach has led to far greater acceptance of antidepressant therapy in patients and much better compliance than if I'd simply told them they were depressed. Also, if the HeartLink monitor shows a normal pattern, I reconsider my diagnosis.

Now will try to bring this back to my Zigbee project which involved wireless monitoring of patient movement and respiration during sleep. This was a modest start to my goal of having a person totally instrumented so that multiple physiologic variables can be measured in real time and on an ambulatory basis. The idea is to walk around engaged in normal daily activities while multiple wireless monitors quantify every step, every heartbeat, time breaths to msec precision, measure eye movements, EEG, peripheral oxygen saturation, skin conductance as well as lots of physiologic variables that don't come immediately to mind. This is all possible now, and in the near future one can go internally with realtime monitoring of blood glucose every second, pCO2, pH, electrolytes, testosterone, cortisol and a myriad of blood constituants which are now measured at a single time point every few weeks with considerable effort.

The ultimate monitoring system would be a system of nanobots which would be ingested as a capsule which would distribute themselves throughout the body measuring any physiologic variable one could think of for a day or so and then downloading their data to a remote computer.

When the first nanobot monitoring system is available, I predict huge lineups of people waiting to be monitored as people seem to have an immense need to find out what is going on inside them. Some patients of mine think nothing of forking out $1800 for a total body CT scan which seems to be used primarily to marvel at the neat 3D computer reconstructions of their own body produced by software. I have no worries about my place in this scheme since they have to come somewhere to find out what it all means.

Based on the crude measurements I have of movement on respiration during sleep, I've discovered a new world to explore. Sleep is a key factor in many psychiatric conditions but something that very few physicians even ask patients about. I've found that asking a patient questions about sleep as well as questions relating to other basic physiologic processes are far more useful than asking about mood.

by Boris Gimbarzevsky  Comments

Posted at:Mon, 15/08/2005 23:04:55