Monday, July 20, 2009



I needed to attend the Society of Nuclear Medicine's annual "Viva Las Vegas" meeting. For some ungodly reason, they hold it in July, when the temperatures are always over 110 degrees F (43 C). It was 114 degrees (45.5 C) Saturday and Sunday. How can we convince them to hold it in October?

All day Saturday and Sunday, my old friend Juan Mas and I sat in uncomfortable restaurant chairs with 350 other nuclear med techs, in a cavernous dark room. Like a real cave, it was bitter cold. While people out on Las Vegas Blvd were passing out from the heat, we were freezing our rear ends off, shivering from the ultra air-conditioned air. Saturday was spent listening to eight--count 'em, eight--boring lectures about basic nuclear medicine that any working nuclear medicine technologist should know. They saved all of the good presentations for Sunday.

Sunday we had one presentation about the supply chain of where 99m Technetium comes from. If you have ever been a patient in a hospital, or have any relatives or friends who have ever had cancer, you should care about this topic. Technetium is a radioactive element that is used to make a whole shelf full of radioactive drugs that are used for diagnostic scans. You show up at a hospital, they're not sure what's wrong with you, but they have a good idea (your CAT scan or Ultrasound was inconclusive, or you can't have an MRI for some reason), so they send you to nuclear medicine. In the nuclear medicine department, they inject you with a drug that is specific to the disease they are looking for. The drug is called the carrier molecule, and it carries the 99m Technetium to the target organ. Doctors look at the pictures on a computer screen, to see what your target organ (your liver, kidneys, heart, etc) did with the drug. There are nuclear medicine scans that are very sensitive and specific for different types of heart disease, liver disease, gallbladder problems, renal failure, blood clots in the lung (called a pulmonary embolism), breast and prostate cancer. The radioactive component of all of these drugs is 99m Tc, which has been either unavailable, or in limited supply for months, now, because of the heavy water leak in Canada at the Chalk River Research Reactor. They don't make this stuff in the U.S.


Why not? Well...Technetium 99 is a daughter product of Molybdenum 99, which is a daughter product of Uranium 235, the stuff they make atomic bombs out of. We have treaties with the Soviets--I mean the Russians--where we both promise to not make lots of atomic bombs. THIS IS A GOOD THING. Like the bumper sticker says, "One nuclear bomb can ruin your whole day". Unfortunately, the side effect of this peace is that we have less Molybdenum (we call it "Moly") available for medical purposes.

The only place that makes Moly/Tc is the Chalk River research reactor, which is 54 years old. The few other research reactors in the world that make Molybdenum/Technetium are in Argentina, Australia, Holland, Belgium, and South Africa. All of these facilities are also somewhere between 45 and 55 years old. Currently, a percentage of the U235 used to produce Moly/Tc is from salvaged Russian atomic bombs that we bought from them. THAT'S RIGHT: YOUR MOM'S BREAST CANCER SCAN WAS DONE WITH LEFTOVER RUSSIAN ATOMIC BOMB PARTS

There are ways to produce Moly/Tc in LEU (Low Enriched Uranium) reactors. This is important, because it means that we could i.e. we need to build a couple of nuclear reactors in the U.S. that would not be useful for weapons production (for that you need a HEU [Highly Enriched Uranium] reactor, which is what the Argentines did in their own country, and also, when they designed and built the Australian OPAL facility). HOW EMBARASSING: THE COUNTRY OF EVITA PERON, THE TANGO, AND EATING DINNER AT MIDNIGHT IS BEATING US IN THE DESIGN AND CONSTRUCTION OF SAFE, PEACEFUL, USEFUL REACTORS FOR MEDICAL PURPOSES.

The other interesting presentation on Sunday was about great improvements in nuclear scans of the breasts for cancer, using a new type of gamma camera (this is a scanner that "sees" radiation i.e. where the radiopharmaceutical is in your body) that is built like a mammogram x-ray unit, so it takes images in the same positions as the mammogram x-ray machine, for direct one-to-one comparisons of anatomy (on the x-ray) vs. physiology (where the radioactive drug concentrated in the breast). Awsome detail, allowing us to catch ever smaller tumors.

A few comments about the meeting, itself:

1) The average age of the nuclear medicine technologists at this meeting was somewhere well above 50. Juan and I were the two young, sexy guys in the room, and we're in our 40s. Right now, the job market for nuclear medicine technologists is in one of its cyclical nose-dives (every 10 years, there are too many of us, and it's hard to find a job). Ten years from now, the typical boom-bust cycle is going to rupture, when all of the AARP-eligible people at the Vegas meeting retire, or drop dead. It'll be worse than 2002, when people were calling me up at the hospital where I worked, trying to hire me away.

2) As someone who teaches radiation safety, and other safety classes at a university, I was appalled by the PowerPoint slides. Many of the slides had too much text on them. A single slide would have 150 words on it, in a tiny, unreadable font, and the presenter would have it on the screen for less than 10 seconds. As a trainer, I want to make these doctors and pharmacists sit down with me, so that I can show them how to break up that one slide's worth of material into 3 or 4 slides, in a large, legible font. In a perverse case of inverse proportionality, the more important or interesting the material was, the less time that overstuffed slide was on the screen.

On the way to and from Las Vegas, I made several stops in the desert, to look for birds. After the first 200 miles from L.A. I arrived at Hole in the Wall Campground, in the deserts of San Bernardino County, California.

I drove my wife's pickup truck, which was unnecessary: I could have made it there in the Celica. You could get there in a Porsche Targa, even the dirt roads are that smooth.

Hole in the Wall campground is fantastic. If you could care less about birds, dragonflies, or mammals, you would still love its bizarre rock formations. Imagine a gigantic rock wall that looks like Swiss cheese. The photographs on the official Mojave National Preserve website don't do it justice. While it was over 110 F on Highway 40, when I drove up into the mountains to Hole in the Wall, it must have been below 90. Around 90 miles east of Barstow, I got off Hwy 40 on Essex Road, and drove north, arriving at Hole in the Wall Campground, where I saw numerous Desert Cottontail Rabbits, and Black-tailed Jackrabbits. Both species have oversized ears, like African Elephants, so that they can radiate heat. It's like having your own external radiator. There were numerous all-black dragonflies, which I could not get a good look at, or photograph. I was surrounded by Rock, Canyon, and Cactus Wrens. I saw one Scott's Oriole before the campground, two Pinyon Jays, and a Crissal Thrasher 1/10th of a mile north of the campground. Lesser Nighthawks flew overhead, easy to separate from Common Nighthawks, as their white wingpatches were noticeably distal. The White-tailed Antelope Squirrels refused to pose for photographs.

From Hole in the Wall, I drove the short distance higher up into pinyon/juniper territory, to get Juniper Titmouse on my California list. No such luck. I think it was too late in the day. There were several small passerines that kept flying away from me, but I'll never know what they were. The only bird that cooperated here was a Gray Flycatcher.

I fully intend to return to this beautiful area to camp, and get Juniper Titmouse in the state, but at a time of the year when the temperatures are much nicer.

In Las Vegas, constant thunderstorms that provded no relief from the heat prevented me from visiting Mount Charlston, an alpine mountain area an hour from Las Vegas, that has pine trees, Virgina's Warbler, Juniper Titmouse, and Broad-tailed Hummingbirds that visit the feeders. Instead, I spent Saturday evening walking around Wetlands Park, , in southeastern Las Vegas, until well after 8:30 p.m.

I liked this place a lot. Apparently, the local birders have yet to find any good vagrants, but the basic desert bird there were cool. There were a lot of Yellow-breasted Chats, Black-chinned Hummingbirds, Verdin, Black-tailed Gnatcatchers, Gambel's Quail, and Lesser Nighthawks. More Desert Cottontails, and Black-tailed Jackrabbits. The Song Sparrows here are very strange looking: small, and a pale rufous in color. Very different from the blackish ones in California. I never saw a single coyote anywhere in Vegas (or in Mojave National Preserve, for that matter), which might explain the ridiculous numbers of tasty mammals running around. Hm...

Sunday morning I birded Sunset Park, across the street, and southeast of Las Vegas' big Mc Carran Airport, from 06:30 to 07:30 a.m. Apparently, the Vegas locals take their dogs to the park at 6:00 in the morning, before it gets hot enough to kill them (dogs tolerate heat even less than we do). You will not see a dog outside on Las Vegas between 8:00 a.m. and 8:00 p.m. Sunset Park had the same birds as Wetlands Park, and I finally found a pair of Lucy's Warblers. Park in the main parking lot, and walk south, into the mesquite desert dirt lots in the back. The Lucy's Warbler were only in the very dry, pale Russian Thistle, known from cowboy films as "tumbleweed". One bird I expected here was Crissal Thrasher, but since I saw one in the mountains of California, I didn't worry about it.

I had to sift through a lot of all-gray, juvenile Verdins, before I found those Lucy's Warblers.

On the way home Sunday afternoon, I got off the 15, and rove up the Cima Road to try again for Gilded Flciker (I also need this for my California list). The heat was so bad, that I feared passing out, and being found dead (I am serious.). I ran into Dany Sloan (that's "Dany" with one "n"). We agreed that the heat was disgusting, and left. We arranged to drive to the Baker Sewage Ponds, to look for migrating shorebirds. It was 112 degrees, and the sewage ponds were dry. we got in our cars, and headed for home.

Back on the 15, I realized that Zzzyzx was next, and remembered being there last fall with Steve Sosensky et al.

Zzyzx was founded by a con artist who was neither an ordained minister nor a doctor, but he claimed to be both. He built the place up around the natural springs, and transmitted his religious radio program from here for years, until the U.S. Marshals hauled him away. Apparently, he never owned the place, and after he had been there for decades, someone in the government figured that one out.

WOW! There were several hundred Western Kingbirds. They were EVERYWHERE. On the ground, in the trees, and even out on the dry lake bed, standing around like shorebirds. The dry lakebed isn't truly dry, like other desert lake beds: it is moist from the local natural spring, which feeds the pools that attract shorebirds, dragonflies, and anybody else who likes water, like the two Desert Bighorn Sheep that I photographed.

There were also over 30 adult male Bullock's Orioles (far too many for this tiny oasis to support as local breeders), 20 adult male Brown-headed Cowbirds in a flock, a Spotted Sandpiper, a male Wilson's Phalarope, Western & Least Sandpipers in breeding plumage, a Killdeer, Cliff, Barn, and Northern Rough-winged Swallows, a pale juvenile Red-tailed Hawk, and two White-faced Ibis.

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