Happy Almost Christmas

Times is Tough

there is a lot of worry lately as hospitals in our area are cutting more staff and slashing department budgets. often time PA's (and NP's, CRNA's, midwives) are the first ones cut, since we work directly for the hospital and cost a lot, but don't actually bring in our own clients like the MD's do.

most of the local hospitals that i know who have cut their PA depts end up hiring them all back because the MD's and other staff find that life is difficult without them. but the short-sightedness and new administration constantly coming in and reinventing the wheel and the frightening amount of red on the budget sheet is making all of us a bit nervous these days.

my plan is to ride it out. keep my head down and hope for the best. i think we're vital to the integrity of the surgical dept and that they'll figure it out, i just don't know how many casualties there will be between now and then. (gulp).

i have felt a little insulated from this economic crisis the country has been suffering for years. now i'm starting to look around my house and wonder what i can sell or burn or put into a soup. :)

What is On the BHE's Mind? Cow Farts.

sorry, sports fans. i've been super busy lately. so in light of my hectic schedule, the BHE has agreed to write a post about what he's been into lately.

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so i've been thinking a lot lately about what we eat and how it gets to our table. frankly, the research i've done shows some very significant issues in our food supply. and since 2/3 of all americans are overweight or obese, i think it's a good discussion for us to have.

the topic is wide-ranging, so while we can make good arguments about the safety and sanitation in the meat supply or the damage that pesticides can cause in our bodies, i'll narrow it down to cow farts. i don't know if you know this, but global warming is kind of a big deal. and we spend a lot of time discussing the impact of carbon dioxide and different ways we can reduce our carbon footprint. and that's all well and good. however, if you really want to have an impact in reducing carbon footprint, you don't have to become a smug hippie who drives a prius 10mph below the speed limit. you have to worry about cow farts.

why?

because cow farts are made of methane, and methane is made of carbon. and what's worse, methane traps twenty times more heat than carbon dioxide. the average cow emits as much greenhouse gas as the average car, and worldwide production of beef and dairy are expected to double in the next 30 years. you can see the numbers problem.

so what does this have to do with our food supply? the vast majority of meat sold in the american marketplace is grain fed. even if you reject the resources consumed in producing the grain as food for our food, consider that it gives our cows indigestion. and that makes them burp and fart all over the place. if we fed our food grass rather than grain, or even just a grain diet that mimics natural grass, we can reduce their methane production by nearly 20%. there are health reasons why grass fed beef is much better for you, too. you can read up if you get off on omega-3 to omega-6 ratios.

food for thought.

Chemo is Awful, But Gravel in The Vagine? Whoa Now.

http://pagingdrgupta.blogs.cnn.com/2010/10/14/how-the-ancient-world-dealt-with-cancer/?hpt=C2

really interesting article on how ancient societies faced/treated cancer.

i assume that one day we'll look back at chemo and radiation with the same horror that we look at blood letting, leaches, and, in this article, injecting gravel into hoo-ha's for uterine cancer. eck!

interesting anyway. :)

Veterinary Medicine Might Have Been the Way to Go

my dog won't stop getting injured. she is a retired greyhound and came to us off the track 4 yrs ago in good shape. but she has a tendency to get wounded just by passing by another dog or by running around our yard, or by stepping foot into the dog park. it's ridiculous. i know for a fact we've spent more on her out of pocket this last couple of years than we have on either me or the BHE.

and this week she had to get a claw amputated! the ligament and claw on one of her front feet. she's limping around all pitiful-like. this was clearly a bigger surgery than i would attempt, but i gotta tell you, for the minor lacerations, i am so tempted to sew her up myself. it's just that i don't want her thinking of me as the bad guy and i don't have a ready supply of lidocaine and stuff. i don't think we could train her to bite down on a strap of leather to get through the pain.

so for now, we're putting our vet's kids through college. you're welcome, susie and george.

Back in MY Day....

we recently launched an electronic (computerized) medical record system at my hospital. i know, i know, we are a bit behind the times. basically, instead of scribbling some illegible order that the unit secretary has to interpret and input into the computer system for the nurse to see and follow those instructions, now we just put our orders directly into the computer ourselves, and they go directly to the nurse's inbox. eventually, progress notes and everything will be on the computer. already, lab and radiology reports, vital signs, lots of stuff has been available exclusively on the computer, so this is just one more step to being paper-free.

there are a lot of positives to this. medication errors should be fewer, and any of us practitioners can access our patients' charts from any computer, which is convenient.

but, the system isn't very intuitive and a lot of people are grumbling. especially our, well, more seasoned physicians. one of my favorite surgeons is brilliant in the OR, but i doubt that he's ever sent an email. watching him attempt to input a simple order for tylenol is like watching a monkey try to do complex math.

things just change so quickly. in the 30 years this favorite MD of mine has been practicing, he went from a simple gall bladder resection taking 5 hours through a blurry, dark camera, cigarette smoke billowing through the halls of the hospital, and all the physicians being treated like gods, to a gall bladders taking 20 minutes, smoking not even being allowed on the hospital campus, and the docs being made to put their own damned orders in a complex computer system. ouch.

the other day i saw a nissan comercial for a remote car starter that uses your cell phone to start the car. for my generation, this makes some sense and doesn't seem all that frightening or sci-fi. but for older generations, this is straight out of the jetsons. it's just too bad that when you text your car to tell it to start, it doesn't fly to greet you at your front door. maybe that's next. :)

A Funny Thing Happened On My Way Into Work...

so, i see weird stuff every day at the hospital. it's just the nature of working with people, i think. people are weird.

yesterday, i saw flesh eating bacteria taking over some poor sap's entire backside before they bothered to come in to get it checked out.

today, i saw an RV parked outside the hospital in the employee parking lot and could totally see inside to some lady blow drying her hair!

what the what?

like i said. people are weird.

Mayhem, Murder, and Medicine

as we near the 5 year anniversary of the devastation of hurricane katrina, news stories and remembrances are popping up. above is a very tragic tale of desperate measures taken during the throws of hurricane katrina and the subsequent legal battle over suspicious deaths of patients. at one of the new orleans hospitals, apparently some 9 patients were not going to be able to be moved/evacuated, presumably because of their degree of dependence (i'm guessing ventilator patients? it never says), and so were given toxic doses of narcotics to facilitate death by the remaining staff physician and pharmacist.

i am dismayed, but not shocked for several reasons. i'm also not entirely sure it was the wrong choice by the caregivers...

during katrina in 2005, i lived in a small town in mississippi, about 3 hrs north of the coast. the hospital where i worked at the time took in patients who were evacuated from our sister hospital in louisiana. from these patients and their families, as well as in local news reports, we heard all sorts of awful stories about hospital wide power failure, then generator failure, and then death for those patients dependent on machines. i heard a lot about MD's having to make tough choices about who could use the remaining resources and who was most likely going to die anyway. there were wings of hospitals quarantined to house the dead and dying with no electricity, no air conditioning, 90 degrees and wet....it was a war zone. and only a scant few of the staff stayed behind to help and didn't evacuate with their families like they were told to do by the state.

things couldn't have been any more bleak and the situation couldn't have been farther from the norm under which these practitioners usually and comfortably practiced (presumably) ethical medicine.

i know i always tend to side with doctors, and i don't know the exact details of these cases. AND the families heart break is compelling. but STILL, if it was as i imagine, put yourself in their shoes... your hospital is drowning, your few staff members have been awake and working for days on end, many of your patients are dying, and you have a choice to either let these few patients who can't get out in time die slow, suffocating, miserable deaths, or you administer meds that will take them quickly.

if that was the situation, wasn't it humane and in fact 'doing less harm' to facilitate death?

you tell me. what would you do?

and then, here's a more happy story about a midwife delivering bebes during the storm.

Post Op Day 2, From the BHE

the OR is really bright and really cold. it took me two days to remember this, because anesthesia is retroactive.

i woke up from surgery on tuesday afternoon, and i'm glad to say the results are considerably better than the surgeon expected. he was able to remove 8 pounds of skin and fat that i wouldn't be able to exercise away or otherwise remove by my own effort. and my amazing wife tells me i look entirely different from every angle. so that starts to make the discomfort i've been in since then generally worth it.

i was told by the doc that i'd be "pretty sore" for about a week. and that's generally true, except that pain meds work. i have a pain pump delivering lidocaine directly into my abdominal muscles and i also have been taking a regular dose of vicodin. so my whole core feels very tight and my range of motion is severely restricted, but my actual pain level is really less than that of a sprained ankle. and that's a pretty crazy thought.

but i have to take a moment to commend the doc, the nurses, the techs, and even the transport personnel at MBH for taking amazing care of me. every single person i encountered at MBH had a big smile and a deep well of concern for my well-being. i felt like a VIP (i kinda was), but i also think my level of care wasn't that much greater than what anyone else receives at MBH. and that is pretty impressive.

most of all, though, i owe a tremendous amount of love and gratitude to the regular author of this blog. she has been incredibly supportive of me from the time i started to losing weight, through keeping it off, through running a marathon, and now through the decision for surgery and my aftercare. she is a model of love and sacrifice, and i'm incredibly blessed to have her.

Post Op Day 1

surgery is done and he's home and feeling pretty good and looking AMAZING.

more details from the BHE to follow.

Guest Blogger: Transmissions from the BHE

hello from the BHE! my former-PA-student-and-current-practically-a-doctor wife has asked me to share about my experiences leading up to what is a very exciting day tomorrow.

i am having abdominoplasty surgery to remove excess skin from my midsection (which she mentioned in her previous blog, "to cut or not to cut"). in fact, i just received a call that i was rescheduled from 9:30am to 7:30am. i have to be to MBH at 6am.

for as much as i've been really excited about results, i'm also a little nervous. i have no relevant experience upon which to base my expectations.

i grew up fat. i was a fat little kid, i was a fat high-schooler, i was fat in college, and i was fat as a young man living his own life. for brief moments, a couple times, i had lost enough weight that people noticed. but i could never sustain the weight loss, and i've always been fat. at my peak i weighed 285 pounds. and then i got married fat. with her help and encouragement i was able to work all that weight off and reach a minimum of 199 pounds. and since then i've put on 20 pounds of muscle. i'm at the peak of my health. i've run a marathon, two half marathons, two 25k races, three sprint triathlons, and an olympic triathlon. i've kept the weight off for four years. i'm ready for the operation. but i've always been fat, so i don't know what it will look like not to be.

the process of elective surgery has been very interesting. there are a lot of procedures and precautions that have to be taken beforehand, and there are a lot of preconditions that need to be met in order to undergo what is very major surgery. surprisingly, because i'm spending a night in the hospital, i'm eligible for FMLA leave, and short term disability insurance, which means i'll be getting paid for about half the time i'm out. it seems a little wrong, but after paying for the surgery in cash, we really could use the money.

i think it will be most fruitful to compare the information i've received and the process i've gone through to this point after the procedure. but i can't help but be impressed with the amount of information that both my doctor and the hospital have been able to convey to me in a very approachable way. but we shall see if the two align tomorrow.

How Would You Design Your Brain?

i would be able to ballroom dance really well and i would speak several languages fluently. i would have a WAY better memory for details and, specifically, things like geography and how to spell werds correctly. i would take out some laziness or complacency and replace it with gettin'-after-it-ness and the tendency to act now instead of sit around for a while instead. i would have already read and retained all the great literary works. i would take out the think/say mean things about other people part and put in more, be-kind-to-them-this-may-be-their-first-time-driving-on-the-street-with-other-cars part. i would greatly enhance the "likes to exercise"part. i might take out the "enjoys peanut butter directly off the spoon and has been known to dip it in chocolate chips and just go nuts for a while" part. i would lose some insecurity and gain some peace of mind.

The World Is a Dirty Place

when you go into medicine, you know you're probably going to get some human waste on you at one time or another. i remember warning my little sister about this when she was considering going into nursing. i promised her that any number of colorful bodily fluids would end up finding their way to her clothes, skin, possibly and awfully, into her eyes/mouth. not at all pleasant to consider, but definitely does happen.

and that's not even counting that funky spunk that could be in said fluids.

yesterday, i was doing a PICC line (peripherally inserted central catheter), which is a fairly invasive, bloody procedure, on a patient with hepatitis. no accidental needle sticks or scary oopses occurred, but this happens not infrequently that we are at risk of exposure. we health care professionals do procedures like this and surgery on patients with hepatitis, HIV/AIDS, chicken pox/shingles, MRSA/VRE, tuburculosis, etc, etc quite often.

we use this safety protocol now called "universal precautions" which means we pretty much never should be touching a patient without wearing gloves. and if they have any known current infection (in lungs, on skin, in stool, etc), we might also wear a gown and mask. but it can get pretty lax. in the OR, we all wear sterile masks, gowns and usually 2 pairs of gloves and we're uber careful when passing/using knives and needles. but i must admit that if we know a patient has a blood borne infection, we proceed with extra EXTRA caution.

lately, everyone in my department has been trying to get pregnant. and though we get fairly cavalier about the whole exposure thing when we're only putting ourselves at risk, it's a whole other ball of wax when you're talking about a vulnerable fetus inside you. in addition to all these nasty pathogens, we work in a fairly hostile environment for growing bebes. cement and xray are both known teratogens and we do our best to stay out of cases that use them (total joint replacements, fracture repairs, etc), but it's a challenge.

some days it feels like to be totally risk-free i would have to leave medicine all together. which i'm not going to do. so i guess you do your best to protect yourself and don't take undue risks while also not living in total paranoia.

no problem, right?

Gross. And Sad. And Gross.

it seems like lately at work, i've been surrounded by more death and dismemberment than i am comfortable with. every time i go down to the cafeteria for lunch, just minding my own business, trying to get a sandwich, there are undertakers in black suits in the morgue hallway, transferring a bagged body onto a gurney.

why you ask is the morgue near the cafeteria? i think it has something to do with refrigeration.

heh....bleh.

it puts me off my feed, but it also is a painful reminder of the gravity of the work that we do. even though all lives will ultimately end in death, and we know this...i can't help but feel a little bit like we failed that one who's being wheeled away, since one of our core tasks as health care providers is, you know, making people stay alive.

most of my days involve elective surgery for hernias or gall bladders...or even for more harrowing things like breast or colon cancer...still, typically, our patients are fairly well when we get to them, and most of them go home at the end of their hospital stay without major problems.

but this week, i had to help amputate a foot for gas gangrene. the patient will hopefully survive, since we got to him soon enough (barely), but part of him will be sent to the morgue.

if you have a clearly infected limb (discolored, bad smell, redness/blackness, hot/cold to touch, non-healing sore, fever) GO TO THE ER. DO NOT WAIT.

i don't want any part of you to be sent down to that cold hallway near where i make my salads.

right then. so we've agreed on that.

5 Babies Have Died From Whooping Cough in California...If Only We Could Have Prevented this Tragedy

tetanus (vaccine= DTap) polio (vaccine= IPV) pertussis (vaccine= DTap)


this just pisses me off.

living in fear and making dumb decisions out of ignorance. how many times do we have to explain that vaccines have not been shown to be linked with autism? and yet people are still not vaccinating their kids. how many ways do the folks associated with the original publication have to rescind their opinion and demonstrate that further studies don't back up the link? how many kids have to be maimed or killed from these awful (SHOULD BE ERADICATED) illnesses? what is wrong with people??

my fear for the kids in our country is this: as long as only small pockets of people aren't inoculating their kids, those kids should be safe, since the rest of the country is covered and won't spread the diseases around...BUT, if this community of un-vaccinated kids gets bigger and, if in our well- traveled, global community, they are exposed to kids from other parts of the un-vaccinated world, these nasty bugs will be shared among friends and we will have epidemics and lots of childhood death here. that were preventable. big kids might just get sick or end up with disabilities. but babies die. and all that sucks. and is preventable.

please read this article from cnn last week. it covers the whole vaccine scare controversy and there's some interesting added juice about how the spear-head MD from the original article that started everything was working for a competing vaccine company and was in it for greed, etc, etc.

the doc i scrubbed with today spent some time doing medical missions in africa and saw the damage that things like polio and measles and tetanus can cause. he said the middle bottom tooth of all the adults is removed so that WHEN they get lockjaw from tetanus, they can still get food and water through the gap. that is how prevalent/expected/normal it is there. this MD has been practicing in the US for 20 yrs and has NEVER seen a case here. we do not expect it. because we have forced it out of our community with vaccines. this generation has no idea what these deadly and mangling illnesses look like. check them out above. not pretty. and those are only a few of them.

please get your kids caught up with their vaccines. for their sake and for that of their friends, family members, classmates, neighbors, and, most importantly, my future children. :)

at the very least keep reading and asking questions about it. check your sources when you're reading "compelling evidence" against vaccines. here is the current cdc recommended vaccine schedule. it's big and complicated. you can also just go see your pediatrician. and i am happy to help find any info you need or do any research to answer questions/discuss these issues.

Good Doctor? Bad Businessman?

so i've twice gone to this dermatologist for various little skin shtuff. i happened upon him because he was on my plan and was extremely local to work.

nice guy. young. clearly a new grad. i know this in part because when i call, i get in within a matter of days (not months) and when i arrive, i wait a matter of minutes (not hours).

he's sort of goofy. i think i mentioned this way back when. when i was complaining about my dry skin patterns on my hands, he showed me how to "fake" scrubbing my hands for surgery, or recommended that i quit my job and find something that would be less traumatic for my hand skin. right.

so, he's a little different. and....either he's supremely ethical and is a trust fund kid with no med school loans, or he simply hasn't caught on yet that he might be inadvertently putting himself out of business.

exhibit a) steroid cream for my eczema/psoriasis itchy winter stuff. most derms i've seen in the past give you a script for wee little pocket size doses of the precious. it lasts about 2 days, covering about 1/8 of your skin problem, and you have to go back to them to get more. this guy gave me a shitton per order with multiple refills- putting himself out of an office visit to get new scripts.

exhibit b) today i went to deal with some plantar warts that have been on the bottom of my feet for an embarrassingly long amount of time. they don't bother me, and i forget they're there until the BHE has my feet in his lap as we do, and he starts making gaggy faces when looking at said warts. they're tiny and not in painful spots, but none the less, to avoid the gaggy faces, i went to again see this doc. he explained that unless i get padding for my shoes and can avoid rubbing those spots and building calluses, wart burning/freezing/excising won't do any good. he gave me instructions on a $10 fix from the drug store and said the warts will either go away on their own or an over the counter remedy will likely cure them. so i was sort of annoyed that he got my $20 copay for just advice and no magic treatment, but he gave me a good 15 mins of his time and a cure instead of a quick fix. but if i follow his instructions, there will be no need for me to come back to him.

maybe that's his trick. maybe he knows that people are non compliant and we will always be back as we will never practice real prevention as we're told. hmmm....

but i appreciate his honesty. he kept saying that he could burn/freeze/dig them out, but they'll just come back until i fix the root problem. and he seems genuinely interested in doing that.

so i like him for his integrity but i do worry for his longevity as a business owner.

thoughts on this?

LEAVE ME ALONE...I'M STARVING!

so i've gained a bunch of weight recently for various reasons (fried fish sandwiches mostly) and now i have to lose it. so i kicked it off with a fast last week. i started monday and intended to go through wed or thurs. the BHE and i have done many 3 day juice/veg broth fasts in the past and find them to be a great cleanse (and how!), and also a time to assess how/what/when we're eating and take some control over it. sort of like a reset button. we do it safely and carefully...like not if we're sick to start or have major runs or other intense physical requirements during that time. and we also use 100% fruit juice and veg broth, so at least our brains are getting carbs the whole time.

but tuesday i did 4 vascular cases back-to-back without much of a break, which is enough to sap your energy on any day, but without any solid food and just the minimal calories of juice, i was pretty tired by the end of it. and then that night i worked late and was on call tues night...so when i got a call at 9pm that i would have to come in at 11pm and would probably be there all night, i ate.

i was worried that in the middle of the night with minimal fuel in me i might be a risk to the patient. i didn't want shaky hands or sleepy reflexes while operating. i didn't end up having to go in to work after all, but i still think i made the right call by breaking fast early.

i've worked with docs who fast for ramadan (islamic month of fasting) and, although that is only a dawn to dusk fast, i've often wondered if any of them worry about losing mental sharpness with patients on those long days without energy. and theirs is an absolute fast (no juice or broth or even water i think?), so that's much harder. i know there are exceptions for people who are ill, elderly, pregnant and nursing women, but i don't know if anyone opts out (instead feeding the poor, saying certain prayers?) because of their job. i'm guessing for these doctors i know, they get used to it pretty quickly. and they're probably better disciplined and healthier than me in the first place and their bodies don't require a bagel an hour to maintain its happy glycemic load.

anyway...food for thought. get it? heh.

And Now I Want Some Corn

so, in my pre-PA days as a social worker, i had to complete an internship for graduation. mine was in farm country with (mostly) mexican migrant farm workers, working with their children in a head start program. it was an amazing experience, and quite an education for me. witnessing the challenges of making a living in the field, with the health risks and dangers, getting a glimpse into the legal issues immigrants deal with while working seasonally, observing the family dynamics as the parents left their kids at our program as young as 2 wks old for 10 hrs a day so they could return to the farms. and there's was a very nomadic life as they followed the crop. most of them made enough money in the 6 month growing season of spring/summer, that they returned home and lived very comfortably, many not having to work at all in the winter. and there was the cultural intrigue for me, too. although some of the families were from columbia and cuba, most were mexican, either from mexico itself or from florida or texas.

we were a school, a daycare center, a resource center, and a health clinic, and i focused more on the financial and health aspects of it. (i also helped teach an adult ESL class which was a total head trip- do you KNOW how messed up the english language is? like "por que se usa 'i' antes de 'e'?" to which i would have to reply, "it's just how it's done. no idea. move on."

so, anyway. i learned of many fascinating cultural traditions, especially as they pertained to health and wellness. here are a few of the folk remedies that i recall. and bear in mind that a lot of these people were from tiny villages deep in mexico where they had only to rely on their own small community and had no access to big city resources. many didn't speak spanish, but rather native dialects.

- "Mal de ojo"... it was my understanding that if your child started acting sickly or strangely, you would suspect that they had had sort of a hex put on them...but it was not totally a malicious thing, it was more like an adult complimented the child or looked at them with envy or pride or something of the sort. to remove the "bad eye" when you put the child to bed at night, you would crack an egg into a glass of water and place it under the bed. then, in the morning, if the egg had cooked, you would know that the curse had left the child and gone into the egg. here is a little snippet on this to read further. apparently the "evil eye" is seen in other incarnations in other cultures, too.

- Fussy baby... if an infant child is being temperamental, you could asses their soft spot (fontanelle) and if it was sunken, you would either put your thumb into the roof (hard palate) of the child's mouth and push up or you'd hold the child upside down by the ankles and pop them on the bottoms of their feet. supposedly, if you correctly diagnosed the problem, you would hear a "pop" when the soft spot went back up. this one is addressed here. apparently it is called "mollera caida" and there are even more interesting remedies available. there is definitely something to this one as a sunken fontanelle can mean dehydration which would make for a fussy baby. you can see how a little education can go a long way.

so, i've always remembered those and found them very interesting. i loved so much the opportunity to learn about these cultures and experience their customs. the people i worked with were so warm and welcoming and eager to teach me new things. and they fed me! really well! to this day, i put mayonnaise, chili powder, and lime juice on my corn on the cob.

try it. ud. lo amará!!

I Saw Sex and the City II...All I Can Say is That Liza Minnelli Should Put Some Pants On

oh my word, i know it's been 10 yrs since i've posted, and i dearly apologize to anyone who is still following me (hang in there!).

life has been crazy throwing medical issues my way directly and to my family. we're vollying them back pretty well, but it's been a chore.

and i've been working like a dog. well, not like my dog, mind you, who sleeps some 22 hrs a day and the other 2 hrs sort of lolls around. i want her life. just for a day or two. i don't want to eat her lamb and rice pellets (bleh!), but all the rest of it, i'll take.

anyway, so i've worked some 30 hrs of call this week and this is my 11th day in a row working. all of it is blurring together...especially considering i came into work at 1 am last night, after that case slept for a few hrs, and then was back at it at 7:30 this morning. but...money, honey!

so anyway, i will do my darndest to be more diligent and post something more than just apologies for not posting.

hope everyone had a delightful memorial day and is enjoying this gorgeous weather (that i keep hearing about). :)

To Cut or Not to Cut?

aaaaahhhhh!!! life has been such a crazy busy emotional mess lately. some parts great, some parts scary.

several times recently i've had to help family and friends make decisions about whether or not to get surgery. just yesterday my dad underwent back surgery for a herniated disk that was causing him agonizing pain, not allowing him to sleep, and totally interfering with every aspect of his life. several months ago my grandfather debated the risks of taking out a tumor in his bowels at his tender young age of 86. the BHE and i have also been discussing the risk/reward of cosmetic surgery after major weight loss.

all these make for hard decisions. surgery can be dangerous. it can also save lives. every day at work i see proof of both. so where does that leave me in advising my loved ones on whether they should let someone cut them open? besides needing heavy sedation for several days leading up to any work i might need myself, i am still very much for it. despite the risks of infections, blood clots, wound ruptures, etc, etc....the list of complications is staggering and we see them all....despite all this, the huge majority of the time we don't see it. everything goes smoothly and patients are wildly improved because they were willing to take the risk.

taking tumors out saves a life. sometimes that's all it takes. taking off the bad joo joo that's pressing on a nerve on the spinal cord and instantly allowing you to be free from the pain that has controlled your life. taking out a diseased and dying organ that's dragging the rest of you down with it. releasing pressure on the brain to give you back normalcy. giving you the body that you've earned after years of hard work losing weight. or reconstructing breasts for you after battling cancer and winning except for the lady parts you're missing...those are such amazing things we can do for people.

and sometimes surgery is not the answer. most of the time every conservative measure is taken to manage the problem without having to cut. clearly. but when all other treatments have failed, or for those things that have to quickly be controlled/removed/assessed/attached/drained right NOW, surgery is the answer.

no one wants to have their abdominal muscles cut through. no one wants a scar. no one wants the pain and fear and risks. but most of the time from all the cases that i've experienced professionally, and now personally, when all is said and done, go ahead and cut.

Learned Some, Ate More

in new orleans last week for a PA conference. and for food. lots and lots of food.

the conference was great- really good lectures from knowledgeable speakers on a variety of subjects. there's always reviews on hypertension and diabetes management, which is helpful. and this conference, though general medicine, was also very gyn-centric, which was great.

the BHE and i lived in a small town in the south for a while and i worked in a hospital there while we did. we quickly learned that the stereotypes of southerners as idiot rednecks is totally crazy. most of the people we knew were brilliant, creative, well-spoken and sophisticated. in the hospital where i worked, the standard of care was up to par with any other hospital i've seen and the staff was very well educated and trained. the only differences in care i could perceive is that people down south are just more polite/friendlier (they really are) and there's a lot more God infused into conversation- even patient/physician dialogue.

so all that being said, it was no surprise to me that the MD's who spoke at the conference (all louisiana physicians) were top notch speakers and i got a lot out of their talks. i do love the local colloquialisms, though. one urologist kept making me smile when he referred to urinary incontinence as "losing water."

and new orleans is one of my all time favorite cities on the planet. we went to a (very muddy) jazz fest on saturday and saw "simon and garfunkel" and "better than ezra" and a couple local bands. totally fun.

and we ate po boys (shrimp, crawfish) and boiled crawfish, fried green tomatoes, beignets, and chargrilled oysters, to name a few. num.

i have been SO BAD in not posting lately. stay tuned for a conversation on mexican folk medicine. i did an internship way back when with migrant farm workers (most of them mexican) and learned a lot about traditional treatments. so crazy cool...and i think you might find it interesting, too. so stay tuned.

Tired of McSurgery ready for a McBreak

well, it's been a loooooong week. i've been working the afternoon shift (3-11:30) and i've been scrubbed pretty much the entire shift every day until today. long cases. tiring cases.

lots of discussion of health care reform. these heated debates around the OR table are welcome relief from the mind-numbing tedium of some of the cases. and then other cases have been harrowing emergencies where we all hold our breath the whole time.

when i get home i stay up late and never entirely catch up on sleep. i also never see the BHE on weeks like these, which is suck. and my brain hurts.

so instead of writing something informative or sophisticated as is my norm (ahem), i will simply share w/ you an article i found on McDonald's menu items from around the world. i was recently having this discussion w/ someone and i contended that some McD's serve beer and they said that was impossible, and we went around and around on the subject and we ended up digressing into Pulp Fiction quotes.

some of these are just fascinating- i would really like to try a McLaks but probably not a McSpaghetti.

This Really Does Play Out

i have a PA student right now and so i'm busy giving her lots of good career advice. like h'eh.


http://scienceblogs.com/insolence/2006/05/how_to_choose_a_career_in_medi.php

Flavored Ice and Family Updates

these are two things we need more of in surgery.

one of my wonderful grandfathers had major surgery this weekend and is doing quite well (praise God!). but again being on the other side of the mask made me realize that we have some room for improvement in the care we give our surgical patients and their families.

being starved sucks and we need to be more aware that checking a diet order on a form has a great impact on someone's mood and well being. and "ice chips" do moisten otherwise parched lips, tongue, and throat but are otherwise just annoying and awful. if only we could make them onion ring or cheesecake flavored- that might be more satisfying.

and when a family is waiting anxiously during a surgery on their loved one, frequent updates (calls from the OR to the waiting room) are SO helpful in curbing the terror that creeps up in your chest.

more soon. i've been slacking in my posts lately. it's been crazy what with my gpa being in the hospital and i'm on the floor this week (BOOH!) and i have a PA student (COOL!), and we're having weekend guests and yada, yada, yada.

more soon. for reals.

(but PS, real quick- SO GLAD I WENT INTO MEDICINE! feeling very fortunate that i was able to both assist with my care when i was the patient last august and also that i have been able to be a resource to my family during my grandpa's ordeal. this whole (surgical) PA thing has paid off. and good timing too, huh?)

Roosters Aren't Allowed in Hospitals, Apparently

been taking lots of call lately. this means that outside of our regular shift (mine is 7a-3:30p mon-fri, we as a dept have to cover all the nights and weekends for all the scheduled and emergency cases. we split up the call, and you can usually take as much/little as you want. mama wants a new pair of shoes (living room furniture, vacations), so i'm taking more lately than usual.

i was on call all last weekend (friday night through monday morning) and worked into the wee hours of sunday night/monday morning, so i started the week kinda tired. and then was on call again last night. i got called in at 11:30, stayed until 1:15, drove the 20 mins to get home (cuz they won't call me back again for sure!)...got into bed about 1:35 and was just falling back to sleep...when i got paged again at 1:45. got back in my car, shivering in the now sub-30 degree weather and was back at the hospital scrubbed from 2:30-4:00....when finished, i dragged myself upstairs to the call room to get a little bit of sleep before my normal 7am day shift started.

the call room is in this very centrally located (so loud!) area and it's always too cold or too hot and there's rarely fresh sheets/towels and the bed is this flimsy little twin bed and...it's always the greatest sleep of my life. by the time i get to it, i'm so desperate for sleep and entirely drained, i'm looking more like a wandering mental patient than a useful PA.

so i slept hard from 4:30 and on through my alarm up until 7:40 when i was paged to come to the OR for my first case of the day. WHAT?! so i frantically tried to unscramble my brain and make sense of where i was and what part of the day it was and where i needed to be. fortunately, we had a little staff cushioning today so i was able to shower and eat and relax for a while before getting into my cases...but i ended up scrubbing 2 long cases and doing admissions and other stuff all day. i stayed pretty clear headed, if not a bit discombobulated.

on a side note, the emergency cases were genuinely urgent and we may have saved lives, or at least, vital organs. it's exciting and stimulating to be in on things like that. even if it is in the middle of the bloody night. (so to speak).

so now i'm home. i indulged in way too much of all my favorite foods (i deserve it! leave me alone!) and my plan is just to watch movies and lie around all night.

greatest feeling ever.

I Plan to Start Smoking, Eating Bacon Cheeseburgers and NOT Dealing with Those Funky Looking Moles

everyone is talking about the health care reform. are we all panicking at the hospital? not so much. but is everyone a little disgruntled about it? well, sure.

here's a pretty good run down of the bullet items on the bill.

cheers.

Squeeeeeze.

for a while now i've been running in these sexy compression socks. if i'm planning a long run, i'll wear them the day before and after, also.

now since everyone is all mad for marchness, i read on cnn.com today that the bball players are wearing a padded version to avoid contact injuries and to give them added support.

compression keeps swelling down and avoids varicose veins from developing. it's also the first thing you do when you have an injury, so having it already applied to the micro tears we endure while exercising can be beneficial.

athletes of all sport persuasions seem to be trending toward them. i dig it.

I Totally Beat Mickey in the Race, but Captain Jack Sparrow Kicked My Arse

well, we're back from Disney and i have to say that Disney is way better than anywhere that is not Disney.

it is seriously, truly a magical, wonderful place. i am an adult. i am without a child as an excuse to be there, and i have no shame in saying that i am smitten.

everything is shiny and perfect and not tarnished, worn, chipped or un-cheerful. they have put so much effort into making every ride, every tour, every show, even every restaurant and shop a perfectly designed theme...it's easy to get swept up in it.

it helped that we were there in a pretty quiet time of year (longest wait for a ride- 30 mins), but even the lines on the rides are fun and engaging.

and the race was great. i ran 10 mins faster than my last half marathon and it was totally fun- characters were out to get pics with and we ran down main st in magic kingdom and since it was a princess themed race, everyone wore tiaras and tutu's and stuff. so totally fun.

and then we broke off our crazy diet after the race (tra-la!). we at french and italian food at EPCOT on sunday, and just kept eating our way through delicious things all week long. num. and no GI rot like i was afraid of- we actually showed some restraint in re-acclimating to dairy and such.

restraint until we got back home and went to town on the 4 boxes of girl scout cookies we'd been saving until after the diet. so good. but so bad. but so good!

and, as the race was a fundraiser for the Leukemia and Lymphoma Society, i was thrilled to raise over $6,000 for the cause! if you haven't heard about Team in Training before, it's the Leukemia and Lymphoma Society's fund raising program where you raise money and, with help and support from your local team, train for a run/bike/triathlon/walkathon. then you go compete in your event and a small part of what you raise goes to your travel/entrance expenses. so you get to travel to a cool location, compete in a challenging event, and raise money for an awesome cause. i had a great experience with it. if you have any inkling at all, do check it out.

so, race and Disney were awesome and fun but now we're back home and back to work.

i'm taking on a PA student for the first time in a few weeks. it's great, because if they ask you something you don't know, you just get a superior look on your face and say, "why don't you look it up and report back to me on it tomorrow." :)

Breast Pumping in the Bathroom in a Business Suit?

well, the Oscars are this sunday and i've seen 7 of the 10 films on the best picture nominee list. i'm going to disney world this weekend (hoooooorrrrraaaaahhhh!!!), so i won't be able to continue on my quest. all my reactions are in a previous post (see below).

the movie that probably stuck with me the most was "up in the air." one of the themes they explored that i've been contemplating is females as successful career women vs family women. are the two mutually exclusive? can we ladies really have both? be both ambitious, successful women and available, successful mothers? can you have a complete and happy home and family if you're also an important and busy big shot at work? and if you try to juggle both, are you guaranteed to be plagued by guilt or be somehow lacking in one role or both?

recently in American society we've seen that there are more and more women who are the primary bread winners in their families. i'm curious about what this has done/will this do to the family unit, if anything. i know some of the concern is how gender roles might be rattled with these changes and that this can add strain to marriages.

any thoughts on this out there in the interweb? anyone have any personal experience on the subject you care to share?

"I'm Mr. Krabs. I like money!"

so having now been a surgical PA for a full year and change, the BHE and i are reaping all the benefits of our inflated combined salary. it's been mostly magically delicious since we've been able to aggressively pay off my loans, go on some great vacations, work on the house, and donate to charities.

but we did our taxes this morning and i think we put all of uncle sam's kids through college last year with what we paid in. oh, well. at least we'll get some help with retirement when that time comes....right? right? guys? hello? anyone?

anyway...we found that we are officially evil white rich people. there was even a stamp that came on my W2 that said "EWRP."

so for every additional dollar we earn, we get to keep an increasingly small part of it. good times.

i guess i don't really mind being an EWRP. but i'm gathering that also being a DINK (dual income, no kids) isn't a good plan. i guess i've come up with another reason to start squirting out some kids. they're not just good for mowing the lawn and mixing drinks. they can also be adorable little tax breaks. hmmm...

What Do the Cure for Autism and Fake Boobs Have in Common?

jenny mccarthy, of course!

she's long been the celebrity spokesperson claiming that vaccines are to blame for autism. she has a son with autism and has started her own resource center which, incidentally, sounds pretty awesome.

what isn't awesome is the scare tactics and rumors employed by her campaign. the autism-vaccine connection has been debunked, but forget what research has found, forget the recommendations by medical governing bodies, you should trust this mom instead. because she just knows. and she's famous...so you ought to listen.

i already talked about the vaccination debate a while ago, but this article on her claims and efforts and how they don't jive at all with scientific findings popped up this week and i decided to reopen the subject.

Since They Don't Pay Me to Watch Movies....

great day at work. i've been really enjoying it lately. i'm attempting to be more useful by learning some new stuff.

i'm now doing feeding tube placements where, for patients who are unable to eat, we place a long thin tube down the nose, through the esophagus and the stomach and with a GPS-like tracking device, we aim to get the tip into the small intestine. although we are using numbing lubricant, this is about as unpleasant as it sounds and often results in bloody noses and patients gagging and cursing us the whole while. it's hard to do (i didn't go into this to torture people, i swear!) but by the time they order this tube, these patients are often wasting away and desperately need the nutrition. that's what we try to remember...although i was helping with one a while ago and the patient (in a thick eastern block accent) kept asking us "what deed i ahver do toh yoh?" good question, buddy.

..also i'm learning (finally, again) to do peripherally inserted central catheters which is an IV line placed in an upper arm vein that tracks to larger and larger veins up the arm and finally lands in one of the veins that feeds into the heart. we use PICC's for long-term antibiotics or for patients who will require IV access for a long time- things like TPN (total parenteral nutrition), etc. we use an ultrasound to find the veins and to watch our placement and then snake in a guide wire before placing the catheter in. it's pretty neat. we do it at bed side and we're able to get a lot done without much disruption to the patients. in interventional radiology when they do one they use sort of moving xray picture so they can see exactly where the tip of the wire is, if it coils, if it goes up the neck instead of down toward the heart, etc. we have to trust the fuzzy ultrasound and our "feel" that it's in the right place (obviously, must be able to draw blood from it and flush saline through it to show it's at least functional) and then we confirm which vein it's in by xray afterwards.

so even though it's february and OR case load is down, i've been staying busy and enjoying the new challenges.

and so far nobody at work in this weight loss competition has started a riot or anything, but i've been hearing a lot of grumbling. paczki day came and went and most people refrained with difficulty. my own weight loss efforts with this crazy diet are sort of meh. energy level still good, but i'm tired of all the food prep and some of the food still tastes like dirty cardboard. just a few more weeks until the half marathon, then we'll ease off a bit.

cheers!

ACADEMY AWARD MANIA!!!

alright, sports fans. here is the list of the 2010 Academy Award Best Picture Nominees. this year i swear. I SWEAR! i am going to see them all and make my predictions before Oscar Night (march 7). the only one i might intentionally bow out on is "push" because it just sounds too hard to watch and i try to avoid movies that wreck me inside and haunt me for days afterward. i've read a lot about it, though, and i think i get a feel for its strengths.

anyway...as always, read my review of the films on the column to your right (unless you're looking at your monitor from behind the computer? then it would be to your left). i will also keep this list up to date with my predictions and thoughts. (in case you care). (you totally know you do).

• “Avatar” - seen it and think it should win for cinematography and art direction, visual effects and maybe even director...but the story and characters and PURPOSE of it were lacking too much for it to win as best pic. But count me not surprised if it does end up winning.
  
• “The Blind Side”- missed (but looks like a made-for-tv movie. just sayin')
  
• “District 9”- missed (have it here from netflix but never got to watch- sigh)
  
• “An Education”- missed (like "the reader" but w/o the nazi's?)
  
• “The Hurt Locker”- scripted but filmed like a documentary. very anxiety-inducing and believable as you follow an American IED squad as they risk life and limb trying to disarm explosives in Iraq. not preachy or melodramatic like a lot of war movies. great characters, cinematography and feel...but not grandiose like the others. kind of simple and to the point, which might not be enough zsa zsa zsu for the oscars.
  
• “Inglourious Basterds”- seen it and think it should win for costumes (though can't since not nominated), maybe original screenplay, maybe cinematography, but def not best pic. it couldn't land on the style it wanted to be and was just sort of long and sloppy. And didn't really feel like Tarantino to me, except for a few random moments.
  
• “Precious: Based on the Novel ‘Push’ by Sapphire”
  
• “A Serious Man”- Coen brothers and their dark world where people suck and luck is bad. The "luck" in this movie is in the form of a curse on the generations of a Jewish family, and how it effects the life of one especially sad sack man. Beautifully shot movie with some moments that would make insanely awesome photographs. Plus the editing, the acting and the script were all really well done. (Except the wife- wasn't crazy about her performance. Just have to put that out there). It doesn't quite have the twisted shock and depravity of "Fargo" or the vastness and viciousness of "NCFOM" but it's a very well put together, satisfying movie. But I don't think it will win.
• “Up” -seen it and think it should def win for animated feature film and maybe music. this movie had it all. it was brilliant animation, fully developed characters and story and just a lot of fun and heart. i don't think this could possibly actually win since it's a cartoon and has talking dogs in it, but that it's nominated gives me some hope in american cinema.
• “Up in the Air”- cool movie. I think this one should win (of the ones I've seen so far). Very cleverly constructed and executed. Thought-provoking and not overly sentimental. Didn't dwell on the heart break scenes, but didn't make nice either. I loved it.
  

..oh, and by all means, PLEASE SHARE YOUR THOUGHTS IF YOU'VE SEEN ANY OF THE FILMS.

So What's Your Beef with the Beef?

as a vegetarian of 13 years, i have had to field a lot of questions on why i don't eat meat and how i get the precious meat vitamins without it. people have even pointed to my incisors and say, "you see, we're meant to be carnivores." and now on this new wacky vegan diet, people are even more curious about how we're not wasting away as little anemic waifs.

through my years of vegetarianism i have found ample health and social reasons why it's better that i don't eat meat. below, i'll do a quick down and dirty synopsis of the health and social reasons why i don't eat beef. (i'm focusing more on beef, since poultry and fish don't have a lot of the same dramatic consequences...and i do recognize that eating in moderation does improve things, but you'll see what a small quantity "moderate" is). and i'm really not going to preach at you or anything- by all means, enjoy your burger... but here's some food for thought. :)

Health:
-Pro's of eating beef: great source of iron, B12, and protein.
-Con's of eating beef: -increased risk for colon cancer, increased risk of heart disease and early death (note that vegetarians apparently live 7 yrs longer and vegans 15 yrs longer than meat-eating counterparts)

Social:
-animal cruelty (this is unpleasant. you've been warned), 22 million animals are slaughtered daily for people to eat them
-we could feed the world if we stopped putting the majority of our grain/soy into feeding the animals we eat
-lots of ground water pollution and grossness from the waste products of said animals


so that's a very brief and in-comprehensive summary of why i choose to be a vegetarian. i kind of got bored there toward the end. the internet is rife with good info and also a lot of crazy propaganda on the subject, so as you do your own research, be careful.

if you're curious about where i get the meaty vitamins as a veg, i'll tell you... Iron= beans, green leafy vegetables (note: iron is best absorbed if combined w/ foods containing Vitamin C), B12= if not vegan- dairy and eggs, if vegan- nutritional yeast and fortified products, Protein= beans, tofu, and nuts. and unlike meat, these all contain all kinds of other nutrients as well.

but...after all that, if it's the flavor of the juicy red meat you just can't live without...i can't really help you there.

:) toodles for now.

The Skinny on the Skinny

the BHE just asked me, "are you gonna blog about our awesome new diet?"

well...i am going to discuss the diet, yes. would i call it awesome? let's decide.

pros: tons of energy, in a good mood, usually full after eating and satiety lasts a good while, down a few lbs.

cons: green poop, cooking/grocery shopping/cleaning kitchen roughly 2-3 hrs a night, all the recipes are unique from each other in many ways but all still retain a general flavor of 'health.' (if 'health' were a color, it would be brown death).

so it's kind of a wash right now. will stick it out. only 6 wks left. sigh.

not much to report from work. been taking a lot of call lately. also am heading up a 60+ person department-wide "biggest loser" contest. first weigh-in is tomorrow. lots of people are really excited about it and it's something unified we can all do together.

so on all fronts the focus is getting skinny and fit. i will start to share diet and exericse fallacies soon. let's start with this hilarious new hand-held battery operated weight. i can't watch this without rolling on the floor laughing.

You Have Some Dirt On Your Shoe, Were You Going to Eat That?

the half marathon is exactly 7 weeks from today. the BHE and a friend and i ran 10.4 mls this morning. i'm doing about 3-5 mls twice during the week and then a large mile number run on the weekends. and my fund raising for the leukemia and lymphoma society (as part of this race) is already all done. people have been insanely generous and supportive.

$286.74 spent so far on the new diet. this includes all the staples that we'll use in many dishes (hemp seeds, lemons, quinoa, etc) plus a fancy grater and a new blender. when we were looking for some of the wackier ingredients, we out hippie-fied even whole foods store, so i'm feeling pretty smarmy about that. :) they only had ground amaranth and we needed whole seeds, herumph herumph, herumph.

so...we'll see how it goes. so far all we've tried from the recipes in the book are "direct fuel bites" which we ate before and during running. blended dates, lemon juice, and coconut oil all chilled and cut into squares. actually quite good. and we didn't fatigue during the run, so they did their job. but the rest of the day we ate normal food (left over cheese pizza, hummus on pita, thai soup, salad) as sort of our 'last meals' before we officially jump on this vegan crazy wagon.

i'm excited, but i really cannot believe how granola we are being. on second thought, i don't even know if we can eat granola on this diet...

Oh, the Hippy in Me Seems to be Winning

so, i am running a half marathon in 8 weeks as part of a fund raiser for the leukemia and lymphoma society. 13.1 mls is a long way and involves a lot of training. the race is in florida, so will likely be in the 50's-60's when i run it, but here and now where i'm doing my training, it's in the balmy teens and twenties. running in the snow is like running in the sand- there's a whole lot of resistance dragging you down. plus, the slushy snow then freezes and becomes hazardous, foot-catching, ankle-rolling pot holes along the way. but over all, it's actually really enjoyable! the obstacles kind of make it more fun and as far as the cold, you bundle up so nothing freezes and falls off, but once you're moving, it's rather comfortable. and i guess if i have to survive winter in the midwest, i'd rather get through it at high(ish) speeds.

and with all the running we've been doing, you'd think the Christmas season lbs would just be melting off, right? wrong. i've been half-assing weight watchers for a few weeks with no results, and now i'm ready for change. the BHE has been reading a book on eating right while training for long distance races called "Thrive: The Vegan Nutrition Guide" by Brendan Brazier, a vegan professional iron man athlete. he talks a lot about whole, simple foods. like fatty acids instead of complex fats, amino acids instead of complex proteins, simple sugars, etc. lots of sprouts and whole grains and greens and fruit and stuff. the idea is that you're giving your body only valuable energy that it can use and not store. i know this will be a challenge, but recall that we're already vegetarians, so the stretch is maybe less than it would be if we had to come off meat, too. and i'm not sure if it requires this, but i will be giving up caffeine and alcohol, too. i don't want to pollute my body while simultaneously giving it the good stuff. the book includes menus and recipes for 12 wks, so starting this coming weekend, we're going to follow it up until the race. i'm excited and nervous. excited to feel awesome and clean, nervous to feel hungry. excited to lose the weight, nervous to not eat cheese and coffee and booze for 2 months!! excited to be back in control of what goes in my body, nervous about how much is going to come out of my wallet at the health food store.

so i'll keep you posted on how it's going. should be an adventure!

I'm at 36 New Years Resolutions and Counting...Think They'll Take?

well, Christmas has come and gone. it was a sort of stressful season this year. and it's been crazy nuts busy at work. with extremely sick patients. i've been distracted by life for the last 6 months or so, but now i'm buckling down and focusing on work. i'm learning new things and trying to get really good at the things i already do. and i'm taking more call. i figured that there's a reason they pay me so much and that is that i'm willing to work some less-than-desirable hours. plus, i have big plans for loan repayment this year and a few little vacations, so the extra overtime cash will be groovy.

so...one of my resolutions is that i will post more often (i know. i'm sorry. i've been la-zy lately with my blogging) and that i'll include some interesting medical discussions. new studies, controversies and concepts. i haven't yet tackled the whole health care reform thing, but i'm working up my chi to do that one, so look for it eventually.

hope everyone had a healthy and happy new year! (and PS- if you have something you think might be interesting to discuss, let me know and i'll get right on it).

for now, so as to convince you that i'm not attempting to make this a boring, all educational and no fun reading experince, i'll leave you with this article posted on cnn today regarding the significant health benefits of having frequent sex. haza!