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). :)