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?