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