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.