My father-in-law Joe doesn't have a primary care doctor. Or if he does, he hasn't been to see that doctor in years. It drives my husband and my brother-in-law crazy that Joe is in his early 70s and never goes to the doctor.
Actually, it's not true that he never goes to the doctor. I remember he had some issue with his ears a year or two ago and got treated in the emergency room. So he does go to doctors if he has a problem. But definitely doesn't engage in any primary care.
As the doctor in the family, I'm supposed to be the one to convince Joe to see a doctor. But actually, I'm sort of on Joe's side with this one.
As I said, Joe is in his early 70s and appears to be in good health. He doesn't smoke or drink. He has had his blood pressure checked, and it's normal. He eats well and is skinny as a rod. He probably walks about 5 or 6 miles every day, maybe more. He seems to have lots of energy.
Even if his cholesterol is a little high, would it really help him all that much to go on a statin that might have unpleasant side effects? If he has borderline diabetes, is that really such a big deal at his age when the negative effects take years to accumulate? I suppose he could get cancer screening, but he's probably at an age where it's not worth it to do that either. Prostate cancer is generally slow growing, and testing isn't recommended for men over 75. I guess he could have a colonoscopy, but again, he's getting to the age where anything they could do that would prevent cancer probably isn't worth it. And if he has colon cancer, he's probably screwed either way.
He feels good, lives a healthy lifestyle, and I figure if he prefers not to take any medications or find out about any terrible diagnoses he might have, I don't see anything wrong with that. I suspect healthcare is over utilized in the elderly anyway, so I actually really respect his decision not to go to a doctor.
What do you think? Should Joe go to his primary care doctor or should his sons leave him alone?
Thursday, July 30, 2015
Tuesday, July 28, 2015
Dr. Orthochick: Achievements
TV in Patient's room
"... A 9-year-old boy who successfully climbed the highest peak this side of the globe, Argentina's 22,837-foot-tall Mount Aconcagua..."
Me: You know, I could have done that, but my parents wouldn't let me.
Patient: Really?
Me: No. I was chubby, unathletic, and always picked last in gym class.
(I actually have no idea what my parents would have done if I had broached them with that idea. They probably would have pointed out that there were no mountains nearby and I should focus on doing math flashcards. But I always wonder about the kid's parents in these cases. I mean, was it their idea or are they just really really really supportive of their kid?)
Anyway, congrats to him.
"... A 9-year-old boy who successfully climbed the highest peak this side of the globe, Argentina's 22,837-foot-tall Mount Aconcagua..."
Me: You know, I could have done that, but my parents wouldn't let me.
Patient: Really?
Me: No. I was chubby, unathletic, and always picked last in gym class.
(I actually have no idea what my parents would have done if I had broached them with that idea. They probably would have pointed out that there were no mountains nearby and I should focus on doing math flashcards. But I always wonder about the kid's parents in these cases. I mean, was it their idea or are they just really really really supportive of their kid?)
Anyway, congrats to him.
Saturday, July 25, 2015
Weekly Whine: One piece
It baffles me how many one-piece outfits there are out there for female adults and children. Whenever somebody buys my daughters clothing, it seems like about half the time it's some one-piece outfit (Shorts attached to a shirt).
I can only assume that the people who designed these outfits are some super humans who don't have to use the toilet. In any case, I just cut the shorts bottom off to make them into a dress.
The worst is one piece bathing suits. Because I'm sure everybody loves having to take every stitch of your child's clothing off so that they can pee. Which, if there anything like my daughter, they have to do on an hourly basis.
Another benefit to being a female....
I can only assume that the people who designed these outfits are some super humans who don't have to use the toilet. In any case, I just cut the shorts bottom off to make them into a dress.
The worst is one piece bathing suits. Because I'm sure everybody loves having to take every stitch of your child's clothing off so that they can pee. Which, if there anything like my daughter, they have to do on an hourly basis.
Another benefit to being a female....
Friday, July 24, 2015
Amazon review
I've written in the past about having had issues with belts I've purchased falling apart. Someone commented hear that I'd be better off buying men's belts, so at the end of May, I bought two nice men's belts.
However, when I got home, I realized the belts were a bit too big. So I got the brilliant idea to purchase a leather hole punch from Amazon.
However, when I got home, I realized the belts were a bit too big. So I got the brilliant idea to purchase a leather hole punch from Amazon.
I bought the number one rated leather hole punch, which didn't ship through Amazon but they have free shipping from a third-party seller. After I bought it, I realized the delivery date was June 24 through July 13. But this has happened to me before, and the item usually arrived much sooner than that.
Anyway, fast forward to July 13, and the hole punch still hadn't arrived. I was kind of annoyed, because I really wanted to use my belts. My pants are falling down! I contacted Amazon, and the third-party seller assured me that my item was in the country (!) and would arrive in the next week.
Yesterday, July 23, two months after I ordered the item, it still hadn't arrived. I contacted the seller and asked for a refund. I had every intention of going on Amazon and giving the product a scathing review. But then I got this email from them:
"Ok, we have make a refund for you, we have send you the item and we have make a refund for you, we lost my product and my money, if you don't mind, could you please don't leave us any bad feedback, bad feebdack fatal to me, hope you can understand, thanks."
And now I feel like I would be a bitch to give the scathing one star review. But at the same time, I feel like people need to know that this could happen. What should I do?
Thursday, July 23, 2015
Religion
In my class in medical school, there was this religious Jewish guy named David who always wore a yarmulke (skullcap). During the first two years of medical school, I never saw him without it.
Then sometime in the middle of third year, I ran into David and I noticed he wasn't wearing it. Someone later told me that he stopped wearing it during the clinical rotations.
It always sort of bothered me that David stopped wearing his yarmulke. I don't know if he felt like people were treating him differently because of it or he was being discriminated against. I know that David was going for a very competitive specialty, so his evaluations were really important to him.
On the other hand, there was a Muslim girl in my class who wore a scarf around her head and she kept right on wearing that during her clinical rotations.
Then sometime in the middle of third year, I ran into David and I noticed he wasn't wearing it. Someone later told me that he stopped wearing it during the clinical rotations.
It always sort of bothered me that David stopped wearing his yarmulke. I don't know if he felt like people were treating him differently because of it or he was being discriminated against. I know that David was going for a very competitive specialty, so his evaluations were really important to him.
On the other hand, there was a Muslim girl in my class who wore a scarf around her head and she kept right on wearing that during her clinical rotations.
Wednesday, July 22, 2015
Party dilemma
A friend of mine was telling me that she wanted to have her daughter's sixth birthday party at an outdoor play area. It's this arcade that's outdoors, and they host birthday parties. It's a really fun place to have a birthday party, and her only reservation is that she doesn't feel comfortable watching 20+ kids in a place where they can easily escape.
I was just completely baffled by this. I asked her why it was her responsibility to watch all the children at the party, when she was hosting it at a third-party location, and presumably those children also have parents. She told me that it's her experience that the parents will just leave the children there, and then it is her job to keep track of them. If one of them got lost, she would be responsible.
Again, I was baffled. If a parent goes to a party and leaves their five-year-old child there without asking if it's OK, and the kid gets lost, how is that in any way the fault of the person holding the party? Does "party" somehow equate to "licensed childcare center"? There's nothing in the party invitation that says your child will be watched. I personally would assume that a person hosting a children's party would be far too busy to take care of 20 children, so as painful as it is, I usually stick around at these parties.
I pointed all that out, but my friend was insistent that multiple parents had left their kids at her parties in the past, and she felt responsible for all the children. She said if something happened to one of them, even at a third-party location, she would almost certainly be legally blamed for it.
What do you think?
I was just completely baffled by this. I asked her why it was her responsibility to watch all the children at the party, when she was hosting it at a third-party location, and presumably those children also have parents. She told me that it's her experience that the parents will just leave the children there, and then it is her job to keep track of them. If one of them got lost, she would be responsible.
Again, I was baffled. If a parent goes to a party and leaves their five-year-old child there without asking if it's OK, and the kid gets lost, how is that in any way the fault of the person holding the party? Does "party" somehow equate to "licensed childcare center"? There's nothing in the party invitation that says your child will be watched. I personally would assume that a person hosting a children's party would be far too busy to take care of 20 children, so as painful as it is, I usually stick around at these parties.
I pointed all that out, but my friend was insistent that multiple parents had left their kids at her parties in the past, and she felt responsible for all the children. She said if something happened to one of them, even at a third-party location, she would almost certainly be legally blamed for it.
What do you think?
Tuesday, July 21, 2015
Dr. Orthochick: Curing cancer (not)
Mom: What's on your agenda for the week?
Me: Curing cancer.
Hey, it's not a total lie.
We did a big sarcoma case today, which I was looking forward to because I've never seen one. Soft tissue sarcomas are pretty rare, which is a good thing because they're aggressive as hell. It's deceptive, you figure if you have a tumor on your arm you can cut it out and you'll be fine, but they tend to invade your nerves and blood vessels, which means if you cut it out, you probably also have to cut off your arm since it won't be viable anymore. Also, they metastasize to the lungs. So they have a pretty crappy 5-year survival rate, and since they're so rare, not much research goes into these things so we don't have great ways of treating them. Usually you hit them with radiation, which in and of itself carries a risk of causing sarcoma.
So like I said, the surgery involves totally gutting the extremity. If you're lucky, you wind up with a functional extremity. If not, you get an amputation. This guy had a giant soft tissue tumor sitting right in his arm. It was about the size of a grapefruit and had been steadily growing for the past few months, but since he didn't have insurance and it didn't hurt, he didn't do anything about it. So by the time he was able to get an MRI of it, it had invaded his radial artery and a couple of nerves. It was also sitting right in the muscle that helps you extend your wrist. It hadn't spread to his lungs, which is good, but it also hadn't shrunk much with the 30 doses of radiation it had been attacked with, which is bad.
We made a long incision over the mass and the radial artery was pulsating through it. Which meant the radial artery had to go. Most people are actually ulnar artery-dominant (even though the radial pulse is the one you feel) so you can still have a functional arm without a radial artery, but it's not a great sign if that's the first thing you see in a surgery. So we tied off the artery, which is probably one of three times in ortho that I hand-tie my surgical knots. (I'm not including arthroscopic knots in this. The other two times that I can think of off the top of my head are when you use pop-off sutures at the end of a spine surgery and when you're with Dr. Smile and he makes you sew wound towels into your sterile field) The only reason I mention this is because this was stressed as very important on my general surgery rotation and my OB-GYN rotation and seriously, it's instrument tie or bust over here. I mean, I know how to hand tie, but I promise, you can be a surgeon without really being good at it.
The rest of the surgery was pretty much more of the same. Since he had received radiation preoperatively, his tissues were really friable, so they bled any time you touched them. Which meant the surgical field was a big bloody mess. Also, we had to sacrifice most of his wrist extensors since they had tumor strewn throughout them. We lost a couple of nerves to the tumor. After about three hours of this, we closed him up and called it a day. Except the thing is, we hadn't removed the whole tumor. It was so extensive that there wasn't going to be a way to get the whole thing out and still give him a viable arm. The tumor had crawled over almost the entire forearm and slimed down to the bones. So normally you resect the whole tumor and 5cm margins in all directions, but in this case we didn't bother since it wouldn't be possible to get margins without an amputation.
Dr. Tumor: We are so intralesional, it's not even funny.
So yeah, surgery was a big bloody mess and the dude is still going to need an amputation. I guess we're not really curing cancer over here.
Me: Curing cancer.
Hey, it's not a total lie.
We did a big sarcoma case today, which I was looking forward to because I've never seen one. Soft tissue sarcomas are pretty rare, which is a good thing because they're aggressive as hell. It's deceptive, you figure if you have a tumor on your arm you can cut it out and you'll be fine, but they tend to invade your nerves and blood vessels, which means if you cut it out, you probably also have to cut off your arm since it won't be viable anymore. Also, they metastasize to the lungs. So they have a pretty crappy 5-year survival rate, and since they're so rare, not much research goes into these things so we don't have great ways of treating them. Usually you hit them with radiation, which in and of itself carries a risk of causing sarcoma.
So like I said, the surgery involves totally gutting the extremity. If you're lucky, you wind up with a functional extremity. If not, you get an amputation. This guy had a giant soft tissue tumor sitting right in his arm. It was about the size of a grapefruit and had been steadily growing for the past few months, but since he didn't have insurance and it didn't hurt, he didn't do anything about it. So by the time he was able to get an MRI of it, it had invaded his radial artery and a couple of nerves. It was also sitting right in the muscle that helps you extend your wrist. It hadn't spread to his lungs, which is good, but it also hadn't shrunk much with the 30 doses of radiation it had been attacked with, which is bad.
We made a long incision over the mass and the radial artery was pulsating through it. Which meant the radial artery had to go. Most people are actually ulnar artery-dominant (even though the radial pulse is the one you feel) so you can still have a functional arm without a radial artery, but it's not a great sign if that's the first thing you see in a surgery. So we tied off the artery, which is probably one of three times in ortho that I hand-tie my surgical knots. (I'm not including arthroscopic knots in this. The other two times that I can think of off the top of my head are when you use pop-off sutures at the end of a spine surgery and when you're with Dr. Smile and he makes you sew wound towels into your sterile field) The only reason I mention this is because this was stressed as very important on my general surgery rotation and my OB-GYN rotation and seriously, it's instrument tie or bust over here. I mean, I know how to hand tie, but I promise, you can be a surgeon without really being good at it.
The rest of the surgery was pretty much more of the same. Since he had received radiation preoperatively, his tissues were really friable, so they bled any time you touched them. Which meant the surgical field was a big bloody mess. Also, we had to sacrifice most of his wrist extensors since they had tumor strewn throughout them. We lost a couple of nerves to the tumor. After about three hours of this, we closed him up and called it a day. Except the thing is, we hadn't removed the whole tumor. It was so extensive that there wasn't going to be a way to get the whole thing out and still give him a viable arm. The tumor had crawled over almost the entire forearm and slimed down to the bones. So normally you resect the whole tumor and 5cm margins in all directions, but in this case we didn't bother since it wouldn't be possible to get margins without an amputation.
Dr. Tumor: We are so intralesional, it's not even funny.
So yeah, surgery was a big bloody mess and the dude is still going to need an amputation. I guess we're not really curing cancer over here.
Saturday, July 18, 2015
2 degrees
In the back office where I do my charting, we had an air-conditioner installed for the summer. I'm one of those people who is basically always cold, and it takes 90° weather to make me even take my sweater off.
So basically, I am constantly changing the thermostat on the air conditioner. I raise the number, then someone else lowers it.
But the crazy thing is that we are fighting over 2°. I raise the temperature to 73° and somebody else lowers it to 71°. I have no idea why those 2° makes such a difference.
It's sort of makes me feel bad for mocking that car commercial where you could have one half of the car at a slightly different temperature than the other half of the car.
So basically, I am constantly changing the thermostat on the air conditioner. I raise the number, then someone else lowers it.
But the crazy thing is that we are fighting over 2°. I raise the temperature to 73° and somebody else lowers it to 71°. I have no idea why those 2° makes such a difference.
It's sort of makes me feel bad for mocking that car commercial where you could have one half of the car at a slightly different temperature than the other half of the car.
Thursday, July 16, 2015
Trivia
Patient: "Now that you've asked me your questions, I've got one for you."
Me: "go for it."
Patient: "there were five presidents who were Generals in The Civil War. Can you name them?"
Me: "Grant…"
Patient: "right..."
Me: "that the only one I can think of."
Patient: "I'll give you a hint. Two of their names start with H, two start with G, and one starts with A."
Me: "Garfield..."
Patient: "right."
Me: "Arthur."
Patient: "right."
Me: "Harrison."
Patient: "right."
Me: "um... Hoover?"
Patient: "oh my God, that's completely the wrong war."
Me: "I give up."
Patient: "it's Harrelson."
Me: "I'm pretty sure there isn't a President named Harrelson."
Patient: "look it up."
I don't need to look it up to know that there isn't a president named Woody Harrelson.
Me: "go for it."
Patient: "there were five presidents who were Generals in The Civil War. Can you name them?"
Me: "Grant…"
Patient: "right..."
Me: "that the only one I can think of."
Patient: "I'll give you a hint. Two of their names start with H, two start with G, and one starts with A."
Me: "Garfield..."
Patient: "right."
Me: "Arthur."
Patient: "right."
Me: "Harrison."
Patient: "right."
Me: "um... Hoover?"
Patient: "oh my God, that's completely the wrong war."
Me: "I give up."
Patient: "it's Harrelson."
Me: "I'm pretty sure there isn't a President named Harrelson."
Patient: "look it up."
I don't need to look it up to know that there isn't a president named Woody Harrelson.
Tuesday, July 14, 2015
Dr. Orthochick: Haircut fail
My last haircut was back in July, I had just finished up Saturday call so I figured Sunday morning would be a good time to go because most people get stuff done on Sunday afternoon. As far as I can tell, the best part about weekend call is when it's over it's usually still early in the morning so you can be the first person at the wal-mart auto department and you don't have to wait in line for an oil change. So all unpleasant tasks get relegated to postcall weekend mornings for me.
Anyway, I was getting my hair brushed out when my pager went off. So I answered it because I feel like it's sort of a dick move to not answer your pager if it's physically on your person and you're getting paged about a patient you saw less than an hour ago. You could also make the argument that it's a dick move to ask the person cutting your hair to stop for a minute, but I feel like the potential for death in that situation is lower.
The pager was quiet until about halfway through the haircut, at which point it went off 4 times and I told the hairdresser it was OK for her to help someone else. Also at that time, Dr. Alcoholic called me about a patient. During the course of the conversation, his computer stopped working and I tried to walk him through how to restart it in safe mode to reboot to etc etc etc.
Dr. Alcoholic: Can you just come back and help me?
So I did. I paid for the haircut (the whole thing, I guess), left a nice tip, and told the woman I would be back later.
Hairdresser: I was jealous of you for being a doctor, but now I'm not.
I was too embarrassed to go back so I finished it up myself at home and I've been wearing it skewered back ever since. According to my hairdresser today, the layers were uneven, the front was choppy, and the right side was longer than the left.
So yeah. I figured I should probably get that remedied before I go for interviews, even though mom told me to wear my hair back to look more professional. I'm not sure how to take that since mom told me to wear my hair down on my first day of internship to look older.
Anyway, I was getting my hair brushed out when my pager went off. So I answered it because I feel like it's sort of a dick move to not answer your pager if it's physically on your person and you're getting paged about a patient you saw less than an hour ago. You could also make the argument that it's a dick move to ask the person cutting your hair to stop for a minute, but I feel like the potential for death in that situation is lower.
The pager was quiet until about halfway through the haircut, at which point it went off 4 times and I told the hairdresser it was OK for her to help someone else. Also at that time, Dr. Alcoholic called me about a patient. During the course of the conversation, his computer stopped working and I tried to walk him through how to restart it in safe mode to reboot to etc etc etc.
Dr. Alcoholic: Can you just come back and help me?
So I did. I paid for the haircut (the whole thing, I guess), left a nice tip, and told the woman I would be back later.
Hairdresser: I was jealous of you for being a doctor, but now I'm not.
I was too embarrassed to go back so I finished it up myself at home and I've been wearing it skewered back ever since. According to my hairdresser today, the layers were uneven, the front was choppy, and the right side was longer than the left.
So yeah. I figured I should probably get that remedied before I go for interviews, even though mom told me to wear my hair back to look more professional. I'm not sure how to take that since mom told me to wear my hair down on my first day of internship to look older.
Monday, July 13, 2015
Saturday, July 11, 2015
Weekly Whine: Teen Suicide
As a person who will be the mother of teenage girls in the not so far off future, the idea of teen suicide scares me. A lot. I think that books about teen suicide may serve a purpose in educating potential bullies, the bullied, and adults about what makes a teenager take their own life.
That's why it makes me so angry that so many of those books are so bad.
One book I read recently was called 13 Reasons Why. It's about a girl who makes a tape blaming 13 people who she felt contributed to her recent suicide. Except none of the people she were blaming actually did anything that bad. One was a girl who was her friend at the beginning of the year, then *gasp* stopped being her friend. Another with a guy who got grabby on a first date, then called her a tease and stormed off when she pushed him away. I kept waiting for one of those people to be the uncle that molested her or something, but no... there was only a guy who voted her Best Ass in the grade. Oh my God, I have a great ass, I'm going to kill myself. The book got really good reviews, although there were a few reviewers who said that they actually work with teenagers who are suicidal, and the book in no way represented them.
More recently, I read a book called Tease. This was an interesting book from the point of view of the bully. Except once again, the suicide didn't make sense. The girl who killed herself basically stole the boyfriend of another girl at her own party right in front of her, then they got revenge by making a nasty Facebook page. Then after the suicide, they got in trouble for being bullies, but really, what did the girl expect after she stole the other girl's boyfriend? I mean, we are talking about 16-year-olds. It's not like she was minding her business and everyone just targeted her.
And these books all feature the most useless guidance counselors ever. In at least two books to read, the girl outright says she's thinking about suicide, and the guidance counselor just says, "you probably shouldn't do that," then takes no further action. I hope that doesn't really happen.
It would just be nice for these books to get into the real reasons that teenagers commit suicide. Because I feel like these books are just an insult.
That's why it makes me so angry that so many of those books are so bad.
One book I read recently was called 13 Reasons Why. It's about a girl who makes a tape blaming 13 people who she felt contributed to her recent suicide. Except none of the people she were blaming actually did anything that bad. One was a girl who was her friend at the beginning of the year, then *gasp* stopped being her friend. Another with a guy who got grabby on a first date, then called her a tease and stormed off when she pushed him away. I kept waiting for one of those people to be the uncle that molested her or something, but no... there was only a guy who voted her Best Ass in the grade. Oh my God, I have a great ass, I'm going to kill myself. The book got really good reviews, although there were a few reviewers who said that they actually work with teenagers who are suicidal, and the book in no way represented them.
More recently, I read a book called Tease. This was an interesting book from the point of view of the bully. Except once again, the suicide didn't make sense. The girl who killed herself basically stole the boyfriend of another girl at her own party right in front of her, then they got revenge by making a nasty Facebook page. Then after the suicide, they got in trouble for being bullies, but really, what did the girl expect after she stole the other girl's boyfriend? I mean, we are talking about 16-year-olds. It's not like she was minding her business and everyone just targeted her.
And these books all feature the most useless guidance counselors ever. In at least two books to read, the girl outright says she's thinking about suicide, and the guidance counselor just says, "you probably shouldn't do that," then takes no further action. I hope that doesn't really happen.
It would just be nice for these books to get into the real reasons that teenagers commit suicide. Because I feel like these books are just an insult.
Thursday, July 9, 2015
Human body
This is a drawing my daughter did of the human body from memory:
I challenge you to find three things wrong with it.
I challenge you to find three things wrong with it.
Wednesday, July 8, 2015
Red Cross
In the upcoming anthology I am publishing, I had pledged to donate all the profits to Red Cross. However, since then, a few people have made me aware of a scandal involving Red Cross.
I'm not sure how much of this all is legitimate. I always thought of Red Cross as being really a good charity. But I don't want to donate money to them if it's not going to go to the right place. I feel like donating to Third World countries is the best use of donations.
Another alternative is Doctors Without Borders, which we already donate to. But I liked the idea of Red Cross better, because it seem to encompass all medical specialties more generally.
Thoughts?
I'm not sure how much of this all is legitimate. I always thought of Red Cross as being really a good charity. But I don't want to donate money to them if it's not going to go to the right place. I feel like donating to Third World countries is the best use of donations.
Another alternative is Doctors Without Borders, which we already donate to. But I liked the idea of Red Cross better, because it seem to encompass all medical specialties more generally.
Thoughts?
Tuesday, July 7, 2015
Dr. Orthochick: Got the giggles
Text message received today from my co-resident:
We consulted urology on a patient and they recommended a jockstrap
We consulted urology on a patient and they recommended a jockstrap
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