Sunday, August 23, 2009

Long, long week

My long week was topped off with a Sat to Sun 24-hour call. I accumulated 84.5 hours this week - it's amazing they make us pay tuition to work this much!

While I was on call I was able to work with a resident who was covering surgery from multiple services. This means I got to see surgical issues outside of bariatric surgery. A lot of elective surgeries are done on weekdays, so I wasn't in the operating room as much as normal. I only saw one surgery. It was a neck lymph node excisional biopsy of an AIDS patient who probably developed lymphoma. AIDS is a devastating disease and wrecks havoc on the body. I'm not sure what it is about infectious disease that fascinates me, but I was enthralled with this man's case. I read through his chart (which was basically a novel), and was able to review several infectious agents and the diseases they cause (Cytomegalovirus, Mycobacterium avium, Cryptococcus neoformans, and many more). AIDS completely destroys the immune system leaving its victims vulnerable to all sorts of crazy infections. It is an infectious disease doctor's dream... or nightmare... patient.

I spent most of my 24 hours in the ER working with Traumas and potential surgery candidates. As a student I basically collect the patient's history and perform a physical exam. I am able to formulate a diagnosis and a plan of action, and then present that to the resident. The resident then assesses the patient and changes or confirms my diagnosis and plan. This has been far more exciting for me than standing in surgery for hours at a time holding a retractor or camera. I love talking to patients, seeing the clinical manifestations of disease, and figuring out a solution to solve the problem. Actually fixing the problem (at least surgically) has been less exciting for me. I guess I'm not intended to be a surgeon...

We only had one trauma last night that was very minor. I guy was loading a scooter into a truck and it fell on him. As the trauma team assessed his condition I was able to help by cutting his clothes off, putting in a foley catheter, and cleaning up his wounds. I really enjoyed my night in the ER and I'm excited to spend the next month there. I'm really just excited to see new cases that don't involve surgically altering people's stomachs!

Sunday, August 16, 2009

Surgery continues...

I'm half way through my general surgery rotation and counting down the days for it to end. I'm really not loving it and I'm not sure what is wrong with me. The hours are insane and the residents and surgeons are some of the most self-centered, unfriendly people I have ever worked with. If this rotation is a true glimpse into the life of a general surgeon-then count me out!!

I am currently working with a bariatric surgeon. I see lots of gastric bypass surgeries and a lot of complications from previous lap band surgeries. Almost all of the patients I have been working with are morbidly obese and the doctor I work with treats obesity strictly as a disease rather than a result of lifestyle. This perspective has been interesting, but not one I fully embrace. I do believe that certain people are more prone to weight gain than others, but to call it a disease seems strange to me.

Obesity is one of the leading preventable causes of death worldwide and is viewed as one of the most serious public health problems of the 21st century. A lot of health problems are directly associated with weight: particularly heart disease, type 2 diabetes, sleep apnea, certain types of cancer, and osteoarthritis. People eliminate a number of health problems simply from losing weight. I was reading about obesity as a disease and came across "treatments" for this disease. The primary treatment for obesity is dieting and physical exercise. If this fails, anti-obesity drugs may be taken to reduce appetite or inhibit fat absorption. In severe cases, surgery is performed or a lap band is placed to reduce stomach volume and or bowel length, leading to earlier satiation and reduced ability to absorb nutrients from food.

These seem more like weight management options than disease treatments. In my opinion people have chronic diseases because of weight and not the other way around.

Seeing the surgery side to losing weight has left me disappointed. Surgery isn't the best solution in my opinion. I have seen far too many complications from bypass surgery, eventual weight gain after initial weight loss, and chronic problems from these surgeries. I feel like people choose to undergo surgery before they have exhausted other resources. I saw a surgery performed on a 21 year old! The doctor I'm working with feels like he is curing obesity by doing these surgeries. I think it is wonderful for people who use the surgery to lose weight, get off diabetes and blood pressure medications, and make a complete life style change. However, I have seen too many people who don't do these things and end up worse than they were before surgery.

These two people are heroes around here, and have proven that weight loss is possible without surgery. Mike and Ron from the biggest loser visit Toledo, Ohio!! Click Here!

Sunday, August 9, 2009

Babies, Bagels and Bloody Bowels

My pediatric surgery rotation ended last week, and I am quickly finding out how spoiled I was. My new rotation in general surgery is going to be insane. I've been on this service since Wednesday and have worked 53 hours!! I was lucky enough to get Sunday off.

I already miss working with little kids. My last week in pediatrics got really busy and I never blogged about some of the exciting things that happened. Our little preemie who was born at 25 weeks didn't do as well as expected with the drains they put in and ended up perforating his cecum. His X-rays showed a ton of free air in his abdomen - not a good sign. The little one went to the OR as soon as they could get an opening. The surgeon didn't know exactly what was wrong but knew he had to operate because of the X-ray. This was going to be an exploratory abdominal surgery to find out what was wrong. Can you imagine an exploratory surgery on a 25 week preemie?!? This little kid would consider my two hands held together as spacious. This whole experience was surreal. Half way through the surgery I thought I had entered a really bad dream. Here was this little tiny creature with a hole in his belly and little iddy biddy bloody intestines spilling out all over the operating area. They found the defect and sewed the ascending colon to the ileum and began to put him back together. When I left the hospital that day I ran into the parents in the elevator. They were anxious to hear any additional insight into what took place. The mother started crying when I told her the surgeons were very pleased with the outcome. It made me hold my boys a little tighter when I got home that night. I'm so lucky to have such healthy children.

There were plenty of other surgeries during that last week: Intussuception, volvulus, appendectomy, hernia repairs, circumcisions, and the most heartbreaking - perianal wart excision of a 2 year old. These weren't just a few warts. These were finger like projections sticking out of the girl's bum. I don't even want to imagine diaper changes after the surgeon was finished with her. This case almost made me consider becoming an advocate for the HPV vaccine. "One less, one less"

My diet during the pediatric rotation consisted of a lot of bagels. They always had free bagels in the resident's hall. Whenever I had a chance, which wasn't often, I would run up and grab a free bagel. I discovered the free PB and Jelly from the cafeteria condiment bar worked great on the free bagels! PB&J bagel sandwiches!! No free bagels at my new rotation. :(