I'm attending a complete dude fest, also known as the annual American Urological Association (AUA) meeting. It's held in the illustrious city of Chicago this year, and it's been quite fun and informative so far. Though it has "american" as part of its acronym, the AUA is actually quite an international event with tons of international urologists in attendance. I'm constantly hearing Spanish, Portuguese, Arabic, French, Korean, Japanese, German and many other languages in the meeting halls. It's quite impressive and makes for a nice multi-cultural event.
However, I'm never more amazed at the paucity of women in urology than when I attend a meeting like this. There are literally thousands of urologists buzzing around at the convention center, most in a conservative (and dare I say unfashionable) grey or navy suit, with the occasional woman thrown in for good measure. The ratio is quite impressive, and I do somewhat feel like a single daffodil in a bed of roses. (or something like that...I can't think of another analogy right now). And more often that not, when I see another woman, she really ends up being a pharmaceutical representative....
The one HUGE advantage for me are the mostly vacant women's restrooms. There is never a line and most of the time, I have the multi-stall bathrooms all to myself! When does that ever happen anywhere else?
And with such a concentration of urologists in one meeting, the conversation is bound the be fascinating!!! Urine, prostate, ED... what more could you ask for?
Monday, April 27, 2009
Wednesday, April 15, 2009
Show and tell
Doctors love it (NOT) when patients come into the office carrying jars or other homemade specimen containers holding all manners of bodily fluids.
I am sure that the average PCP or ENT doc has seen their share of "funny-looking" or -insert favorite color- sputum that the patient carefully brought with them to the office, after they had been saving the used Kleenex for a day or so....or perhaps the occasional stool specimen.
You can see where this is going, since I am a urologist....
I actually encourage patients to bring me the kidney stones they have passed. We can get those analyzed, and the information is quite useful in terms of preventing new stones. I've also had patients bring me samples for semen analysis, and it never fails, but these patients always seem to bring the specimen in a baby food jar...?!
However, I have also been presented more bizarre specimen, including incontinence pads where "the urine just looked a funny color", but nothing can quite top the patient who comes in with hematospermia.
For the non-medically inclined, hematospermia means "blood in the semen", which is most often a benign condition, though it may be somewhat alarming to the patient who experiences it for the first time. I've actually had patients bring me their used condoms as demonstration aids. However, the recent octagenarian who saw me for hematospermia had the good graces to bring me two used kleenex full of ejaculatory material in a ziplock bag... and they didn't exactly look like recent specimens... After donning gloves and gingerly placing the ziplock in the trash, my first thought was actually congratulatory: 80+ years old and sexually active? Way to go!!!
I am sure that the average PCP or ENT doc has seen their share of "funny-looking" or -insert favorite color- sputum that the patient carefully brought with them to the office, after they had been saving the used Kleenex for a day or so....or perhaps the occasional stool specimen.
You can see where this is going, since I am a urologist....
I actually encourage patients to bring me the kidney stones they have passed. We can get those analyzed, and the information is quite useful in terms of preventing new stones. I've also had patients bring me samples for semen analysis, and it never fails, but these patients always seem to bring the specimen in a baby food jar...?!
However, I have also been presented more bizarre specimen, including incontinence pads where "the urine just looked a funny color", but nothing can quite top the patient who comes in with hematospermia.
For the non-medically inclined, hematospermia means "blood in the semen", which is most often a benign condition, though it may be somewhat alarming to the patient who experiences it for the first time. I've actually had patients bring me their used condoms as demonstration aids. However, the recent octagenarian who saw me for hematospermia had the good graces to bring me two used kleenex full of ejaculatory material in a ziplock bag... and they didn't exactly look like recent specimens... After donning gloves and gingerly placing the ziplock in the trash, my first thought was actually congratulatory: 80+ years old and sexually active? Way to go!!!
Monday, April 06, 2009
New favorite website of the day
This is why you're fat.
It's like watching a car accident in slo-mo – I just can't take my eyes off of it. It makes my stomach churn, but I can't figure out whether it's in a good or a bad way.
It's like watching a car accident in slo-mo – I just can't take my eyes off of it. It makes my stomach churn, but I can't figure out whether it's in a good or a bad way.
Thursday, April 02, 2009
Picture perfect
Imagine this scenario:
Two hard-of-hearing patients both in a crowded clinic waiting room.... (sounds like the start of a good joke, doesn't it?) The nurse opens the door and calls out a name: "Mr. Will Shakespeare!!!" An elderly patient stands up and walks into the exam room. The nurse proceeds to take vital signs and obtains a urine sample and other pertinent information before informing the doctor that the patient is ready to be seen.
The doctor walks into the room and says: "Hi Mr. Shakespeare, how are you doing today?" to which the patient promptly replies: "Huh??? My name's not Shakespeare, it's Andre Gide!"
Yes, indeed, the wrong patient got up from the waiting room after mishearing the name (though the two names did NOT sound alike in the very least), and no-one figured this out until I walked into the room. The real Will Shakespeare had not even heard his name being called in the waiting room. Yikes...
Not only that, but the same thing happened TWICE that day, though the second time, the nurse caught the mistake early in the encounter.!!! But what are the chances????
I have subsequently become a total convert on the merits of patient pictures pasted clearly on the front of the chart. Many practices, especially those with EMR have this in place already, and I simply cannot wait until we get ours. The practice of medicine is confusing already without identity snafus. And please wear your hearing aid at the doctor's office.
Two hard-of-hearing patients both in a crowded clinic waiting room.... (sounds like the start of a good joke, doesn't it?) The nurse opens the door and calls out a name: "Mr. Will Shakespeare!!!" An elderly patient stands up and walks into the exam room. The nurse proceeds to take vital signs and obtains a urine sample and other pertinent information before informing the doctor that the patient is ready to be seen.
The doctor walks into the room and says: "Hi Mr. Shakespeare, how are you doing today?" to which the patient promptly replies: "Huh??? My name's not Shakespeare, it's Andre Gide!"
Yes, indeed, the wrong patient got up from the waiting room after mishearing the name (though the two names did NOT sound alike in the very least), and no-one figured this out until I walked into the room. The real Will Shakespeare had not even heard his name being called in the waiting room. Yikes...
Not only that, but the same thing happened TWICE that day, though the second time, the nurse caught the mistake early in the encounter.!!! But what are the chances????
I have subsequently become a total convert on the merits of patient pictures pasted clearly on the front of the chart. Many practices, especially those with EMR have this in place already, and I simply cannot wait until we get ours. The practice of medicine is confusing already without identity snafus. And please wear your hearing aid at the doctor's office.
Monday, March 30, 2009
Happy National Doctor's Day!
I know this was the main thought of your day today, with March 30th being national doctor's day. And there was great celebration and rejoicing!!! ...huh, not really. Despite the fact that this has been an annual event for the past several years, I'm only really aware of it when I start getting letters from my hospitals telling me how much they appreciate me.
So I did a little internet research regarding this so-called holiday. Apparently this got started on March 30, 1933, a date which marks the anniversary of the first use of general anesthesia in surgery. However, the first national doctor's day was not officially celebrated until 1991.
Anyway, the perks for me include cafeteria coupons from two hospitals for $2.50 and $5.00, and another hospital actually offering a free lunch today (!), which I was unable to attend because of a crazy schedule. I just wonder whether the hospital who gave me the $5.00 coupon cares more about me than the hospital that only offered me a $2.50 coupon....
So I did a little internet research regarding this so-called holiday. Apparently this got started on March 30, 1933, a date which marks the anniversary of the first use of general anesthesia in surgery. However, the first national doctor's day was not officially celebrated until 1991.
Anyway, the perks for me include cafeteria coupons from two hospitals for $2.50 and $5.00, and another hospital actually offering a free lunch today (!), which I was unable to attend because of a crazy schedule. I just wonder whether the hospital who gave me the $5.00 coupon cares more about me than the hospital that only offered me a $2.50 coupon....
Friday, March 27, 2009
Redemption
Despite the nature of my job, and despite what some of my readers may think, I don't actually enjoy causing pain and suffering. In fact, I'm barely able to watch a gory horror movie though I know intellectually that special effects and acting (some of it bad) are creating the images.
I'm acutely aware that some surgeries/procedures hurt more than others, whether the pain be purely physical, or with a significant psychological aspect. I think orchiectomies (removal of testes) definitely fall into this category.
Even though an orchiectomy is technically a very simple procedure, most patients (especially the male patients) tend to cringe more at the very thought of it, as opposed to something like a nephrectomy (removal of a kidney), even though the latter is a much bigger and complex operation. I know men who have undergone significant guilt and trauma at the thought of neutering their male dogs.
Unfortunately, when a patient is diagnosed with a solid testicular tumor, we need to remove that testis since the chances of it being testicular cancer is extremely high (>90%). Thankfully, testicular cancer is a relatively rare disease with approximately 8000 new cases diagnosed each year in the US. It affects mostly younger patients (kids to men in their thirties) and it's an extremely curable type of cancer, with Lance Armstrong being the poster child. In fact, I tell newly diagnosed patients that though it sucks to have cancer, if you had to get cancer, this would be the one to get. Even with metastatic disease, the survival rate is about 96%!
Normally, I tend to see one new testicular cancer patient every couple of years, but this past month exceeded my expectations. I saw two new patients within a week of each other, and ended up doing their orchiectomies back to back on the same day.
"Ball buster" and "emasculator" were some of the more polite nicknames being passed around in the OR that day, and truth be told, I wasn't too comfortable with these monikers. For some reason, removing a pesky kidney or prostate just seems so much less personal to me. One of my older partner's tried to console me by telling me his record of NINE bilateral orchiectomies in a single day. (Those were the olden days before the advent of Lupron, when patients with prostate cancer needed to be surgically castrated to keep their cancer in check. Lupron is an injectable drug that lowers testosterone that we use nowadays as opposed to surgery.)
And then just yesterday, I had a patient come into the ER with testicular torsion. He was one of the rare patients who presented in enough time for me to swiftly whisk him to the OR and save his testicle! (there is a window of 6 to 8 hours before the testis undergoes permanent damage for lack of blood flow and oxygen, at which point I have to do an orchiectomy). I felt some degree of redemption, and all was right in the world again....
I'm acutely aware that some surgeries/procedures hurt more than others, whether the pain be purely physical, or with a significant psychological aspect. I think orchiectomies (removal of testes) definitely fall into this category.
Even though an orchiectomy is technically a very simple procedure, most patients (especially the male patients) tend to cringe more at the very thought of it, as opposed to something like a nephrectomy (removal of a kidney), even though the latter is a much bigger and complex operation. I know men who have undergone significant guilt and trauma at the thought of neutering their male dogs.
Unfortunately, when a patient is diagnosed with a solid testicular tumor, we need to remove that testis since the chances of it being testicular cancer is extremely high (>90%). Thankfully, testicular cancer is a relatively rare disease with approximately 8000 new cases diagnosed each year in the US. It affects mostly younger patients (kids to men in their thirties) and it's an extremely curable type of cancer, with Lance Armstrong being the poster child. In fact, I tell newly diagnosed patients that though it sucks to have cancer, if you had to get cancer, this would be the one to get. Even with metastatic disease, the survival rate is about 96%!
Normally, I tend to see one new testicular cancer patient every couple of years, but this past month exceeded my expectations. I saw two new patients within a week of each other, and ended up doing their orchiectomies back to back on the same day.
"Ball buster" and "emasculator" were some of the more polite nicknames being passed around in the OR that day, and truth be told, I wasn't too comfortable with these monikers. For some reason, removing a pesky kidney or prostate just seems so much less personal to me. One of my older partner's tried to console me by telling me his record of NINE bilateral orchiectomies in a single day. (Those were the olden days before the advent of Lupron, when patients with prostate cancer needed to be surgically castrated to keep their cancer in check. Lupron is an injectable drug that lowers testosterone that we use nowadays as opposed to surgery.)
And then just yesterday, I had a patient come into the ER with testicular torsion. He was one of the rare patients who presented in enough time for me to swiftly whisk him to the OR and save his testicle! (there is a window of 6 to 8 hours before the testis undergoes permanent damage for lack of blood flow and oxygen, at which point I have to do an orchiectomy). I felt some degree of redemption, and all was right in the world again....
Wednesday, March 11, 2009
Out of Jail!!!
I would like to say that I was pitifully huddled on a pallet in a Singapore jail, awaiting my sentencing for smuggling illegal chewing gum, but the truth is much more simple: I have just been busy and preoccupied. Thanks for all the caring and concerned messages you have left on my last post. It's really nice to feel loved...I am very much alive and doing quite well.
The last time I wrote was before my trip to Southeast Asia, which now seems such a long time ago. How did we get to be in March already? AND it's the year 2009???? Yikes... Time really seems to fly by when you are busy. And please, don't think that I am complaining about being busy. Au contraire, I say a daily prayer of thanks for having a steady job that allows me to pay my bills... And more importantly, brings out the creative literary side of my character...
Being in Southeast Asia was quite an amazing experience. I especially enjoyed Hanoi in Vietnam because I felt so removed from the Western world. There is still very little western influences in Vietnam compared to the rest of Asia, and it made for a truly enjoyable and memorable authentic experience.
Another immediate noticeable difference in Asia was the average body mass index. This trip really highlighted a recent urology consult request by the hospitalist. It was one of my least favorite type of consult: difficult foley catheter insertion.
Now there are many things that can cause problems with placing a foley catheter including urethral strictures, BPH (enlarged prostate), tight sphincters (really!), previous prostate-related surgeries etc... But this was the first time I was asked to help in actually locating the patient's penis! He weighed in at a whopping 550 lbs, had been bed-bound for the last year or so, and his thighs and belly were so big that no-one could actually find his penis.
I was a little apprehensive after getting the call. I mean, this was not a typical difficult foley consult. I wasn't really sure they needed a urologist per se as opposed to an archeologist with a team of excavators... I can finagle a catheter through the tightest urethral stricture, but trying to find the opening of the urethra (meatus) when the penis is "lost"amidst a sea of flesh? A daunting task indeed...
I went to the ward armed with my physician assistant and four nurses. Two nurses held apart the patient's legs while two others were pulling up his pannus (the big hanging belly fold) away from his groin area. Where the genitalia should normally be was just a big dimple and my hopes for a miraculous emergence were dashed. Using both my hands, I pushed down onto the area where I thought the penis should be, and with a lot of pressure, something that looked like the meatus slowly unfolded. With even more steady pressure, the rest of the shaft slowly materialized and my PA was finally able to slip in a catheter.
I felt victorious for a self-congratulatory second, but these feelings quickly faded as I interacted with the patient. He was actually a very nice man, but completely trapped into a unmanageable body that was rapidly failing him. How does anyone get so big? Why does this seem to happen mostly in the States?
The last time I wrote was before my trip to Southeast Asia, which now seems such a long time ago. How did we get to be in March already? AND it's the year 2009???? Yikes... Time really seems to fly by when you are busy. And please, don't think that I am complaining about being busy. Au contraire, I say a daily prayer of thanks for having a steady job that allows me to pay my bills... And more importantly, brings out the creative literary side of my character...
Being in Southeast Asia was quite an amazing experience. I especially enjoyed Hanoi in Vietnam because I felt so removed from the Western world. There is still very little western influences in Vietnam compared to the rest of Asia, and it made for a truly enjoyable and memorable authentic experience.
Another immediate noticeable difference in Asia was the average body mass index. This trip really highlighted a recent urology consult request by the hospitalist. It was one of my least favorite type of consult: difficult foley catheter insertion.
Now there are many things that can cause problems with placing a foley catheter including urethral strictures, BPH (enlarged prostate), tight sphincters (really!), previous prostate-related surgeries etc... But this was the first time I was asked to help in actually locating the patient's penis! He weighed in at a whopping 550 lbs, had been bed-bound for the last year or so, and his thighs and belly were so big that no-one could actually find his penis.
I was a little apprehensive after getting the call. I mean, this was not a typical difficult foley consult. I wasn't really sure they needed a urologist per se as opposed to an archeologist with a team of excavators... I can finagle a catheter through the tightest urethral stricture, but trying to find the opening of the urethra (meatus) when the penis is "lost"amidst a sea of flesh? A daunting task indeed...
I went to the ward armed with my physician assistant and four nurses. Two nurses held apart the patient's legs while two others were pulling up his pannus (the big hanging belly fold) away from his groin area. Where the genitalia should normally be was just a big dimple and my hopes for a miraculous emergence were dashed. Using both my hands, I pushed down onto the area where I thought the penis should be, and with a lot of pressure, something that looked like the meatus slowly unfolded. With even more steady pressure, the rest of the shaft slowly materialized and my PA was finally able to slip in a catheter.
I felt victorious for a self-congratulatory second, but these feelings quickly faded as I interacted with the patient. He was actually a very nice man, but completely trapped into a unmanageable body that was rapidly failing him. How does anyone get so big? Why does this seem to happen mostly in the States?
Saturday, December 20, 2008
Happy Holidays!
I will be taking a short break over the holiday season. We are traveling to Southeast Asia for the very first time, and I am really looking forward to all the new culture, colors and culinary delights awaiting us. Moreover, we will be traveling with my parents, which should make it an even more interesting trip.
I will be back the first week of January to give a mini trip report. Hope everyone has a safe and happy Christmas/Hanukkah/New Year!!!
I will be back the first week of January to give a mini trip report. Hope everyone has a safe and happy Christmas/Hanukkah/New Year!!!
Thursday, December 11, 2008
Radiation scare
Recently, I have begun to see more and more patients who are sent to my office from the ER with presumed renal/ureteral stones without a CT scan.
They present with typical symptoms such as blood in the urine, sudden flank pain and mild nausea, and if they've had a stone in the past, some ER physicians will not order a CT scan for fear of radiation exposure, and subsequently will send these patients to see me as an outpatient.
So what do I end up doing? Yup, I order a CT scan after talking to the patient about the risks of additional radiation, especially if the patient has been suffering for a few days already without resolution. Most patients are willing to do this since they also want to figure out what is going on and determine the best course of treatment. The last such patient actually had a 5 mm stone with severe hydronephrosis, and I took her to the operating room exactly 17 hours after I ordered the CT.
So I understand the desire to cut back on unecessary and potentially harmful tests. If the patient already had a CT that revealed stones, and he returned to the ER a couple of days later with the same pain, I probably would not order another one. But there are also times when these tests are crucial.
PS: I'm forever grateful to my husband who tirelessly constructs new looks for my blog. I really like the new simplified motif, though I'm glad he still left some pink, being that it's one of my favorite colors. Thanks honey!
So I understand the desire to cut back on unecessary and potentially harmful tests. If the patient already had a CT that revealed stones, and he returned to the ER a couple of days later with the same pain, I probably would not order another one. But there are also times when these tests are crucial.
PS: I'm forever grateful to my husband who tirelessly constructs new looks for my blog. I really like the new simplified motif, though I'm glad he still left some pink, being that it's one of my favorite colors. Thanks honey!
Tuesday, December 02, 2008
Pantomime
Though one of my nice older patient does not speak a word of English, this has never been a problem since he is always accompanied by a bevy of daughters who provide excellent translational services. However, communication issues arose after his admission to the hospital, when his relatives were not always present as I made rounds.
Though I speak four languages pretty fluently (including English!) and know a smattering of words in a dozen other languages, Vietnamese is not one of them... In order to ask a few basic questions, I resorted to pantomiming at his bedside.
As I was trying to ascertain whether he had ambulated that day, I did my version of the moonwalk. Then I asked him whether he had lunch by putting an imaginary spoon to my mouth and masticating imaginary yummy hospital food. Then wanting to know if his pain was under good control, I contorted my face into a painful grimace while holding my belly. (Now you must all envision this happening while I'm wearing nice pants with high heels and a white coat...)
I know Marcel Marceau would have been proud of my miming abilities! I want to go as far as to say that even the patient was duly impressed with my fine acting skills and I think he understood everything I was asking.
However, I had to draw the line at asking whether he passed gas or had a bowel movement....
Though I speak four languages pretty fluently (including English!) and know a smattering of words in a dozen other languages, Vietnamese is not one of them... In order to ask a few basic questions, I resorted to pantomiming at his bedside.
As I was trying to ascertain whether he had ambulated that day, I did my version of the moonwalk. Then I asked him whether he had lunch by putting an imaginary spoon to my mouth and masticating imaginary yummy hospital food. Then wanting to know if his pain was under good control, I contorted my face into a painful grimace while holding my belly. (Now you must all envision this happening while I'm wearing nice pants with high heels and a white coat...)
I know Marcel Marceau would have been proud of my miming abilities! I want to go as far as to say that even the patient was duly impressed with my fine acting skills and I think he understood everything I was asking.
However, I had to draw the line at asking whether he passed gas or had a bowel movement....
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