6 posts tagged “medicine”
I'm not really sure what the fascination with intravaginal laparoscopy is. At first, I guess it was kind of cool that we could take out an appendix without leaving a scar... except for that the scar is pretty minimal for laparoscopic appendectomies anyway. Now, I just feel like surgeons have this bizarre fascination with seeing what kinds of things we can pull out of a woman's body via her vagina.
It's not even like the size of a kidney is impressive. Women push 9-pound, 22" infants out of them all the time... so the size of a kidney - even an adult one - isn't all that impressive. It's all about traffic, and making sure that you don't cut any of the stuff between vagina and kidney.
Laparoscopy is strange to me anyway, because it feels very much like surgery via video games. The surgeon has toys and a camera, and the goal is to perform the surgery by snaking these instruments and a flashlight and a camera around via a very small incision. It's fine for an appendectomy, which is (I am told -- having no real basis for comparison yet) a relatively simple procedure.
But removing a kidney is a Big Deal. It's one where I want there to be a big incision - because that's how I can guarantee that my surgeon is being thorough. I'm not impressed by aesthetics here - there are vessels to redirect and tubes to tie. Your kidney gets 20% of your blood supply - I'd like to keep as much of that in me as I can, and I'm not sure I'm comfortable with the idea of an impaired view of what he/she is working with. I don't want any ruptured arteries, or nicked bowels (...ew).
Plus... if I'm giving a kidney away, I think that's a scar I would want, and one I would be okay with seeing.
That being said, my personal views on any such matter should not be taken into account when making medical decisions. I am generally okay with laparoscopy - it's a wonderful tool for many surgeries, especially gallbladder removal. Kidney removal is commonly done by laparoscopy, anyway... I'm just not wild about the idea of a kidney being removed via this point of access. I don't think that vaginas are disgusting... I just don't think that the aesthetic concerns here merit a scar "there," rather on your abdomen, and I don't like the idea of what would happen if there was a complication via that route of access.
That's all. I should really go to bed.
Last night at sundown began the first night of the Jewish holiday of Pesach, or Passover, for those who are not well-versed in, well, Hebrew. It's a beautiful story - one that reminds us of the preciousness of our freedom, and of the suffering of those people who are not yet free. It's a wonderful time to gather with one's family, to sit together and enjoy a meal.
However, the holiday itself comes with a strict set of dietary laws that go beyond even the normal "Kashrut" laws. If one follows the laws to a "T" (and I don't, for several reasons that I will not go into here), then one eliminates anything that may have even a trace of leavening agent in it - nothing with non-approved wheat flour, legumes, corn... it gets tough (and I think, often a little silly). The market for Kosher for Passover food is huge. My personal observance tends pretty much towards "Don't eat anything with leavening in it." So, I do eat a lot of matzah - the topic of this educational entry.
Matzah is, quite literally, the "bread of affliction" our ancestors ate as they fled from Egypt after their freedom was granted. They did not have time to allow the bread to rise, and so it remained flat and hard as a pancake as it baked on their backs in the hot dessert sun. We eat it in copious amounts during the week, so as to remember the struggles of slavery, and the value of our redemption. During the year, there are several tasty varieties. During Pesach, this is pretty much what you get:
Except for one thing: you've forgotten that you think this every year. And it's never true. By the fourth or fifth day, your stomach will be positively crying out, begging for something, anything other than matzah. What makes your body do this?
That's right - paste.
So in effect, what you are doing when you consume matzah, is to chew and churn and otherwise break up the matzah, which has been baked, and add more water, to further break apart the bonds that allow the matzah, in dry form to stay together. This is pretty similar to any other food that you would happen to digest. However, in this case, you are digesting paste that was baked to become a cracker, and then breaking it back down once more into paste.
"Oh no!" your digestive tract screams, "There's a huge lump of paste sitting in my stomach!!" And so, in its infinite evolutionary wisdom, it adds more water, in hopes of solvating enough of the paste to make it passable. Once your small intestine has absorbed every possible shred of nutrition from this devil of a food, it sends it further down, where your large intestine tries desperately to reclaim the water that it put into it, but to no avail. That matzah is a sponge - it's going to take all of your body's moisture and hold onto it as tightly as physics will allow.
The cumulative effects of this process on the body lead to dehydration (and frankly, constipation) that can destroy a person who is not fully prepared to celebrate Pesach. I usually double my water intake (which is already significant) starting the week before. There are fruits and vegetables aplenty, the bonus of which is that, during Passover, I'm eating something that is NOT matzah. However, these steps are still never enough to fully combat the cruelty incurred upon the digestive tract by the appropriately-titled "bread of affliction."
So, I beg of you - if you, in a public restroom, hear little more than the constant groans of someone keeping Passover - be sympathetic. Offer up a few prunes, or even just an understanding smile.
... I am super, super busy. No more than usual, I suppose, but I have my time budgeted through midterms. I have about 22 hours of study time left this week, and about 12 hours of class. I'm going to the talent show on Friday night (and then perhaps out for pie?)
... I am done with Genetics until the final in a couple of weeks. Hurrah!
... I was the contrary person in my medical ethics discussion group. It was kind of fun. And a little frustrating at the same time, just because it happened to be an issue that I've thought a lot about. Then again, I've taken medical ethics coursework before, so I've seen most of the "big" case studies on the stuff we're talking about this term - right-to-die and end-of-life options is the topic for this week.
... Excited for St. Pat's! To be fair, it might have more to do with the fact that "The Big Bang Theory" is coming back, and additionally, that there will be corned beef. And cabbage. And potatoes. And a super-secret dessert that I can't wait to make.
... Already anticipating the fatty nap I'm taking after midterms are over. My life improves so much when Genetics is over - I'll only have two finals (and Ethics and Epi... but whatever).
I spent the day shadowing a geriatrician - he's a family medicine physician with fellowship experience in geriatrics. Old person medicine, basically. It was mostly really interesting, even though there was quite a bit that I didn't get to see. I had lots of time to think about things... seven pages worth of time, in fact. Here's a summary:
The American population is beginning to trend towards older people, as the lifespan continues to increase. The average lifespan was once in the early fifties. Now, the average is closer to 80 years old. This should fundamentally alter how we look at funding Medicare, Medicaid, and health care in general.
Medicare is funded by a payroll tax of 2.9% of gross payment. In 2004, the average American made $43,389, and so, not taking into account inflation, the average American will pay in around $54,000. This isn't a reliable figure, because I'm not capable of predicting inflation patterns. Suffice it to say, the actual number is more than that, but health care costs should also increase at or slightly greater than the rate of inflation. The average lifetime per capita expenditure for health care is $316,600 [1] , including childcare health costs, which are generally covered under parental health insurance if available, and if not, by state or federal government insurance programs. Because this is an average, it's safe to assume that this balances out somewhat. Some people die young or suddenly and incur relatively few health care-related expenses. Others are plagued with chronic health problems from very early on and use much more than the average. However, comparing the amounts paid in per annum to the amounts paid out makes it easy to see why Medicare isn't going to be financially solvent for much longer.
This presents any number of problems. To begin with, how do we keep Medicare solvent for as long as possible? Because it is a tax-based problems, the only solutions are tax-based. We can raise taxes and maintain the current retirement benefits. We can maintain tax rates and cut benefits, either by raising the retirement age or by limiting services covered, or both.
Here's is another way of looking at it. Right now, as soon as you turn 65, you are automatically enrolled in Part A (In-patient hospital benefits). You can choose to opt out of your Part B benefits, but you are penalized, something along the lines of 10% per year on your premium fees when you do enroll. Not everyone who is eligible for Medicare needs the coverage right away. Most people now work at least a little bit past age 65. Other people receive decent retirement benefits, including low-cost health insurance. If you receive better benefits from your employer-provided insurance, and you're in relatively good health, shouldn't we provide incentives in exchange for opting out of your Part B (and possibly Part D) coverage?
Why this would work: Medicare insurance premiums are automatically taken out of the monthly SSI check. If you didn't need to spend the money on health care, and are taking relatively few prescription drugs, wouldn't you rather have the extra money in your pocket? What if the government promised to reduce your premium costs by say, $2 per month for every year that you opted out?
- If you do work until later in life (by your own choice), then you win because you pay less in monthly insurance premiums, AND you have the higher monthly SSI checks from working longer. You're also paying into the system longer, which improves solvency.
- If you choose to retire at 65 but opt out of Part B and/or D, then you receive a higher monthly payment, and when you do sign up for benefits, you save money. (Example: If you postpone receiving benefits until you are 70, then you save $10 on your monthly premium - $120 per year, which might be two prescriptions filled).
- If you retire at age 65, but don't opt out of any of your insurance, then your coverage continues as promised.
Dear Podiatric Schools of America,
While I am sure that podiatry is a noble profession, and a well-paying one at that, I would like to request that all of you remove me from your mailing lists. I do not want to become a podiatrist. I will not want to become a podiatrist tomorrow. Even if I am rejected from all of my allopathic medical schools, I will still not want to become a podiatrist. This is for any one of several reasons, some of which are listed below:
However, I will be happy to refer my stinky, flat-footed, callus-scarred patients to your graduate practices, where they can feel free not to accept their insurance.
- Feet are gross. You walk on them, you stuff them into moldy tennis shoes, and they are oft ignored in the bathing process.
- Feet generally smell horrifically. No one yet has developed a completely effective method of removing foot-stink. Powders, careful bathing, and breathable shoes help only minimally. Until there is some way to prevent foot-stink, I would prefer to touch feet only sporadically.
- I have seen podiatrists in action. I don't want to spend my days scraping the calluses from the feet of blue-haired women. I don't want to be an authorized Birkenstock dealer. I would rather not be an expert in the art of removing ingrown toenails. I am well aware of the fact that as a general practitioner, I will be required to be somewhat versed in the latter, but do not choose to take pride in such an area of expertise.
Respectfully,
Melissa Ann
I go to school at the University of Missouri. I'm majoring in biochemistry, with minors in rural sociology and chemistry. I work in a laboratory that studies the way ovarian cancer and prostate cancer get past the immune system. I also work as an intern for the a religious reproductive rights organization, teach religious school on Sunday mornings, and do PR and fundraising for the campus Hillel. I'm also involved in an organization called Spiritual Youth for Reproductive Freedom.
Right now, I'm in my last semester, so I'm taking my capstone (a hellacious research experience with a lab partner who is dumber than a box of hammers) and applying to medical schools. I think I want to do family practice in a smaller town, or perhaps specialize in OBGYN.
I love all forms of art, and do my best to make my own. I love photography. I use a Sony Cybershot digital, and I have a Canon 35 that I'm still learning how to use. I play flute and acoustic guitar, and have piccolo and piano skills. I like to doodle, and I make snide jokes and cartoons in my class notebooks.
Right now, I have a boyfriend who goes to school about 100 miles away. It's hard, and we're handling it, but per usual, I make no promises as to its longevity. The fact of my life is that I don't know where I'll be in a year. I handle the distance a lot better than he does, which has been an issue recently. I'm pretty independent, and I know that I'm a hard person to live twith. It's just a fact of being me.
I have a mommy and a daddy in St. Louis who love me very much, and a sister in Cleveland who just started college and probably loves me more. As of this writing, I have two English bulldogs, Millie and Gus, and my room at home is inhabited by a gerbil named Ethyl. My cat, Heidi, was very sick and we made the decision to end her suffering yesterday. She was my cat, as cats can be, and it was very hard and sad, especially being away from home. I have one living grandparent. I have lots of cousins who are very distantly related to me, and recently found out that a girl who I became friends with in June is one of my two first cousins. My extended family is very fragmented; my mother doesn't talk to her sister. My favorite person in the world is probably my Aunt Ruth, who isn't really my aunt. I visit her whenever I'm home, and take her grocery shopping and we eat lunch together.
So that's me, at this very moment.
