Gall bladder

I was doing non-cardiac cases the other day... thought I might have a straight forward day for the first time in a while. Things seemed in order looking at the patient's history for a cholecystectomy (Gall bladder removal). I said hi to the patient asked a few questions and then moved along to see my other patient that morning.

The resident came up to me a few minutes later and told me there was an "issue". The history has looked unremarkable and was wondering what I had missed.

Apparently the patient wanted to take her gallbladder home with her as was getting visibly upset when the surgery resident told her that wasn't the usual procedure.

Now I'm wondering why someone would want to take a nasty old gallbladder home...yuk.

I think the gallbladder usually gets sent to pathology after these surgeries. I can only guess what they're looking for but 1)they're checking that you actually took out a gallbladder and not something else 2)possibly looking for cancer in the gallbladder... i'm not sure but that seems reasonable to me.

"I think she's gonna walk" said the surgery resident after 10 minutes of talking to the patient "I need to talk to the attending surgeon"

Apparently the patient wanted to bury the gallbladder in the backyard as some sort of spiritual closure from having it removed from her body... not too unreasonable if that's what you believe in.

The attending surgeon came down and sorted it all out.... She was not going home with her gallbladder... and she wasn't walking out.

Random walls

Image from freefoto.com

I'm walking out of work late yesterday. I'm tired. I'm on cardiac call i've been here for 12 hours. Not bad hour-wise but i've had to work with one of the stressful surgeons and just finished helping code a patient in the operating room.

I just want to go home and put up my feet...

All of a sudden there's a wall along the corridor where I usually walk out. It was open this morning

"Detour -->" I guess they're finally connecting the new building to the old one.
Now I wander through the basement and finally get to my car.

Perfect ending to a long day. Hope I don't get called back in.

Transvaginal Cholecystecytomy

In a word -- Yuk!

These words together mean removal of the gallbladder through the vagina.

Yuk yuk yuk.
If I had a vagina, you're not removing my gallbladder through it.

And to boot there's a Natural Orifice Surgery Consortium for Assessment and Research.

You can leave my natural orifices alone... I mean look what great scientific advances there are in this decade.

New York Times online via Book of Joe

Room temperature

It's important to keep the patient in warm in most cases. Most cardiac cases this is not an issue much because the heart-lung bypass machine has a heat exchanger on it which allows the perfusionist to warm or cool the (patient's) blood as it goes through it.

We were doing a big cardiac case under left heart bypass -- where part of the blood is taken after it gets passed through the lungs, and rerouted to the femoral artery in the groin so that work can be done to the descending aorta with most of the blood flow being perserved. This is nice so that damage to important organs like the kidneys and intestines can be limited.

Since we have less control over temperature because it's only partial bypass, we had the room temperature way up. It was warm for me, but must have been killer for the surgeons who were wearing waterproof gowns, etc.

On of the attending surgeons was scrubbed in and asked for temperature to be turned down. He's generally very expressive. "Turn down the temperature or I'll vomit in the wound and the patient will get septic and die!" I just about died laughing...

(For those not in the know... sepsis in a severe systemic infection caused by bacteria. If you vomited into a patient surely this would happen but it's not a scenario you contemplate ... well ever.)

Being a patient

So apparently I have diabetes. I went innocently enough to the doctor's office to ask about getting a sleep study for sleep apnea (which I probably have). So he's asking all these questions and running all these tests because it's the first time I've gone to the doctor's in years. My Hemoglobin A1c was through the roof. The hemoglobin A1c measures the average blood sugar over the last 120 days or so in your blood. Also I had a pretty high blood pressure in the office.

Now I'm checking my glucose (almost) every morning, supposed to be checking my blood pressure regularly so he can decide if I need an anti-hypertensive medication. My sleep study is scheduled, and I'm making calls to the insurance company to see if things are covered.

I guess I'm a set up for this. Even though I'm in my early 30s, I'm overweight, I eat poorly, diabetes and hypertension run in the family ... let me continue.

I don't think I'll like being a patient.

death in the or

Somehow as morbidly ill someone is when you are in charge of their case, as little chance as they had of surviving.... you can't help but take it a little personal when they expire in the OR.

More later... maybe.

House

I'm not one usually to watch House M.D. on TV, but i was over a bud's and was forced to. It was the most unrealistic episode ever. Many strange procedures in the name of making a strange diagnosis. I'd review it but I'd be reworking something already done...

Check out the House review at Polite Dissent

horrible

had a horrible day today. couldn't start an iv, an aline or an epidural to save my life. worse yet, wet tapped that same patient (a complication from placing an epidural for those non medical types). argh. luckily i killed no one. ended up with a femoral aline and several neck lines (several patients)

(apologies for the extremely lingo filled post. had to vent.)

on the plus side went to have arab food with my buddy who finished his cardiac anesthesia fellowship. it was a good time, tasty food, good conversation, damn road construction detours though.

Eww!

I learned yesterday though a convoluted conversation that there is such a thing as "defecography". Don't ask how we got to it... Don't even ask what it is...

Defecography is a test used to evaluate the disorders of the lower bowel that are not evident by direct visualization. Radiologic liquid is instilled into the rectum. Then the patient is instructed to empty the rectum while a fluoroscopic exam of the pelvis is carried out. This radiologic test allows the doctor to evaluate the pelvic floor muscles and rectum during defecation. This type of test, although awkward, provides valuable information that will aide your doctor in diagnosing your problem.

The following is a list of conditions for which Defecography can be used to gather more information and/or confirm a diagnosis.

-Rectal prolapse, irritable bowel syndrome, obstructed defecation
-Solitary rectal ulcer, proctalgia, fugax,a rectocele/enterocele
-Fecal incontinence, internal prolapse, constipation
-Rectal/anal intussusception anismus (inappropriate spasm of the anal sphincter)
(UMHS website)

Apparently the "liquid" they use for this test is the consistency of mashed potatoes.
Thank god I'm an anesthesiologist. I'm glad on the other end of the patient.