MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'UroStream' source. Sat, 10 Oct 2009 19:38:45 +0100 http://www.medworm.com/index.php?rid=2376428&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2009%2F04%2Fdude-fest.html 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 unfashionab... UroStream blogs http://www.medworm.com/rss/comments.php?id=2376428 Tue, 28 Apr 2009 03:24:00 +0100 2376428 http://www.medworm.com/index.php?rid=2349050&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2009%2F04%2Fshow-and-tell.html 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 b... UroStream blogs http://www.medworm.com/rss/comments.php?id=2349050 Thu, 16 Apr 2009 01:39:00 +0100 2349050 http://www.medworm.com/index.php?rid=2319073&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2009%2F04%2Fnew-favorite-website-of-day.html 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. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=2319073 Tue, 07 Apr 2009 04:36:00 +0100 2319073 http://www.medworm.com/index.php?rid=2319074&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2009%2F04%2Fpicture-perfect.html 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... UroStream blogs http://www.medworm.com/rss/comments.php?id=2319074 Thu, 02 Apr 2009 18:04:00 +0100 2319074 http://www.medworm.com/index.php?rid=2319075&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2009%2F03%2Fhappy-national-doctors-day.html 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 (!... UroStream blogs http://www.medworm.com/rss/comments.php?id=2319075 Tue, 31 Mar 2009 02:26:00 +0100 2319075 http://www.medworm.com/index.php?rid=2319076&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2009%2F03%2Fredemption.html 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... UroStream blogs http://www.medworm.com/rss/comments.php?id=2319076 Sat, 28 Mar 2009 00:19:00 +0100 2319076 http://www.medworm.com/index.php?rid=2258943&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2009%2F03%2Fout-of-jail.html 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 creativ... UroStream blogs http://www.medworm.com/rss/comments.php?id=2258943 Thu, 12 Mar 2009 04:02:00 +0100 2258943 http://www.medworm.com/index.php?rid=2055756&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F12%2Fhappy-holidays.html 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!!! (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=2055756 Sat, 20 Dec 2008 22:27:00 +0100 2055756 http://www.medworm.com/index.php?rid=2032982&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F12%2Fradiation-scare.html 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. With mounting evidence on the risks of radiation, especially after multiple studies, I can understand the reluctance. However, what am I supposed to do with the patient? How can I offer them any medical advice, including the likelihood of spontaneous passage, if I don't know where the stone is located, what the size of the stone is and assess the presence of hydroneph... UroStream blogs http://www.medworm.com/rss/comments.php?id=2032982 Thu, 11 Dec 2008 17:40:00 +0100 2032982 http://www.medworm.com/index.php?rid=2005519&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F12%2Fpantomime.html 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. Th... UroStream blogs http://www.medworm.com/rss/comments.php?id=2005519 Tue, 02 Dec 2008 17:51:00 +0100 2005519 http://www.medworm.com/index.php?rid=1996201&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F11%2Fgiving-thanks.html I am on call this year for Thanksgiving, and it's already been mildly painful and busy (an exploratory laparotomy AND a kidney transplant last night!). The even more painful part is that this call lasts from wednesday until monday morning!!! Yikes....But as I was rounding at the hospital today and encountering sick patients and their families, I became profoundly thankful that my loved ones are in good health. Perhaps I am getting more emotional in my dotage, but I was feeling almost teary as I was walking through the wards, as there are few places sadder and lonelier than a hospital during the holiday season. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=1996201 Thu, 27 Nov 2008 22:54:00 +0100 1996201 http://www.medworm.com/index.php?rid=1984688&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F11%2Fharley-riders-beware.html I have to admit that I've never liked motorcycles, especially Harleys since their riders seem to derive great enjoyment at making their machines be as loud as possible. I find it rather obnoxious. However, as this new information is coming to light, it might be possible they are trying to compensate for something????This information is straight from the AUA (American Urological Association) Daily Scope: "Australia's The Age (11/23, Benson) reported that a survey found that men who ride motorcycles "risk impotence and urinary problems because the engine vibration damages nerves in their penises." For the survey, researchers looked at "more than 230 motorcyclists who ride for about three hours every weekend." They "found that almost 70 percent had problems getting an erection or emptying the... UroStream blogs http://www.medworm.com/rss/comments.php?id=1984688 Mon, 24 Nov 2008 17:54:00 +0100 1984688 http://www.medworm.com/index.php?rid=1980498&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F11%2Fnot-looking-foward-to-it-yet.html As the appointment with a follow-up patient was nearing its end, he suddenly quipped: "I gotta tell you doc, I don't know what you did to yourself but you look about 20 years younger than when I last saw you. I hardly recognized you...."Considering that I just saw him only a month ago, that comment took me somewhat aback. I could take it as a very nice compliment, or it meant I simply looked like hell a month ago...After trying to convince him there had been absolutely no recent plastic surgery involved, I informed him it was actually my birthday today, but that I was really not too excited about this event ever since I turned 35 years old a few years ago.The patient then told me he reached the point where he was actually looking forward to each of his birthdays, as an acclamation of being... UroStream blogs http://www.medworm.com/rss/comments.php?id=1980498 Sat, 22 Nov 2008 05:54:00 +0100 1980498 http://www.medworm.com/index.php?rid=1947005&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F11%2Fwhat-do-you-do-for-living.html Simple question for most people.... However, this seemingly innocuous question used to stress me out when I first began training as a urologist. I was raised by my very conservative parents that talking or even mentioning certain areas of your anatomy was taboo, or at the very least, not an appropriate subject to bring up. Yet, the very essence of my job entails a journey into a realm which produces squirming in a polite society.Inevitably, this question would be raised in public setting such as in a plane, at a bar or some sort of social gathering where escape was not a possibility.I thought about lying outright and feigning to be an actuary, but I couldn't come to terms with that deceit (thanks mom!). So I usually tried to reach a compromise by trying to be vague and mentioning that I m... UroStream blogs http://www.medworm.com/rss/comments.php?id=1947005 Sun, 09 Nov 2008 17:18:00 +0100 1947005 http://www.medworm.com/index.php?rid=1938865&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F11%2Fhope.html I have been criticized for talking politics on my blog (though my long-time readers will know that it's certainly not the first time). We have just voted for the new president of the most powerful nation on the earth. How could I not speak about it today unless I lived with my head buried in the ground?I know we cannot agree on everything politically. This very choice is what makes this country so great!!! We have the freedom to research and make informed decisions based on it. It is the basis of a democratic nation...I love this country, as I am sure all of you do as well, and I want the best for it. Whether you are blue or red, I think we can all agree on that premise. I just happen to feel that Bush was not the best choice for our country. No matter what the spin is, a lot of us will ag... UroStream blogs http://www.medworm.com/rss/comments.php?id=1938865 Thu, 06 Nov 2008 02:23:00 +0100 1938865 http://www.medworm.com/index.php?rid=1933006&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F11%2Fnew-day-has-arrived.html With tears in my eyes and a soaring heart, I extend a huge welcome to President Barack Obama!I feel that I have just been part of a historical and unforgettable moment in the history of the United States of America. He ran an amazing, almost flawless campaign, but the victory truly belongs to the man himself. He is smart, thoughtful, eloquent and inspirational, basically the anti-thesis of Bush. He is a breath of fresh air after eight years of a truly horrendous and corrupt administration.I even liked John McCain tonight during this concession speech, though I cannot feel the same generosity towards Sarah Palin. What an odious woman...Finally our beautiful glorious country can begin to unite and heal. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=1933006 Wed, 05 Nov 2008 04:58:00 +0100 1933006 http://www.medworm.com/index.php?rid=1914497&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F10%2Fhallelujah.html O Most glorious of days!!! Most anticipated time since AD 1991!!! Sweet bright light at the end of the tunnel!!! Most welcoming of happenings!!!I just officially paid the last cent off my medical student loans today!!! And I thought this day would never come...I started med school in 1991, right after graduating from college, and I didn't want to burden my parents for additional funds after they had generously paid my college tuition in full. I distinctly remember the first loan check I got for my medical tuition, and feeling scared... very scared... (but not as scared as some of my medical colleagues who went to private med school and racked up >$125,000+ in loans). With each additional year of schooling, I saw my debt mounting into a mini version of Mount Everest (at least in my mind), a... UroStream blogs http://www.medworm.com/rss/comments.php?id=1914497 Tue, 28 Oct 2008 17:58:00 +0100 1914497 http://www.medworm.com/index.php?rid=1911285&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F10%2Frisk-management.html I recently attended a risk management workshop with presentations from various medical professionals and attorneys (both plaintiff and defense) regarding ways to avoid being sued. It's an absolutely lovely way to start your saturday morning (7:30AM!!!)This is especially apropos after reading Shadowfax from Movin' Meat receiving his first lawsuit notice. I really feel for him, since this is one of the most dreaded event in the career of a physician.The workshop consisted of impromptu video interviews from people off the street who were invited to talk about their doctors, and what they considered good and bad medical care.One major theme began to emerge from these interviews about being a good doctor: spending enough time with the patients without feeling rushed, good communication using e... UroStream blogs http://www.medworm.com/rss/comments.php?id=1911285 Mon, 27 Oct 2008 17:51:00 +0100 1911285 http://www.medworm.com/index.php?rid=1891902&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F10%2Fshot-interrupted.html It's flu shot season again, and I know I've covered my morbid fear of injections in prior posts ad-nauseam, but here we are once more. Doesn't it seem to come sooner every year???Yes, call me a hypocrite, a poltroon, a coward, but whereas I have no trouble wielding a scalpel or a hypodermic syringe on my patients, the thought of getting an injection on my tender deltoid puts me into a hyperventilating diaphoretic mess. Mind you, it's not the pain, because truth be told, the stupid injection does not hurt a bit. I've had more painful sessions with a pedicure... But it's just the thought of a needle... going into my flesh... argh... My nurse just announced today that we got our flu shots delivery for the office, and wanting to change my usual pattern of endless rumination and worry leading t... UroStream blogs http://www.medworm.com/rss/comments.php?id=1891902 Mon, 20 Oct 2008 21:41:00 +0100 1891902 http://www.medworm.com/index.php?rid=1879757&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F10%2Fno-need-for-thanks.html I was finishing up a clinic visit with a new patient, when, as I was heading towards the door, she uttered these parting words: "Thank you for seeing me and taking my insurance."Since I don't personally check ahead of time what insurances my patients have, I was intrigued by her comment and asked her who provided her healthcare coverage. She answered Tricare, which is the healthcare insurance provided to the United States Armed Forces and their families.The reason for her gratitude was because she was finding it progressively more difficult to find physicians who would accept Tricare. Though it pays marginally better than Medicaid (not Medicare), it is one of the worst insurances around, with notoriously finicky pre-authorization requests and terrible reimbursements for doctors (usually le... UroStream blogs http://www.medworm.com/rss/comments.php?id=1879757 Thu, 16 Oct 2008 04:04:00 +0100 1879757 http://www.medworm.com/index.php?rid=1859389&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F10%2Fplease-dont-make-me-cry.html Though no death is ever easy to deal with, I find it particularly emotional when it's one of my older patient who has recently lost their spouse. It's absolutely devastating to see the sorrow etched on their face, the dazed and lost look they have in their eyes and the palpable grief emanating from their body.One of my patient had recently lost her husband of 59 years. Thankfully he passed away gently in his sleep, but it had obviously taken a toll on my patient. A normally brave, independent and spry woman in her 80s, she looked incredibly vulnerable and tiny that day. She could not help the tears that slowly rolled down her face as she told me their story.And I have to tell you, this is a surefire way to make me lose my composure in the exam room. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=1859389 Tue, 07 Oct 2008 22:03:00 +0100 1859389 http://www.medworm.com/index.php?rid=1788624&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F09%2Falternative-treatments.html Few things frustrate me more than patients diagnosed with cancer that could be cured via conventional medical therapy, who end up resorting to alternative "treatment" options.I could learn to accept these decisions if these were real legitimate treatments they were exploring, as opposed to the utter quackery offered by exploitative and unscrupulous individuals.I'm already distraught enough when I have to reveal the diagnosis of cancer to a patient, and I usually spend a good amount of time in clinic discussing the problem, prognosis and various legitimate treatment options. But then my distress turns to perplexity and disbelief when the patient wants to try the new "cancer-fighting" minerals found only in the jungle of Ecuador, or the all juice antioxidant diet or the mind-over-matter canc... UroStream blogs http://www.medworm.com/rss/comments.php?id=1788624 Fri, 12 Sep 2008 15:03:00 +0100 1788624 http://www.medworm.com/index.php?rid=1768774&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F09%2Fshivers.html There are few things as horrific as seeing a patient with advanced penile cancer. Thankfully, it's not a common disease, and over the last 6 years, I've only seen a handful of cases, which is to say a handful more than I want to see...The horror comes not only in the diagnosis of cancer in such an unusual area (most people are probably shocked to learn that there even exists such a condition), but also in the treatment for this diagnosis which, even in the best possible scenario, can only be called mutilating.Unfortunately, the best cure lays in surgical extirpation of the cancer. In lay terms, that means we have to cut it out... If the cancer only involves the foreskin, then a simple circumcision can be enough, but unfortunately, a lot of these cancers affect the glans or shaft of the pen... UroStream blogs http://www.medworm.com/rss/comments.php?id=1768774 Fri, 05 Sep 2008 19:01:00 +0100 1768774 http://www.medworm.com/index.php?rid=1708860&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F08%2Fatonement.html Med list for my new patient:-Omega 3 fish oil-Gingko biloba-Green tea extract-Centrum multivitamin-Saw PalmettoHe's actually quite healthy without any serious medical issues. Yet despite all these nutritional supplements that would seemingly identify him as a health-conscious individual, I also noticed that he smokes a pack a day for the last 40 years....I'm always a little amused yet perplexed when I see something like this. Do the supplements somehow "atone" for all those cigarettes? Do the antioxidants negate the carcinogenic effects of tobacco? If only it were that easy...Perhaps this line of thinking is akin to ordering a double burger with fries and a diet coke. Drinking a regular coke with that meal would put it over the edge!!!! Or taking cholesterol lowering medication without cha... UroStream blogs http://www.medworm.com/rss/comments.php?id=1708860 Fri, 15 Aug 2008 03:33:00 +0100 1708860 http://www.medworm.com/index.php?rid=1692083&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F08%2Fsummer-fare.html I'm just writing a little warning note for my readers. Don't expect any insightful posts (have I ever written one?), or even any posts at all over the next 17 days. Didn't you hear? The summer Olympics just started tonight!!!!I absolutely ADORE the Olympics, especially the summer games. There is something almost surreal about thousands of athletes from hundreds of different countries coming together for a little over two weeks to compete. I love the individual stories of people who, against all odds, are able to make it to the games. There are people who know they are never going to win a medal, yet still compete just for the sake of participating in this global event.Despite the fact that this year's Olympics is fraught with political undercurrents, I love the fact that during the competi... UroStream blogs http://www.medworm.com/rss/comments.php?id=1692083 Sat, 09 Aug 2008 05:01:00 +0100 1692083 http://www.medworm.com/index.php?rid=1676913&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F08%2Ftardiness.html One of my biggest pet peeves is tardiness. As a rule, I am a fairly punctual person, and I like to be even a little early for my appointments. Call it my obsessive-compulsive nature, or a lifelong fear of displeasing others, but few things stress me out more than being late. I think my upbringing also plays a crucial role, since my parents are known to show up at the airport a minimum of two hours before their flights. They both have type A personalities that will not allow them to be tardy for anything.There are lots of surgeons who are known in the OR for showing up chronically late to their cases, which drives me crazy since by a cascading series of events, they end up delaying everyone who follows them. I am proud to say that I have a reputation for being on time.But enough about me a... UroStream blogs http://www.medworm.com/rss/comments.php?id=1676913 Sun, 03 Aug 2008 18:40:00 +0100 1676913 http://www.medworm.com/index.php?rid=1640200&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F07%2Fe-mail-funnies.html Two e-mails put a smile on my face today:The first came from my AUA Daily Scope (daily news bites and articles of interest from the American Urological Associations) with a bold title that announced:"Global warming may increase kidney stone rate!"Mind you, not that global warming is funny at all, but the headline just sounded so unnecessarily alarmist, and so unlike the usual "less sensational" articles the AUA presents. And as a side note, I do believe that global warming will make us urologists busier.The second came from one of my bestest of friends, whose mother actually reads my blog! Mom came to visit her, and said:"I don't like it when she (meaning me) writes about penises."Yikes, that puts a severe restriction on the variety of my posts..... (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=1640200 Sun, 20 Jul 2008 17:02:00 +0100 1640200 http://www.medworm.com/index.php?rid=1618004&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F07%2Fnot-so-insignificant.html Even though I'm just a dumb surgeon-type, and not a clever endocrinologist or nephrologist, I still need to know all my patients' medical history in detail. (I've always thought the specialities mentioned above attracted the super intellectual types...Urologists are more akin to the humble plumbers whereas the nephrologists are considered the engineers...) Yes, I like to be in the operating room and I like to use a scalpel to help people, but that doesn't mean I don't do some thinking of my own.I am always astounded at the details that patients omit on their medical history form. I'm clued in when I look at their medication list and see 3 different antihypertensive medications, yet they don't list hypertension as one of their medical condition. Usually the explanation is something like: "b... UroStream blogs http://www.medworm.com/rss/comments.php?id=1618004 Sun, 13 Jul 2008 20:12:00 +0100 1618004 http://www.medworm.com/index.php?rid=1552931&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F06%2Fapprehension.html You know my previous post about the rule of three? Well, I just took care of two penile fractures in a 24 hour period of time.OK, technically the human penis does not have a bone (though other animals like dogs do), hence a "fracture" is somewhat of a misnomer. However, this is the correct medical term for a rupture or tear in the tunica albuginea, which is the tough yet elastic sheath that surrounds the erectile tissues in the penis called the corpora cavernosum. (I admit that there is a tremendous amount of incomprehensive medical mumbo jumbo, but don't blame me for the nomenclature since I wasn't the one who thought up of all these names. Blame it on some dead white guys. If it were up to me, I would have chosen much better and cuter gwords...)There are certain sexual positions associa... UroStream blogs http://www.medworm.com/rss/comments.php?id=1552931 Sat, 28 Jun 2008 15:46:00 +0100 1552931 http://www.medworm.com/index.php?rid=1525921&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F06%2Fretained-stent.html Seaspray's unfortunate close encounters with ureteral stents reminded me of the nightmare that is a retained stent. (not that you have that Seaspray, and I really hope you feel better soon!!!) If anything is guaranteed to shave years off the life of a urologist, it would be a retained stent.Ureteral stents, unlike vascular stents, are not meant to stay inside permanently. They need to be removed, or at least changed every few months (depending on the patient and the type of stent), otherwise the stent becomes calcified and it becomes virtually impossible to remove the stent. Anytime there is a foreign object in the urinary tract system, crystals form which lead to stone formation. Imagine having concrete poured directly within the ureter and letting it set inside, and you can understand wh... UroStream blogs http://www.medworm.com/rss/comments.php?id=1525921 Mon, 16 Jun 2008 18:07:00 +0100 1525921 http://www.medworm.com/index.php?rid=1499826&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F06%2Frule-of-three.html There must be some cosmic rule that urological conditions come in groups of three. I have mentioned this on a previous post, but I have noticed that when I see a patient with a somewhat unusual medical condition, I am guaranteed to see two more patients within a short period of time with the same problem. I'm not talking about UTIs, stones or incontinence, but more like ureteral tumors, penile cancer and peri-urethral cysts. Nothing that is outrageously unusual, but not conditions we see daily.Recently, within a span of one single week, I have see three patients with acute urinary retention (over 3L) being admitted for elevated Cr (over 10) whose renal function improved markedly with catheter drainage but needed to stay inhouse for a few days because of post-obstructive diuresis (over 6L/d... UroStream blogs http://www.medworm.com/rss/comments.php?id=1499826 Sat, 07 Jun 2008 17:17:00 +0100 1499826 http://www.medworm.com/index.php?rid=1497332&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F06%2Fin-slump.html Sorry about the long break. It seems that within just a few days of returning from vacation, I felt like I never went away at all. Isn't that always so?In any case, I have been trying to keep afloat of my very hectic schedule. Besides my clinical duties, I've also had an unusual amount of administrative type meetings that are always scheduled at the convenient time of 7AM. Things have been so crazy busy at work that I have even cancelled one of the few treasured activities that I strive to attend bi-weekly: my Pilates class. Not only is it badly needed exercise, it is also a huge stress reliever and one of my therapeutic indulgences.I love Pilates. I discovered it a few years ago, when I was tired of hauling my protesting body (and mind) to the gym, to work on a treadmill or an elliptical... UroStream blogs http://www.medworm.com/rss/comments.php?id=1497332 Fri, 06 Jun 2008 06:01:00 +0100 1497332 http://www.medworm.com/index.php?rid=1414883&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F09%2Fhow-to-tell-you-are-married.html Our nightly bedtime ritual involves my husband lovingly putting a Breathe-right strip on my nose. (allegedly, I snore, though I'm not convinced) .Before my LASIK surgery, I used to fall asleep next to my husband with my glasses on. Really sexy...When I reach over to cuddle with my husband, I also try to sneak in his monthly testicular exam.Hubby now feels perfectly comfortable to inform me that I look like a "car accident victim with a head injury" when I wake up in the morning. Granted I'm not a morning person and my AM conversation usually involves unintelligible monosyllabic grunts (hence the head injury part), and I guess I don't look so hot either.I sleep with all 9 (yes, that's nine) of my stuffies (stuffed animals) at night and hubby doesn't complain. In fact he encourages this beha... UroStream blogs http://www.medworm.com/rss/comments.php?id=1414883 Thu, 01 May 2008 17:16:00 +0100 1414883 http://www.medworm.com/index.php?rid=1397582&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F04%2Fgratis.html I encountered a somewhat difficult patient the other day to whom I recommended a standard of care cystocopy as part of a hematuria (blood in the urine) workup. He proceeded to question everything I was doing and my decisions for doing so. I usually encourage these questions, but I had the sense that this patient was extremely anxious and was just talking himself into an even higher state of anxiety.Finally, after all the relevant medical questions were exhausted, he asked me how much the procedure was going to cost, and I told him that "it depended but I could give him a ballpark figure". He then flew off the handle and ranted about how medicine is the only business where the key players don't know how much things are going to cost and how could such a business survive etc...I gently corre... UroStream blogs http://www.medworm.com/rss/comments.php?id=1397582 Thu, 24 Apr 2008 20:28:00 +0100 1397582 http://www.medworm.com/index.php?rid=1385665&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F04%2Fsix-word-memoir-meme.html I'm very late in the game as this meme came out a few weeks ago, but I got tagged by Seaspray, and since I've let her down so many times before, I thought I would give this one a try.The Rules are:1. Write your own six word memoir.2. Post it on your blog and include a visual illustration if you want.3. Link to the person that tagged you in your post and to the original post if possible so we can track it as it travels across the blogosphere.4. Tag at least five more blogs with links.5. Leave a comment on the tagged blogs with an invitation to play.I've been very busy these past few weeks, to the extent that I've even had to do an elective surgery this saturday (my off day since I'm not even on call!) because my regular weekday schedule has been triple booked....So I was tempted to write so... UroStream blogs http://www.medworm.com/rss/comments.php?id=1385665 Sat, 19 Apr 2008 22:42:00 +0100 1385665 http://www.medworm.com/index.php?rid=1362356&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F04%2Fvocabulary-lesson.html Presenting some new medical verbiage in the field of urology, as introduced to me by numerous patients:Prostrate:Male gland that likes to worship face down on the ground. Frankly it makes me feel uncomfortable when I encounter it because my god complex is not that highly developed.Sphinxter:Enigmatic yet strong lion-like little muscle in control of certain nether functions. May have egyptian etymology.Urether:In-betwixt a urethra and a ureter! It transports urine directly from the kidney straight out into the toilet!Blatter:Can be used to store and hold urine, as well as carry food on special occasions.Penes:A multi-purpose instrument. Urination, reproduction, calligraphy... (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=1362356 Thu, 10 Apr 2008 03:49:00 +0100 1362356 http://www.medworm.com/index.php?rid=1349432&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F04%2Finformation-overload.html We are required by law to give an informed consent on any medical procedure/surgery we perform. This involves explaining in detail what the procedure is, what the risks and benefits are, and what other alternatives are available for treating the ailment. It's something we are taught to do very early on in our career, not only because it's a requirement, but it's also the correct course of action in order for the patient to make an informed decision about his/her medical care. Should you fail to do so, not only would you be deemed a bad doctor, but there are many unpleasant legal ramifications that can await you...I take care to go into great detail about each surgery I am about the perform. I really want the patient to understand exactly what is going to happen, what the expectations are ... UroStream blogs http://www.medworm.com/rss/comments.php?id=1349432 Fri, 04 Apr 2008 03:12:00 +0100 1349432 http://www.medworm.com/index.php?rid=1329929&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F03%2Five-changed-my-middle-name.html I've come to realize that I have become increasingly obsessive-compulsive in my old age. I don't know exactly when this change occured, but I can assure you that I wasn't born this way. Procrastination was my middle name. Growing up, I always did my homework at the last minute, waited until the very end to send in college applications and always pulled all-nighters to finish up papers and other assignments due to poor time management. Medical school wasn't much of an improvement, and the lack of sleep and constant fatigue during residency ensured that I rarely did anything ahead of time. Utility bills were often paid late and I once had my hot water shut off because I wasn't home enough or even cared enough to dig through the mail. I could hardly call myself a very organized person.However... UroStream blogs http://www.medworm.com/rss/comments.php?id=1329929 Thu, 27 Mar 2008 04:30:00 +0100 1329929 http://www.medworm.com/index.php?rid=1323097&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F03%2Fplease-dont-press-that-button.html PCA (Patient Controlled Analgesia) is a godsend for most patients and nurses. It's a pump attached to your IV that contains your narcotic of choice (usually morphine or dilaudid), and by pressing a button whenever you need it, you are able to get a preset amount of pain med into your system.You can order the settings in a variety of ways, from the dose of each pain med, to how often it can be administered, to a four hour maximum dose limit. This way, no matter how many times a patient pushes on the button, you only get a certain set amount, and very rarely do you see overdoses. And if you don't need any pain meds, you just don't push on the button. Simple as that.I almost always use a PCA pump for my post-operative patients. This way, they don't have to call the nurse and wait for them to ... UroStream blogs http://www.medworm.com/rss/comments.php?id=1323097 Mon, 24 Mar 2008 17:07:00 +0100 1323097 http://www.medworm.com/index.php?rid=1306495&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F03%2Fjust-call-me-bozo.html For those of you who don't give a hoot about women's hair issues, you can stop reading now. This post is for the 51% of the population who can commiserate with me. I had a somewhat eventful trip to my hair stylist yesterday whom I love and who usually does a top-notch job. She just returned from an 8 month hiatus and had been sorely missed. Since I was overjoyed at seeing her again, I decided to entrust fully in her artistic flair and became putty in her capable hands. She cut my hair to perfection, but when I mentioned I wanted "vibrant highlights" in my hair, she interpreted this to mean "fiery orange-red".To my dismay, as I stepped out of the salon, my hair actually glowed in the sunlight. I admit that the effect was rather striking, and would have been perfect had I worked in a creativ... UroStream blogs http://www.medworm.com/rss/comments.php?id=1306495 Mon, 17 Mar 2008 02:59:00 +0100 1306495 http://www.medworm.com/index.php?rid=1269537&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F02%2Fbizarre-interruption.html I've already discussed this topic on one of my previous posts, but I always shudder when I get a consult from the locked psychiatric ward. No matter which hospital you happen to be in, the locked ward is always the same. First of all, it's a veritable hassle to enter, as you have to call from the phone outside of the impressive-looking set of steel doors, and wait for someone from the central desk/tower to let you in. It's the same process (though perhaps more frantic) when you are trying to exit the ward as well.Inside are rather depressing bare rooms with unmade beds, while heavily-medicated lost souls slowly wander around the hallways, looking quite pitiful in their ill-fitting hospital gowns. There is a general sense of bone-deep weariness and even hopelessness. There is no pretense he... UroStream blogs http://www.medworm.com/rss/comments.php?id=1269537 Sat, 01 Mar 2008 06:53:00 +0100 1269537 http://www.medworm.com/index.php?rid=1256181&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F02%2Fsmug-and-proud-of-it.html At the risk of sounding extremely smug and self-satisfied, I have to tell you that I had a very productive Saturday morning this past weekend. Alas, I happened to be on-call, and there were several patients at different hospitals that needed to be seen, in addition to new consults and procedures to be done.Nevertheless, before 11:00 AM, I was able to:-Wake up at 6:45 AM. (Come on! Remember that this was a SATURDAY... this should be considered a major achievement already!!!!)-See a trauma consult for a bladder rupture and meatal stenosis (tightness at the opening of the urethra, making insertion of a foley catheter impossible). I reviewed the CT scan, evaluated the patient, dilated his urethra (some might say 'tortured with barbaric instruments") and placed a foley. Thankfully the ICU nurse... UroStream blogs http://www.medworm.com/rss/comments.php?id=1256181 Mon, 25 Feb 2008 19:33:00 +0100 1256181 http://www.medworm.com/index.php?rid=1247794&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F02%2Flunar-eclipse.html Was anyone else able to catch a view of the lunar eclipse last night? It was quite amazing! I was worried that clouds would obscure our view, but it was an unusually clear night, and the event was wonderous.We have a telescope that I bought as one of my better christmas present for hubby several moons ago, that is now mainly used as a decorative accent to our living space. I always feel like Jimmy Stewart from "Rear Window" when I look through it, but this was the perfect opportunity to use it as it was originally intented. The shadow of the earth eclipsing the moon is a sight to behold! (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=1247794 Thu, 21 Feb 2008 18:34:00 +0100 1247794 http://www.medworm.com/index.php?rid=1246565&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F02%2Fgirlls-best-friends.html No, not diamonds, but high heels!!!I just read this little article on high heels from BBC online which suggests that "high heels may improve sex life".An Italian urologist and self-professed lover of the sexy shoe set out to prove that high heels are not as bad for women's health as some suggest. Although high heels can cause a host of problems, Dr Maria Cerruto asserts in her letter to European Urology (an academic journal) that they improve pelvic muscles (Kegels anyone?), which can assist in sexual performance and satisfaction, and provide support to the pelvic organs, including the bladder.I'm inferring from the article that if high heels tighten pelvic muscles, they can help with urinary incontinence. Who'd have thought that those Manolo Blahnik heels would actually become a useful ur... UroStream blogs http://www.medworm.com/rss/comments.php?id=1246565 Wed, 20 Feb 2008 19:42:00 +0100 1246565 http://www.medworm.com/index.php?rid=1237395&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F02%2Fstreet-diagnosis.html I was walking around my little part of town this Saturday with Hubby, doing a little shopping--embracing the clinical benefits of retail therapy, not to mention fulfilling my patriotic duty to help out ailing retailers in these dog-days of looming recession.I was feeling just a tad sorry for myself since the last three pairs of jeans I tried on were far from flattering, emphasizing the less desirable aspects of my physique. Try as I might to shift the blame on the jeans themselves, still, I could not help being just a little sulky. Hubby attempted to convince me that my thighs were not hideously obese and lard laden, but I could not be persuaded...We then simultaneously noticed another pedestrian walking towards us, with the biggest bulge EVER in the crotch area of his jeans. Incredulously... UroStream blogs http://www.medworm.com/rss/comments.php?id=1237395 Sun, 17 Feb 2008 02:54:00 +0100 1237395 http://www.medworm.com/index.php?rid=1233218&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F02%2Fproject-runway.html Why hasn't anyone told me about this show before??????I just discovered it last night because hubby was working late, and I was listessly flipping through channels, looking for anything of interest. I suddenly happened upon Heidi Klum looking annoyingly perky and blonde amidst a group of anguished would-be designers, and the remote control locked itself in place.There is so much drama, cruelty, back-stabbing and tears!!! I was immediatly hooked.I admit that I don't usually watch the "popular" TV shows. I've never seen "Grey's Anatomy", don't know that the big deal is about "Lost" and couldn't tell you what "Desperate Housewives" is about (though I have a pretty good idea from the title...) The resolved writer's strike really did not affect my viewing options at all.But I have to admit that... UroStream blogs http://www.medworm.com/rss/comments.php?id=1233218 Fri, 15 Feb 2008 03:01:00 +0100 1233218 http://www.medworm.com/index.php?rid=1207190&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F02%2Fmr-grumpy.html I've known Mr Grumpy for a little while now, and he didn't come by this nickname because I love Snow White. (well, I actually do love classic Disney animated movies, but that's beside the point). Mr Grumpy always comes to my office full of piss and vinegar, generally annoyed at the whole world. The 30 minutes office visits consist of a litany of grumbles about everything, even when I try to direct the conversation to pleasant topics like kittens and pink cotton candy. Perhaps he is allergic to cats, but then again, he would have to be allergic to the whole world to excuse his mindset.Mr. Grumpy has cancer, and I have to operate on him. The thought fills me with some trepidation because I can predict with great certainty that his mood will not improve with the presence of a large surgical i... UroStream blogs http://www.medworm.com/rss/comments.php?id=1207190 Wed, 06 Feb 2008 03:17:00 +0100 1207190 http://www.medworm.com/index.php?rid=1188506&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F01%2Fabbreviations.html Abbrevations are incredibly common in the medical world. They are practically a way of life in medicine, and I use them on a daily basis in my notes, dictations and orders. It was a mark of great pride when I managed to write the following clinic note as a 3rd year medical student:67 yo H M c/HTN & DM, dx c/PCa (init PSA 5, Gleason 3+3) s/p RRP 3 yrs ago. PSA:0, DRE: neg. No c/o. No LUTS, mild ED. RTC 6mo with PSA.*This two-liner managed to convey all the critical pertinent information while being terse enough as a surgical note, and even my senior resident at the time was thoroughly impressed by this feat.However, recent JCAHO rules has prohibited some of the more common abbreviations for fear of causing medical mishaps, and hospitals have really rallied behind these changes.This "no ... UroStream blogs http://www.medworm.com/rss/comments.php?id=1188506 Wed, 30 Jan 2008 16:21:00 +0100 1188506 http://www.medworm.com/index.php?rid=1187088&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F01%2Fheavy-stones.html Again, I must apologize for my lack of blogging of late. My insidiuous cough has persisted, keeping me up at nights, and it's been rather trying. Moreover, being the ever dutiful wife, I have given this lovely virus to my husband who is seriously attempting to cough out one of his lungs.Needless to say, neither one of us has gotten much sleep recently, and I'm feeling tired and perhaps the tiniest bit guilty. I have been concocting some homemade naturopathic remedies from the "old country" consisting of lemons, pears, ginger, dates and honey (slice and dice, mix it all up and pour hot water to make a wonderful aromatic and restorative tea). I'm truly convinced of its miraculous medicinal properties, but after three nights of little or no sleep, my husband has become rather skeptical, and h... UroStream blogs http://www.medworm.com/rss/comments.php?id=1187088 Tue, 29 Jan 2008 17:53:00 +0100 1187088 http://www.medworm.com/index.php?rid=1159459&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F01%2Fdiplomacy-needed.html Sorry about the recent lack of blogging. The recent combination of the start of the new year, the return from a week off and a heavy on-call schedule has conspired to keep away from writing.On top of it all, I am now harboring an odious virus whose intent is to have me cough out a bronchus or two. I'm at the tail end of this infection, and I no longer have chills and muscle aches, but the persistant coughing is keeping me up at night. I really do not understand how smokers can tolerate this slight perpetual shortness of breath and imminent phlegm. Yuck...Though I don't think I'm still in the infectious stage, I'm also in the process of losing my voice in between fits of coughing, so simple conversations with my patients have become rather strenuous. I have always had a difficult time talki... UroStream blogs http://www.medworm.com/rss/comments.php?id=1159459 Thu, 17 Jan 2008 18:54:00 +0100 1159459 http://www.medworm.com/index.php?rid=1124140&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2008%2F01%2Fsome-culinary-delights-courtesy-of.html We just came back from a fantastic trip to Mexico City. The colors, culture and cuisine were just some of the highlights. Six days were hardly enough but to get a small sampling. As you have all probably realized by now, food plays a huge role in all of our trips, and here are some pictures to prove it: This was the popular Tostaderia Coyoacan in an enclosed market with an infinite number of toppings available for a delicious tostada. Yummy yummy tostada de ceviche Limon con coco: a sweet mexican delicacy from the famed Dulceria Celaya. Candied lime stuffed with coconut. My new favorite sweet snack! Quesadilla de flor (squash blossom). Que sabrosa! Churros y chocolate Carne al pastor Taco de carne al pastor Aguachile de callo (scallops in "chili water") Coctele de cevicheFeliz Nuevo Ano! (... UroStream blogs http://www.medworm.com/rss/comments.php?id=1124140 Tue, 01 Jan 2008 16:05:00 +0100 1124140 http://www.medworm.com/index.php?rid=1114410&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fwho-gets-stds.html STDs (Sexually Transmitted Diseases) commonly seem to affect the patient who hasn't had sex in 5 years, or the person who professes to be completely monogamous, or the guy who swears he uses a condom every time. I'm getting cynical these days, but anytime I see a patient with the slightest suspicion of an STD, I will do a urethral or a vaginal swab for GC/Chlamydia. I've seen too many positive ones to do otherwise. And I always hate the ensuing conversation when I have to tell the patient about the results. There is always some amount of disbelief and denial, recriminations (with the partner but often with oneself), and a very large dose of anxiety.Recently, a patient came in with a new labial lesion that looked suspicious for HSV (Herpes Simplex Virus), and when I sent her for blood work,... UroStream blogs http://www.medworm.com/rss/comments.php?id=1114410 Mon, 24 Dec 2007 01:02:00 +0100 1114410 http://www.medworm.com/index.php?rid=1101334&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F12%2Fhome-ed.html You can easily tell the guys who have a "strong" wife at home. They're the ones who clean up the exam room before they leave.After I'm done with the examination and discussion, I usually get up and head towards the door, expecting the patient to follow me and make their next appointment. However, these are the patients who immediately wipe the water splashes on the counter with a paper towel, put away all the magazines back to the rack and roll out a new exam table paper sheet before they leave. For lack of a better expression, they are "well-trained" by someone who obviously rules the household with a firm hand. I know this for sure because many a times have I tried to stop a patient from cleaning up, and they will just sheepishly tell me -while continuing to straighten up the room- that ... UroStream blogs http://www.medworm.com/rss/comments.php?id=1101334 Tue, 18 Dec 2007 05:30:00 +0100 1101334 http://www.medworm.com/index.php?rid=1096086&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F12%2Fno-dress-code-part-ii.html My previous post about the bathrobe-clad gentleman in my office reminded me of this other occasion when I was leaving the hospital and walking towards my car. Right across the street from the hospital is a convenience store that sells the usual sundries at inflated prices in addition to some alcoholic beverages.Imagine my surprise when I saw a hospital patient inside the store, wearing his hospital gown (yes, the kind that exposes the whole back), but also thoughtfully wearing pyjama pants and hospital slippers. He was encumbered by his IV pole, but that did not stop him from standing in line with a six-pack of beer in his hand.I wonder where he kept his wallet... (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=1096086 Fri, 14 Dec 2007 18:52:00 +0100 1096086 http://www.medworm.com/index.php?rid=1082037&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F01%2Fsecret-code-in-my-clinic-notes.html I have discovered that the "art" of medical dictation is actually a carefully nurtured skill. You want to give as much information as possible in a concise manner, yet you don't want to spend an inordinate amount of time doing so. I try to do my dictations in between patients during "down-times", but that is not always possible on a busy day, and when I see the mountain of charts piling up on my desk, a sense of overwhelming fatigue and languish takes over. I must admit that dictating is one of my very least favorite chores as a physician. (It ranks very closely to washing the dishes...)Over the years, I have fine-tuned my dictation skills, and I have become much more proficient, but I remember the first few dictations I've had to do, and they were not pretty. I think my very first operati... UroStream blogs http://www.medworm.com/rss/comments.php?id=1082037 Sun, 09 Dec 2007 17:57:00 +0100 1082037 http://www.medworm.com/index.php?rid=1062732&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F11%2Fno-dress-code.html A urology clinic would be a difficult place to work in if you have prudish sensibilities. There are frank discussions about sex, STDs, urinary and bowel functions and other delicate topics. Because we address the genitourinary health of patients, we are singularly interested in the "nether regions", hence our particular focus in the area "below the belt" during our physical exams. ("What made you go into urology?" is an oft asked question, both from patients and family members, and perhaps a topic for a future post).At one point or another, I have seen most of my patients naked from the waist down, just like an opthalmologist would have looked into the eyes of all his/her patients. It just part of being a urologist. During my very early days in medical school and internship, there was a mi... UroStream blogs http://www.medworm.com/rss/comments.php?id=1062732 Fri, 30 Nov 2007 05:59:00 +0100 1062732 http://www.medworm.com/index.php?rid=1049826&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F11%2Fdisposable-dell.html My barely three year old Dell laptop died last week. It was quite sudden and completely unexpected. There were certainly no symptoms at all until my husband came home one afternoon, and found it down in our study. There were no lingering agonizing last moments, no prolonged suffering (except coming from yours truly) and no obvious reasons. He tried a couple of heroic maneuvers, and finally brought her emergently to the computer hospital (his IT department at work), but alas, even the IT professional could not revive it. Apparently the hard drive and motherboard (who knew computers had moms?) were both completely fried, and I lost everything. My photos, itunes, powerpoint presentations on fun topics like hematuria, incontinence and interstitial cystitis.... argh...The IT guy told us that ... UroStream blogs http://www.medworm.com/rss/comments.php?id=1049826 Mon, 26 Nov 2007 01:15:00 +0100 1049826 http://www.medworm.com/index.php?rid=1032870&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F11%2Fbeing-generally-averse-to-using-public.html Being generally averse to using public restrooms, I try to avoid using those at the hospital that are situated in high traffic areas. I'm talking about the restroom next to the main elevators, cafeteria or in the main lobby. I usually like the ones that are located in restricted areas or remote corners of the hospital. I consider that one of the few perks of being a physician.Today, I just wanted to wash my hands and entered for the very first time the women's restroom located right next to the emergency room, which I conjecture to be quite busy.Imagine my surprise when I saw a condom dispenser next to the sink!!! What an unlikely and perhaps even inappropriate place for one. Would this be in the event of extra long waits at the ER? Before a visit with your convalescent loved one (and hopi... UroStream blogs http://www.medworm.com/rss/comments.php?id=1032870 Fri, 16 Nov 2007 03:18:00 +0100 1032870 http://www.medworm.com/index.php?rid=1022113&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F11%2Fclose-to-home.html Many members of my family as well as close (and not so close) friends started to ask me for medical advice very early on in my medical career. Dare I say the first day of medical school? There were all sorts of questions ranging from laryngitis to irregular menses, and I tried to my best to answer them, with the ever present caveat that I wasn't a real doctor yet, and didn't know all that much.Since specializing in urology, I have a similar caveat that I still don't know much beyond the genito-urinary system, but that certainly doesn't stop the phone calls and e-mails. I'm happy to answer all queries and give medical advice (which usually goes something like: "It sounds like you have sprained your ankle. Ice it down, take some ibuprofen and try not to bear any weight on it, but if it doesn... UroStream blogs http://www.medworm.com/rss/comments.php?id=1022113 Tue, 13 Nov 2007 04:49:00 +0100 1022113 http://www.medworm.com/index.php?rid=1018776&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F11%2Ftale-of-two-patients.html Both patients are elderly women in their eighties, who live in a skilled care facility.Both have advanced dementia and are no longer able to make decisions for themselves.Both have close relatives who have power of attorney over their medical care.Both are admitted to the hospital on the very same day for failure to thrive.Both need a urology consult.And that's where the similarities end.One patient was found to have advanced invasive high grade cancer of the renal pelvis extending into the ureter and the bladder and I had to fulfill my very least favorite task as a physician: telling patients and their loved ones that they have cancer. This diagnosis came as a complete surprise for the family. Fortunately for the patient, she was really beyond understanding what was happening to her. I th... UroStream blogs http://www.medworm.com/rss/comments.php?id=1018776 Sat, 10 Nov 2007 19:25:00 +0100 1018776 http://www.medworm.com/index.php?rid=1007184&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F11%2Foffice-flora.html Erma Bombeck once quipped:" Never go to a doctor whose office plants have died".If you were to heed this sage advice, I would have to warn patients about coming to my office. After we remodeled our clinic a few years ago, I wanted to make my office space a little cozier by adding some plants. Make that many plants... I have to admit that we've actually had a succession of plants that have ended up shriveled and a wee bit on the dead side despite my attempts at excellent botanical care. I've tried Miracle Gro, special potting soils, frequent watering, infrequent watering, sun, shade, daily sweet talks, directing my positive 'chi' towards them etc... Sadly, I've discovered that leaving the plants alone, and letting my co-workers take care of them is their single most important survival adva... UroStream blogs http://www.medworm.com/rss/comments.php?id=1007184 Mon, 05 Nov 2007 18:34:00 +0100 1007184 http://www.medworm.com/index.php?rid=989608&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F10%2Fconfession-of-addict.html I've finally admitted it to myself after my husband confronted me the other night, but I have a seriously debilitating addiction. It's been consuming me for the past month, and though I have truly been busy at work, this is probably the reason why I neglected my blog recently.I've also neglected TV, conversations with my husband and reading books because of this addiction. I obsess over it once I get home, during dinner and until the wee hours of the morning. I can't stop and it's driving everyone crazy, myself included.SUDOKU!How can a simple numbers game take over my life? This goes way beyond solving the daily sudoku printed in the newspaper. I bought an actual sudoku book with over 150 puzzles before we left for Orlando. This was supposed to keep me busy during the long flight, and it ... UroStream blogs http://www.medworm.com/rss/comments.php?id=989608 Tue, 30 Oct 2007 01:58:00 +0100 989608 http://www.medworm.com/index.php?rid=983764&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F10%2Fblonde-moment.html I was seeing an elderly patient for the first time, and I was in the midst of obtaining a full medical history. She was accompanied by her daughter, who was helping out with some of my questions.I came upon the subject of past surgical history, and asked the patient when she had her hysterectomy. Both women paused for a while to think about the answer, and the daughter finally turned to her mother and asked:"Mom, did you have your hysterectomy before I was born?"As soon as the words tumbled out of her, all three of us looked at each other and burst out laughing. The daughter turned to me and good-naturedly remarked: "another blonde moment for me!". (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=983764 Sat, 27 Oct 2007 19:08:00 +0100 983764 http://www.medworm.com/index.php?rid=980467&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F10%2Fin-blink-of-eye.html It's just amazing how life in general can really get in the way of keeping up a blog. I went on vacation for a week, then returned to an extremely busy schedule at work (to make up for the fact that I was gone for that week), and next thing I know, it's been five weeks since I last wrote!!!! It feels like I blinked and time just flew by....So never fear, I'm still here. I'm just reeling from the fact that it's now the end of October and my vacation was a month ago!!! Yikes....Orlando was as much fun as anticipated. Husband and I just love DisneyWorld, though truth be told, we would probably have enjoyed the parks more if there weren't so many kids running around. (I jest...but not really...). I also had ample time for a few of my patented keen observations:Crocs: I'm talking about the rubb... UroStream blogs http://www.medworm.com/rss/comments.php?id=980467 Fri, 26 Oct 2007 01:42:00 +0100 980467 http://www.medworm.com/index.php?rid=889561&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F09%2Fthriving-on-stress.html I've discovered that in order to be a successful physician, especially a surgeon, you have to like being on edge. In fact, I'm not sure it's such a big secret. Why else would we have chosen a profession where responsibilities and major decisions are daily events? Not only do we like stress, we also thrive in it.It's not always as obvious as I make it sound. Certainly if you were to ask any practicing physician, I don't think any of them would willingly admit to liking stress. None of us in the right frame of mind would knowingly put ourselves in a stressful situation, yet we do it all the time when we go into the operating room or take call for an emergency room.Right before a major surgery, or before facing an unknown situation in the ER, I get a mild sense of trepidation combined with an... UroStream blogs http://www.medworm.com/rss/comments.php?id=889561 Fri, 21 Sep 2007 05:06:00 +0100 889561 http://www.medworm.com/index.php?rid=867202&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F09%2Fwhy-does-it-always-come-as-surprise.html The cycle of life and death is an inexorable constant of Nature, death being one of the inescapable absolutes of life.As a physician, one would think you would get used to death since we tend to encounter it more often than most people. You confront the whole concept of mortality the very first day of medical school when you come face to face with a cadaver in gross anatomy, continuing on in pathophysiology and pathology when you learn about all the different processes that can eventually end your life.But the truth is that you NEVER get used to death. Rationally I understand that people don't live indefinitely, but it's hard to come to terms with that, perhaps even more so as a physician. We are trained from the very beginning as wide-eyed malleable naive creatures in med school that deat... UroStream blogs http://www.medworm.com/rss/comments.php?id=867202 Wed, 12 Sep 2007 17:33:00 +0100 867202 http://www.medworm.com/index.php?rid=852065&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F05%2Fpharmacy-woes.html This is just a small annoyance, but when the pharmacist from MegaSuper Pharmacy pages you about a prescription that you or your partner has written, I wish they would give me a direct number so I could bypass the whole automated beginning. They make me go through their entire menu before I am able to talk to a real live pharmacist, and I find the whole process thoroughly distasteful and annoying. I detest those automated voice prompts. More and more pharmacies AND medical offices are using them, though I'm proud to say that our clinic hasn't fallen prey to those things. It's one thing when my credit card company makes me "talk" to the voice prompts for 10 minutes, but it's another when it's the PCP's office.They are probably more "efficient" than a real human being, but I feel that medicin... UroStream blogs http://www.medworm.com/rss/comments.php?id=852065 Sat, 08 Sep 2007 02:48:00 +0100 852065 http://www.medworm.com/index.php?rid=837409&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F09%2Flonely-on-call.html I'm on call this entire Labor Day weekend, and I have to tell you that there is no place lonelier than a hospital on a holiday weekend. The usual hustle and bustle of a hospital is normally muted during weekends, but it seems especially more pronounced on holiday weekends. As I wander down subdued hallways, look at films in a deserted radiology area, and search for special catheters in the eerily quiet OR, I feel strangely isolated.So far, I've been proud of the fact that on saturday, I was able to finish two OR cases and round at 4 different hospitals all before 11:30AM. Of course, I won't tell you what time I started my day... I've also been able to save a patient's testicle from torsion, placed a couple of "difficult" foley catheters in patients with retention, and removed a few pesky k... UroStream blogs http://www.medworm.com/rss/comments.php?id=837409 Mon, 03 Sep 2007 00:42:00 +0100 837409 http://www.medworm.com/index.php?rid=824549&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F08%2Fhappier-hunting.html I can barely bring myself to write about this now, but we had to put down our 16 yo terrier mix a few weeks ago. She was affectionately referred to as "Crusty McTerrier" by my husband, mostly because she had that typical terrier coat that gave her a slightly disheveled (yet adorable) look, but also because of her curmudgeonly demeanor.I adopted Crusty when she was 3 months old, about one month before I started medical school. I was walking through the heart-wrenching kennels at the local Humane Society when I spotted a rambunctious and scruffy looking puppy that was just begging me to take her home. And the rest is history. We went through medical school together (her favorite subject was pathophysiology as evidenced by several bites taken out of Robbins' textbook), then she spent some qua... UroStream blogs http://www.medworm.com/rss/comments.php?id=824549 Mon, 27 Aug 2007 16:30:00 +0100 824549 http://www.medworm.com/index.php?rid=819455&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F08%2Fgoing-bare.html ...which, in the medical world, refers to the practice of not carrying malpractice insurance.There are many states where it is mandatory for every physician to carry medical liability insurance in order to practice medicine and be on staff at a hospital. However, there are a few states where having malpractice insurance is optional. Notably Florida is one of them, and there is a growing number of doctors who are "going bare".It is certainly not surprising, especially when you consider the fact that some of the "high-risk" specialties such as OB-GYNs need to shell out between $150,000 to $300,000 a year to have coverage. I am sure that even the harshest critic will agree that is an INSANE amount of money! In fact, I'm not sure that as an OB, you can make enough money to pay for your premium... UroStream blogs http://www.medworm.com/rss/comments.php?id=819455 Fri, 24 Aug 2007 03:55:00 +0100 819455 http://www.medworm.com/index.php?rid=799154&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F08%2Fquote-of-day.html From today:As I was talking to the patient's husband in the surgery waiting room, he remarked:"Even though you are a surgeon, you are knowledgeable about medicine..."I think he meant this as a compliment, so I just smiled and nodded.From yesterday:I scheduled a pre-op patient for a test that was absolutely necessary in order to proceed with a planned operation. I learned yesterday that he didn't show up for the test, and when we called him about it, he replied:"Well, I talked it over with my family, and we decided it really wasn't the right thing to do. But we are still going ahead with surgery right?"The answer would be NO. How about talking it over with me, your doctor? (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=799154 Tue, 14 Aug 2007 19:47:00 +0100 799154 http://www.medworm.com/index.php?rid=786639&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F08%2Fwere-all-in-this-together.html Our clinic once employed a physician assistant who left shortly after she was hired. During her exit interview, she stated that she felt she was given work that was "beneath her".I actually never got to work with her personally, since we were mostly at different locations, but I was shocked when I heard this. What work could we have given her that was so distasteful?After going through a surgical internship and residency, where you really are in trenches, I would NEVER assign something unpleasant that I wouldn't be willing to do myself, and haven't already done so on multiple occasions. As a surgical resident, we are trained to be very "hands-on", and as an intern, we are actually asked to do all the scut work ourselves (removing drains and skin staples, changing the packing in an open wo... UroStream blogs http://www.medworm.com/rss/comments.php?id=786639 Wed, 08 Aug 2007 05:11:00 +0100 786639 http://www.medworm.com/index.php?rid=783812&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F08%2Fand-just-to-prove-that-im-total-geek.html The sorting hat says that I belong in Gryffindor!Said Gryffindor, "We'll teach all those with brave deeds to their name."Students of Gryffindor are typically brave, daring, and chivalrous. Famous members include Harry, Ron, Hermione, Albus Dumbledore (head of Hogwarts), and Minerva McGonagall (head of Gryffindor).Take the most scientific Harry Potter Quiz ever created. Get Sorted Now! (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=783812 Tue, 07 Aug 2007 03:00:00 +0100 783812 http://www.medworm.com/index.php?rid=777543&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F08%2Fsimple-explanation.html Before I entered the patient's room, his caretaker took me aside and whispered:"He's from West Virginia".He said it in a tone that suggested I should immediately understand all the implications of that statement. After seeing my rather blank look, he elaborated:"Well, that's why he can't read or write, and why he may be prejudiced against seeing a lady doctor".So I thought about just dictating on my Assessment and Plan:1. From West Virginia. Period. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=777543 Fri, 03 Aug 2007 21:42:00 +0100 777543 http://www.medworm.com/index.php?rid=762920&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F07%2Fpoliteness-versus-common-sense.html I am certain that there is no polite way to tell a patient that a large part of her medical issues stems from poor hygiene and that my treatment plan would largely include showering at least twice a week. I venture as far as to say that even a shower once a week would fall under good patient compliance.The patient was seen for recurrent bladder infections, and upon spending just a few minutes with her, it was eminently clear why she was prone to them. She desperately needed a few private moments with soap and water.The icing on the cake came towards the end of the clinic visit when the patient wanted me to culture her belly button, upon which she proceeded to insert her index finger into her umbilicus, dug around for a few seconds, then placed it up to her nose for a deep extended inhale b... UroStream blogs http://www.medworm.com/rss/comments.php?id=762920 Thu, 26 Jul 2007 22:09:00 +0100 762920 http://www.medworm.com/index.php?rid=745453&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F07%2Funfortunate-allergies.html Compilation of drugs with corresponding "allergic reactions" as described to me by patients over the years. (I kid you not)Compazine: nauseaBenadryl: rashPrednisone: anaphylaxis (I encountered this one today which prompted this post)Epinephrine: heart racingValium: dizzinessPercocet: constipationmorphine: hallucinationCoumadin: bleeding (OK, I made this one up)And my all time favorite:"general anesthesia": completely puts me out (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=745453 Fri, 20 Jul 2007 04:21:00 +0100 745453 http://www.medworm.com/index.php?rid=734797&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F07%2Fyou-know-youre-surgeon-when.html You change your own flat tire at the hospital parking lot (and you're a woman!).You don't own a stethoscope anymore after you lost the last five during medical school and residency.You freak out when you discover your dog has eaten your favorite Dansko clogs on the morning of a busy OR day.You have extra clogs stashed at all the hospitals in which you operate.Your H&P has never been longer than one page.Your discharge summary has never been longer than half a page.You like to butter your toast with a surgical instrument.You use unused OR sutures and a needle driver to mend your clothing and darn your socks. (I prefer 2-0 silks for my black socks)You rise earlier than anyone else you know.You fall asleep as soon as you hit horizontal.You have the bladder of an elephant (they have big bladde... UroStream blogs http://www.medworm.com/rss/comments.php?id=734797 Sat, 14 Jul 2007 14:44:00 +0100 734797 http://www.medworm.com/index.php?rid=726190&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F07%2For-barbershop.html Over the years, I feel I have developed a special talent for haircuts.... below the navel. It's common practice for surgeons to clip the area of the surgical incision in order to minimize wound infections and for ease of the surgery itself (don't want to be fighting with hair), and naturally, my area of expertise just happens to be in the nether regions.I have removed hair on innumerous occasions. That's just part of my job, and I have tried many different approaches. I have recently switched from razors to clippers, mostly because the surgical literature suggests that clipping is better than shaving in terms of reducing wound infections. I started out shaving/clipping just in the vicinity of the surgical incision, but many times, that would result in a very uneven pattern. The asymmetry ... UroStream blogs http://www.medworm.com/rss/comments.php?id=726190 Wed, 11 Jul 2007 04:55:00 +0100 726190 http://www.medworm.com/index.php?rid=714659&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F07%2Fglamorous-life.html Being a general urologist, I don't restrict my practice to any particular urological condition (and despite rumors to the contrary, I will see patients with dermatological issues on their genitalia), but there are some conditions that I see more frequently in my practice. Kidney stones are very common and because of my gender, I see a lot of female patients with incontinence and recurrent UTIs year round.After days of dealing with very similar chief complaints, I will begin to reflect that it's been a while since I've seen a new patient with kidney cancer, or helped out with a kidney transplant. No sooner do these thoughts cross my mind that I will suddenly encounter four new patients with a kidney mass, and get involved in a marathon weekend of transplants. Call it fate, irony or the Gods... UroStream blogs http://www.medworm.com/rss/comments.php?id=714659 Wed, 04 Jul 2007 23:10:00 +0100 714659 http://www.medworm.com/index.php?rid=700913&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F06%2Fmajor-gaffe.html One of the cardinal rules in medicine is NEVER MAKE ASSUMPTIONS. .. about anything... This may explain why I'm such an insane micro-managing control freak.However, I was meeting a patient in the pre-op area today, and there was a nice older man accompanying her. I said hello, chatted a little bit, then turned to her companion and asked:-"So are you Dad?"-"No, I'm actually her husband"I normally do not make this kind of assumption (my usual question is: "are you family or friend?"), and my only sorry excuse was that my defenses were down after an unusually long day at work. I was absolutely mortified and apologized profusely. Yikes... This is on par with asking a woman: "When is your due date?" when she is not pregnant. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=700913 Thu, 28 Jun 2007 05:08:00 +0100 700913 http://www.medworm.com/index.php?rid=692588&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F06%2Fadults-only.html Thanks to Seaspray and Gruntdoc, I found this fun site that rates your blog as if it were a movie rating. This was the result:This rating was determined based on the presence of the following words:penis (16x) pain (10x) semen (4x) poop (3x) orifice (1x)Who would have guessed I was an X-rated sort of girl? And who knew "orifice" was a key word for an NC-17 rating?This brings home the fact that my husband lamented on the content of my previous post. Because of the key words "penis" and "ejaculate" and "semen", I'm sure my blog is popping up at the top of every google search with those particular words, which means lots of "unusual" traffic for my site. And there, I did it again! (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=692588 Sat, 23 Jun 2007 22:48:00 +0100 692588 http://www.medworm.com/index.php?rid=687659&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F01%2Fwhats-this-thing-on-my-penis.html Urologists get asked this question a lot. In fact, I get asked this more frequently than I care to remember. "This thing" on the penis can be anything, from a small rash, to a little blister, to an area of skin discoloration. There is also the completely phantom lesion invisible to the naked eye except to the patient himself who doesn't understand why nobody else seems concerned, but who has harrassed his primary care doctor into sending in a referral to the urologist.I am speaking for most urologists when I say that we HATE getting asked this, primarily because most of the time, we have NO clue to what that is either. Please consult your dermatologist!!!! It's still a skin issue, even if it is penile skin!!! I don't know why there is a little redness right there, or why that area seems bu... UroStream blogs http://www.medworm.com/rss/comments.php?id=687659 Thu, 21 Jun 2007 17:15:00 +0100 687659 http://www.medworm.com/index.php?rid=674207&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F06%2Fare-you-sure-you-wanted-urologist.html There are many times when patients or doctors call me, and I ask myself if they really needed or wanted the services of a urologist.One of the most appalling abuses of our on-call service happened to me recently. Seeing a doctor from our group means that there is always someone available 24 hours a day, seven days a week. It is understood that when you contact the physician on call after hours, it is usually for an emergent reason. Even more so when it's in the wee hours of the morning, when sleep is all you should be thinking about.I got a call at 1AM, and when I tried to call the number back, the line was disconnected. The patient had given us a wrong number. I could do nothing else but try to go back to sleep. He actually called 45 mins later, with another wrong number until our answeri... UroStream blogs http://www.medworm.com/rss/comments.php?id=674207 Fri, 15 Jun 2007 01:48:00 +0100 674207 http://www.medworm.com/index.php?rid=674208&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F06%2Fwhite-cloud.html I was somewhat dreading call this weekend, because one of my partner who had been on the call the previous two weekends, including Memorial Day weekend, had been slammed. He performed an insane number of surgeries (about 10 cases over 3 days), and saw a lot of hospital consults.My dreaded weekend was actually quite calm! I've always had a black cloud on call during residency, but this state of affairs seems to have turned around now that I'm in private practice. On the other hand, this one particular partner ALWAYS has weird events happen to him while on call. He IS the black cloud of the group, though truth be told, he loves being busy and operating during his call days, so I guess he wouldn't really consider himself unlucky.My lone triumphant moment this weekend was when I was called for... UroStream blogs http://www.medworm.com/rss/comments.php?id=674208 Mon, 11 Jun 2007 16:01:00 +0100 674208 http://www.medworm.com/index.php?rid=674209&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F06%2Fequal-opportunity.html For those of you who think I only direct my frustration and anger at my husband, family, friends and patients, let this post tell the truth! I am an equal opportunity venter! (this may explain why I have no friends...) I was quite disappointed in some of my fellow urologist the other day.I was in the esteemed company of about 30 of my colleagues during the Vegas workshop, and we sat through an hour-long lecture before moving on to the cadaver lab. Much to my dismay, there were ringing cellphones galore!!! The added insult was that all these urologists who received calls actually answered them in the middle of the lecture, while the speaker was going over his powerpoint slides!!!!"Hello? How are you doing? Blah blah blah...(for what seemed like an eternity...) Listen, I can't talk right now... UroStream blogs http://www.medworm.com/rss/comments.php?id=674209 Thu, 07 Jun 2007 04:47:00 +0100 674209 http://www.medworm.com/index.php?rid=655364&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F06%2Fvegas.html I was in Las Vegas over the weekend for a workshop. When the plane landed, it was 95 F at 9PM, and I really don't like Vegas at that temperature. Truth be told, I don't like Vegas at any temperature, period.Vegas is gross. That's the only adjective that comes to mind when I think of that city. It's just not my style. The throng of people hypnotically gambling away, drinking and smoking just puts me off. And I hate that ad that says "What happens in Vegas stays in Vegas". It insinuates that it's perfectly fine and even encouraged to do crazy anonymous things in this crazy city and then return to your normal life without any consequences. I'm far from being a puritan, but I'm just not a big fan.But Vegas was where this workshop was being held, and I really wanted to learn how to do this new ... UroStream blogs http://www.medworm.com/rss/comments.php?id=655364 Mon, 04 Jun 2007 02:26:00 +0100 655364 http://www.medworm.com/index.php?rid=650497&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F06%2Fsmall-laughing-matter.html I just perused this article on webmd about the small penis syndrome, which apparently is no laughing matter for those affected. I have copied the article, but please click on it for references.Here is the article, emphasis mine:June 1, 2007 – Eighty-five percent of women are pleased with their partner's penis proportions -- yet many normal men suffer "small-penis syndrome," urologists report.Small-penis syndrome is the anxiety of thinking one's penis is too small -- even though it isn't. It's a totally different condition from having a truly tiny tinkler, a condition known by the cold, clinical name of micropenis.Urologists Kevan R. Wylie of Royal Hallemshire Hospital and Ian Eardley of St. James Hospital in Leeds, England, review the literature on penis size in the June issue of the uro... UroStream blogs http://www.medworm.com/rss/comments.php?id=650497 Fri, 01 Jun 2007 22:25:00 +0100 650497 http://www.medworm.com/index.php?rid=650498&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F05%2Flets-not-use-our-brain.html I know that JCAHO is coming down hard on hospitals, and we've all been told to be on our best behavior. This is especially prominent in the OR, where the paperwork nazis have been working extra hard to obfuscate matters by adding a few more forms to fill out before we are allowed to take our patients to surgery. In the guise of patient care, this has made it more difficult for us to do what we really want to do, namely practicing medicine. In one particular hospital where bureaucracy reigns, the nursing staff has been recruited to become paper pushers, to the point of ridiculousness. Case in point from a page I received a few days ago, after I just finished a case and sent the patient to the Recovery Room (RR). RR Nurse: Dr Keagirl, you just finished with patient X, and I noticed that your... UroStream blogs http://www.medworm.com/rss/comments.php?id=650498 Thu, 31 May 2007 16:38:00 +0100 650498 http://www.medworm.com/index.php?rid=637550&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F05%2Fno-time-for-frivolities.html It's probably the fact that I've been away for two weeks, but clinic has been extremely busy this past week. I've barely had time to catch my breath.Friday (today) was the culmination of this grinding schedule. I was double booked the entire morning, and had two prostate cancer discussions back to back. Cancer discussion is never an easy task. First you have to break the news to the patient that he has cancer, which is difficult in itself, then you have to go into all the treatment options and risks and benefits of each said treatment. Sometimes the choices are easy because you only have one viable option (eg: nephrectomy for a large kidney cancer). Options for prostate cancer treatments are numerous and quite varied, which means that it takes a minimum of 30 mins for one of these discussi... UroStream blogs http://www.medworm.com/rss/comments.php?id=637550 Sat, 26 May 2007 05:17:00 +0100 637550 http://www.medworm.com/index.php?rid=628760&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F05%2Foverheard-at-great-wall.html Amazing place, incredible views, brutally tough climb...I have to admit that scaling the Great Wall really kicked my ass. Husband and I had to take frequent breaks to catch our breath.It was a little disheartening to see little eight to ten year old girls whizz by us and realizing how out of shape we were.My weekly pilates sessions just didn't prepare me for the Great Climb. But it was all worth it for the view and most of all, the immense sense of history and achievement...It's also very telling when you return from a two week vacation much fitter then when you left. Though we did consume an obscene amount of food, we must have walked the equivalent of 10 to 20 miles a day (no joke!).Naturally, no matter what corner of the world we were in, there were always Americans announcing their pre... UroStream blogs http://www.medworm.com/rss/comments.php?id=628760 Sun, 20 May 2007 23:25:00 +0100 628760 http://www.medworm.com/index.php?rid=622981&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F05%2Fwhy-pediatrics-was-never-option.html I must admit that I'm not a huge fan of little kids. I don't know how to talk to them (in residency, I tended to refer to 3-4 yo old toddlers as "Mr. or Ms. Smith"), I don't interact with them all that well, and I generally don't do well with anxious parents. It's just not in my nature, and I've accepted that and stayed as far away from Peds as possible.However, there is the whole subspecialty of pediatric urology, which doesn't come into play until the pediatric urologist from our group goes on vacation and off pager. I absolutely DREAD those moments because it means I have to deal with the parent calls at night."The surgical bandage fell off. What shall I do?" (Nothing)"There is poop all over the surgical bandage. What shall I do?" (Just take the dressing off.)"There is poop all over the... UroStream blogs http://www.medworm.com/rss/comments.php?id=622981 Fri, 18 May 2007 19:51:00 +0100 622981 http://www.medworm.com/index.php?rid=611072&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F05%2Fwriters-block.html I've been back to the States since Saturday night, and I have to admit that it has been an unwelcome jolt to be whisked back to my "real life" after two amazing weeks in Asia. I cannot even begin to describe the sights, sounds and cuisine we experienced! (but I will try...)For some reason, though I went back to clinic on monday morning, I'm not feeling all that tired or jet-lagged. I had a really hard time adjusting after our trip to Hong Kong in December, but I'm physically feeling quite well at this time.Mentally, it's a different story. I'm finding it somewhat arduous to return to the drudgery of dictation, paperwork, charts, labs and e-mails (Mt. Everest of medical charts and postal mail was awaiting my desk monday morning...). Thankfully, either through sheer luck or the foresight of ... UroStream blogs http://www.medworm.com/rss/comments.php?id=611072 Wed, 16 May 2007 03:27:00 +0100 611072 http://www.medworm.com/index.php?rid=574690&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fode-to-imp.html Hello dear readers, I'm The Imp. I'm guest blogging for my mommy Keagirl because she is going on vacation (again!) on a trip she calls "Asia Extravaganza". She will be traveling to Seoul, Beijing and Tokyo for the next two weeks . Keagirl (we're actually on a first name basis) wasn't sure how much internet access and time she would have during her travels, since she and the Tall-Guy-Who-Feeds-Me will be exposed to so many new sights, cultures, customs, languages and food. Hence she asked me to fill in for her today.She has written so much already about the three canines with whom I share this abode (rather insipid and inane creatures in my humble opinion), and I was feeling a tad bit neglected. But Keagirl knows I am smart and literate despite my purring habits, and she was confident that ... UroStream blogs http://www.medworm.com/rss/comments.php?id=574690 Fri, 27 Apr 2007 16:41:00 +0100 574690 http://www.medworm.com/index.php?rid=572033&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F04%2Fto-point.html Picture an elderly patient, perfect make-up, two-piece skirt suit and excellent manners. Just the quintessential darling little old lady from Georgia.With a very pronounced southern drawl she ended the clinic visit with: "Doctor, do I have to see you every year until I die?""Err... yes, unfortunately you do.""Well dear, I don't mind, I was just wondering..."For some reason, this made me smile and brightened up my morning. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=572033 Thu, 26 Apr 2007 18:52:00 +0100 572033 http://www.medworm.com/index.php?rid=566045&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F04%2Ftrauma.html Again, kudos to all ER physicians out there... I don't know how you all manage to work in such a high stress environment, day in and day out.I got called to our local ER, which also happens to be a level I trauma center. They were really swamped and stressed, as they had received 5 traumas all at once. One of them was a 17 yo kid taking a ride in the back of a pick-up truck with his friends after school. The truck flipped over and basically crushed him. He sustained a spinal cord injury at the T7-8 level, and was paralyzed from the waist down. I was called because they were unable to place a catheter in him.The poor kid was beginning to realize he was seriously injured and kept asking the staff: "is my back really broken? Am I really never going to be able to walk again?"I also saw his fri... UroStream blogs http://www.medworm.com/rss/comments.php?id=566045 Tue, 24 Apr 2007 03:11:00 +0100 566045 http://www.medworm.com/index.php?rid=563847&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F04%2Fsador-is-it.html This is something I overheard recently during a non-medical social gathering. A woman was talking about a sad situation and uttered:"I want to cry, but I can't because I took 2 Wellbutrins this morning."Do anti-depressants really blunt your emotions to this degree? So many people are on them. There is no doubt that some patients really need them (I honestly wouldn't wish major depression on my worst enemy), but I do believe they are somewhat over-prescribed. They certainly help with depression and anxiety, but I fear that some patients develop a flat affect on them. Personally, I want to be able feel it all, whether it be good or bad. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=563847 Mon, 23 Apr 2007 04:16:00 +0100 563847 http://www.medworm.com/index.php?rid=555378&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F04%2Fgroundbreaking-iguana-urology-news.html This article make me glad I went to med school as opposed to vet school. I guess I should expect that priapism exists in any animal species that has a penis, but frankly, I was surprised... (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=555378 Fri, 20 Apr 2007 04:42:00 +0100 555378 http://www.medworm.com/index.php?rid=550745&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F04%2Fcowardice-or-self-preservation.html It is certainly no secret that there are "nice" patients and "unpleasant" patients, just as there are "nice" doctors and "unpleasant" doctors. The interaction between the two makes for a large number of posts in medical blogs, because it is such a huge component of our daily lives.There are some patients who are simply wonderful human beings, and I truly enjoy interacting with them. I consider it an honor to be given the opportunity to take care of them, and these are the patients who make practicing medicine all "worth it". All of you health care professionals out there know which patients I am referring to. I'm very lucky indeed in that I consider a large number of my patients to belong to this group (let's call it group A).However, there is another group of patients whom I am less eage... UroStream blogs http://www.medworm.com/rss/comments.php?id=550745 Tue, 17 Apr 2007 00:44:00 +0100 550745 http://www.medworm.com/index.php?rid=527752&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F04%2Fretort-of-week.html I was consenting a patient today for a ureteroscopy for the treatment of a kidney stone. She asked me what the post-operative period would be like, and what her limitations would be in terms of activity.Since a ureteroscopy does not involve any surgical incisions at all (it's a purely endoscopic procedure), I predicted she would actually have few restrictions, if any at all. In fact, I told her that she could jog the next day if she felt like it.The patient glared at me and quipped: "do I look like I go jogging?"5'3, 210lbs, one pack a day habit... I guess the question was rhetorical and I was duly chastised.... (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=527752 Sat, 07 Apr 2007 07:00:00 +0100 527752 http://www.medworm.com/index.php?rid=526214&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F04%2Fpervasive.html I am not anti-big-pharmaceutical company. In fact, I get along well with almost all of my drug reps, and they are quite welcome to bring lunch to my staff in clinic. I really don't have a problem with that, as long as they don't talk endlessly about their product. I mean, if I've been using that drug for the past few years, it would be safe to assume that I do know something about it, and there is no need to repeat the same spiel over and over. Pharmaceutical pens are a dime a dozen. Our office is overrun with them, and I would be hard-pressed to find a medical office that didn't have at least one pen with a drug name on it. Patients love these "goodies", and a lot of mine will take a few Viagra pens home with them.What is more disturbing is when I see a pharm pen "out of context". I just ... UroStream blogs http://www.medworm.com/rss/comments.php?id=526214 Sat, 07 Apr 2007 03:25:00 +0100 526214 http://www.medworm.com/index.php?rid=517421&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F03%2Fgrand-rounds-vol-3-no-28.html Welcome!I have the honor of hosting Grand Rounds for the second time! I can't believe it has already been a year since the last time I put all these great medical posts together. Time does indeed fly when you are blogging away.I thought of many different ways to "spice up" Grand Rounds. After much deliberation, I finally decided to" stick to the basics" and just present "the facts", as I did many times before as a resident during our weekly nerve-wracking, anxiety-inducing Urology Grand Rounds.Editor's choice:Keith from Digital Doorway writes about the nursing care crisis. It's an eloquent, well-written and wonderfully apropos post about the current nursing shortage, especially in the military healthcare system.Sunlight Follows Me is written by a physician from the UK, and her story, Denni... UroStream blogs http://www.medworm.com/rss/comments.php?id=517421 Tue, 03 Apr 2007 07:01:00 +0100 517421 http://www.medworm.com/index.php?rid=510380&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F03%2Fup-creek-without-paddle.html My worst nightmare came true last monday. I came home from clinic after a crazy busy day to find myself being paged right back to the ER on the other side of town. Alas, I was on call yet again...I had enough time to briefly walk the doggies before their bladders exploded (rather embarassing for a urologist owner...), then quickly headed back into traffic.Much to my horror and dismay, I discovered that I had accidentally left my cell phone at home. This would normally not be such a stressful event, but I was on call, meaning that I got paged multiple times to a couple of different ERs not to mention a few patient calls during the 20 minutes it took me to drive over to the first ER. And I could not call any of these people back right away!!!I was really distressed. I absolutely HATE to answ... UroStream blogs http://www.medworm.com/rss/comments.php?id=510380 Fri, 30 Mar 2007 06:00:00 +0100 510380 http://www.medworm.com/index.php?rid=505231&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F03%2Fgrand-rounds.html this week are up at Medviews who is an internist specializing in Allergy/Immunology.I have the pleasure of hosting Grand Rounds next week. It is almost to the day when I hosted it for the very first time last year, and I hope it will be as much fun! Please send me your submissions to: keagirl@gmail.com. Deadline will be Monday at noon at whatever time zone you are in. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=505231 Tue, 27 Mar 2007 16:00:00 +0100 505231 http://www.medworm.com/index.php?rid=484076&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F03%2Ffirst-day-of-spring.html Yes, March 20th 2007 is the first day of spring! Though the day is marked by clouds and some drizzles, it is the first step towards warmer and sunnier days. In recognition of this joyous occasion, I managed to get a pedicure during my lunch hour. I have brightly painted red toenails now, and they make me feel happy. I don't know if my male readers will be able to relate (and kudos to you if you can!), but there's something comforting about having nice feet with pretty toenails. Even if you have to wear clogs or closed toe shoes during the day, the knowledge that I have painted toenails makes me feel warm and fuzzy inside. In fact, I used to paint my toenails year round during residency.And don't forget to check out Grand Rounds at Blog, MD written by a pediatric hematologist-oncologist. (S... UroStream blogs http://www.medworm.com/rss/comments.php?id=484076 Tue, 20 Mar 2007 19:58:00 +0100 484076 http://www.medworm.com/index.php?rid=477129&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F03%2Fsweet-retirement.html I know several active urologists in their late 60s and early 70s who have full time medical practices. Some of them still take call, and all of them still perform surgeries. Even if they seem to enjoy the work, I really want to ask them why they aren't retiring. Don't they want to spend more time with their families? Explore new hobbies? Travel? Decrease their daily stress? Stop dealing with inane insurance policies?It's certainly not the money that's keeping them in practice. Most of them were practicing during the "heyday" of medicine when doctors, especially surgeons, were compensated generously for doing their job. This was the oft-reminisced era (that I just heard about but never experienced personally), where the practice of medicine was "purer", with less paperwork and bureaucracy, ... UroStream blogs http://www.medworm.com/rss/comments.php?id=477129 Sat, 17 Mar 2007 02:05:00 +0100 477129 http://www.medworm.com/index.php?rid=467718&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F03%2Ff-word-strikes-again.html Life is ironic. I just wrote that post about Fournier's gangrene on saturday, and I took a call this morning (monday) from the ER about another rule out Fournier's. This particular phonecall was marred by one of the rudest encounter with an ER doc since I've been in practice. On the whole, I have a very congenial relationship with all my ER colleagues. Since I belong to a big urology group that practices at several locations, we interact with 6 different ERs in town when we are on call, and I pride myself on being nice, helpful and minimally obstructive to patient care when the ER calls me. I am quick to accept admissions with very little grumbling, and promptly see patients who need to be seen in the ER.This particular ER physician must have been new since I've never heard of him prior to... UroStream blogs http://www.medworm.com/rss/comments.php?id=467718 Mon, 12 Mar 2007 14:27:00 +0100 467718 http://www.medworm.com/index.php?rid=463323&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Ffourniers-gangrene.html I'm talking about Fournier's gangrene, also known as necrotizing fasciitis of the male genitalia. The popular press likes to give the friendly moniker "flesh eating bacteria" to describe this horrible infection.This 'F' word is guaranteed to put the fear of God in any urologist. It's an extremely aggressive, rapidly spreading infection that can become life-threatening in a matter of hours. It's very different from the regular garden variety scrotal cellulitis, which is commmon. This rare infection usually starts in the scrotal region and can spread to the whole perineum, upper thigh and lower abdominal area. The patients are very very sick, and the only treatment is prompt surgical debridment, which is a nice way of saying you have to cut off all the infected skin and underlying tissue.The... UroStream blogs http://www.medworm.com/rss/comments.php?id=463323 Sat, 10 Mar 2007 17:03:00 +0100 463323 http://www.medworm.com/index.php?rid=463324&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F03%2Fdoes-not-read.html When I first saw this patient, there was a note in the chart from the front desk saying "patient does not read". I asked if this was a deliberate decision from the patient, or whether they had meant to say that the patient was illiterate and could not read. Unfortunately, the latter is true. The patient is a retired janitor who is somewhat "developmentally delayed" (I think that's the current correct term), and has never been able to learn to read. He has no family and is functional enough that he does not have a guardian or someone with power of attorney.This poses a difficult situation because I diagnosed him with prostate cancer after doing a biopsy, and tried to explain to him all the options available for treatment. Prostate cancer is a disease where there are several treatments choic... UroStream blogs http://www.medworm.com/rss/comments.php?id=463324 Fri, 02 Mar 2007 18:27:00 +0100 463324 http://www.medworm.com/index.php?rid=463325&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F02%2Fweird-question-of-week.html Just got this call today at the office:"Can I have sex with my catheter in?"We told him no, but what I really wanted to say was: "If you can actually convince your wife to engage in sexual intercourse with your catheter still in, then be my guest, and let me know how it went..." (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=463325 Sat, 24 Feb 2007 02:46:00 +0100 463325 http://www.medworm.com/index.php?rid=463326&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F02%2Fdrug-dealer.html Like most other physicians, I find it very difficult to treat patients with a history of IV Drug Abuse (IVDA) who are always on the "11 out of 10" pain scale, and commonly possess "allergies" to vicodin and all NSAIDs but do well on "that drug that starts with a 'd'". Like they don't know that it's called demerol or dilaudid... It's difficult to feel sympathy when you feel like you are being manipulated or swindled. Mind you, not every IVDA patient acts this way, but I would be lying if I said I didn't observe a certain pattern of behavior.However, the situation gets even tricker when I perform surgery on IVDA patients and I am directly responsible for the pain that was inflicted. The trouble is that controlling the pain is incredibly difficult because of the low pain tolerance these patie... UroStream blogs http://www.medworm.com/rss/comments.php?id=463326 Fri, 23 Feb 2007 17:59:00 +0100 463326 http://www.medworm.com/index.php?rid=463327&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F02%2Fbearing-brunt-of-mankinds-follies.html I'm guessing that readers of this blog eagerly await in anticipation of my call nights because something "amusing" is almost certainly bound to make it way onto these pages. I know these medical "mishaps" make for great blog material, but sometimes I have to admit that I would rather sleep a full uninterrupted night's sleep. Boring, but true.Alas, my last call night was far from the boring kind. I got called to the ER to deal with a man who had placed a piece of plastic tubing (an aquarium pump tube to be exact) up his urethra, and it was now stuck inside and neither the patient nor the ER physician were able to retrieve it. The story may sound familiar since I've already written about foreign objects in a previous post, let me assure you that every "trapped foreign object" tale is unique.... UroStream blogs http://www.medworm.com/rss/comments.php?id=463327 Thu, 15 Feb 2007 02:46:00 +0100 463327 http://www.medworm.com/index.php?rid=463328&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F02%2Fdoggie-karma.html We took our three dogs to the vet for their routine exam on saturday. We've known our vet for about 5 years, and my husband and I love him (the dogs seem to be fond of him as well). In fact, my husband remarked wistfully after leaving his office that he wished our vet could be our PCP. Yes, he is that good and thorough, which is why we are willing to travel almost 15 miles out of the way to see him, despite the fact there are many other vets closer to us.Our animals get far superior preventative medical care than we do. They've had more routine physical exams and routine lab work - including Chem 7, LFT, CBC, TFT, UA, Stool O&P- than we've had. I'm to the point where I'm more aware of my dog's liver function than my own. My husband will probably argue this point, but I think the dogs h... UroStream blogs http://www.medworm.com/rss/comments.php?id=463328 Mon, 12 Feb 2007 17:43:00 +0100 463328 http://www.medworm.com/index.php?rid=463329&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fnobodys-home.html There is nothing more challenging than seeing a new patient from a nursing home who gets dropped off by an ambulance service to my clinic, and there is scant paperwork as to the reason why he/she is here to see me. I'm talking about confused or demented elderly patients who barely remember their names, let alone why they need to consult a urologist. I usually get a registration form with insurance information, the medication list and a set of vital signs if I'm lucky. I also get a blank progress note page to write my observations. And that is IT!!!Oftentimes, the patient has been referred by the primary care physician, in which case I usually call their office to see if there are any appropriate chart notes they can send me, or I look up the patient on the hospital computer to see if he/sh... UroStream blogs http://www.medworm.com/rss/comments.php?id=463329 Mon, 05 Feb 2007 22:15:00 +0100 463329 http://www.medworm.com/index.php?rid=463330&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fpasswords-galore.html I'm running out of memory space in my brain. It's the sad truth. It's brought on by the fact that every hospital computer system has a different user name and password, and I'm expected to keep all of those straight in my head. Remembering a password shouldn't be too difficult since I tend to use the same one for almost everything, but one of the hospital I go to requires us to change our password every 3 months, compounding the problem. I admit to having a particularly difficult time not only coming up with a new password, but remembering later what I came up with. Furthermore, I have different usernames for accessing the Radiology computer files even within the same hospital.I go to 3 different hospitals to operate and see patients, and each place has a unique combination code for the OR... UroStream blogs http://www.medworm.com/rss/comments.php?id=463330 Wed, 31 Jan 2007 21:03:00 +0100 463330 http://www.medworm.com/index.php?rid=463331&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F01%2Fparanoia.html I was on-call this weekend, and it was surprisingly quiet. (Of course, I realize that having said this, my next call weekend is guaranteed to be hellish...) But a "restful" call-weekend is not all that you may think it is, especially if you are somewhat neurotic and paranoid by nature. And lo and behold, I believe I do fall into the "neurotic" and "paranoid" category.My pager went off a total of 6 times, which is somewhat akin to a miracle. On average, I tend to get about 15 to 20 calls per weekend. But instead of enjoying the peace and quiet, I was secretly worrying about whether my pager was working properly, which is why I test-paged myself a couple of times, Then having ascertained that my pager was indeed functioning, I had the horrible feeling that if saturday was a good day, I would... UroStream blogs http://www.medworm.com/rss/comments.php?id=463331 Mon, 29 Jan 2007 23:48:00 +0100 463331 http://www.medworm.com/index.php?rid=463332&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F01%2Flearning-curve.html This is a rather humbling story.Though I am quite comfortable these days with urethras and catheterizations, it was not that long ago that I had a rather embarrassing experience.I was a medical student on my first surgery rotation, and I was asked to place a foley in a female patient. No big deal, right?Well, it was the first time I had to place a foley in a woman, and the anatomy is a little more complicated than a man's (What can I say... Boys have one obvious opening. Not so simple in girls...) I am ashamed to say that I spent a good 30 secs trying to catheterize this poor patient's clitoris. I just couldn't understand why the foley would not go in, until my resident took pity on me and showed me what I was doing wrong. I was absolutely mortified. Thankfully, the patient was already asl... UroStream blogs http://www.medworm.com/rss/comments.php?id=463332 Thu, 25 Jan 2007 23:01:00 +0100 463332 http://www.medworm.com/index.php?rid=463333&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F01%2Fbroken-record.html Don't get me wrong, I love what I do for a living, but even urologists can fall into a rut. Since we tend to see the same diseases over and over again, there are days when everything feels very repetitive. I have standard talks about a variety of urological disorders that I can spout off at will, including my "stress incontinence talk" which includes the "pretend my fist is the bladder and my index finger is the urethra" visual aid, my "hematuria talk" (showing off my artistic skills with drawing of the kidneys, ureters and bladder), my "elevated PSA talk" leading into "prostate needle biopsy talk" (using a nice plastic model of the male pelvis) which may turn into "prostate cancer talk", my "recurrent bladder infections talk", "kidney stones talk" and many many more. I think every physici... UroStream blogs http://www.medworm.com/rss/comments.php?id=463333 Tue, 23 Jan 2007 04:19:00 +0100 463333 http://www.medworm.com/index.php?rid=463334&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F01%2Ffood-thoughts.html I think I wrote on a previous post how much I love food, and I'm not averse to trying all kinds of ethnic and "unusual" dishes, which makes traveling so much fun. My husband shares a similar passion for good food, and we are always excited about visiting countries that have a strong "food culture", and Hong Kong was certainly one of those places.As an aside, I tend to believe that the majority of the US does not have this profound "food culture" seen in other countries. We certainly consume a massive quantity of food, but I think we care less about the quality and freshness of the food. Just go to your local supermarket and read the ingredients listed in most foodstuff. It's like reading something from a chemistry class, and I am reasonably certain that this basic fuel for your body should... UroStream blogs http://www.medworm.com/rss/comments.php?id=463334 Mon, 15 Jan 2007 16:46:00 +0100 463334 http://www.medworm.com/index.php?rid=463335&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F01%2Fday-and-night-in-life-of-urologist.html I spent about an hour last night squeezing a man's penis. And no, it wasn't my husband's!!!!As you can guess, I was on call last night and was about to retire to bed when I was called in for a priapism (painful sustained erection of more than 4 hours). This poor man did not have any risk factors for developing priapism, and was actually a nice, albeit unfortunate man. I had to do some intra-corporeal irrigation (which involves putting a needle in the penis and flushing the blood out with some saline), and manual compression (hence the squeezing), and finally his erection went down. I was able to get a few precious hours of sleep until 5AM when I assisted on a kidney transplant.However, as I was doing all this in the ER, I kept thinking about the utter absurdity of the situation. I wonder ... UroStream blogs http://www.medworm.com/rss/comments.php?id=463335 Wed, 10 Jan 2007 19:05:00 +0100 463335 http://www.medworm.com/index.php?rid=463336&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2007%2F01%2Fhappy-new-year-twice.html I am back after a fabulous trip to Hong Kong. The city is absolutely fantastic, and we were able to squeeze in a lot of activities in one short week. It's funny how time just flies by when you are having a good time...I will write more about Hong Kong in my future posts, but for now I will keep it short because I am still extremely jet-lagged.We had the unusual pleasure of experiencing New Year's Eve twice. We left Asia on Dec 31st at 11:55 PM and arrived home at around the same time. Amazing what air travel and time zones will do to you.I got about an hour's worth of sleep last night because of the time difference, and I started out my first day of work in the year 2007 by doing a vaso-vasostomy (more commonly known as a vasectomy reversal). It was a 7:30 AM case (very painful), and basic... UroStream blogs http://www.medworm.com/rss/comments.php?id=463336 Wed, 03 Jan 2007 04:34:00 +0100 463336 http://www.medworm.com/index.php?rid=463337&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fand-off-we-go-again.html Unless I find an easy internet connection at my hotel, I will be unable to write any new posts for the next week. You see, I am going to Hong Kong for Christmas with my husband, and we cannot wait. We are leaving tomorrow and will be there for almost a week. It's the first time in Hong Kong for the both of us, and we are already salivating at the thought of authentic dim sum, shiny & crispy peking duck, as well as low-key congee and noodle shops. As you can tell, food is always a priority on all our vacations, and I feel like we are going to hit the jackpot.The icing on the cake is the fact that the Weather Channel is predicting a nice sunny 71 degrees for Christmas day. These days, I'm just so past the phase of wanting a "white Christmas".In any case, I will return in just enough time to ... UroStream blogs http://www.medworm.com/rss/comments.php?id=463337 Sat, 23 Dec 2006 04:41:00 +0100 463337 http://www.medworm.com/index.php?rid=463338&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fvanity-justified.html According to this article on WebMD, surgeons tend to be the better looking doctors...Interesting...Too bad they didn't mention anything about female surgeons... (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=463338 Fri, 22 Dec 2006 04:34:00 +0100 463338 http://www.medworm.com/index.php?rid=463339&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fwilly-wonka.html Just bring to mind Willy Wonka's chocolate factory with rivers of milk chocolate streaming by, delicious treats sprouting from the ground, and the whole place generally overflowing with goodies....Well, that's our office right now. This time of the year, we are inundated by chocolate and other fattening treats. Patients, pharm reps and other well-wishers have been extremely generous (as they are every year), and I've been snacking constantly for the past 2 weeks. Oh no, I'm not complaining, but it is requiring a supreme amount of willpower to limit myself to just a couple of pieces of dark chocolate truffle with caramel per day. And truth be told, I sometimes have three pieces.So please forgive me if I come into the consulting room with a couple of smudges on my lips, a tighter white coat,... UroStream blogs http://www.medworm.com/rss/comments.php?id=463339 Wed, 20 Dec 2006 17:10:00 +0100 463339 http://www.medworm.com/index.php?rid=463340&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fjehovahs-witness.html For those of you who have been following my blog, you will surely have guessed that I'm a knee-jerk bleeding heart liberal, and I'm extremely tolerant and open-minded. (to my family members and friends, there was absolutely no need for that outright snickering....) But I have always been somewhat perplexed by the philosophy of Jehovah's witnesses regarding medical treatments.I was on call a couple of weekends ago (no, not this past one when I over-imbibed. Give me some credit!), and we ended up doing two kidney transplants. Now I really like doing transplants these days, but they used to be the urology resident's anathema, mostly because they always happened between the hours of 2AM and 6AM (when we could get the OR time), and my residency program did over 250 transplants a year. You can d... UroStream blogs http://www.medworm.com/rss/comments.php?id=463340 Tue, 19 Dec 2006 03:37:00 +0100 463340 http://www.medworm.com/index.php?rid=463341&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fnever-again.html That was my vow on friday night as I was cradling the porcelain goddess into the wee hours of the morning. You see, we had our annual Christmas party/dinner, and I must have overindulged in the alcoholic beverage department. Though truth be told, I am a real lightweight since I only had two martinis.Yes, just two martinis to send me over the edge into the realm of intractable nausea and vomiting. What I would have given for a little Zofran... I had the displeasure of experiencing my scallops and salmon twice...Even today my stomach is feeling a little queasy and I've been nursing a headache over the whole weekend. I guess the moral of the story is that I shouldn't really be drinking at all, or I just drink much more often to build up my tolerance.So I say: "Never again!!!!" ... until the n... UroStream blogs http://www.medworm.com/rss/comments.php?id=463341 Sun, 17 Dec 2006 19:18:00 +0100 463341 http://www.medworm.com/index.php?rid=463342&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fbane-of-my-existence.html The PagerI remember the very first time I received my own pager. It was the first day of internship, about a month after I graduated from medical school. It's not to say that I never had a pager during my medical school years. I wore one during particular rotations but it was always the generic "med student" pager for that particular service, and never had my name attached to it.But that day I received my very own pager was quite memorable. Mostly because it was the ONLY day I was ever glad to have a pager. It was a status symbol, something to say that I was finally a real doctor and nurses and colleagues would page me for real orders and real consults. I was thrilled and felt a sense of validation as a physician.Things went downhill pretty quickly the first day of internship when I was on... UroStream blogs http://www.medworm.com/rss/comments.php?id=463342 Mon, 11 Dec 2006 20:42:00 +0100 463342 http://www.medworm.com/index.php?rid=463343&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fif-all-else-failsblame-anesthesia.html Notice that I didn't say blame the anesthesiologist... just blame the anesthesia. The adage in the OR is: "it's always the fault of the anesthesia...." I jest (not), but I frequently find myself blaming the various side effects that patients experience after a surgical procedure on the anesthesia. These can include nausea and vomiting, headaches, muscle aches, lethargy, constipation, sore throat and a general feeling of malaise, not to mention the pain from the procedure itself.When a post-op patient comes in, complaining of various little ills, I nod slowly, and in my most "knowing" and empathic tone, I will say: "yes, it's all because of the anesthesia." I can usually get away with this for up to three weeks after the surgery. And it's a no-blame situation. It's certainly not the fault o... UroStream blogs http://www.medworm.com/rss/comments.php?id=463343 Fri, 08 Dec 2006 16:36:00 +0100 463343 http://www.medworm.com/index.php?rid=463344&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fmorning-workout.html I'm all for exercising and getting a nice cardio workout, but I hate it when I have to do it unexpectedly.I live on the 13th floor of my condo (strangely, I'm not superstitious about this), which is nice because we have a great panoramic view and we don't hear much street noise. But it is a nightmare when the elevators stop working, and you have to go up and down 13 flights of stairs with three dogs....Much to my dismay, there was an electrical overload that shut down the elevators this morning, so I was forced to take the stairs in order to walk the dogs. The stairs are metal, so they make an enormous racket when you walk on them (kind of akin to taking a 3x4 and pounding on an empty oil drum); this was only compounded by the fact that I was wearing clogs, which made my dogs very uneasy, ... UroStream blogs http://www.medworm.com/rss/comments.php?id=463344 Wed, 06 Dec 2006 02:52:00 +0100 463344 http://www.medworm.com/index.php?rid=463345&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F12%2Fnot-good-at-anything-else.html I have wanted to be a doctor ever since I was about 5 years old. It was definitely not an obvious choice since nobody in my immediate family is a physician, and I really didn't know anyone in the healthcare industry.As far as I remember, I just knew that I wanted to wear a long white coat and cure people. It was as simple as that, and I certainly was a tenacious little kid. I am not sure where this compulsion came from, but it never left me, even as I was majoring in French literature in college. It's certainly lucky for me that I've found something I enjoy and in which I seem to be proficient, because at this point, I don't think I'm good at anything else. I have spent over 11 years training to be one very specific type of doctor, neglecting any other "life survival" skills I may have pos... UroStream blogs http://www.medworm.com/rss/comments.php?id=463345 Mon, 04 Dec 2006 03:52:00 +0100 463345 http://www.medworm.com/index.php?rid=463346&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F11%2Fempty-threat.html Why do patients threaten to leave AMA (Against Medical Advice) and act as though that would hurt me, the physician. They use it as a threat or leverage to try to get what they want. Truth be told, if they choose to leave AMA, the only person they're hurting is themselves.Patients who make this sort of threat frequently have complaints related to their pain meds. "It's not strong enough", "not the right type of med" (eg: "ONLY 100 mg demerol ever works, and I'm allergic to everything else"), not given often enough etc... I'm always wondering how leaving the hospital AMA would alleviate their pain... My most recent episode involved a man who is known to everyone in my practice as Needle Dick. Not only was his first name Richard, but he was admitted because he had placed 26 broken hypodermic ... UroStream blogs http://www.medworm.com/rss/comments.php?id=463346 Wed, 29 Nov 2006 05:10:00 +0100 463346 http://www.medworm.com/index.php?rid=463347&cid=s_34703_119_f&fid=34703&url=http%3A%2F%2Furostream.blogspot.com%2F2006%2F11%2Ffailed-post-thanksgiving-resolution.html My husband and I went to visit my sister, bro-in-law and delightful niece for Thanksgiving weekend. We ate out EVERY single night, including Thanksgiving Dinner. It was so much fun and so delicious, but after three days of over-indulgence comprised of insane amount of animal protein, mac & cheese and french fries (the few items my niece will eat in a restaurant), I promised myself that I would only eat salad when I got back home.Well, I've been home for three nights, and I broke my promise the first night back.Pathetic...However, Thanksgiving was wonderful. I got to spend time with my niece who turned two the day after thanksgiving (missed being a moody scorpio by a couple of days), and spent many blissful hours shopping. (Source: UroStream) UroStream blogs http://www.medworm.com/rss/comments.php?id=463347 Wed, 29 Nov 2006 05:00:00 +0100 463347