A little booger humor

I was having a discussion with a friend about my snot.

Still reading?

Anyhoo, I just got over a bout of the flu, and I was wondering if I had a secondary staph infection since my snot is disturbingly bright golden yellow. And profuse.

She told me to look it up on the interwebs.

So I did.

Considering how disappointing some comment threads can be, the one above really cheered me up.

I don’t know if this is my favorite:

“It’s unmistakable, that is the golden mucous of God. He has chosen you. Earlier there was a question asking about some mysterious YELLOW pus coming from a girl’s vagina, she was one of the other chosen ones. There are seven in all, and they will save the world and turn us all into energy beings. We’ll have to wait and see who the rest are, but be patient, they will be revealed with time. Who am I, you ask? Just an observer… a man who has seen the truth.”

or

“See A doctor or pharmacist and you should just use your common sence, use kleenex and just dont sneeze directly on anyone obviously, dont worry unless you get A headache or other type pain then see A Doctor”

due to the really random capitalization, spelling and punctuation

or

“maybe it’s your diet like not enough nutrients to turn your snot green”

this one, due to the plain out bizarre factor. I worked in the health food industry for almost a decade, and I never heard that lack of nutrients theory.

Laughing while my head explodes

I don’t know if the entries at My OB said WHAT?!? are more funny or head-exploding inducing. I sputter and smile simultaneously with each one.

I think my favorite so far is this one: “Your baby may end up being retarded if we don’t do this test” was one nurse’s way of performing informed consent about a fasting blood sugar test.

Doublethink in health care

A four-month-old exclusively breastfed baby in the 99th percentile for its weight and height was refused health insurance because it has “obesity” as a preexisting condition.

*Shakes head in disbelief*

This story in the Denver Post is a perfect example of the sort of Orwellian doublethink that must exist for people to oppose health care reform because it will add a layer of evil government bureaucracy into medical decision making.

Here’s a great quote from the article:

Health insurance reform measures are trying to do away with such denials that come from a process called “underwriting.”

“If health care reform occurs, underwriting will go away. We do it because everybody else in the industry does it,” said Dr. Doug Speedie, medical director at Rocky Mountain Health Plans, the company that turned down Alex.

This kind of um, logic, for lack of a better term, is what these newly enraged self styled radical libertarians are advocating as a superior framework for guiding medical coverage than the government?

(A tip o’ the chapeau to Hoyden About Town)

Edited to add:

Here is a picture of Z when he was about that age:

I am sure he was in the 99th percentile, if I cared to measure it. Oh, yeah, and he has always been accident prone, like his mommy.

My head hurts

Today was a long day back under the fluorescent lights and in front of a computer screen. I like this fellowship because it allows me to do research, and I am confirming that I like academia. But, I definitely know I want to have a clinical practice. I am not liking being back in an office all day, every day.

So, after having to deal with defending Obama from being called a Nazi and a socialist, and helping with an ob/gyn interest club meeting, and being filmed for a promotional video for the medical school, I was trying to sit at my desk and fight my headache when I got a message from a friend of mine who is on his ob/gyn rotation.

He is rotating with a team of our professors, one of which I have already complained about. Well, everything he told me about what he has learned so far made my head explode message by message. I will give you a play by play:

He got to see a woman have a cesarean for a 4,300 g baby. He called the baby “macrosomic”. ACOG recommends that macrosomia should be defined as 4,500 g and up.

The physicians told him they cut episiotomies for every vaginal delivery. They told him “She’ll tear anyway.”

They do cesareans on whoever they can convince and then call it an “elective cesarean.”

The female ob/gyn told my classmate that in the 80’s the “trend” was toward cesarean section, and in the 90’s the “trend” was toward vaginal delivery because people wanted to get “back to nature.” Yeah, because anyone who wants to avoid major abdominal surgery with worse outcomes for the mother and the baby obviously is a crunchy hippie who is just following the latest trend. Evidenced based what?

She also told him that African American women (she is one, by the way) do not have adequate pelvises (pelvii?) to deliver vaginally. I know anthropoid pelvises (pelves?) are more likely in African American women, but they seem to have reproduced and delivered for millions of years without having a race wide dystocia.

That’s all I can remember. I better not have to do a rotation with them. I will switch, mainly because they have a very light practice and I want to see a lot more deliveries. But, I would also spend the entire time arguing with them or biting my tongue as my head exploded, and would probably fail the rotation when I need to pass my ob/gyn rotation with honors.

Obama’s prepared remarks to students

Here is a preview of what President Obama will be saying to our nation’s schoolchildren this week. It is similar to speeches given by George H.W. Bush and Ronald Reagan.

Here is an excerpt:

No one’s born being good at things, you become good at things through hard work. You’re not a varsity athlete the first time you play a new sport. You don’t hit every note the first time you sing a song. You’ve got to practice. It’s the same with your schoolwork. You might have to do a math problem a few times before you get it right, or read something a few times before you understand it, or do a few drafts of a paper before it’s good enough to hand in.

Don’t be afraid to ask questions. Don’t be afraid to ask for help when you need it. I do that every day. Asking for help isn’t a sign of weakness, it’s a sign of strength. It shows you have the courage to admit when you don’t know something, and to learn something new. So find an adult you trust – a parent, grandparent or teacher; a coach or counselor – and ask them to help you stay on track to meet your goals.

And even when you’re struggling, even when you’re discouraged, and you feel like other people have given up on you – don’t ever give up on yourself. Because when you give up on yourself, you give up on your country.

The story of America isn’t about people who quit when things got tough. It’s about people who kept going, who tried harder, who loved their country too much to do anything less than their best.

It’s the story of students who sat where you sit 250 years ago, and went on to wage a revolution and found this nation. Students who sat where you sit 75 years ago who overcame a Depression and won a world war; who fought for civil rights and put a man on the moon. Students who sat where you sit 20 years ago who founded Google, Twitter and Facebook and changed the way we communicate with each other.

Some idiots, such as Florida GOP Chairman Jim Greer, think this is spreading socialist propaganda.

If that is socialist propaganda, I would hate to see what conservatives think should be taught in schools.

Oh, wait, this, and this, and all of this.

Two things I found out yesterday

Rixa, the intrepid blogger at Stand and Deliver, won Lamaze International’s 2009 Media Award! If you haven’t read Rixa’s blog, (or Lamaze’s Science and Sensibility, for that matter), please check them out through the links above.

Her interview with Amy Romano is fantastic, chock full of analysis and information about modern maternity care. I was so tickled to see Rixa say she likes my blog! Like a cherry on the top of a sundae of a post. It is a wonderful, comprehensive look at both the quantitative, outcome based aspects of pregnancy and birth care, and the emotional, woman centered view of being pregnant and birthing.

I also found out that the Kali project shares a name with an escort service and live web cam of women sex workers in British Columbia. I was slightly amused and slightly dismayed. I consider myself to be “sex positive” and don’t mean to shame sex work. I am not a fan of exploitative sex work that exclusively involves women fulfilling what the mass media says is the male heteronormative ideal. Anyway, I hope they don’t mind sharing the name.

Umm, yowza

My reading list for this “vacation” also includes some journal articles. Sometimes when I search for an article by author, I find that the author has written many interesting articles. That happened today when I was juggling multiple portals to find a link for a long reply turned post in progress. I entered the author SL Clark in the search for the American Journal of Obstetrics and Gynecology, and got a list of gems.

One on the use of oxytocin made me sigh as I saved a copy. We are visiting with my in laws right now. My sister in law was given oxytocin for what ended up being a three hour active labor and delivery. I try not to second guess treatments of my family and friends once they have occurred, but this surprised me so much that I stammered “Why??!!”

She, like her mother, has incredibly quick labors, and we were all concerned whether she would make it to the hospital in time. Unfortunately for her, her epidural didn’t “take”. She thought the augmented contractions were unbearable. I had augmented contractions without an epidural my first labor, and they aren’t any fun, even if it is your plan to tough it out pain-wise. I wish I had known to refuse it or at least challenge its use. Like her, I was in active labor with intact membranes, I was low risk, and the fetus wasn’t in any distress. We were both given oxytocin upon admission. She told me she wasn’t going to take any childbirthing classes before her first delivery because her physician told her she “didn’t deserve to feel any pain.” I found that statement infuriating and misleading, but I kept my mouth shut. Unfortunately, by his logic, she was less deserving this time around.

Another article of his is what led to the title of this post. The results of his group’s review of maternal mortality since 2000 concludes that mortality during cesarean section is eleven times that of a vaginal delivery.

RESULTS: Ninety-five maternal deaths occurred in 1,461,270 pregnancies
(6.5 per 100,000 pregnancies.) Leading causes of death were
complications of preeclampsia, pulmonary thromboembolism, amniotic
fluid embolism, obstetric hemorrhage, and cardiac disease. Only 1
death was seen from placenta accreta. Twenty-seven deaths (28%)
were deemed preventable (17 by actions of health care personnel and
10 by actions of non-health care personnel). The rate of maternal death
causally related to mode of delivery was 0.2 per 100,000 for vaginal
birth and 2.2 per 100,0000 for cesarean delivery, suggesting that the
number of annual deaths resulting causally from cesarean delivery in
the United States is about 20.

Comment policy

I don’t have an official policy. I obviously don’t routinely censor anyone who disagrees with me. I am all for constructive conversation.

I do have my comments set that any new commenter has to be cleared by me, and I get notified of every comment. So, just a tip to anyone who wants to post comments calling Med Students for Choice “fucking liars”, that killing an abortion provider is somehow defensible as a “choice” with equal footing as termination of early pregnancy or anything else along those lines, it’s not going to get through. I will use such comments as proof that so called anti-choice activists are unreasonable fringe elements that defend murderers, however, and are not pro-life. So, thanks for the fodder.

I also don’t allow anonymous posting, so I will have your email address. Not that I would want to communicate with someone with that point of view on purpose, I’m just saying, spewing hate with a trail is kind of….stupid. Especially if it’s a work address or you are affiliated with a university.

If you are of the anti-choice persuasion and for some reason enjoy reading my blog, however, please feel free to check out my blog for choice day post from this January and see if you are believing any of these myths and letting them guide your comment attempts.

I have wanted to do a post on common ground for a while, and I may have time to do it soon. I am totally cool with people wanting to support women with unplanned pregnancies and who want to help them keep their pregnancies and raise happy, healthy children. Hell, I carried two unplanned pregnancies to term. Obviously I support that option. However, hateful rhetoric is not welcome here. Exercise your freedom of speech on another site where such filth is welcome. Thanks!

Reply turned post, fair fight style

I was inspired by Shakesville’s Quote of the Day yesterday, (sorry, been busy!) which was the always inspiring (laughter / horror / disgust ) Michelle Bachman complaining that the public option “would offer equal or better benefits than any plan—but cheaper.”

I was listening to NPR this morning, and they had an interview with one of the representatives from Tennessee who identifies as a “blue dog” democrat. He is in some group that is trying to work out a “bipartisan” bill with 2 other blue dogs and 3 republicans. According to the NY Times today, a similar group in the senate is most likely coming out with what will be the successful Senate version of the bill.

So, what we have, is bills written by groups shutting out the liberal democrats that were elected en masse to reflect the public’s will. 70 to 80% of the public want a public option. So….

…this Tennessee representative today said he is one of the few in the group who actually was OK with the public option (way to represent- snort) as long as it operated on a level playing field.

I’m sorry, sir, does this mean the public option has to be expensive, bureaucratic, confusing, and deliver few benefits with poor service? Is he agreeing with Michelle Bachman that a public plan that covers people and isn’t prohibitively expensive was somehow unfair or undesirable?

So, if it works, it’s bad. And if it doesn’t work, it’s good?

One day until COMLEX

My second step I board exam, this time the COMLEX, is tomorrow. More luck and vibes, please!

I just took a sample exam on the NBOME website. I am pretty happy, having gotten an 86%. A few of my errors were really stupid, and I knew the right answer. One could have easily been remedied by reading more slowly and not being distracted. I won’t being singing Intergalactic by the Beastie Boys and jamming out to my iPod in a crowded coffee shop during the real deal, so I may notice that the scenario about the fainting young woman includes the tidbit that she never injures herself on the way down, indicating malingering.

My pessimistic side is saying I just answered 50 questions on their website that most likely will not be on the exam, since they are on their website. Meh. I hope this indicates that I have a breadth of knowledge likely to be on the exam, but I am not sure.

One comment. We are actually allowed to type and save comments about specific questions on the exam, apparently. I don’t know if I will exercise this option. The instructions did not indicate if these would be read or considered by the powers that be, or a place for me to make notes in case I have time to return to the question.

I used to write comments on my paper exams at school, such as “WTF?” and “You said we didn’t need to memorize specific degrees of angles of components of normal gait!!” next to offending questions. Since it wasn’t on the scantron form, only on my paper copy of the test, I figured it was just garbage. I stopped doing this once I realized my test was always up there first (I am an obnoxiously fast reader and test taker), usually in the hands of a bored department head (or lackey) with not much else to do and no other tests to look over yet.

I never thought of it until one of the professors pointed out, in front of most of the class, that he noticed that I had corrected typos on my exam. I was slightly embarrassed, since my test taking speed is already a much discussed topic among my classmates. I felt a bit of redemption, since people should hear (and stop asking!) that I actually have time to read the questions. Um, yeah, I passed two years of medical school (not to mention the classes and standardized tests leading up to it) by skimming and picking “C”. (That’s my standard sarcastic answer to that.)

But, then I realized if he read my corrections, he most likely read my other editorial comments. I racked my brain trying to remember if I had written anything rude about any of his questions. I doubt it; he tends to be a straightforward test writer, but you never know. I stopped writing out the sarcastic comments at this point.

Anyway, back to the practice test and the ability to write comments. I did type one on the practice test, just to try it out. I doubt I will use it on the actual COMLEX, but I was spurred to try it out today. The stem of the question was the patient’s history. A middle aged male patient came in with various complaints, the chief complaint being headaches. Examination of the patient finds hemiparesis. Um, huh? My comment: “What patient would not complain of being paralyzed on one side?”

Mr. Patient, I know you mainly are concerned with your headaches, but did you notice you can’t move half your body and most likely couldn’t have even walked in on your own volition?

Lazy question writing. Just saying. Poor dude had a chronic subdural bleed.