Reply turned post, second verse, same as the first

Dr. Dangerpartum Von Deathtrap (ha ha ha ha, Jill!) is at it again at The Unnecesarean.

The replies are flying quickly, and the manure is flying even more quickly. Dr. Amy is in poor form, misquoting abstracts and using the death due to shoulder dystocia baby card for babies within normal weight range. Huh?

Anyway, I can’t reproduce all my replies, because they are flying too fast and furious to keep up with.

When I told of a personal experience of being at a frustrating delivery that involved a protracted labor due to an induction in a first time mom, I pointed out that her normally sized baby (8 lb 11 oz) had no shoulder dystocia problems. And, evidence on the subject, including UpToDate, agrees that fetal weight below 4500g (that baby was below 4000g) is not associated with shoulder dystocia.

Dr. Amy’s response:

MomTFH:

“He ended up being 8 lb 11 oz, and there was no problems delivering the shoulders.”

So what? Do you think that’s a defense suitable for court: “the last woman with a big baby didn’t have a shoulder dystocia”?

What would you do if you were RESPONSIBLE in the event that a baby died because you didn’t do everything you could to prevent it? Would you shrug it off? Would you tell the mother, “Too bad things didn’t work out, but it’s more important that fewer women have C-sections than that you have a live baby?” How well do you think that would go over?

Oh, OK, because when I say he didn’t have any shoulder delivery problems at all, what I meant was, the baby died and I shrugged it off, and all I care about is practice patterns, not live and healthy babies.

Here is my reply

Wow, I guess that’s what happens when I comment without reading the other comments.

Dr. Amy – She had NO risk factors or indications for a macrosomic baby and the baby did not have macrosomia. Are you proposing if, in 3 years when I am a practicing obstetrician, I do not section all similar patients, I am risking killing their babies?

Here is a quote from Up to Date:

Fetal macrosomia — Studies have consistently shown that macrosomia is a major risk factor for shoulder dystocia [2,3]. Fetal macrosomia is best defined as an estimated fetal weight (EFW) of greater than or equal to 4500 grams, as morbidity and mortality increase above this level [4,5]. The overall prevalence of birth weight over 4000 grams in the general obstetric population of the United States is 10 percent [6], but falls to 1.5 percent for birth weight over 4500 grams [4].

Her baby was more than 500 g below this threshold, and did not have an EFW above that threshold.

What do you think of the idea of doing an induction at 39 weeks with a Bishop’s score of 2 on this low risk patient? Based on ACOG Practice Bulletins and other online materials on quality care, my interpretation of the risks and treatment decision tree is pretty spot on. How much more do you think the baby would have grown if her physician waited for her due date at least, and how much would that increase her risk of shoulder dystocia?…

Have you read this article yet? The Obstetrics and Gynecology Risk Research Group still thinks obstetricians are misrepresenting risk to patients, to the detriment of women and their babies. You do it also, repeatedly. You have this citation from the thread from more than a week ago. You proceeded to cite a study from the same group the very next day, so you must think it is a good source.

Then the good doctor wanted to set some baseline “facts” about defensive medicine:

Let’s go back to the facts that I set out.

1. Most parents of a baby who dies will contemplate suing the doctor.
2. Many parents will consult a lawyer.
3. The ONLY way to prevent a lawyer from filing a lawsuit is to convince him that he can’t win.
4. The ONLY way to convince a lawyer that he can’t win is to demonstrate that everything possible has been done.

Do you agree?

I responded (in a tag team with hostess Jill):

Right, because obstetric litigation is actually due to substandard care (note the use of citations, Dr. Amy).

One documented way to decrease obstetrics litigation is to DECREASE unnecessary interventions by following evidence based protocols. Funny, one of those protocols was on induction, which is what I was complaining about upthread. Not only did these evidence based algorithms decrease interventions, including cesarean sections, and improve outcomes (preventing those preventable deaths), but they also reduced litigation. Imagine that. With a citation.

Watch Dr. Amy completely invent imaginary conclusions contrary to the actual studies I posted, and then dig her heels in when I present her with the actual conclusions of the studies, and she can’t provide any quotes.

Whole Fools strikes again

Argh, I wish I had known this earlier today, when I went to Whole Foods for the first time since John Mackey wrote this bunch of hooey that says we just need to deny more benefits to enable the insurance companies to make more money….huh, we were supposed to make it better for the public? Hey, look over there, FREE MARKET! *runs from room*

Well, apparently he is still a tool. He is instituting a program at his stores that gives 10% higher discounts to workers who pass certain BMI, blood pressure, cholesterol, or smoking status targets. Don’t worry, BMIs below normal range are rewarded, just as long as you’re not a fatty boombolatty.

According to the Bloomberg article:

The offer reflects his published opinion that most health problems are “self-inflicted” and can be prevented through proper diet, exercise and similar lifestyle changes. Cost savings are achieved by “less government control and more individual empowerment,” he has said.

So, got familial hypercholestemia, idiopathic hypertension, hyperthyroidism, polycystic ovarian syndrome, hypothyroidism, a disability that precludes a lot of exercise, a genetic predisposition to a large frame, a prior eating disorder you don’t want to trigger, a current eating disorder, a medication that causes you to gain weight or retain water, or any of a multitude of other reasons why may not be able to make these cut offs?

You will be fined, slacker. That’ll learn ya.

Something tells me Mackey has got his empowerment mixed up with his control.

Hello, Trader Joe’s? Please build something in my town!

Conversations only med students have

A chat between a friend, who is studying for a block of exams (good luck, LAB!), and me, via an internet messenger:

My friend: **** kitty barfed grassy nastiness all over the 10 hours of renal notes last night

Me: um, that’s just wrong
he could have at least barfed on the GI notes.

My friend: indeed

A banner day

Well, it’s been quite a day. My blog got over 1,000 hits in one day for the first time. Not bad for a part time venting project. That may sound like doodley-squat to some bloggers, but that is an avalanche for me.

Foul language warning – push the kiddies out of the room

Also, I got called a “racist cunt” on twitter solely based on this post. Right before that, the so-called feminist criticized me for attacking other bloggers, (project much?) and pointed out how stupid I was because she could see what I was saying about her, because she has a google alert on her name. Except that I already said it on the thread I linked to, (note the reply turned post nature of the post she is so incensed about) a thread she was a part of, not behind her back. And, my post only marginally dealt with her, but she has inflated that to mean it was a post obsessed with her, obviously. And, she linked to my blog (which I can see, duh!) on her twitter page.

Then she called me a racist cunt.

Way to prove a point.

I argue about racial privilege because I care about inequality. She argues about how her personal story about growing up poor is more important than all of these conversations, and twists all of these conversations to malign people of color (I’m not the only one who thinks this, she is even being accused of this by others on her own blog right now), and takes this fight to Facebook and twitter because…”It’s Personal”, according to her Facebook and twitter. It’s a shame that someone who calls herself a feminist would resort to such high school mean girls behavior, especially all in the name of denying racism and white privilege, because it’s not about her.

I am OK with the difference between these two positions. I am proud of why I am arguing what I am arguing, and I really doubt she is. It breaks my heart, a little, because we are both associated with the birth advocacy community, but there is room for both racist cunts and people who call people racist cunts in the community, and people who are both (ahem). I am officially done arguing with anyone who would resort to such tactics, however, and hope we never cross paths again.

Am I reading too much into this?

Models with skins of various coffee shades

I was reading one of many cooking magazines in the lead up to Thanksgiving, and I stumbled across an ad with what seemed like a biracial family. At first I thought “Wow, great! An ad with some racial diversity!”

Then I saw it was advertising a hot beverage appliance. And its selling point is being able to individualize your beverage: hot chocolate, coffee or latte! (With the words in various shades of brown.)

Ummm, really? Wow. I, uhh, no. Just, no. Why couldn’t it be an ad for prewashed salad greens or peanut butter or something, not various brown shaded beverages?

Overheard in the hallway

Let me paint a scene for you all.

[In a medical school hallway, two academics greet my visibly pregnant cousin Susan, who has a history of anorexia prior to pregnancy that should have been clearly apparent to these people who work on the same floor as her]

Not Clueless Academic: (to my cousin Susan) How’s the mama? Lookin’ more like a mama these days!

Clueless Academic: (to Not Clueless Academic, in front of my cousin Susan) I can’t wait until that skinny minnie gets HUGE!!

[Close scene]

*headdesk*

OK, I can’t resist

I am supposed to be writing a lecture right now on anatomy and physiology during pregnancy. I learned some new terms:

souffle /souf·fle/ (soo´f’l) a soft, blowing auscultatory sound.
cardiac souffle: any cardiac or vascular murmur of a blowing quality.
funic souffle, funicular souffle: hissing souffle synchronous with fetal heart sounds, probably from the umbilical cord.
mammary souffle: a functional cardiac murmur with a blowing sound, heard over the breasts in late pregnancy and during lactation.
placental souffle: the sound supposed to be produced by the blood current in the placenta.
uterine souffle: a sound made by the blood within the arteries of the gravid uterus.

Huh. Who knew? A placental souffle. Since I heard about people eating their placentas and have cooked a few souffles (placenta free, I might add) before I heard this term used for the sound of the blowing murmur, I have an ewwww moment going on here.

And, I also just wanted to point out how problematic and difficult it is that most imagery for the medical discussion of the anatomy and physiology of pregnancy is really inconsiderate of the whole woman. I have given up trying to find images where the woman’s face and/or head and/or extremities are not severed and are either present or merely disregarded.

As it is nearly impossible and too time-consuming, I am giving up. I am using these kinds of images and discussing them in context, pointing out why they are problematic:

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.