Archive for September, 2012

It’s probably a good thing that my cataract surgery patients are in the twilight zone during surgery.  Conversations are often random, and, um, difficult to explain.  Hence the strange title of today’s post.

It all started innocently enough.  The surg tech who helps me injured her foot running on the dreadmill treadmill.  She fears she might have a stress fracture in her foot, probably from wearing minimalist shoes (Skele-toes.)  I can certainly sympathize with that, having dealt with a stress fracture in my tibia last year.

So between cases she had one of our local podiatrists look at her x-rays.  After checking the x-ray, she was concerned that our surg tech may have a stress problem.  But she also commented that her navicular bone was particularly nice.  Attractive, even.  For a bone.

“Are you hitting on me?” our surg tech quipped.

Nice navicular, babe!

This begat a random conversation about the sexiness (is that a word?) of a navicular bone.

“Hey babe!  Nice navicular!”

“What’s a nice navicular like you doing in a place like this?”

“Do you come here to be imaged often?”

I think the rest of us, those with mundane naviculars, were suffering navicular envy.  After all, some of us have cold feet.  There’s shrinkage!

Then the radio announcer came on with a call-in contest where you have to answer a question of the day.  The question today was, how long can a snail sleep without eating?  Now I don’t know about you, but I sleep every night without eating, but I don’t think that is what they meant.  The DJ further added that the answer was according to Wiki answers.  So the first caller won, being the fastest to surf the net and then call the station.

Three years.

Seriously?  How do you sleep for three years, with or without food?  I know snails are slow, but that is ridiculous!

But before the answer was revealed, there was the requisite discussion amongst the operating room staff.

Our circulating nurse offered that cockroaches can survive 90 days without eating.  In fact, they can survive without their heads.

What kind of life is that?  Three months without your head.  Obviously, you couldn’t eat if you wanted to at that point.  You couldn’t communicate with other cockroaches.  You couldn’t see where you were going.  Why would you even want to go anywhere?  I don’t know what the quality of life is for the average cockroach, but I would imagine that it is diminshed even further by the lack of one’s head.

If you only had three months to live, would you want to live that time without your head?  And, according to this article, it may be only weeks they can survive.  The head can survive too, “waving its antennae back and forth for several hours until it runs out of steam. . .  If given nutrients and refrigerated, a roach head can last even longer.”  Isn’t that good to know?

But that was cockroaches.  She thought snails reproduced by extruding something out of their mouths that contacted another snail doing the same.  But then she corrected herself.  That was slugs, not snails.

Unprotected Slug Porn

I’m not sure how you get from headless cockroaches to slug porn, but by God we did it.

I wonder if I can count this toward continuing medical education?

Probably not, unless I start treating cockroaches and horny slugs.

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What’s Your Emergency?

In honor of 9-11, I am going to digress on a topic of emergency medicine today.

As an ophthalmologist (or pretentious eye doctor depending on how you pronounce it) I occasionally get paged when I am on call.  Perhaps less so than an orthopedic surgeon, pediatrician, or cardiologist, but more so than your busy dermatologist or geneticist.

After business hours at night, on weekends and on holidays, our office is closed.  The answering machine at our office clearly states
that our office is now closed.  There is an option to leave a message.  Then, the recording tells our patients that if this is an emergency, to call the answering

As an intern many years ago, I was introduced to the wonderful world of being on call.  I was awoken at 3 a.m. by a patient who asked if it would be okay to take an aspirin tablet that had fallen on the floor.  I.  Kid.  You.  Not.

How bad does your headache have to be to take this?

Does the five-second rule apply here?  Is there fuzzy stuff on the tablet, or does it look clean?  Can you rinse it off quickly and pop it in your mouth before it melts?  Might we just consider the possibility of throwing it away and taking another one that has not contacted the floor?

Labor Day weekend, I got a call at 7:30 am Sunday morning to refill a prescription.  The patient normally sees another doctor we were covering.  She didn’t know the name of the drop but thought it began with a P.  It had a green cap.  That actually was helpful, since it narrowed it down to pilocarpine, used for some forms of glaucoma.  But it comes in an array of strengths ranging from 1/8% up to 4%.  Of course she didn’t know which one she was on, but she knew she was going to run out before Tuesday.  And guess what, after several calls later, her pharmacy was closed anyway.  So much for sleeping in.

Seriously?  I take a baby aspirin daily ever since I had an episode of atrial fibrillation.  When I notice there are only about 7-10 tablets left in the bottle, I put it on the grocery list for my wife to pick up more.  She usually shops at least once a week, so I get my new bottle before the last tablet is gone.  Is that so hard?

Granted, you can’t see the drops in your medicine bottle, but you can generally tell, particularly if you have been using drops for years, when you are about to run out.  Plan ahead people.  Don’t let those pesky holidays creep up on you.  Buy a calendar.

Once, on Good Friday, a lady called complaining of itchy eyelids.  Now while that could sound like an emergency, most eye doctors will tell you it is not.  Uncomfortable perhaps, but not generally vision threatening.  This lady was the patient of another eye doctor as well.  Apparently, I am the only April Fool who takes call on holidays anymore.  Or I’m not smart enough to sign out to someone else.  Whatever.

So I ask her how long her eyes have been itching.

On or off.  For about a year.

This is an emergency????

Has she seen anyone else about it?

Oh yes.  She saw a dermatologist who prescribed a cream for her face that worked.

Did she call her dermatologist back?

His office is closed today.

Imagine that!

But he told her previously that she could use it on her eyelids as well, but she wasn’t sure she should.  The eye doctor I was covering for told her she could use it as well.  Apparently, she wasn’t convinced and needed a third opinion.  On Good Friday.  That has the weight of the Father, Son AND the Holy Spirit behind it as well.

Let me think about this one.  Hmmm.  The cream worked for the rash on your face.  Two doctors, including an eye specialist told you to use it on your eyelids.  Your eyelids are itching?  It’s Good Friday.  .  . I got nothing.  I don’t know what to tell you (although I know what I’d like to say) but maybe, just maybe, you should try the medication.  It’s a shot in the dark here, but if your eyes are bothering you enough to call a professional on a holiday, then I’d go for it.

I don’t want to sound insensitive.  It’s not that I don’t care about your itchy, watery eyes that have been bothering you for months.  Just don’t call me on a holiday or on a Saturday afternoon when Penn State is playing football.

I’m sure every job has its moments.  I imagine that most grocers have received phone calls at three in the morning asking whether or not it is okay to drink
milk that is one day over its expiration date.  Don’t you wonder about that?  It’s only one day.  But you don’t want to get sick.  It smells okay, but you just can’t
be sure, can you?  Better call and find out right now!  Oh, and I just noticed I’m running a little low on toilet paper . . . could you send some out in the morning?  Thanks!

Today is 9-11.  What’s your emergency?

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