Thoughts on Doctors

Yesterday, the an advisory committee to the FDA recommended for the removal of Vicodin and Percocet from sale in the United States due to the acetaminophen (Tylenol) component. Acetaminophen overdoses are directly related to acute liver failure, and long-term use is linked to other liver issues.

At the Emergency Department, we are not unfamiliar with overdoses on a variety of issues, acetaminophen included. We are not also unfamiliar with people pleading -- pleading -- for painkillers, usually vicodin or percocet. See, they are relatively inexpensive and innocuous as compared to the more powerful ones like dilaudid or fentanyl. Why we don't see more people begging for morphine tablets escapes me, but I have no doubt it's due to the sheer obivousness of morphine in comparison.

Which brings me to my point...

As we are speaking, right now, a new class of doctors is arriving in Cincinnati for their very first shifts as MD's. Sure, they've had their time in clinical rotations, but today they begin the arduous process of doctorin' up people, and they will get to learn the lessons and make the decisions that so many have before them. They will get to learn the difference between a grimace of real pain and the grimace of a needy 20 year old dislocating his shoulder regularly for the sole purpose of obtaining pain medication. They will get to hear the crazy tales -- the STD check who brings both his pregnant baby mama and his pregnant girlfriend in to get tested -- and they will become familiar with our frequent fliers.

At the same time, a class of doctors is leaving. I have fought with these doctors and become friends with them. I have learned to like them, and I've learned to hate them. Though my job does not near approximate the nurses roles, and my judgment on who is good and who is bad is slightly skewed to who refers to me the most, I have a pretty good and I am sad to see them go. But it also reinforces a sharp divide within the hospital.

We are a team together, working towards health, working towards homeostasis. However, as doctors move from R-1 (first years) to R-2 (second years), or as the R-4's leave, or as the R-1's enter, the doctors are still the doctors in a class in and amidst themselves. They know each other best. And the nurses know each other best. And the other services are so dwindled and separated out as to not be able to say that we really know each other. Thus, these new doctors will learn from all of us, and we will learn from them. They will take with them, as they move onto bigger and better things, the memories of our combined efforts. They will remember the patients we diagnosed together, and the crazy patients we held down together.

But they will move on, confident in their ability to cure. For my part, I will be part of "this cool program we had during my internship;" and the nurses will likely fall into one general lump of people known simply as "the nurses at my last job," individual faces and names forgotten and left behind. (See, when a nurse leaves, it is known, and we say good-bye a little and hug but there are a lot of them and they pass on; when someone lower leaves, it is not known and likely forgotten more often than it is remembered.)

I guess I'm just a little sad this morning, seeing work friends depart and realizing that they were never, perhaps, my friends. I was just part of their learning experience.

In the next month, I will teach the newbies about HIV and sexual health. They will look to me for answers about behaviors they had never heard about, and they will ask me questions about my program, my experience, and some snippet of neat information they missed over the newswire. Or, they will use me -- well, all of us in the Emergency Department -- to supplement their knowledge and to carry out their great and wonderful work, and we will support them. We will help them become better doctors.

Then, on their final day years later, they will look at me over their guitars and say, "I'm just ready to get the fuck out of here," and forget to say good-bye when they go and never acknowledge the part we all played in making them, them.

And I wonder who I will say good-bye to, and who will guide me, much like these doctors in a class all their own did for each other.

In a weaker moment, I might say that I just want to be remembered, that I want to matter in some way. I wonder, for those doctors already gone, if I did.

ER Bloggers

HA -- so I work in an Emergency Department at a large hospital in town, and I absolutely love it. There are more nights than I can mention that I would like to tell you stories, but I've always been terrified of the cursed HIPAA (Health Insurance Portability and Accountability Act), which guarantees your privacy as a patient. I think it was a fabulous move on the part of the government to require things like, your consent for one hospital to send information to another. But, we run into 100 middling little details where we're never sure if we're breaking HIPAA or not. (And it's said like that, too, "Are we breaking HIPAA?" or, "That's a HIPAA violation.")

I was never sure, in other words, if telling you stories would be appropo and whether I would be tearing apart HIPAA by saying something.

But, after my morning meeting with Julie from Wine Me, Dine Me, Cincinnati, I discovered that there are other people who are risking HIPAA and posting stories that sound oh-so-familiar to me -- seriously. And I thought I'd share with all of you what we did tonight here at work when things got a little more peaceful; we read ER blogs about other people who work in ER's around the country and experience the exact same shit we do.

Crass-Pollination (the largest ER blogger in the country)

From June 15:

Patient #1 chief complaint: Tired
Patient #2 chief complaint: Weak
Patient #3 chief complaint: Dizzy
Patient #4 chief complaint: Fall
If you'd have lined all my patients up next to each other and told them to play-act their chief complaints, it would be like a flip-book or some shit.

20 out of 10 (named after patient's tendency to overstate their pain on a 10 point pain scale)She writes down funny chief complaints that people give her on their check in sheets, here are some:

heR thing is hurting
Bad tooth ache on Right side Bottem
Medical
Problems
my head poped
THROWT HURT / CANT EAT SWALLOW

Weird Nursing Tales

From a post on 1/4/08 entitled "What I've Learned in the ED"

If you're looking for a free meal in the ED, say you have chest pain, not "I wanna kill myself," that way you can leave after your meal.

Never leave your last refill of Percocet in plain site if one of these 3 is coming over for a visit: some dude, my friend, or that bitch

If you are a belligerent drunk, don't piss off the guy with the shotgun.

If you are afraid of heights but the gutters need cleaning, having a 'couple of beers' to alleviate those fears is a bad idea.

Tales from the Serenity NOW Hospital (written by a Psych and ER Doctor)

From a post on March 15, 2009:

For her reason to visit the ER, the patient wrote "I have an abscess in my vagina that squirts pus out when I squeeze it. Also, I think I got scabies from my baby." Quality mom....

HA! And while you're at it, here are some other great bloggers that, no doubt, will lift your spirits and make you feel special to be a part of the American Health Care system:

• WhiteCoats' Call Room (some gross pictures, but wrote an amazing piece on his malpractice suit that was featured in Emergency Physicians Monthly)
• ERStories (you can't fault 'em for not being direct with their title)
• madness: tales of an emergency room nurse
• A Day in the Life of an Ambulance Driver
• Ten Out of Ten
• ERNursery

One day, in a fit of genius, one of the attending's who has been with us for a better part of 20 years looked around, and said to no one in particular: "We could make our job a lot easier if we just set up four tables outside: one to hold the sandwiches and juice, one to hold narcotics, one for STD medications and other antibiotics, and then the actual triage desk. If you make it to desk four, you win... come on back."

Truth. Seriously, I love where I work.

Healthy is for the Wealthy

“…What do the young know or care about health insurance?”

According to conservative columnist Michael Barone young people have “the fewest medical problems of the whole population.” Clearly this guy hasn’t talked to me. I’m one of the millions of young people carrying the permanent label “sick-for-life.”

I’ve been in and out of doctors offices and hospitals for as long as I can remember. As a kid I was lucky enough to have health care through my parents plan, but I still understood my treatment had a cost. My parents voices still echo in my head: “Without insurance we’ll go bankrupt. We’re not going to just let you die.”

As I got older, the expectation of losing insurance became a serious pre-occupation with getting insurance. I calculated the costs of the bare-minimum medication I need to get by… It’s over $3,000 a month.

No one should have to be rich to be healthy.

For the rest of my life I have to be sure to have a job with benefits, not just any benefits, good benefits. Some plans don’t cover prescriptions, others don’t cover certain types of doctors or testing. “PRE-EXISTING CONDITION” is a haunting phrase. If you got it when you get there, then its not covered. My condition is pre-existing…

“NOT MEDICALLY NECESSARY” is another scary slogan, especially for us genderqueers. If a company doesn’t think your condition is important enough, you don’t get covered. Almost every U.S. insurance company considers any gender-related transitional care not medically necessary. We are diagnosed mentally ill and then are incapable of getting “treatment.” Precious few are close enough to a non-profit informed-consent based clinic, the rest pay hundreds to thousands of dollars out of pocket. I drive to Chicago: five hours there, five hours back.

The power that the medical institution has over us is sickening. I am dependent on other people’s decisions in order to live a close-to-healthy life. Doctors decide if I get treatment, insurance companies decide if I deserve it. Last time I checked this was MY life and MY body. I think I deserve more control than run-around phone calls and piles of paper appeals. Who is sitting on these faceless boards that decide my fate? I doubt if it is anyone who is really on my side because my side costs money. If health care becomes “universal” will the government be on my side? From where I’m standing the record doesn’t look good, but at least it would not be a wealth based system so I would have a better chance.

With all the so-called great minds in the world I can’t believe that no one can think up an accessible health care system that is high-quality, cost effective, and promotes patient autonomy. Anyone who argues against universal health care must have never had face the fear of living in uncontrollable pain or realize the chance of losing their physical ability to function. Someone who is healthy or someone who is wealthy can not possibly fully conceive what it feels like, which makes it an easy concept to ignore. We need comprehensive, universal health care now. I’m sick of waiting for health care and I’m tired of being afraid to lose it.

-JAC
Midwest GenderQueer
x-posted midwestgenderqueer.com

I'm a Quitter

I quit.

I know I'm not alone when I say...quitting smoking sucks. Yes, I have decided to stop smoking. When I think of that word, "decided", I don't feel like its something that's been decided, more like its something that I'm forcing myself to do. It is an addiction and like any addiction, typically you know you need to quit, or you should quit and some can even honestly say they WANT to quit. I wish I could be the one to say I WANT to quit. I'm quitting because I know I need to. Its been a 17 year addiction for me...I know its not going to be easy. So far, I've had headaches, moodiness and trouble concentrating. Wait...I'm like that usually anyways, so I guess it hasn't been that bad. The worst part is not thinking about it....but its all I can think about.

For the past week I've been on vacation with my beautiful girlfriend Penny and I have not had a ciggerette in 7 days. For me, this is a miracle in itself. My friends will tell you that I smoke like a freight train, lighting one after another if I'm in a place that I can do so. But, its been surprisingly easy as far as the withdrawl symptoms go. One reason, I've been with my girlfriend all week, and I don't smoke around her. She's never seen me smoke and she never will. Two, I was out of my normal routine and habit. So, as much as I want to celebrate, I know that the challenge is just beginning.

Tonight, I have the option of sitting at home and dwelling on the fact that I'm not smoking, which I know I will do or I can go hang out with a friend who smokes. Which almost all of them do. Hmm...not much of an option to keep myself away from smoking. But I'm determined to do it...not smoke that is. I thought that since there are alot of you that are trying to quit or thinking about trying to quit, I would chronicle my stop smoking experience with you. I'm hoping that this will help that sabatour in my head that wants to smoke and maybe even help some of you in letting you know that this is a struggle that millions of people deal with everyday.

I am very optimistic and have a lot of support. However, I hate to say it, but even though I don't want to let these supporters down, I know that my chances are high that I will. So, I got a game plan and strategy in place. Things I can do with my hands to keep me from smoking. Too bad my girlfriend lives in another city! Ha! But seriously...things like painting, writing, excercising, things like that. There is even a telephone support meeting tonight...1-605-475-6230 Code #4567891 at 8pm EST. I don't know how legit it is, but its worth trying. So, stay tuned...hope I'm still a non-smoker tomorrow.

Think I'll start smoking tomorrow? According to http://www.stopthesmoke.com/ I have about an 80% FAIL rate with quitting cold turkey. So much for staying positive.

Juliet

Two new bloggers

Everyone knows how much I like to talk about myself here on this page; and it's true -- I am the most interesting thing I can talk about. But there is a wide blogging world out there with amazing people with amazing stories and unbelievable truths that need to be told. Occasionally, I get the opportunity to highlight some of them. As I had a little time today (I woke up way late after a disappointing night out last night, even though I was with the klassy AA), I had the opportunity to peruse a few locations on the interweb, and I wanted to share two of them with you.

First we have Cirque du Savory, which I found after one of the authors was featured on the cover of CinWeekly. I am a burger freak; if you've ever been to a restaurant with me before,  you'll find me searching the menu for the burger. Why? It's classic American cuisine. I would argue that it is definitive American cuisine. Every place specializes in something, but it is their hamburger that tells me how serious they are. When I went to Lavomatic for the first time with AmyInOhio and Kate_The_Great, I ordered the burger; my philosophy is that restauranteurs know that the inexperienced or less cultured eaters (or those of us who are hesitant to try new foods when you're paying for them at a restaurant) will go for the one thing on the menu they know -- the burger. Lavo's, btw, isn't bad. My taste and my feelings on the burger are so strong that I've often said that I should start a blog searching for the best hamburger in the city.

The ladies and gentlemen over at Cirque du Savory did that for me. They rate the city's hamburgers based on a rather amusing classification system named after the Huxtables a la the Cosby Show ("The Rudy" are burgers that score a 90-100, for example, where as failing grades until 60 get the demarcation of "The Sondra"). If you're looking for a good burger, their current top score (94) goes to Zip's Cafe in Mt. Lookout, while Fatburger in Oakley has the lowest score at 64.

Update: I have also added The Church Experiment to the blogroll. That blog was the reason for the above mentioned CinWeekly article and, though I am not a believer, it is an interesting read and a fascinating snapshot of the city that I have never participated in.

The second blog I have to offer you is an amazing tale of a woman who is blogging her emotional, spiritual, and physical healing after a botched breast augmentation and lift two years ago... appropriately entitled Boobcast (she is also a long time twitter friend of mine, @Herbwoman). She sought the procedure for purely personal reasons in her late 30s and was met with more complications than any individual should ever go through. After extensive, full-torso bruising and necrosis that left her without nipples (which had literally rotted off her body), compounded by a compassionless healthcare team who told her to calm down and take a valium (seriously), she has begun the painful and oft-times depressing tale of restoring herself and refinding hope. 

I'm in nursing school, and I don't often hear about the experiences patients have. In fact, in my job, I have already developed the callous no doubt many people are aware of with nurses. Cold and professional, my interactions with patients are more often than not a reflection of a jadedness that has settled over my heart when it comes to the patient experience. School doesn't help, as the focus is more often than not on the medical issues rather than the psycho-social aspects of patient care (we spent only one class talking about active listening, and I have only once ever been taken seriously when I say the patient's major concern is body image, not his inactive gut that left him with a colostomy bag). Hearing her story, like working at the Ronald McDonald House, reminds me about why we do what we do, and what we strive to do in healthcare. Her story will touch you. I have, officially, read every single blog post she has, and it's an amazing tale. (The picture above is her after one of her most recent surgeries that left ... she's entitled it "The After Shot" :-)). 

I'm still perusing the web this afternoon, so there may be more later, but I've had a good time on these two sites this afternoon, both have been added to the blogroll to your right.

Hospital Equality Index

The HRC has put out another study (I've said it before -- they are really good at doing reports and studies). This time, it's an evaluation of 166 medical facilities around the country. Unfortunately, not a single Cincinnati hospital participated, nor did any Columbus hospital; we have primarily Cleveland medical facilities. No facilities participated in either Kentucky or Indiana.

The hospitals were scored on the following characteristics:

1a Patients’ Bill of Rights and/or non-discrimination policy includes “sexual orientation”

1b Patients’ Bill of Rights and/or non-discrimination policy includes “gender identity or expression” or “gender identity”

2a Visitation policies allow same-sex partners/spouses the same visitation access as opposite-sex spouses and next of kin

2b Visitation policies allow same-sex parents the same visitation access as opposite-sex parents for their minor children

3a Recognize advance healthcare directives allowing same-sex partners/spouses decision-making authority for their partner/spouse under care

4a Provide cultural competency training addressing sexual orientation and healthcare issues relevant to lesbian, gay and bisexual community

4b Provide cultural competency training addressing gender identity and healthcare issues relevant to transgender community

5a Equal employment opportunity policy includes “sexual orientation”

5b Equal employment opportunity policy includes “gender identity or expression” or
“gender identity”

5c Domestic partner health insurance benefits are offered

As you can see if you embiggen the picture above, which is a cutout of just the Ohio hospitals, that they didn't do too poorly. The points missing universally are cultural competency trainings and gender identity/expression in Patient Bills of Rights.

I think those are totally "doable" goals.

But, again, the index itself may be inappropriately scored. As JereKeys brought up with the HRC Corporate Index, it does nothing to gauge actual environment. For example, University Hospital here in town generally has a negative perception in the LGBT community's head, but is probably the most open and accepting environments out of all the major hospitals (at least, from my experience; though I hear Children's is like a big gay heaven :-)).

At least it's a good jumping off point to start the conversation, though, yes?

Swine Flu, from Gawker

HA! Best response yet to the swine flu "epidemic," from Gawker:

Possible Swine Flu Outbreak, Gay Marriage Probably Somehow to Blame
...Don't sugar-coat this, Doc. We get it. We'll all be wiped out very soon by this virus that (I can only assume) turns people into pigs and, yes, the only hope for the future of the human race is for the Long Noses (that's their name for us) to start breeding, constantly, and repopulate the planet. Anyone in Brooklyn can drop me a private message if they want to join the Resistance.

Do we really need another massive public health panic? Seriously.

Overdoses lead motor vehicle accident fatalities in OH

From Ohio.com:

The Ohio Department of Health says drug overdoses now top car crashes as the leading cause of accidental death in the state.

A newly released department report shows unintentional deaths from drug and medication-related poisoning exceeded traffic fatalities in 2006 and again in 2007.

The department says illegal drugs such as heroin play a big role but that prescription pain medicines are responsible for the increases.

The Ohio Association of County Behavioral Health Authorities highlighted the statistic Thursday at a news conference in Columbus to promote continued funding for substance abuse programs.

The association says that every dollar spent on drug and alcohol abuse treatment saves $11 on health care and involvement by the criminal justice system.

The report has some great numbers in it -- like, unintentional poisonings (96% of which come from drugs and medications) grew 249% between 1999 and 2006 versus motor vehicle crashes declining 11% over that same period. Suicides, homicides, firearm accidents, and falls all saw increases in mortality over the same period.

Short story: more people are dying, but the roads are safer.

Health and Gay People

What's wrong with this anti-gay article (written by a Christian celibate man who "left the gay community") quoting these statistics:

· Life expectancy of gay/bisexual men in Canada is 20 years less than the average; that is 55 years.
· GLB people commit suicide at rates from 2 to 13.9 times more often than average.
· GLB people have smoking rates 1.3 to 3 times higher than average.
· GLB people have rates of alcoholism 1.4 to 7 times higher than average.
· GLB people have rates of illicit drug use 1.6 to 19 times higher than average.
· GLB people show rates of depression 1.8 to 3 times higher than average.
· Gay and bisexual men (MSM) comprise 76.1% of AIDS cases.
· Gay and bisexual men (MSM) comprise 54% of new HIV infections each year.
· If one uses Statistics Canada figure of 1.7% of GLB becoming infected, that is 26 times higher than average.
· GLB people are at a higher risk for anal cancers.

How about other studies showing similar health differences in other minorities? Let's say, African Americans, for example. Or, Asian Americans. (NOTE: literally the first websites that popped up)

The problem with a baseline is that sometimes it's the wrong base. White guys have higher rates of heart attacks -- does that make heterosexual sex wrong? Or the WASP-y lifestyle? Oh, and can we start talking about obesity? Seriously. Don't play the health game, especially when this is your closer:

The culture of pushing sex down people's throats is not working. There is nothing wrong with abstinence from sex. This goes for everyone who is not married to someone of the opposite sex. I've been single and chaste for many years after having left the gay community. You don't die from not having sex. It's not like air or water.

Recent laws, policies and public funding aimed at reducing the rate of suicide, addiction, partner abuse, and STI's by granting more sexual freedom have not diminished those statistics. In fact, there has been an increase since the beginning of the 'rights' movement in the early 70's, and it's getting worse, not better. In places like San Francisco and the Netherlands where gay sex has been normalized, many of these stats are worse, so I have difficulty with the theory that more freedom, money and legislation will reduce these stats. That is just not where the facts point.

The Church talks about Natural Law and says that if something is true it will prove true in many ways. The Bible says gay sex is a problem, biology doesn't support it, and health statistics demonstrate its problems. Why not abstain? That's what I'm doing.

Or when this is linked off your front page.

How much of the mental health/depression issues, for example, arise for your outright bigotry? Leave the gays alone, guys. Seriously. We were perfectly content to leave you alone, but, every now and again, some of the religious folk in the world... well, it just makes it hard to live and let live.

I can tell you now, shaming people does not a healthcare relationship make.

But that doesn't alleviate our duty to protect ourselves and make sure that we have a good thorough understanding of health concerns that affect us, and have important discussions on how we can better improve our health.

A little activism...

...on the part of the Cincinnati Health Department?


I've seen this sign up for months now and I just paid attention. CHD isn't known for its hard work in the community, or for sticking their neck out. They prefer to fund and let go.

The website they are pimping -- CovertheUninsured.org -- is worth a visit.

"Equal Pay"

Picture courtesy of Writes Like She Talks

The New York Times has an interesting bit about the difference between women and men's pay. Women earn more than men in exactly three fields: data entry, postal work, and special education teachers (but nothing more than 5%). Women and men earn exactly the same in ticketing and travel agents.

Everything else... it goes way way down. The biggest difference? Physicians, where women earn 40% less than men.

The next three blogs come from ohioBNN on Twitter.

Rectal Chlamydia!!!!

We just learned about gonoccocal urethritis in class and four things struck me: in our discussion of STDs and nursing care, we barely talked about HIV; we only talked about urethral and vaginal infections; the med class fluroquinolones (typical treatment for gonorrhea) is contraindicated in men who have sex with men with gonorrhea due to risk of resistance; and my standards are really low if I think the Christian rapper at school is hot with his awful skin.

Anyways... (via LifeLube, via AIDSMap)

Gay men should have rectal tests for chlamydia as part of their routine sexual health care, investigators recommend in an article published in the online edition of Sexually Transmitted Infections. Researchers found that more gay men had rectal infection with chlamydia than had urethral chlamydia or rectal gonorrhoea. Furthermore, the majority of rectal chlamydia infections were asymptomatic and would therefore have been missed without routine testing.

They also found that over a third of the men with rectal chlamydia were HIV-positive.

Right. So, I told you that.


What I should also tell gay men is this: you should probably have an anal pap smear done to check for carcinogenic growths related to anal HPV, and you should probably encourage the FDA to start testing the HPV vaccine on men against the above mentioned disease.


YEA! STDs!!! Aren't they fun?

National Go Red for Heart Day!

And don't forget to donate to me for the Heart Walk!

On how the Dems bow down to conservative propaganda...

From Planned Parenthood PAC via BreitBart:

This weekend, House Minority Leader John Boehner wrongly claimed that the Medicaid Family Planning State Option, a common sense provision to expand basic health care to millions of women, would cost hundreds of millions of dollars. The option, which became the victim of Boehner's misleading attacks and partisan politics, was dropped from the economic stimulus bill.

"This option rightfully belonged in the economic recovery package," said Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California. "The Republican leadership, which demanded its removal, has once again shown just how divisive and out of touch they are with the American public, which overwhelming supports access to family planning services."

The Medicaid Family Planning State Option will ultimately save money in tough economic times. The Congressional Budget Office estimates that the state option would save the federal government $700 million over ten years, freeing up money to go toward other pressing state and national priorities during these tough economic times.

In California, independent evaluations of the current family planning expansions have significant estimated cost savings - approximately $1.5 billion annually in state and federal government savings from costs associated with unintended pregnancy. Allowing a waiver also saves state administrative costs in tough budget times.

The Medicaid Family Planning State Option would allow millions of low income women to obtain basic health care including breast and cervical cancer screenings. It extends safety net health care coverage for millions who are losing their jobs and health insurance in the economic downturn.

"During this tough economic time, expanding access to basic health care is critical for women and families," Kneer said. "Medicaid Family Planning State Option is an essential priority for the health of low-income working women. We expect a clear and public commitment from the administration to secure family planning services for low-income individuals and we urge Congress to act quickly to include the family planning option in the next possible moving vehicle sent to the President."

Thanks, guys. Really appreciate all of your hard work.

PPPAC is encouraging you to call. As well you should.

Bush is still president???

In a giant middle finger to the country as he is about to waltz out of off, President W. Bush and his administration has enacted some rules for healthcare providers via the Department of Health and Human Services. 

Via the Huffington Post:

Very little about the Bush administration could surprise me anymore, but I was completely disheartened when -- despite the written opposition from more than 200,000 Americans, 150 members of Congress, a bipartisan coalition of governors and attorneys general, the American Medical Association, and women's health organizations like Planned Parenthood -- the Department of Health and Human Services issued a last minute regulation that will undermine health care access at nearly 600,000 pharmacies, clinics, and hospitals across the country.

This sort of "take the drapes on your way out" approach is the final chapter of an administration that has prized political ideology over health care for their entire eight years -- and the rule issued yesterday, with little more than 30 days left in office, is the ultimate holiday gift to the extreme right.

Under this new rule, doctors and health care workers of all kinds can deny patients vital health care information and services, without the patient even knowing. No patient is exempt from the reach of this rule: sexual assault victims could be denied information about emergency contraception that could prevent unintended pregnancy, moms hoping to time their pregnancies can be denied contraception at their local pharmacy, young adults hoping to be tested for sexually transmitted infections could be denied treatment by health care employees who oppose premarital sex.

In short, this rule is likely to create total chaos in an already stressed health care system, and for low-income women and families, this rule may spell the end of the few available health care options. Essentially, any patient that utilizes health care at a provider that receives any federal funds will be subject to the luck of the draw in terms of what kinds of reproductive health care they are offered. This might seem far-fetched, until you realize that groups like Pharmacists for Life have campaigned nationally to have pharmacies refuse to provide women birth control prescribed by their physician.

This seems to be what the new rules are saying: that if you are a health care provider and do not believe in something, you are not ethically required to offer it. Birth control and abortion tend to be the big two that people are mentioning, but my question includes questions like PEP or STD treatment... etc. etc. etc.

I thought I was being taught that we don't place our personal judgments on our patients when we enter the healthcare field...

...but apparently a few people skipped class that day.

Planned Parenthood has a petition up to ask Pres-elect Obama to reverse these rules. I signed it -- will you?

Cardiovascular Step Down!!!!

(image from the Hypertrophic Cardiomyopathy Association)

I just found out my clinical floor for next semester -- yea! Cardiovascular Step-Down!!!!

That's exciting because, as I've talked briefly about before, I have a heart problem known as "Hypertrophic Cardiomyopathy" -- HCM, for short -- which was first described to me as the symptom described as Left Ventricular Hypertrophy -- LVH, which I thought was a disease for a long time until I started in nursing school and they were like "no" and then I started asking better questions. (If you look at the picture above, my heart is kinda like the picture on the right... note the blockage of the aorta? If I ever pass out, please don't grab the AED... thank you, Urban Active ... LOL)

I'm working on a post about it and how it affects my life.

Anyways, the point of this post is just to share my excitement -- I GET TO WORK ON THE HEART FLOOR!!!! :-) I get to learn about the HEART!

...unlike the freakin' orthopedic floor I was on last semester... if I had to give another 90 year old with dementia but with a full hip replacement another full bed bath, I was going to scream.

Bless the souls of the people that can do that.

(Plus I get to learn about a lot of really cool diseases of the heart -- cardiovascular diseases tend to be very hard to conceptualize because there are so many variations on a theme. CV diseases have such wild side affects and affect such a huge segment of the population ... and a blockage in the aorta has such different affects than one in a radial artery... anyways... I'm just really siked :-))

"Um, sir, it seems we've cured your HIV."

From the Wall Street Journal:

The patient, a 42-year-old American living in Berlin, is still recovering from his leukemia therapy, but he appears to have won his battle with AIDS. Doctors have not been able to detect the virus in his blood for more than 600 days, despite his having ceased all conventional AIDS medication. Normally when a patient stops taking AIDS drugs, the virus stampedes through the body within weeks, or days.

The breakthrough appears to be that Dr. Hütter, a soft-spoken hematologist who isn't an AIDS specialist, deliberately replaced the patient's bone marrow cells with those from a donor who has a naturally occurring genetic mutation that renders his cells immune to almost all strains of HIV, the virus that causes AIDS.

The development suggests a potential new therapeutic avenue and comes as the search for a cure has adopted new urgency. Many fear that current AIDS drugs aren't sustainable. Known as antiretrovirals, the medications prevent the virus from replicating but must be taken every day for life and are expensive for poor countries where the disease runs rampant. Last year, AIDS killed two million people; 2.7 million more contracted the virus, so treatment costs will keep ballooning.

While cautioning that the Berlin case could be a fluke, David Baltimore, who won a Nobel prize for his research on tumor viruses, deemed it "a very good sign" and a virtual "proof of principle" for gene-therapy approaches. Dr. Baltimore and his colleague, University of California at Los Angeles researcher Irvin Chen, have developed a gene therapy strategy against HIV that works in a similar way to the Berlin case. Drs. Baltimore and Chen have formed a private company to develop the therapy.

We, of course, are still waiting and hoping, but we are hoping this is a good sign.

Thanks, Trevor.

HEALTH: In which a pharmacy tech knows too much about me...

Went to the pharmacy the other day to fill my prescription for Aldara Cream -- I have perennial toe warts (I know, gross, but the story is funny) and the stuff works better than anything else I've tried. Anyways, so the pharmacist pulls up my records and there are two other things on my file: Cipro and Flagyll.

If you know anything about antibiotics... these are two common STD medications. No, really. I had them, however, for a situation earlier in the year involving a process that nursing school delicately refers to as "elimination" or "hyperactive parastalsis," and then the brain-consuming tooth abcess I had in early summer.

Here I am, in Walgreen's in Clifton, asking for wart cream after recently having prescriptions to two STD medications. The (obviously gay) pharmacy tech takes the information, looks at me, places one hand on mine and says very gently:

Is everything ok, Mr. Floore?

Needless to say, I moved all my prescriptions to CVS and will be dividing up my prescription needs in the future in case I should ever show and need something for a more... ahem.. personal reason in the future.

WEARING *WHAT* WEDNESDAY: Kellen Winslow

I know, a little early, but this picture caught my eye on CNN...

And I thought, DAMN, check out those arms! And then I read the story...

The problem came to the forefront last week with Cleveland Browns player Kellen Winslow, who recently had his second staph infection. He is reportedly the sixth player to acquire staph among the Browns in five years.

Peyton Manning of the Indianapolis Colts was revealed to have a staph infection, the Indianapolis Star reported Friday. University of North Carolina-Asheville fans also recently learned that Kenny George, the 7-foot-7 center on the basketball team, had a staph infection complication that led to part of his foot being amputated.

It's unclear how these high-profile athletes acquired their infections, but locker rooms have been found to habor staph bacteria in previous outbreaks. The topic is generating buzz throughout the sports world as more players' staph cases are revealed. Hospitals have long been known to be hot spots for transmitting staph, but recently cases have cropped up in other community settings. Regardless of where these players got their infections, the close quarters of a locker room raise questions about overall risks.

About 30 percent of people carry staph in their noses without exhibiting symptoms, according to the Centers for Disease Control and Prevention...

Experts say Methicillin-resistant Staphylococcus aureus, or MRSA, a form of staph resistant to common antibiotics, has become a more prevalent problem in settings such as contact sports that involve skin-to-skin touching.

Most MRSA infections acquired in community settings present themselves as sores or boils and often appear red, swollen, painful or with drainage such as pus, the CDC says. Infections often occur in cuts and abrasions but also on body parts covered in hair, such as the back of the neck, armpit or groin.

They have a link on the page to the CDC's Fact Sheet on MRSA and athletes (although I think it's funny and sad that they don't actually distinguish between MRSA and staph, but you know...). What is also interesting as, earlier this year, the CDC came close (but not quite) to labeling MRSA as an STI that has started to be found in men who have sex with men:

The strains of MRSA described in the recent Annals of Internal Medicine have mostly been identified in certain groups of men who have sex with men (MSM), but have also been found in some persons who are not MSM. It is important to note that the groups of MSM in which these isolates have been described are not representative of all MSM, so conclusions can not be drawn about the prevalence of these strains among all MSM. The groups studied in this report may share other characteristics or behaviors that facilitate spread of MRSA, such as frequent skin-to-skin contact.

MRSA is typically transmitted through skin-to-skin contact, which occurs during a variety of activities, including sex. There is no evidence at this time to suggest that it MRSA is a sexually-transmitted infection in the classical sense.

Anyways, I am not making any implications about what's his face... right, Kellen Winslow. I just thought people who read my blog might be interested to know more about MRSA.

They might also be interested in his amazing body...

And, of course, the piece de resistance...
Unlike what my family will tell you...

...sometimes, I do like football.

PS There is also the strange and interesting case of the Turkish wrestlers who appeared to have transmitted and contracted Hepatitis B through sweat/skin-to-skin contact. So STDs in athletics are neither new nor unusual...

LGBT HISTORY: APA's Strange Relationship with LGBT People

1948
Alfred Kinsey publishes Sexual Behavior in the Human Male, the first major sexological research scientific study. Its results challenged the growing conservatism that would define the next 10 years.

1952
Homosexuality is listed in the first DSM as a Sociopathic Personality Disturbance. (I actually didn't know this; the Catholics told me.)

1953
Alfred Kinsey publishes Sexual Behavior in the Human Female, the follow up to his popular 1948 piece. Less successful, and with fewer "wow's." The conservatism had set in, and people were no longer interested in listening.

1957
Evelyn Hooker's paper, "The Adjustment of Male Overt Homosexuals," was published which put psychological tests to both "healthy" homosexuals and heterosexuals. When the results were presented to professionals, they were unable to distinguish between the two groups. The lesson: you can't tell a homo by the psychological profile alone. Bigger message: gays aren't that different.

1968
Homosexuality is moved from sociopathy to "other sexual deviations."

1974
Homosexuality is removed from the Diagnostic and Statistical Manual (DSM) by the American Psychological Association. It is replaced, instead, by sexual orientation disturbance. The move was credited as the result of three things: 1) Alfred Kinsey, 2) Evelyn Hooker, and 3) the gay rights movement.

1980
Sexual orientation disturbance is replaced in the DSM by "ego-dystonic homosexuality." This is defined (to this day in the ICD-10 by the World Health Organization) as:

The gender identity or sexual preference (heterosexual, homosexual, bisexual, or prepubertal) is not in doubt, but the individual wishes it were different because of associated psychological and behavioural disorders, and may seek treatment in order to change it.

The ICD-10 (universal medical diagnosis coding system) has a whole section on sexuality, the F66 section. Egodystonic sexual orientation is F66.1. They also have relational and maturational diagnoses.

The argument against this is that homosexuality is egosyntonic -- that is, aligning with the values or beliefs necessary to a person's ego or person's self-image. Seems very personality-based, so I would think it's difficult to make a universal statement there. Especially since anorexia nervosa is considered egosyntonic.

1987
Ego-dystonic homosexuality is removed from the revised DSM, but "sexual disturbance not otherwise specified" persists which is defined as "persistant and marked distress about one's sexual orientation."

2000
The American Psychological Association comes out against reparative/conversion therapy. They find, though there is little evidence either way, that conversion therapy is potentially harmful. From their statement:

In the current social climate, claiming homosexuality is a mental disorder stems from efforts to discredit the growing social acceptance of homosexuality as a normal variant of human sexuality. Consequently, the issue of changing sexual orientation has become highly politicized. The integration of gays and lesbians into the mainstream of American society is opposed by those who fear that such an integration is morally wrong and harmful to the social fabric. The political and moral debates surrounding this issue have obscured the scientific data by calling into question the motives and even the character of individuals on both sides of the issue... Psychotherapeutic modalities to convert or "repair" homosexuality are based on developmental theories whose scientific validity is questionable. Furthermore, anecdotal reports of "cures" are counterbalanced by anecdotal claims of psychological harm. In the last four decades, "reparative" therapists have not produced any rigorous scientific research to substantiate their claims of cure. Until there is such research available, APA recommends that ethical practitioners refrain from attempts to change individuals' sexual orientation, keeping in mind the medical dictum to First, do no harm.

2012
The DSM-V, the latest manual, is due out. They are currently analyzing current diagnoses. There are two that are being challenged this time around:

• Gender Identity Disorder -- actually listed under a couple of categories. GID is the psychological "disease" necessary to have before undergoing sexual reassignment surgery. It is the only psychological condition that has a surgical cure. Think about that one for a moment.
• Transvestic Fetishism -- listed as a "paraphilia." This specifically revolves around people who cross -dress and may, in fact, gain sexual arousal out of cross-dressing. People diagnosed with TF would be what we would call "transvestites" or "cross-dressers."

GID Reform Advocates is seeking to either delete or significantly alter both of these diagnoses to "affirm that difference is not disease, nonconformity is not pathology, and uniqueness is not illness...[and] serve a clear therapeutic purpose, are appropriately inclusive, and define disorder on the basis of distress or impairment and not upon social nonconformity."

And that's the whole purpose of this blog... we are gearing up for this one. So, um, yea.

There you go.