Monday, September 10, 2012

Meet Mr. Bones


Mr. Bones at Kiehl's

Mr. Bones stands up for Canadian AIDS Society

We went up to Toronto this weekend (extended birthday celebration tradition) and I visited Mr. Bones again at Holt Renfrow Department store.  He was wrapped in paper sayings when I saw him this time.

"You have a screw in your sternum"




Mr. Bones is part of a fundraising effort sponsored by Kiehl's and The Canadian AIDS Society.  I took my picture with him earlier this year at Holt Renfrow and wrote a blog post on preparing for PA school while shopping.


Me and Mr. Bones in April 2012




This is one of my favorite posts because I wrote about my son's sternum reconstruction surgery in Norfolk, VA at Children's Hospital of the King's Daughters.

If you are interested in pediatric orthopedics, there is a cool video clip in that post of his surgeon, Dr. Robert Kelly doing a pectus carinatum (pigeon chest) corrective surgery, like the surgery my son had.

Owen goes back next month to see Dr. Kelly to determine when they need to do the surgery to take out the steel bar that supports his sternum and ribs.


First anatomy lab

Tomorrow is my first day in the cadaver lab in PA school.  I'm nervous and excited at the same time.

I will pull my blue scrubs out of the drawer and and hope they aren't too tight.  I swore I would burn these scrubs after leaving my microbiology position at the hospital.  But I never got around to it, and now I'm glad.

Anatomy Lab Post Script -- the scrubs fit.


So we had our introductory anatomy lab today.   All went smoothly.  We didn't actually see our group's cadaver yet.  One cohort of our group dissects the back tonight and we get to do our first real lab next Monday.

We learned the ground rules for the lab today and saw the new iPads and dissection videos that the faculty spent the summer preparing for us.  I admire their dedication in making these instructional videos.  I think they will be very helpful in learning the techniques of dissection.

My scrubs did have a mild formaldeyde fragrance when I got home, so I threw them in the laundry.



 

Thursday, September 6, 2012

Positive Predictive Value: the "Truth" of PA School

The positive predictive value (A/A+B)
for me liking PA school is currently at 98%.


So here is a simple chart that we learned on our first day in Pathophysiology class that shows positive and negative predictive values given a % prevalence of a disease relative to the sensitivity and specificity of a test or assay.

So here's my question:


WHY after so many years of being in clinical lab medicine and teaching clinical lab medicine (and being Program Director at two different colleges!) have I never encountered this chart!?!  Interesting....

I find it very interesting and enlightening to re-learn clinical lab science from the other side of the coin, so to speak.  I am learning it now from the ordering side as opposed to the performing or testing side.  It is a very different perspective.  Most informative.  It really makes me see the BIG PICTURE in a way that I did not previously.  Good stuff.


Physician Assistant School


I am only at day three here, so...bear in mind that this COULD (and probably will) change.  I accept that.....maybe.
I still think we (saying my class as a whole) are off to a good start.

So here's to a good start!

LIKE:
  • Classes
  • Students
  • Professors
  • Material
  • My schedule


DISLIKE:

  • Parking shortage

'Nough said.  Back to organizing and studying.

Monday, August 27, 2012

What to do when a woman wants to show you her breast at a football game?

This is not a riddle or a Mardi Gras story

--but a true experience from my years as a lactation consultant 

 

This anecdote came to mind when I read a post on Dr. Bryan Vartabedian's blog, 33Charts, on how medical practitioners handle questions from patients and non-patients on social media and in social settings in general.

I have many, many fond memories and humorous stories from my years owning my breastfeeding store, Mother's Best in Baton Rouge.  And this one stands out vividly.

I had just finished a busy Saturday at the store on this particular Louisiana Saturday in September.

My family was already at Tiger stadium, aka Death Valley, waiting for me.  I had stayed after hours helping a customer with her nursing and was already late, and in fact had not only missed kick off but the better part of the first half of the LSU football game I was trying to get to.


I was grateful to find a parking spot not too far off campus and was making my way along a half mile trek to the stadium when I was approached by a friendly past customer just outside Tiger Stadium.

She stopped me to say hello and update me on her baby's milestones.

Hello quickly evolved into "I have one quick question" and can we go over here "so you can look at my breast for me?" 


So there you have it ladies and gentleman,

how you get asked to look at a woman's breast at a football game.

 

How did I handle it, you wonder?  I told her that her baby was adorable and asked her to come see me at the store.

P.S. 
I once worked for a family practice doc who would scratch his fingernails over the cell phone receiver saying "I can't hear you, the reception is bad..." when his service put through a call about constipation while he was at a ballgame.


What would you have done?  Tell me in a comment.


Saturday, August 25, 2012

What Not to Wear on Your First Day of PA School

Because I love a good list, here goes:

The hit parade of what not to wear:


#1 The Bikini
 

Even if you look like this wearing one--don't. 

Actually, especially if you look like this wearing one--don't!

 

 

 

Reasons:  obvious

 

1.-class mates (girls) will hate you instantly

 

2.-class mates (guys) will never look you in the eyes again

 

3.-professors- 

either #1 or #2, possibly both. 

 

And guys, this means 

SPEEDO = NO for you.

 

Just say NO to the Bikini concept, your life in PA school will go smoother.

 

 

 

 


#2 The Tux

 or any Formal Wear 

 

Anything that suggests you just rolled in from last night's adventure is a definite NO!


 

Again, Reasons:  obvious

 

You are here to learn to be a physician assistant, a medical professional, not a reality show celeb -- that comes later.


If you have to think too hard about this one (or #1), revisit your choice of profession. 

 

#3 Stiletto Heels 

Or any type of "fun shoe"

 

Reasons:

 

-Preserve the longevity of your feet, and your ability to stand on them and be a PA when you finish school.

 

-Don't look like you violated choice #2

 

And guys, I guess this means no cowboy boots for you, unless you live in Texas.  

Then anything goes!

 

#4 Absolutely anything you wore last summer!

For me, this will include the above outfit worn in Cairo this past summer (see my Egypt post, "View from a Camel") with my uncle.  

We were trying to blend in, hence the head scarf and long black robes. You will NOT see me in this in PA school.


Reasons:

 

Wear something new and different.  Last summer is so five minutes ago! 

 

You are starting a new and important phase of your life!  Wear something fresh, comfortable and appropriate.

 

 

Buy some new mechanical pencils, highlighters.

Stock up your book bag and open up a new page in your life! 

 

YOUR TURN:

If you are a fellow PA student or a school veteran, let me know in a comment what you would add to this list!

 

 

 

 

Thanks go out to my fellow blogger at TheLondoner for her photos.
http://www.thelondoner.me/2011/09/glad-rags-rag-muffins.html

Friday, August 24, 2012

Microbes & Spiders

Bread mold - Aspergillus niger

Microbes we love to hate


I found this cool article on some fascinating microbial organisms we take for granted.   Some of these organisms are beneficial to us yet we fear their reality.

There are many microbes that we are unaware of, many that we know and love and many that we fear disproportionate to their power to interact with us.

Personally, I feel very comfortable handling many pathogenic bacteria and I did so for a living for several years.

I can't say the same for spiders.  I have a disproportionate fear of all spiders.  There will be NO spider pictures on this blog.

Spider Seuss


I do not like spiders.
I do not like them in a tree.
I do not like them with a flea.
I do not like them one or all.
I like spiders not at all.

I don't want to know if there are beneficial spiders or should I say spiders that are beneficial to humans.
I understand that there are many that are helpful to plants.  That's fine plants don't know any better.  I do.

 

Camp Effie 

Live Oak trees at Camp Effie
A visitor saw a brown widow spider in my yard today. 

It was under a large tree in the front yard hanging on a thread of silk.  She identified it and offered to knock it down.  I declined her kind offer thinking that if it ran on the ground I couldn't see it and it might run up my leg.  Yes, probably irrational.  I'm over thinking spiderness. 

She had previously been bitten by a brown widow and was told by the ER doctor that her hallucinations were a common effect of the bite and "enjoy the trip."

 

Brown widows a gift from Katrina


These brown widow spiders, a nasty relative of the black widow, were blown into our state from the Caribbean during Hurricana Katrina.  Interesting how weather shapes our for years to come.

Thursday, August 9, 2012

Medical Professionalism for PAs (and students thinking of PAdom)

Jim Anderson's article on medical professionalism in this month's JAAPA, brings up some important topics for PAs.  He presents a hypothetical scenario of a supervising physician whose personal life has taken a tumble and their professional conduct has been tarnished by alcohol abuse and a personal, romantic relationship with a patient.  The PA working in this practice has a longstanding relationship with this physician and their obligation of action is brought into focus.

I am very interested in how communication between clinicians and impacts patient care.  This article touches on some key points in communication as well as medical ethics.  The juxtaposition of these two topics is fascinating.

The hypothetical scenario that PA Anderson writes about is shaped by the relationship and rapport that the supervising physician and the PA share.  Therefore, their communication style and habits are key to the central quandary presented in the article.


These are the issues at hand that I see:
  • When does "one" equal "one too many"? OR When is a single violation of ethical behavior at work enough to warrant a whistle blowing action?
  • What are our personal and professional obligations to report bad behavior?
  • When does this become a legal matter that requires participation to avoid legal consequences?
  • How does reporting unethical behavior change our professional relationships?  How does one react to these changes?
  • How are we teaching medical professionalism in PA school?

As I approach the start of my PA school, I am eager to learn more about how we handle situations that challenge our interpretation of medical professionalism.  I've just completed a course this summer in Medical Ethics and was exposed to many fascinating case studies and situations.  I wrote a post on my privilege theory that evolved from my theory of "don't do dumb stuff."

I have worked in healthcare for the last twenty years and have seen instances in the workplace that called for intervention or at least reporting to a manager for action. 

Often the guidelines and standards we learn in school are difficult to apply to the gray edges of everyday life.  We make friendships and collegiate alliances with those we work with and seeing exactly how to act and doing so at the right moment is not always as obvious as it appears in a textbook or classroom scenario.

Sunday, July 22, 2012

Bioethics: Privilege Theory

What is the study of medical ethics?
"Where does it begin and where does it end?" may be a better question. 
I have certainly learned that there are more questions than there are answers in this field and the more you study it, the more questions pop up.

"Don't do dumb stuff" approach no longer sufficient:

 

I used to like to sum up my course syllabus to my students this way after going through an eight page diatribe of not texting in class, being punctual, etc., I would tell them it all boils down to "don't do dumb stuff."  I admit that I tend to oversimplify at times.  I liked how fellow Buffalo blogger, Shaun Doyle, Jr. wrote about "What ought to be done."  (See his post for a lively read.)
While this is generally a valid approach to life that keeps me out of trouble (for the most part), it is not a sufficient philosophical theory of bioethics given the burgeoning capabilities of medicine and its technological advances.

I am taking a medical ethics class this summer in the philosophy department at Canisius College to transfer to physician assistant school this fall at Daemen College.  Our class is a small group of individuals from diverse backgrounds and perspectives.  Indeed, part of the education here is listening to classmates evolve through their thoughts and begin to embrace new ideas without realizing their own process.  

One person's "dumb stuff" is quite often someone else's "good idea."  This is how we got God committees, such as the one in Seattle in the 1960s. Then the power of the media comes in because it brings with it the power of public opinion.  Dr. Scribner harnessed this power when he took a dialysis patient to a media convention to plea for more dialysis machines in 1962, but it was the God Committee that ended on the front page of the New York Times.  And the power of the media pulled the public and then Congress into the process bring to bear Medicaid and Medicare funding for dialysis. (Medical Ethics: Accounts of Ground Breaking Cases by Gregory E. Pence p. 221.)

The last forty years or so have been a roller coaster ride in medical ethics as transplant and reproductive technologies have raced headlong ahead of our social and legal readiness to encompass them into our healthcare system creating an explosion in the field of bioethics.
Stem Cell

We have studied several important philosophical theories of ethics in my Medical Ethics class and how they intersect with bioethics.

Kantism, utilitarianism, consequentialism, virtue ethics to name a few.

While I can parse my way through a couple of these, I have come to develop my own theory.

Privilege Theory

I have an ethical theory of my own that I am calling, "privilege theory."
And I don't mean "privilege" in the sense of affluence. A privilege is a vantage point from which one person can lift or assist another onto a higher level or plane.
I believe that each of us has privileges that it is our duty to pass on.  It may be as simple as holding a door for the person behind you entering a building, sharing a smile, or teaching a simple life skill to someone who may benefit from such whether it is your child or a stranger.  All of us have privileges that it is our obligation and gift to pass on.  When we fail to pass on or share a privilege because we are too tired or selfish, we smother it and lose an opportunity to not only lift up another individual but also a chance to liberate some small part of us that needed to be set free.  It's like finding a great free snack sample at Wegman's (a great grocery & deli store in WNY) and not telling another shopper!

Privilege Equalization


How we choose to share these privileges is, of course, up to each individual.  In the interest of theory discourse, we could call this "privilege equalization."
We must equalize our privileges.
This may sound socialist but I don't intend
it as a financial matter of dispersing property and assets.
We all have privileges to share.
We each have something within us that we can use and share to lift up another.  That thing may be an education, a skill or a well timed hand shake at the right moment.

How do we use this theory to decide who gets scarce medical resources?   Which patient will be able to receive that much needed organ transplant?  How do we decide these ever more complicated decisions?

The limited answer is that we keep handing up privilege with each action and each person who can serve the one who needs them at that moment.  That means we all check off the organ donor box on our driver's licenses and let loved ones know that we want every usable piece of tissue, bone and organ harvested before our body is put to rest.  And it means that we continue as a nation to dialogue and struggle to bring forth a national health care system that serves our entire nation.

Healthcare in Europe

 

I was recently in Europe when a German traveler engaged me in a conversation on a flight to Moscow.  He wanted to know two things:
  1. Who will win the election this fall, Mitt Romney or Barack Obama?
  2. And why don't Americans want to have health care for their country?
"I don't know who will be the next President," I told him.  My uncle, a family physician who was traveling with me, and I tried to explain the complex state of medicine and public opinion in the U.S. to our German friend.  We spoke with citizens in Germany, Hungary and Russia about their healthcare and insurance options.  Europeans seem perplexed by America's lack of a consensus for quality healthcare for all of its citizens.  This seems a simple right or need to them and they are watching us in puzzlement.

In Hungary, it seems that physicians make low salaries relative to their education and work.  Many doctors in Hungary work in multiple capacities to increase their earnings.  And patients and their families go to the hospital with envelopes of cash that they give to doctors and nurses when a patient's outcome was satisfactory or pleasing.  So basically, they are tipping their physicians according to their performance. 

 

Privilege Theory in Medicine


Those who choose to study medicine are privileged folk.  And note that I am describing all aspects of medical care here, not only physicians, but also nursing, radiology techs, occupational and physical therapists, clinical lab techs and all who work in healthcare.
They are privileged because they have the ability to study hard and apply themselves to a chosen field, often to serve others.  They have an inherent duty to act responsibly in supporting their patients medical needs in their particular aspect of care.

How we distribute these privileges may be a function of one's political or philosophical alignment with utilitarianism or other forms of theory that applies a basis for bestowing justice and merit.  But if each one adopts the ideal of sharing their privileges faithfully and honestly, some needs may fall away.  Imagine for a moment, the patient being seen for sore ankles, knees and foot pain who is overweight and works on their feet.  Is it wise for their caregiver, to advise them how to treat their joint pain and foot discomfort without also sharing direction with them how diet and exercise may help them reduce their weight and therefore their joint and foot pain?  By sharing the privilege of understanding how someone may improve their health and lifestyle, we can alleviate other disease processes and treatments in the future.

We should not have to be "tipped" with envelopes of cash to be motivated to share the privilege of this knowledge with each other.

DISCLAIMER:
This is more of a practice run of me thinking through my personal philosophy and how it fits with various ethics theories than it is an espousement of how things really are or actually should be. 

Tuesday, June 19, 2012

View from a Camel: Cairo, Egypt

My view from a camel in Cairo, Egypt

 

View from a Camel:  

I just got back from Cairo four days ago.  What an experience.  It really was too much to absorb in the few days we spent there. 
Here are a few of my impressions and observations.
One of my favorite parts of the trip

Democratic elections in Egypt

The Egyptians are holding a democratic runoff election this weekend.  The Islamic Brotherhood may prevail and if it doesn't it seems that the military regime in place will enforce their agenda regardless as they reserve most of the governmental decision making through veto power.
Boy driving donkey cart in Cairo

Media Coverage

The media is full of coverage that is spotty and not always complete.  This must be in part because they do not have timely, reliable sources in Cairo to draw from.  Today MSNBC.com reported on an overnight shooting on the street between vendors that made it sound as if this was a result of political unrest or discord when in fact it was a turf squabble among street merchants.

Life in Cairo

Having just returned from my first trip to the third world, my eyes were opened to the life on the streets of Cairo.  It was dusty, dirty, hot and crowded at times.  Sidewalks filled with street vendors offering watermelons, bread, fruits and sheep and goats.  Children driving tuk tuks (small 3 wheeled trucks often seen in India) in dense urban aggressive traffic.  Donkeys with ribs showing pulling carts laden with bricks amidst eight lanes of choked up stop and weave traffic, blaring horns and unforgiving sun revealed the difficulty of life in this city of nineteen million.
Street scene at Tahrir Square


Street vendors at Tahrir square


Though we went to see the iconic pyramids and The Sphynx, my thoughts were on how these people live on the streets in the rubble of crumbling buildings amongst piles of garbage and scraggly dogs looking for food.  Children smaller than the height of the cars dart out and around traffic weaving their way to a median or the other side of the street.  And beasts of burden fared less well than the people.


Photos from Cairo

King Ramses II
Streets of Cairo
Here are a few of my favorite shots of Cairo.


These young girls were making hand knotted wool and silk rugs at a carpet school where they attend or work four hours a day for five days a week for anywhere from a hear to five years.  Their fingers moved like lightning.  The young lady on the left was about 12 years old and they each had their cell phones in their laps.
Young girls at a carpet school keep
 their cellphones in their laps




I really enjoyed seeing the goats and sheep in the streets.  I know they were being fattened for the kill.  But it was neat to see them eating out of troughs along the streets and sidewalks.  And the youngsters tending them smiled when I waved.
Goats and sheep fill the streets where they are sold
My uncle

Livestock being sold on the street

Pyramids at Giza showing the wives pyramids in foreground

Sphynx in foreground

Buffchic and Sphynx

Streets in Cairo

View from balcony in my hotel room

High rise apts. in Cairo

View from balcony in my hotel room



Two fellows on a bike

Step pyramids





Sunset in Giza

Friday, June 1, 2012

The fence isn't sausage even in Budapest

Raining in Budapest


Rain in Budapest.  Me and our tour guide Katalin protected by umbrellas.
Woman washing window in Budapest
Sunrise was at 4:50am today, but it was the rain that awoke me this morning in Budapest.   My hotel room windows were open to the courtyard and the rain was steady on the roof tiles outside my window.

Pink polka dotted suitcase arrives in Budapes
After a late arrival from Frankfurt last night, I got up this morning at 7:00 local time but it was midnight on my internal clock as it was back home in Louisiana.  As you can see below my pink polka dotted bag arrived safely and was easily "spotted" on the luggage carousel.  Never underestimate the power of a little duct tape and spray paint!


The fence isn't always sausage


Our tour guide, Katalin gave us historical insights as well as art, culture, architecture and the "state of Hungary" lessons this morning.

While she told us that native Hungarians often pay mortgages on their apartments in Budapest of only $3.00 or $4.00 per month, they do pay what amounts to maintenance fees of approximately $130.00 per month that then get pooled and saved for renovation on the aging historic buildings.  While these flats are often only 800 square feet, they seem more spacious with their high ceilings and large windows opening onto fabulous boulevards and vistas along cobblestone streets.

She says that foreigners can move here and rent "a little something" for about $200 or $250 a month and that for $500 a month one can get something quite nice and large.  But for $1000 per month, she reports that you can get a place with an 18 karat gold bathtub!  Now I don't need the gold tub, but I sure wouldn't mind a flat in Budapest.

Our guide, Kathy (Katalin), says that some young couples move outside the city so that they can build a new home but then they are committed to a one and a half hour commute into the city of Budapest each day for work as they have no large highways or freeways here and the narrow winding streets make for lengthy traffic jams.  Then she quickly added, "so you see the fence is not sausage."  The fence may not be sausage, but the gulyas and csirpetke noodles were excellent at lunch.

General who fought off the Turks 

Budapest farmer's market

Thursday, May 31, 2012

Buffchic checks in at Frankfurt-delayed on way to Budapest

Ten hour flight from Houston to Frankfurt, Germany was smooth and easy.  I slept well after watching a mindless chic flick movie (The Vow) chiefly worth watching for the nude shots of Tatum Channing.
at New Orleans airport

This was in contrast to the pre airport trip to MSY in New Orleans when we got a speeding ticket on I10 and a wheel broke off of my carryon luggage roller going into the airport.

Delayed in Frankfurt

I missed my flight to Budapest in Frankfurt due to delay in "de-bussing" the plane despite a United on time arrival.  No gate was available. So here are all these 767 and 747 jumbo jets parked out on the tarmac off loading passengers onto a series of buses to the terminal.
Beer & franks while charging
By the time I got through immigration and security, flight to Budapest was closed.  Watching the Lufthansa gate agents bicker and argue behind the counter was the only amusement here.

So I am spending the day waiting in the Lufthansa lounge for the 9pm flight to Budapest.

Luckily the accommodations are decent.  Sausages with crepes and German beer (round 2).  Earlier I sampled their artisan breads, made to order salads with fresh snipped herbs from their garden growing on the counter, fresh strawberries and some German Reisling as well as a couple German sparkling wines followed by an espresso and apricot custard-- quite delightful.

Fellow travelers amuse

Earlier I sat next to a table of professional mountain cyclists (didn't know there was such a thing) and their coaches who were all drinking water with lemon and comparing their body fat composition percentages and race results of cohorts amid waitresses offering cheesecakes, gelatos and pretzels.  Their bikes had been shipped ahead last week via truck and they were on a tour.
German sparkling wine and strawberries at Lufthansa lounge


Now I am amid business men skyping with their home offices discussing sales prospects, trends and issues.  Overheard - one man's phone call  in Italian, the next in German and the next in Japanese.  I admire these guys who can converse fluently in so many languages.

Back to my Rosetta Stone study of Russian.

Blogger in German


Did I mention that blogger is suddenly in German here?  Good thing I am familiar with the layout of the program.
Redeeming tidbit
Ah, but there is a Tiffany store in the airport here, along with the requisite McDonald's, of course.

Monday, May 28, 2012

Buffchic goes to Eastern Europe

Preparing for PA school by relaxing and traveling:

When I asked Harrison Reed, Yale PA student, what he advised doing this summer as I prepared to enter PA school in the fall, I expected him to recommend some texts that I should review.  Instead, he advised relaxation and travel.  I am taking him at his word.  Smart guy that Harrison.  Here's a look at Harrison's excellent blog on his PA school life.

So when my uncle invited me to accompany him to Eastern Europe and then on to Cairo, I said "yes!"  I will be visiting four cities I have never been to before:  Budapest, St. Petersburg, Moscow and Cairo.  I leave Wednesday.
Basilica in Budapest, Hungary
Summer in Budapest










Shanx looks cooler than Shanks
Today after breakfast, we painted my pink suitcase with multicolored polka dots and emblazoned a version of my last name (Shanx) down the side in blue and silver spray paint.
Polka Dot is ready for the road.
 And tomorrow I pack for my journey.


Sphynx
Memorial Day 2012

Today (Memorial Day) I visited my father at Oak Haven nursing home where he resides.  As we ponder the losses of service men and women, I wonder how he felt when he entered WWII as a 16 year old.  He rarely spoke of his time as a Navy corpsman aboard a light cruiser in the Pacific, and now he is past being able to recount any stories that remain untold.


Missing IMPACT in Toronto

So though I am missing AAPA IMPACT in Toronto, I've been tuning in to the town hall meeting posted online.  Sorry to miss the conference, but must prepare for PA school in the fall as Harrison urged! 

Cairo, Egypt