I Love Scrubs, But....

I used to be so proud when I finally got to wear my first set of hospital scrubs. It's standard uniform inside the operating room, the delivery room, the nursery and all the other places that required a very clean environment. Changing into scrubs (from street clothes) is a precaution against bringing in microbes that would infect the patients that are particularly susceptible. Now only people who are already given the go signal to enter those areas that were considered off limits to many get to wear scrubs. So just imagine how I felt wearing scrubs and entering those "hallowed" areas.

Our scrubs used to be boring -- just one color, with a generic design. My first pair of scrubs was white, because it was the required color for medical clerks (4th year of medical school). Later on, though, some enterprising individuals made scrubs out of printed fabric. With more designs to choose from, it became sort of like a fashion statement. I remember that I bought quite a few.

I don't know when the trend started, but when cheap nursing scrubs with cartoon characters became available, some mommies snapped them up as uniforms for their kids' nannies. Protest is futile. They will never understand what those scrubs meant to us. It's like uniforms for soldiers. Or even uniforms for students in a certain school. Nobody else gets to wear them except those who earn it by being qualified.

Now I only wear the hospital issued, boring scrubs inside the operating room. Never outside the OR. While I still love the designs (and prices) of the discount nursing scrubs now widely found, I am aware that people no longer associate them with my profession, but instead think of them as uniforms for nannies.

But there's hope, I've found that there are actually more elegant versions of this hospital staple. I just don't know if the hospitals here would accept a design like this, for example...

Hmmmm.....I'd probably get something like that for myself!

Too Excited To Be A Doctor!

I bought an ophthalmoscope-otoscope set very early on in my medical career -- in fact, when I was still in medical school. Even bought it brand new, at full price. I probably bought it at about the same time I bought my first stetoscope and an aneroid blood pressure monitor. I was very excited about learning how to use them. You see, being a doctor was my lifelong dream, and buying acquiring these equipment make me feel more like one!

Later though, when I underwent training to become an ophthalmologist, I had to buy another ophthalmoscope set, one which is rechargeable and comes with a retinoscope which I needed in order to do objective refraction, unlike my older set which was purely battery operated. I no longer have use for an otoscope, except maybe for looking into my son's ear when I suspect him of having an ear infection. Looking back, I could have probably just bought a second hand one for my first set, and sold it later on, and bought my brand new ophthalmoscope-retinoscope set when I was already set to be an ophthalmologist. But, my friends who are now in pediatrics, and of course, otorhinolaryngology use their otoscopes regularly and very rarely use their ophthalmoscopes.

The lesson here for medical students and doctors in training: Don't buy everything yet. Borrow first if you haven't decided on which course to take before wasting your parents' money.

Heart Repair

The mitral valve is one important component of the heart. In some cases of congenital anomalies, this may have some problems, either being too slow to move (too stiff) or too loose. This also happens in some cases of acquired heart conditions especially in elderly patients.

One option for these cases is to do a mitral valve repair. This is an open heart procedure and should be done by cardiothoracic surgeons who are especially trained to do such advanced, delicate procedures.

Sometimes the damage is simply too great that the only other option is to do a mitral valve replacement.

It's always prudent to look for the right doctor for the job, but more than that, we should always remember that we, as patients, should be proactive in looking after our health, observing the proper diet and the proper habits, so that we could have a better quality of life.

Branded vs Generic Medications

Branded, or more expensive medication? Or, generic and more affordable medication? In these matters, if I could afford it, I would rather go for the more reliable brands even if they are more expensive because, as a doctor myself, I've found them to be more consistent and reliable in their quality, hence there is a greater chance for patients to actually get the right dosage and the right medication, and as a consequence, get better faster. The faster you heal, the faster you can recover your productivity.

On the other hand, if I do not have enough money to buy the whole prescribed course of branded medicine, I will consider going for their generic equivalents, but I would first look at the drug company that manufactured the medication. There are some legal drug companies that offer lower priced, but still quality generic drugs. Those are what I would go for.

The drug development process is quite a complicated process, so I would much rather go for a company which has the means and the experience to produce quality medications, rather than some fly-by-night company whose credentials may be doubtful.

Cord Blood Banking

Over the past decades, there is a phenomenal rise in advances in the field of medicine. The discovery that stem cells in the umbilical cord has a great potential in managing a wide range of otherwise difficult to treat diseases is one of the most promising. Cord blood banking now offers an insurance against potentially fatal diseases, since the blood from the umbilical cord is a rich source of undifferentiated and "privileged", meaning it has not been exposed to most diseases. Cord blood is collected from the umbilical cord just after giving birth with a special collection kit. Lots of parents have already opted to have this done because they are assured that their children will have access to their own stem cells for possible future use.

Monthly Pain

I know somebody who doubles up in pain whenever she has dysmenorrhea but refuses to take medications for it because she believes that she will develop "immunity" to the medication. I have told her that it's best to take pain relievers if she's suffering because she won't be productive at all when she's in pain. Another long held belief is that taking medications would lessen the flow of the menses. This is thought to be bad as the "dirty blood" is not passed out.

I'm in a field where women who have dysmenorrhea and can't work because of the pain would be accused as trying to get out of doing her job and thus uses her monthly visitor as an excuse. This is especially coming from the males who would never experience how painful it is to have such a condition. Since the solution is relatively simple, I'd rather swallow a pill so that I could go on with my usual duties rather than have those unsavory comments hurled at me.

The pain during dysmenorrhea is caused by the production of prostaglandins. Most pain relievers are designed to block prostaglandin. No more prostaglandin -- No more pain. But the endometrial lining continues to shed, hence the menstruation itself is not hampered.

I tried looking for evidence against "immunity" to medications. This is what I found.

So, ladies, no need to be afraid of taking a pain reliever pill if you're really suffering every month. :)

Why didn't they do a stool exam???

I love watching medical dramas and shows because I learn (or relearn) a lot of things. But, sometimes we find something in those shows that are not consistent with what doctors in real life might do.

Last night, my husband and I started with House MD. It was very enjoyable for us, because we were able to relate with the doctors as they try to find out what the problem was with the patient.

We just started with the pilot episode last night. They diagnosed neurocysticercosis, which is an infection with Taenia solium (or pork tapeworm) in which larvae migrated to the brain and caused the patient's neurological symptoms. What I really don't understand -- once they already had that diagnosis in mind and they can't convince the patient to go through the treatment because they don't have evidence that there IS a worm -- they ordered x-rays of the leg so that they can look for the larva encysted in the muscle. Sure, it's rather simple and non invasive, but a simpler and more non invasive test, not to mention one with more yield -- would be a stool exam. Taenia solium is primarily an intestinal parasite. If there are larvae in the brain and in the muscles, it stands to reason that there are probably worms in the intestines and they lay a lot of eggs or shed proglottids which are passed out with the stool. Which could then be seen microscopically. That's what the medical technologists and parasitologists are there for. And, it's quite a cheap test -- at least here in the Philippines.

Oh well, maybe the stool exam is not as dramatic as an x-ray showing the larvae. :D