Friday, January 20, 2006

Five Medical Myths

Five medical myths I wish would die a horrible death:
  1. Green mucus = go to the doctor. NOT TRUE. Somewhere, somehow, someone started the myth that while it's ok to have clear or white snot or phlegm, green snot is an ominous sign, and means that you must seek medical attention, quick! In fact, any run-of-the-mill respiratory virus can produce a whole palette of lovely snot shades, from palest ivory to pea-soup green. This has been studied; color of sputum has never been shown to indicate whether an infection is viral or bacterial. (And the vast, vast majority of illnesses that cause you to cough up nasty greenies are viral.) There is a type of pneumonia that can cause rust-colored sputum, but we don't see this much, and in those cases the sputum alone is not the only clue as to what's going on. Yet doctors keep on asking patients about the hue of their snot, and every magazine article about respiratory infections says, "you don't need to see the doctor unless you have green phlegm."

  2. "It's just a virus." And its corollary, "you don't need antibiotics." NOT TRUE. Patients get frustrated when they go to the doctor feeling lousy and are told the above, and they should; they're really sick, and they shouldn't be told they're not. Viruses are bad; viruses can kill you, or at least make you wish you were dead. We don't give antibiotics for them because the antibiotics we have, with the exception of a couple of flu medicines, don't work on viruses, not because you don't "need" them. Believe me, if and when an anti-cold virus antibiotic is developed, we will be using it. (Of course, you won't have to take these hypothetical antibiotics, but then, you don't have to take antibiotics for bacterial infections, either. Yes, you can survive many bacterial infections without antibiotics.)

  3. High blood pressure gives you headaches. NOT TRUE. Studies such as this, this and this have repeatedly shown that this is not true, yet patients and doctors continue to believe it. The problem with this is twofold: patients may assume that if they don't have a headache, their blood pressure must be ok, and patients don't get their headaches adequately treated.

  4. Drinking lots of water is good for you. NOT TRUE. This one really gives me a headache. I think it started because of a misunderstood study long ago that the average amount of water a person uses for the business of existing for 24 hours is equal to about 8 eight-ounce glasses of water. The misunderstanding is that this is not EXTRA water; it's the water that already exists in all the foods and beverages a person takes in during the day. Thirst is actually a wonderful mechanism for telling you how much water you need. Extra water does not benefit you. It doesn't help constipation, it doesn't help your skin, it doesn't benefit your kidneys (unless you have kidney stones), it doesn't help you exercise. Perhaps it helps some people avoid eating and drinking a lot of fattening junk, but this is questionable. What it DOES do is make you pee constantly, and in severe instances can actually kill you. If you're truly dehydrated, you don't need water, you need water plus electrolytes. The water myth is reprinted in every issue of every health and beauty magazine published, so I have little hope of it dying.

  5. Coffee is bad for you. NOT TRUE. People have been trying to prove this for decades, and they haven't been able to do it convincingly. (Which means that there have probably been a lot of unpublished studies that showed no harm.) In fact, there's evidence that coffee may be good for you. Now, plenty of people don't tolerate caffeine well, but for those who do, drink up!
Any myths in your field that you'd like to put to death?

Wednesday, January 18, 2006

Shopping with Rose-Colored Lenses

I had another dentist appointment today. My upper teeth look human again, so that I can now toss my head back and laugh affectedly the way they do in bad commercials. I pre-medicated a bit for the visit (HATE going to the dentist), and then it went a little faster than expected, so I left feeling a liiiittle too good to get in the car and drive immediately. But hey, look — shops right near the dentist! With lots of pretty things to buy! And no HellBoy to distract me with his pesky screaming and thrashing.

It wasn't till I got home that I realized that everything I bought is PINK. Pink sweater, pink tank top, pink underwear, even some fuzzy pink flipflops. I almost bought a pink purse, but I didn't really like the shape, thank heavens. I must have increased the number of pink items in my closet by 500% today. Note to self: no more shopping under the influence. At least it was all on serious sale.

I still haven't made an appointment with my RE, but I will, I promise. I wonder, if my ovaries are indeed little dried-up husks, will I be devastated? Or will I be slightly relieved that I won't ever undergo another fertility procedure? I'm honestly not sure. But I agree, it's time.

At any rate, all of your comments definitely helped make me feel 1. appreciative about all that I have and 2. less embarrassed about feeling jealous.

I've been thinking about one of the comments that Bihari wrote:
I have several friends who are trying hard for children right now, and I really want to be a good friend to them through this, even though I have Mother Of Two stamped across my forehead. Any suggestions? I usually have just been keeping in mind that we all have our own set of losses and disappointments, and even if they're different, the experience of living through loss and disappointment per se can be the same, so that gives us a lot of common ground. But I could be full of shit. What say you?
Full of shit? Definitely not. In fact that's how I make myself feel better about someone else's fortuitous fertility: would I want her life? Everyone has some hard things to deal with. OK, this approach doesn't always work — there's one person in particular I know who has NEVER had ANYTHING go wrong in her entire life, in fact has had all sorts of wonderful things happen, and although she's a very nice person, I can't help it, I'm not a big enough person to be able to get past it. I know that people probably think that I've had it easy, too — I've got a great job and a TrophyHusband, we don't have to worry so much about money anymore, I've got a healthy baby. I even like my inlaws. Hell, I'm starting to irritate myself. But I have had some pretty crappy things happen to me in the past; I know what it's like to feel as if nothing will ever go right. And I think that loss and disappointment do indeed give you common ground.

As for specifics about talking to someone who's struggling with infertility when you yourself drop eggs like a hen and can get pregnant by shaking hands? Midwestern Deadbeat mentioned that she'd read Tertia's piece on how to be good friends with an infertile, and I think it is good advice. I myself was not/am not an especially touchy or bitter infertile (I think. Others may beg to differ). I've had worse things happen to me than infertility, and my experience was about a tenth as bad as some — it was only a few years of trying, I didn't have to do THAT many cycles of IVF, a lot of it was covered by insurance, and I didn't have any wrenching pregnancy losses, just one miscarriage of a "chemical" pregnancy — so I don't feel I'm able to speak for Infertiles in general. But I do have two pieces of counsel:

First, if someone is undergoing treatment, try not to take their bitchiness and/or craziness personally; it's not about you, and it will pass. Because those hormones make a person insane. I was never a PMS-er, and figured, how bad could ART be? Answer: really, REALLY bad. There were times when I would walk around in a white-hot rage for a week. I locked myself in a room during one vacation at my in-laws because I couldn't trust myself not to say something that would ruin my relationship with them forever. Seriously. TH had to bring me meals.

Second, there's a magic phrase that is always appropriate and that is guaranteed, if not to make an infertile person feel better, at least to not do harm: "You're handling this amazingly well." TH must have said that to me a thousand times, and while I sometimes doubted whether it was true, it always made me feel at least a tiny bit less psychotic. (Turns out it really wasn't true. Poor TH.)

Friday, January 13, 2006

It's Not Like My Toes Are Even Pretty

I have heard about three pregnancies in the last 24 hours. First, Angelina. Next, one of my students who wanted to explain why she's been MIA for some required exercises (she was vomiting in various bathrooms around the hospital, poor thing). Finally, one of my colleagues.

I have long noticed that some pregnancy announcements make me wince a little, and some do not. Angelina's, now, I feel irrationally happy over, maybe just because it's cool to think of two such gorgeous people combining genes, and maybe because she's certainly paid some dues (albeit with a fat checkbook). My student's, well, a tiny bit. Because I didn't have a guy who was willing to undertake parenthood with me at that stage in my life, even though I was already getting slightly long in the tooth (and I knew I couldn't do it alone).

My colleague's announcement was pretty hard to take. She's my age, and she sees outpatients in the same office as I do. She got married when I was in year three of my fertility quest, and she wasn't worried in the least about whether she could get pregnant — she used birth control for a while, even. Then of course she got pregnant two weeks after I finally did. (Which meant that we were out on maternity leave at almost exactly the same time, which just about shut down the practice — despite ample advance notice, none of the higher ups seemed to grasp what kind of problem this would be — but I digress). Recently I asked her if she thought she wanted another, and she said, maybe, sort of ... then she stopped her birth control again and had sex exactly ONCE, and now she's pregnant again.

I hate this evil finger of jealousy scratching at my back. I don't begrudge her this pregnancy, and I know she has a lot more to deal with than I do in life — she has a chronic medical condition that leaves her in pain and fatigued, her husband does almost nothing to help with their son or the house, and she's a really kind, generous person who has helped me often. And, I already have a fantastic (though hell-bent) baby myself, which a lot of people probably begrudge me. But it's hard to shake this ugly feeling. Jo wrote about it much more eloquently than I a little while ago.

It also makes me do something I hate to do, which is face up to my own desires and motivations. I have not made an appointment with my RE, despite knowing full well that time may have run out for me. I have not weaned HellBoy, despite knowing full well that nursing is probably interfering with any chance at fertility I might otherwise have. I become very adolescent about the whole issue. I'm still pissed off that I don't have the luxury of deciding how many biological children I want. I want to be able to ponder when would be a good time to have a second baby, without the incessant noise of the clock winding down making it hard to think. I'm finding this whole gig pretty overwhelming at times, and the thought of adding another baby to the mix sometimes seems outrageous. Not to mention the hideousness of infertility treatment. It would be nice to know that I could wait a couple more years to catch my breath.

I have a slightly ridiculous reason for wanting a second biological child: HellBoy looks almost nothing like me. He's got exact replicas of his father's cleft chin, distinctive nose, big brown eyes, even his long flat feet. The things that may have come from me are all pretty generic — straight fine hair, smallness, maybe his mouth? Probably his eyebrows? I mean, we're grasping at straws here. I joke sometimes that at the IVF center they finally got fed up working with my tough old eggs and just borrowed one from a nice young woman who resembled me. There's no easy way to prove this isn't true.* I coached my cousin's wife at the birth of their first child, and I was the first person to hold and dress the baby. I noticed right away that she had my cousin's toes, which are unmistakeable, and which I also have (maybe I'll post a picture sometime, but for now you'll have to trust me, these toes are better than DNA testing for tracking family connections). And I thought that was the coolest thing.

I want a baby with my toes.

So that's a pretty stupid reason, and yes, I realize that even if I had a second biological child it could be mini-TrophyHusband #2. I need to appreciate my incredibly good fortune in having HB at all (which I do, I do). I need to decide whether I want to get my butt to my RE and let them tell me if the door is really closed, because until I know that it's all rhetorical anyway. And then I probably need to wait a little while and talk some more with TH about what would be the best adoption scenario for us.

OK. Enough about me and my whining. Let's talk about lurkers, shall we? Because for de-lurking week, this blog is kind of a bust. Hundreds and hundreds of you, yet only one de-lurker ... why so shy? (You still out there, E?) Well, really, I'm not going to harangue anyone. I always hated my creative writing workshops where we were required to make comments. Some stuff was just crap, and the less said about it the better, and some days I felt like crap and didn't think I should impose that on the author either.

So forget I even brought it up. Carry on.

*No, of course I don't really believe this. Because they wouldn't give those nice fresh eggs out for free, now would they?

Thursday, January 12, 2006

OK, But Let's Make It Quick

I warn you, I'm not very good at these.

10 years ago:
Trying to make it through my surgery rotation my third year of medical school. I got home at 9pm the very first day and burst into tears as I walked through the door. And I'm not much of a weeper. I was living with an older man, a scarily ambitious member of the intelligentsia who was the most self-absorbed asshole I ever hope to meet.

1 year ago:
Doing resident interviews. And I was on call one year ago tonight.

Snacks I enjoy:
  1. Jelly Bellies
  2. Peanut butter, straight up
  3. Chocolate ice cream with peanut butter in it
    Can't think of any more. I don't much like snacks. I like breakfast and dinner, the rest is kind of a chore.
Songs I know the lyrics to:
  1. Itsy-Bitsy Spider
  2. Senor Don Gato
    That's it. I can't remember lyrics for shit.
If I were a (multi-)millionaire, I would:
  1. Get a house with a parking spot
  2. Pay off my student loans
  3. Keep a nanny on call for when HB has a fever and can't go to daycare and for occasional evenings out
  4. Visit Australia and New Zealand
  5. Buy a house for my brother
Bad habits:
  1. Candy
  2. People magazine
  3. Staying up too late
  4. Sleeping too late on workdays
  5. Blogging
Things I like doing:
  1. Sleeping with the baby
  2. Running
  3. Reading the Sunday papers while someone else runs herd on the baby
  4. Blogging
  5. Sitting on the patio in the summer drinking drinky-drinks
Things I'll never wear/buy again:
  1. Painfully pointy shoes
  2. Alpaca anything
  3. Heavy earrings
  4. Plastic flip-flops
  5. Nightgowns
Favorite toys:
  1. My mac
  2. My Scion XB
  3. My Zach & Dani's coffee roaster
  4. My white-noise machine
  5. Froogle

Saturday, January 07, 2006

I Swear I Didn't Drug Him This Time

Something strange and new has been going on in the DoctorMama household. Although the refrigerator is still empty except for limes, beer, and dozens of quarter-full containers of takeout food of indeterminate origin; although the floor under the desk in the study still has a faint yet evocative odor of pissed-off cat piss; although the plants continue their slow march toward death; although nothing else has changed, HellBoy is becoming AngelBaby.

I agreed to watch him by myself for three hours straight today. While this may sound laughable to those who are single-handedly juggling twins, puppies, and broken pipes, let me tell you, I was dreading it. I am not a wimpy person. I am even rather skilled at taking care of babies (I was an au pair in Switzerland, for chrissake!). I don't go down easily, but HellBoy can take me down. And he saves his really special moments for me alone. But TrophyHusband needed to get some important work done, so I took HB to ... the outlet mall.

I chose this because it's the sort of frantic place where an extra minion of hell is not especially noticed. Also because he's just finally grown out of his 12-month overalls and actually needed new clothes. I prepared as if going on a secret assassination assignment into the deepest jungle -- DVD player for the car, check; lollipops, check; binky, check; diapers, check; toy cell phone featuring Glinda the Good Witch chirping "I love you SO MUCH!" over and over until your ears start to bleed but at least it makes him happy godammit, check.

And then off we went. And I have nothing to report, except that I never had to pull out the DVD player in an hour total of driving (longest time by far); he SAT IN HIS STROLLER in the mall (I swear to god, he hasn't done that for longer than 15 minutes since he was two weeks old -- we've been using it as a shopping cart since then); he didn't cry, not even ONCE; he didn't require lollipops nor grab at my breasts screaming "DAT! DAT!", just politely held his hand out for veggie puffs and said "More"; and there was a crying baby in one store whose mother said, "Look, there's a good baby. Why can't you be a good baby?" And she was pointing at HellBoy!!!!

This could be temporary, I realize. My nose only just today stopped making a weird clicking noise when I scratch it. But if it keeps up, I'm going to have to look around for something else to bitch about. And I'm going to have to find another way to get my upper-body workouts if I'm not going to be heaving a thrashing toddler around for hours every day.

Wednesday, January 04, 2006

Nose Update: My Modeling Career is Over

Under pressure from TrophyHusband, I went to see an ENT guy today. (Who has an unprotected wireless network from his office, bonus!) He looked at an old picture of me, then wrestled with my nose a bit (ouch), and finally said that it looked like I had done a reasonable job resetting it on my own (thankyouverymuch!), but yes, it was probably still a tad out of joint (no surprise to those who know me), and if I wanted he could put me under anesthesia and yank it around some more. I joked that my modeling career is pretty much over at this point anyway, which he laughed a little too heartily at, in my opinion. Anyway I said thanks but no thanks.

Now I'm off to the dentist to get the first two of seven fillings replaced. At least they'll be swapping my metal fillings with white ones, so even though my nose is less lovely than it once was, my mouth will lose some of its Terminator appearance.

Tuesday, January 03, 2006

I Guess I'm Not the Patient Whisperer After All

I aspire to be — or to at least appear to be — the kind of nonjudgmental doctor that patients can tell anything to, and from the kinds of hair-raising things I've been told, I'd thought I was succeeding. But I recently discovered that there's a very common concern that none of my patients have ever asked me about.

When I took my current job, I took over for the only male doctor in the practice. He had collected a patient panel that included a lot more male patients than the other doctors, which I was glad about, because I really enjoy seeing men. Not that I don't like seeing women, but women tend to go to the doctor more often than men do, and it can get a tad boring.

I had to work at gaining the trust of some of these men, and more than once a patient would halt in the middle of telling me his story and say, "It's a little strange to be telling this to a lady doctor ..." which was my cue to bring up the topic of impotence (or ED — erectile dysfunction, the euphemism du jour). Heck, I'd ask about it even if they didn't seem like they had something they were getting flustered about. (My favorite answer of all time: "Well, yes, doctor, I have been having some trouble with my, you know, with my — direction." Which was actually true — he wanted the direction to be up instead down.)

But recently a man joined our practice, and I noticed that several of my male patients started showing up on his schedule. I wasn't shocked; I knew that these patients had always wanted a male doctor. But I was a little disappointed that I hadn't been able to keep them, given my simply breathtaking skills at patient rapport.

The other day I mentioned to my new partner that he was leaching all the testosterone out of my patient roster. "Well, you know there are things that men just won't tell a woman doctor," he said.

"No, they ask me for V*agra all the time," I said.

"Oh, not about that," he said. "There's something that I bet no male patient has ever asked you about, yet it's one of the most common concerns men come to me with."

"I doubt it," I said. "Try me."

"That their p*nises are too small."*

And I had to admit that he had me there. Though I have heard many, many penile concerns, that has never been one of them.

This has left my doctoring self-esteem a tad shaken. How could I have been missing this major thing? One of my favorite parts about being a doctor is being able to reassure people. And here all these guys have left my office feeling, well, inadequate, and unable to tell me about it. I mean, I knew that men worry about this, but I didn't realize that so many of them think it's enough of a problem that they should see a doctor about it.

And I'm not sure I'll be able to include it in my review of systems. "Do you have any constipation? Diarrhea? How's your urination? Any problems with erections? And — how about your johnson? Feeling cheated? Under-peckered? Got a wiener instead of a brat?" At least my partner told me what to say if I ever do get this complaint: "Too small compared to what? You've been watching porn, right? Well, you need to remember that those guys are in the top 1 to 2 percent of the population. The other 98 percent look about like you do."

Which is not at all what women are taught to say in private life ...

*Trying not to attract too many folks who will be very disappointed if they find me popping up in their Google searches.