Monday, September 30, 2013

"Doctor"

I don't know about the other interns out there, but since starting my residency in July, I have referred to myself as doctor a grand total of one time. That one time, by the way, was only because I was signing a death certificate (quite the process- requiring ME to get fingerprinted), and the medical examiner asked me directly who he was speaking with. I am speaking with Dr......?" he asked. Usually, in the hospital, we all return pages as "trauma intern," or "general surgery intern," basically whatever service we happen to be on at the moment. The nurses call me Amanda on the floor for the most part. The few times they have referred to me as doctor (and I promise you I am not being paranoid), has been with a mocking tone. Like "patient is post op day one and in rapid a fib, what would you like to do- DOCTOR?" Aka "I know what to do in this situation and you should too instead of looking at me like a lost puppy." I can't really blame them though, some of them have been at this hospital for 30+ years, and every July they are forced to interact with a new group of inexperienced, clueless interns (who do not know even a fraction of what they do), who place orders and make decisions for their patients. I guess if I were them, I would mock the term "doctor" too.

Thursday, September 26, 2013

Cronut Update

 


      Crumbs Bakery (now nationwide, very well-known in nyc, and most importantly easily accessible), famous for their flavored cupcakes (cookies and cream, cookie dough, etc.) has taken the plunge and made a copy cronut. I was very excited to hear this, because there is a Crumbs virtually down the block from my apartment, so I immediately had to buy both of the available flavors to test out. Just for the record, they are calling them "Crumbnuts," and not "Copy-Cronuts." They have one with bavarian cream, and one with powdered sugar on top. They are only $2.95, compared to the $5.00 price at The Dominique Ansel Bakery.
      Unfortunately, and very disappointingly I might add, the "Crumbnuts" were not even a quarter as good as the original cronuts. There was no flakiness, really no distinction from a regular donut in my opinion. They were also a little too doughy for my taste, especially since I have been exposed to the real cronut. Don't get me wrong, I ate them both, as regular donuts are still delicious, but it wasn't really very different than a Dunkin Donut. Maybe if I hadn't been so privileged and was unable to experience the original cronut in the first place (thanks again Matt!), my opinion would be different. So, in conclusion, there is a reason that the original cronut is such a coveted pastry, it is amazingly delicious, and clearly hard to replicate.

Saturday, September 7, 2013

SICU and Fall Favorites

      I am one week into my SICU rotation. The hours are tough- I mean much longer than trauma and minimally invasive surgery, and the atmosphere is intense (which is understandable) all day, every single day. I am literally counting down the days until it is over (and yes, as a future anesthesia resident, I should technically enjoy working with patients on ventilators who are critically ill, but what can I say......it is just not my cup of tea). It makes me kind of sad to be there all day. Anyway, in an effort to cheer myself up since I am off today, I thought I would share some of my favorite things about fall since it is now September.


1.) Starbuck's Carmel Apple Spice drink: This is a new discovery. I have been drinking this a few times a week now (not low in the calorie department, but worth the splurge) and it is so delicious. It tastes like fall in your mouth. I order a tall and skip the whip, but I highly suggest you try it. If you feel guilty, or don't want to splurge, here is a recipe for a much lower calorie version: Lower Calorie Carmel Apple Spice Recipe.

2.) Dunkin Donuts' pumpkin donut: Clearly I like to splurge in the fall, and pumpkin muffins are back. They are so delicious and also remind me of fall, crisp air, and the holidays around the corner. If you want to bake your own low calorie pumpkin muffins (still really good), you can use this recipe: 85 Calorie Whole Wheat Pumpkin Muffins.

3.) Candy Corn!!!! 

4.) Beautiful fall scarves: Etsy is my new favorite place to buy unique, colorful handmade scarves (especially since I a). can't knit myself and b). do not have the time to learn how knit right now). A few of my favorite Etsy shops to buy them: Cherished VintageSwak CoutureFairytale 13.

5.) Apple picking: For the past 4 years, my best friend from med school and I have gone apple/pumpkin picking at a great farm up in Westchester called Wilkens Farm. They have tons of activities, and our favorite part is obviously the bake shop they have there. Every year I have hoarded a few dozen apple cider donuts which I can only describe as a non-drug form of ecstasy. I eat many and freeze the rest to enjoy for the next 1-2 months. They also have apple butter, pumpkin butter, pies, tractor rides, and more. We always have the best time, but since we are both residents now, we are trying to find a day in our schedules so that we can go this year. I will be devastated if we can't coordinate our days off to make the trip. Anyway, check out there website here: Wilkens Fruit and Fir Farm. Definitely worth a trip out of the city....especially because there is gorgeous scenery and changing leaves to see on the trip up there.








6.) The Start of Football Season: Ok, this is actually one of Matt's favorite things about fall, but I would like it to be noted that I have gone with him to games for the past few years as a supportive wife. I even root for his team, the Redskins (he is a DC boy), even though I am a New-Yorker.

7.) Halloween Decorations: How cute are these pumpkins that were displayed in the children's hospital I rotated at last year. I just had to take a picture. Note: Bert is a spaghetti squash! I am SO going to make homemade decorations like that when I have kids/more time to do anything.


Sunday, September 1, 2013

Minimally Invasive Surgery

      For the past month, I have been the intern on minimally invasive surgery.The surgeries that are done on the service are mostly bariatric surgeries, which include both gastric bypass aka the Roux-en-Y and the gastric sleeve. In order to qualify for bariatric surgery, a person's BMI must exceed 40 OR be over 35 with associated co-morbidities (health problems related to the obesity, which can include anything from diabetes to hypertension to sleep apnea, and so on). The patient is referred to the surgeons at this particular hospital by their primary care physicians, and they are required to attend an information session about the surgeries and the lifestyle changes the surgeries require before they even meet with the surgeon.
      Once the patient meets with the surgeon and the surgeon determines that they are a good candidate for bariatric surgery, the patient must decide what kind of bariatric surgery they desire. A majority of patients choose either the Roux- en- Y or the gastric sleeve, and there are differences between the two (the gastric band is hardly used anymore at this hospital because the weight loss is not as effective, and there are a lot of complications associated with it). There are two mechanisms by which people lose weight after bariatric surgery, restriction and malabsorption. The gastric bypass incorporates both of these components while the gastric sleeve and the gastric band incorporate only the restrictive component for weight loss.
      Restrictive procedures limit caloric intake by reducing the stomach's resovoir capacity. Malabsorptive procedures decrease the effectiveness of nutrient absorption by shortening the length of the functional small intestine. Although malabsorptive procedures cause profound weight loss, they also frequently cause protein deficiencies and vitamin malabsorption. The goal of bariatric surgery in general, is to reduce the morbidity and mortality associated with obesity, and improve organ function.
      Both the gastric sleeve and the Roux-en-Y can be done laparoscopically (or as a minimally invasive technique, which means reduced blood loss, lower incidence of incisional hernia, lower incidence of wound infection, faster recovery, and a shorter hospital stay ). In layman's terms, a Roux-en-Y entails decreasing the size of the stomach, and then dividing (the Y part) and reconnecting one part of the small intestine to the new smaller stomach and the other to an area closer to the area where the bigger leftover part of the stomach, pancreas, and liver drain. The small stomach that is left over can only hold about an ounce of food (eventually it stretches to hold a cup) and this causes early feelings of fullness and satiety. Additionally, less calories are consumed because food bypasses most of the stomach and the upper small intestine. This also causes improved metabolism by changing the release of different hormones that influence fullness and digestion.
      The gastric sleeve is formed by removing part of the stomach and re-shaping the remaining portion into a banana shape.This prevents the stomach from being able to stretch and eliminates most of the area where ghrelin (the hormone that causes hunger) resides. While the gastric sleeve is considered a safer operation than the gastric bypass because it is only restrictive as opposed to both restrictive and malabsorptive, it is also an irreversible procedure as opposed to a gastric bypass, which can be reversed if necessary.
      The big moral of the story is that obesity is a huge problem in our country and America spends around $100 billion dollars annually to treat it and its associated co-morbidities. While both of these procedures are done frequently, they are not operations that should be taken lightly, especially because there are many potential complications associated with them. Complications can occur for no reason, but some depend on how complaint the patient is with the pre-op and post-op protocols. In the hospital that I work in, the patient is required to meet with a nutritionist (for up to 6 months depending on the patient's insurance), get medical clearance from an internist, undergo a psychiatry clearance, attend 2 support groups at minimum, +/- other necessary hoops they must jump through in order to even be considered for the procedure. They must follow a high protein diet in order to shrink their liver pre-operatively (because many of them have fatty livers that will get in the surgeon's way in the OR), and are on a clear liquid diet for at least 2 weeks post-operatively before moving on to purees for an unset amount of time. Eventually, they will be able to eat real food, but only a few spoonfuls at a time.
     I think you would agree that given all of this information on bariatric surgery, I would be a little shocked by the following patient encounter that occurred last week:  I walk into one of my patient's rooms (a patient who had gastric bypass surgery the day before) just in time to see her taking a big bite of a Burger King whopper and then reaching for a milkshake to wash it down with.

            Me: "What is going on here? What are you doing? How did you get that?"
           Patient: "My boyfriend brought it for me."
           Me: "But why are you eating, you know you can't eat, you are supposed to be on clear liquids for 2 weeks."
           Patient (shrugging): "I know, but I got hungry."

      And this is what is wrong with society everybody. People believe they can have a drastic surgery and then resort right back to their old habits. Personally, if I were so concerned about my weight and obesity that I was going to have surgery to combat it (and have Medicaid pay for it I might add), I would at least follow the diet that goes along with it for the first DAY after surgery. But that is just me. I think I am becoming jaded.........especially because of the conversation I had shortly after that incident with my attending."

      Me: "Can you believe it? I just can't believe she would do this, I mean she was cleared by psych, she went to the education sessions and was deemed fit for the surgery. Clearly she wasn't fit."
     Attending (who is not half as shocked as I am): "I guess you just missed the girl who had Chinese food delivered to the hospital for herself last month and then complained she was too full to eat the whole thing."