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Grand Rounds 3:39

Welcome to Grand Rounds 3:39! This is my fourth time hosting (The second four-time hostess!) and to commemorate the occasion, I’ve decided to unleash Henrietta the Healthcare Worker, my inner advice columnist. Enjoy the links!

DEAR HENRIETTA: I’ve had a problem for a long time. I’ve seen many specialists and have had many tests to figure out what’s causing my problem. None of the treatments work. Surely the doctors in the ER have seen it all and might know how to help me? –OUT OF OPTIONS IN OKLAHOMA

DEAR OUT OF OPTIONS: GruntDoc puts it best – “Sometimes expectation management is the best we can do, for everyone.”

DEAR HENRIETTA: My child has physical limitations. He’s resistant to doing his therapy and everyone treats him as though he’s made of glass! How can I encourage him? –DAD TO DELIGHTFUL TOT IN DELAWARE

DEAR DAD: Ambulance Driver has experience with this topic and writes eloquently about how to incorporate exercises into everyday situations: “I let her steer, taking care to keep her left palm firmly pressed to the handlebars. The vibration is good feedback for those dormant nerve pathways we’re trying to awaken. We do lots of right turns to, once again, extend that left arm, and we also do plenty of flat spins to the left, to teach her to shift her weight.”

DEAR HENRIETTA: I feel sad and frustrated about the patients who are brought to my hospital because they have intentionally overdosed. I just can’t relate. What on earth are they thinking?? –FRUSTRATED IN FLORIDA

DEAR FRUSTRATED: Sometimes suicide attempts are meant to be successful, sometimes not. In either case, drytears tells us exactly what she was thinking: “I was scared, I felt there was no way out, and down went the next two.”

DEAR HENRIETTA: Why can’t we all just get along? –ANGSTFUL IN ANAHEIM

DEAR ANGSTFUL: Kim at Emergiblog shares her observations and has a few suggestions for keeping the peace: “May we never forget that there is a person on the other side of that URL.”

Rita from MSSPNexus Blog gives some tips for building relationships at work: “You could accurately describe a rose as soft and beautiful or as difficult and thorny; it all depends on your focus.”

If you want to walk away from the drama and just do your job, Dr. Emer at Parallel Universes lets us know what patients want: “Human interaction requires skill sometimes, and for overworked and stressed physicians [ed: and everyone else!], that can be quite a challenge.”

DEAR HENRIETTA: I have my own practice and am struggling to make ends meet. A colleague has asked me to buy into a new practice that he’s starting. What should I do? –STRUGGLING IN SACRAMENTO

DEAR STRUGGLING: Mother Jones RN at Nurse Ratched’s Place has done some reconnaissance work and has some interesting findings: “And I thought nurses were the only ones who could be that malicious to their colleagues.” I dunno, Struggling – doesn’t sound good!

DEAR HENRIETTA: My husband was just diagnosed with diabetes and he won’t follow his treatment plan! Doesn’t he care about what could happen to him? –MRS. NON-COMPLIANT IN KANKAKEE

DEAR MRS. NON-COMPLIANT: Being diagnosed with a chronic illness is a big deal. Most chronic illnesses require major life changes. It takes some getting used to! Kerri from Six Into Me explains how even grocery shopping becomes an internal struggle: “Stomach: Baby spinach, baby carrots. You eat babies. Heh heh. FEED ME. I’m running out of patience.”

Chronic illnesses affect both young and old and can interfere with even the most basic human activities. Ann, featured on Chronic Babe, describes the difficulty she had after giving birth due to having been on bedrest during the end of her pregnancy: “The worst, though, was having no strength whatsoever. I couldn’t even move myself up on the bed, or get up and attend to my daughter.”

We do our best to predict or explain our chronic diseases, as Dr. Lei from Eye On DNA found out when she interviewed Kendra RN, who had a genetic test for diabetes: “I was primarily concerned that if “those” genes were present in my DNA, there would be an increased risk factor for my 3 daughters.”

Fortunately, when we have problems managing diseases such as diabetes, there are advocacy groups ready and willing to help us out, as Amy at Diabetes Mine discovers: “DM) OK, so if one of our community is arrested during a hypoglycemic episode we can really call you? MG) We have enough money in our slush fund to get you out of any jail. It’s called bail money.” Whoa!

And when it all gets to be too much, Rachel from Tales of my Thirties reminds us that sometimes a moment to relax and have someone pamper us can put things into perspective: “Ahhh, she’s working on my aching calves. The words metformin, Januvia, and Byetta slip away from my mind.”

DEAR HENRIETTA: I work night shift and am finding it difficult to make it home in the morning! What can I do? –SLEEPY IN SYRACUSE

DEAR SLEEPY: Maybe you could take a page out of TC’s (donorcycle) book when the sky goes from navy to pale pink: “Row houses and hospitals, court houses and schools, all come alive again with a rosy light. Look out the corner of your eye and instead of morning traffic, you’ll swear you see a guy delivering ice with a team of Clydesdales.”

Or maybe you need to start working day shift. Your call!

DEAR HENRIETTA: My grandmother was just diagnosed with Alzheimer’s Disease. What can I expect as this disease progresses? –WORRIED IN WICHITA

DEAR WORRIED: It’s probable that the disease will make her regress, as Dr. Val from Revolution Health writes, “But the strangest part of grandma’s journey with Alzheimer’s was that it took her on a reverse tour of her former life. She seemed to be reliving each day that had had the most emotional impact on her – in descending chronological order.”

DEAR HENRIETTA: I was a patient in the Emergency Room the other day and the person in the gurney next to mine was ranting and screaming. No one paid her any mind and eventually I was discharged home. What was that all about? Why wasn’t anyone trying to help her? –CONCERNED IN CONNECTICUT

DEAR CONCERNED: The person next to you may have had a mental illness or was withdrawing from their substance du jour. Sometimes security personnel can keep an eye on them, but sometimes not, as Susan from the Rickety Contrivances of Doing Good relates: “Security will still show up to evaluate each of these patients, and will put them in restraints if there seems to be any danger of violence, but they’ll no longer sit with them.” I guess I always assumed every ER already operated this way. Henrietta is sad that this ER is cutting back on security services for this patient population which seemed to be serving in the best interest of the patient and the staff.

DEAR HENRIETTA: I am a consumer of healthcare, not a provider, and am also an avid reader of medical blogs. The other day I came across a blog written by a doctor that included details of a patient’s history, including their name and procedure! Is this accepted practice? Should I be worried about my doctor having a blog? –APPALLED IN APPALACHIA

DEAR APPALLED: It is absolutely NOT an accepted practice to divulge any details about patients in any kind of public forum. Mike at Interested Participant describes a recent case in Australia involving this very topic, and muses about how this case would go down in the US. (No quote here – you’ll have to read to find out just how bad it might get!)

JC at Health Observances also proffers some advice to healthcare bloggers: “Sure, we all need to let off steam now and then about stressful situations at work, but when it involves intimate details of the lives of other human beings – we have no right to parade those details in a public forum.”

DEAR HENRIETTA: Is there anything in the world that is quite such a lovely phenomenon as the incredible wicking white cotton granny panty? –WONDERING IN WAIKIKI

DEAR WONDERING: MonkeyGirl has just the answer for you!

DEAR HENRIETTA: I can’t stand when bad things happen to my favorite patients! I go home at night and I can’t get them out of my head. Do other practitioners have this problem? –DISTRESSED IN DELAWARE

DEAR DELAWARE: Of course they do! It’s hard not to become attached to some patients. Bohemian Road Nurse describes a recent event when a home-health patient of hers coded in the hospital, while the agency’s CNA looked on: “Jenna was helping Mrs. Turnwater hobble over to a chair next to her bed after her bath, and Mrs. Turnwater suddenly grabbed Jenna with both arms, pinning Jenna’s own arms. Then Mrs. Turnwater went unconscious and limp.”

And Dr. Bishara from The Doctor Blogger relates a story about a patient that not only has little support at home for her major illness, but is taken advantage of as well: “She is trying not to think about the cancer and “keep going”. Weirdly, her son and his family have moved back in with her so she can support them because her adult son lost his job. The family does not believe she has anything really wrong with her and keep telling her “you’ll be alright” while still living under her roof and allowing her to work and pay all their bills.”

DEAR HENRIETTA: I don’t get all of this single-payer national health insurance business. Some people say it’s good, some say it would be a disaster. What is your take on it? –PERPLEXED IN PITTSBURGH

DEAR PERPLEXED: Henrietta is not the person to ask about such things, as they are very confusing to her also! But Bob at InsureBlog has some thoughts: “Seems no one ever mentions the queue in other nations. No one says anything about how some citizens of these supposedly superior systems buy private insurance to supplement the nationalized system or they pay out of pocket or sometimes even come to the U. S. for care.”

And here’s an account from Prudence of Prudence and Madness regarding a practice in the Philippines – pre-payment for services: “So now comes the almost never-ending haggling. The hospital wanted them to make a deposit of, at least, P10,000 within 24 hours because 2 patients will be having major operations and the money can be used to cover the initial treatments and the units of blood that will be used. The relatives just couldn’t make up their minds.”

DEAR HENRIETTA: How can I ruin the birth of my child? –NUTTY IN NASHVILLE

DEAR NUTTY: Dr. Nic at Shoe Money Tonight has 12 suggestions on how to do just that!

DEAR HENRIETTA: How do practitioners know when new treatment therapies have been discovered? –OLD SCHOOL IN OSWEGO

DEAR OLD SCHOOL: They read blogs :-) Dr. Rosielle at Pallimed informs us about a study published in Neurology regarding early treatment limitations and their effect on mortality: “Translation: don’t withdraw/limit life-prolonging care immediately because you may be wrong.”

Dr. Schwimmer from Tech Medicine describes aquapheresis as a new therapy for heart failure: “In an attempt to overcome the problems with diuretics and the requirement of a dialysis machine for ultrafiltration, a company called CHF solutions has designed a device for ultrafiltration — which they call “aquapheresis.” (In two parts, link at bottom of part 1)

And Matt at the Behavior Ecology Blog explains results from a study about pre-op hematocrits and surgical outcome: “Unfortunately, in a recent study published in JAMA, and highlighted in ScienceDaily about hematocrit and surgical risk- the 2 relationships are seriously confused…”

DEAR HENRIETTA: How do practitioners know about new drug therapies or new uses for old drugs? Or how Coca Cola can be used in medicine? –PRO-PHARM IN PENSACOLA

DEAR PRO-PHARM: Again, blogs! Liana from Med Valley High professes this: “Interestingly enough, Coca Cola also reigns supreme as the most commonly used therapy in a small but important area of medicine: the unclogging of gastrostomy tubes.” Look for the scientific explanation in the comments.

Girlvet at Madness: Tales of an Emergency Room Nurse muses about the new birth control pill that can stop menstruation altogether: “This feels like another step toward trying to control nature. If it’s inconvenient get rid of it. There can be no discomfort in our lives.”

Dr. Bookspan at The Fitness Fixer addresses the recent news about a teenage girl that died after using too much Bengay: “Deaths are rare, but salicylate poisoning is not rare or unknown.”

And David Williams at the Health Business Blog writes about an interview with Genentech’s CEO, who was quite involved with the development of the cancer drug Herceptin: “I think his points are generally right. But he uses a classic technique: talking about the issue in macro terms. I don’t know that anyone has said that cancer drugs are bankrupting America.”

DEAR HENRIETTA: I’m a first-year medical student. This is the most stressful year of school I’ve ever experienced! Tell me it gets easier! –STRESSED OUT IN SANTA FE

DEAR SANTA FE: Ah, I cannot tell you such a lie. And Vitum Medicinus delivers the truth better than I: “I was talking to a doctor the other day who described third year like this: ‘You get thrown into it and are just like ‘WOAH – I’ve learned more in my first four weeks of third year, than in my entire last six years of university.’ Scary.”

DEAR HENRIETTA: What is this crazy news I heard recently about Dr. Heimlich infecting HIV patients with malaria?? Why would he engage in such madness? –SHOCKED IN SOHO

DEAR SHOCKED: Tara from Aetiology explains how malaria was once thought to cure syphilis, and why trying it out on HIV is fallacy: “And unlike syphilis, HIV doesn’t directly attack our heart, or our circulatory system–it damages the very system we rely on to defend ourselves against a host of pathogens.”

DEAR HENRIETTA: Enough questions! Just tell me something I don’t know! –FED UP IN FRESNO

DEAR FED UP: Okay! Here are a few things you may not have known!

Mousetrapper at Med Journal Watch delivers some good news in the bad: “Women who are at risk of getting a more aggressive type of breast cancer are also most likely to detect the cancer by breast self-exam.”

The Clinical Cases Blog points us to YouTube, where a pathologist has uploaded hundreds of histopathology videos.

Bertalan Mesko of ScienceRoll shows us what could be in store for the future, wheelchair-wise.

And Jeffrey of monash medical student informs us of how best to eat while training for a marathon and throws in some info about what exactly triggers thirst, a very interesting race photo, and a neat little tidbit about the hippocampus.

And thus concludes another edition of Grand Rounds! As always, thanks to Dr. Nick (who must have more inbound links than any other medblogger EVER) for his management of this carnival. And send your latest submissions on over to Wandering Visitor, who is hosting next week.


I don’t prune submissions for Grand Rounds – everyone is included. If you don’t see your submission here, see this post for a possible explanation and then resubmit your post if you like – I’ll add it in as soon as I can!

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Thanks for hosting again, and for the cool presentation!

Dear Henrietta,
Wow, where have you been? We could use a font of healthcare advice like you :) Thanks for hosting!

What a classic presentation! LOL! Great job! : )

[...] 23, 2010If you like Dear Abby (and even if you don’t), you’ll love this week’s Grand Rounds. Geena, hostess of Codeblog, presents her 3 dozen-entry ‘Rounds as an advice column, with [...]

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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