Sunday, February 3, 2008

Super Sunday

I got tired of blogging for a while. It happens. But then you check your site and you see the same damn post day after day, and that gets even more annoying and depressing. So it's halftime of the Super Bowl and I'm watching a disturbingly older-looking and bizarre Tom Petty "rocking out" and I think maybe I'll write something instead. So here's some random unconnected thoughts.

1. Three spleens in a 10 day period. Never thought it possible outside a major level I trauma center. I know I had a previous post where there was gnashing of teeth regarding whether I did the right thing, but by the third one, there was no hesitation. Peritonitis? Check. Hemodynamic tenuousness? Check. Awful-looking CT scan? Check. Out with your spleen, young man.

2. There's an entity in suburban general surgery known as the "vacation home gallbladder". These are the referrals for lap chole on patients who maybe don't really need surgery. The "complicated" (aka crazy) 47 year old single woman with chronic abdominal pain who has been admitted to the hospital seven times in the last six months, multimillion dollar workups, scoped up and down, no diagnosis, maybe it's the gallbladder, refer to the surgeon sort of case. You take those gallbladders out and bank the reimbursement in the vacation home fund. I got called last week on a 88 year old lady, pleasantly demented, who was admitted with mental status changes and dehydration. Basically she had a UTI. Workup, though, demonstrated mildly elevated AST/ALT (liver function tests). For some reason US and HIDA scans were ordered. The gallbladder filled on the HIDA normally, but with cholecystokinin her ejection fraction was only 8%. Less than 30% is considered abnormal. But this lady was asymptomatic. She had no pain. I saw her and she was sitting up in a chair with the TV on some televangelist and there were corn flakes stuck to her chin. She smiled and told me good morning. I pushed her belly a little bit and she kept smiling. I respectfully declined to book her for lap chole. There's better ways of making buck. General surgeons who do these cases, rest assured, are trying to make that second mortgage payment on a condo on Kiawah Island.

3. Al Qaeda apparently has run out of young impressionable men to brainwash for their suicide missions. Who do you turn to when you want someone to blow themselves up in a crowded shopping center? Well, the mentally retarded of course. I don't think I've heard a more reprehensible, more morally bankrupt story in my life. It's just sick.

4. 3:10 to Yuma an excellent flick.... rent it.

5. New absorbable tack on the market for ventral lap hernias.... going to try it next week.

6. Brady looks rattled. Giants got a shot.


rlbates said...

Glad you are still around.

make mine trauma said...

Have assisted two lap hernias with the asorbable tacker. Both surgeons liked it. No more errant corkscrews.