The pic above was my Easter lunch last month. I ate at the hospital, and as you can see, I balanced my “healthy” option with some “not-healthy” options. I love candy. And one of my most favorite things to do is raid the pharmacies after holidays in search of super cheap leftover candy. My hospital gift shop happened to have a huge variety of super cheap candy, so I splurged a little. Actually, I went back for seconds and thirds.

I don’t have a whole heck of a lot to say right now, but I realized I had not posted in a while, so I wanted to give some updates. I have one week left of my gastroenterology rotation, then in June, I will be doing a radiology elective, and then July 1st I take the USMLE Step 2 CK. I opted not to take any time off to study. I have yet to find out whether this was a good decision or bad.

Do you ever have those moments where you think, “wait, I’m an adult, I can do whatever I want”? It might sound strange, but I have those thoughts a lot. I wonder if I will continue to have them, even when I’m an old fart. Anyway, studying for the Step 2 CK has been like that so far. I have studied and done questions, but I definitely have not hit the books incredibly hard. I know I should. But I just haven’t had the motivation. And I’m an adult. I can study as little or as much as I want to. Today, I studied for a portion of the day, then went to the gym, and have taken the rest of the day off. I guess I keep thinking, “I’ve made it this far, so I must know what I’m doing.” I will study hard when I’m darn tooting ready.

It’s good to be an adult.

Here are some tidbits:

1) What the Discriminate function is (an equation to determine the severity of alcoholic hepatitis).

2) If you see massive, tender hepatomegaly and ascites, think budd-chiari syndrome.

3) What a GAVE (gastric antral vascular ectasia) is, what it looks like, and how to treat it (APC argon plasma coagulation).

5) If you see a colonic polyp < 7 mm, it is malignant less than .5% of the time, but many GI doctors remove anyway (better safe than sorry).

6) What a Klatskin tumor is (cholangiocarcinoma occurring at the confluence of the right and left hepatic bile ducts).

7) What the Amsterdam criteria are (identifies families likely to have Hereditary nonpolyposis colorectal cancer (HNPCC)).

8 ) If a patient has abdominal pain and eosinophilia, think adrenal insufficiency (and check the cortisol levels to diagnose it).

9) How to perform an abdominal series, with small bowel follow through and do a 3 phase abdominal series (no contrast, IV contrast, arterial contrast).

I’m rather tired now, and don’t feel like writing a long post. But I wanted to let everyone know that I will be posting more “stuff learned” very soon. I really do enjoy gastroenterology.

Last night, Midori and I went on a fun doggy walk/neighborhood exploration/photographic excursion. I have a bunch of awesome pics to post, but I don’t feel like sorting through them right now, so please enjoy this very awesome one right now.

Also, I have a received many comments on my recent Medscape post, “That Is So Gay.” I have A LOT to say about all these comments, but right now I will comment on one item. 20% of people have responded to my poll saying that racist and homophobic comments in the medical setting do not bother them at all. REALLY?! I mean, REALLY?! These are my colleagues. It makes me incredibly sad.

Good night for now!

“Yo Brooklyn, Fuhgeddaboudit” Photo Series

Since I promised I would update all of you on my “stuff learned” during my gastroenterology rotation, here is a very incomplete list:

1) Hepatitis B seroconversion involves going from Hep B E antigen positiive to Hep B E antibody positive.

2) Hep B is a unique virus in that it’s the only DNA virus that carries reverse transcriptase.

3) Interferon is not used to treat Hep B as much these days, due to the many side effects.

4) For Asians, if they have Hep B core IgG, it can progress to hepatocellular Ca, so you always treat (although you wouldn’t for other races).

5) Alkaline phosphatase can be found in 4 places: liver, bone, kidney and placenta.

6) With extra-hepatic cholestasis, you usually see more symptoms and the bile ducts become dilated.

7) WIth intra-hepatic cholestasis, it’s usually more subtle and chronic, and can be caused by drugs.

8 ) A nuclear scintigraphy scan can detect .1 ml/min of blood flow.

9) Hepatorenal sydrome involves increased amounts of estrogen, which leads to systemic vasodilation, which leads to renal hypoperfusion.

10) You can use Questran (a bile binding resin) to treat relapsing c diff infections.

11) With a paracentesis you want to send the fluid to analyze albumin levels, cell counts, cytology, and gram stain and culture.

12) Blind loop syndrome can occur with diabetic patients. There is decreased gut motility, which leads to increased bacteria, which causes increased folic acid production, and decreased B12.

13) It takes a few times, but eventually you get quite accustomed to the sounds of very loud, long burps and farts coming from your patients.

During my clinical rotations so far, I have encountered very few racist comments by fellow students, residents, or attendings. Every once in a while I might hear a comment that could be vaguely considered racist, but nothing incredibly striking. Sadly, the same is not true for homophobic comments. Just the other day I heard an attending refer to a homosexual male using the “f” word. This isn’t the first time I’ve heard such comments. I’ve actually heard a variety of disparaging words spoken about homosexual persons.

It’s not just the comments that bother me, either. There also seems to be a general lack of education and awareness in medical education about homosexuality, transgenderism, transsexuality, transvestites, and other sexual and gender orientation topics. I once overheard a doctor talking about their transgendered patient by referring to her as a transvestite, which she clearly wasn’t. It seems that although these topics might be briefly reviewed in some medical school curricula, there is clearly more room for improvement. I could go on to list all the reasons that it’s important for a physician to have a broad base of knowledge with respect to these issues, but I actually think it’s rather self-evident.

So, I started thinking today about why I rarely hear healthcare professionals make racist comments, but have heard them make all kinds of homophobic and homo-illiterate comments. I think it’s likely due to our general acceptance of different cultures versus different sexual or gender orientations. Our society has simply become more accepting of racial equality, and not of homosexual equality. A perfect example is that in this country, it used to be illegal for a black person to marry a white person. Thankfully, these laws were eradicated years ago. However, in this country, it is still illegal for a man to marry another man, or a woman to marry another woman.

Another good example of our society’s level of comfort with other races versus other sexual orientations is our use of derogatory terms. I’ve never heard a medical professional refer to a black patient by using the “n” word. However, I have heard both students and doctors use the “f” word to refer to a homosexual patient. I find this incredibly saddening, and it causes me quite a bit of angst.

Obviously, I’m not the only person to notice the ways in which our society uses disparaging homophobic phrases, without actually considering the consequences. In fact, there is a whole advertisement series (which won an award), featuring various celebrities, the goal being to make people aware of how offensive the phrase “that is so gay” can be. You can view one of the commercials with Wanda Sykes on YouTube here.

I think that everyone should consider the impact their words have on other people. But as healthcare professionals, it’s even more important to be cognizant of the effects. We need to educate medical students on all the various permutations of gender and sexual orientations. I believe that education is always an important step in reducing stereotypical and prejudicial thinking. We also need to take a stand when we hear someone make an off-hand comment that we find offensive. Otherwise, people might never truly understand the impact their words can have on other people.

I encourage you all to share your thoughts. What do you think about medical students and doctors who make racial remarks or pejorative comments about homosexuals? Does it even offend you? If so, have you ever taken a stand?

Click Here To View the Original Entry on Medscape

So far, I am thoroughly enjoying my gastroenterology rotation. The butt, poop and fart jokes have also not ceased to be immensely entertaining to me.

I have some “stuff learned” to post, and a lot of other random thoughts. But right now, I am too pooped to write (the hours at the hospital are fairly long). So please enjoy a photo instead. I just took it, and it’s me, Scope, and the duck that Molly just eviscerated and de-eyeballed.

Good night!