109. Glass of Wine?

Question from antepartum clinic:  "Can I have a glass of wine with Easter dinner?"

I'm supposed to say, "no, never."  One of my partners defers the question by noting that "there is no evidence that it is safe to do so."

My answer: It's probably okay (for first trimester patients I would say no).

But I'd probably be more scientifically (and politically) correct if I copied my partner.

108: "I Don't Like Needles"

Pertussis (whooping cough) is now an epidemic in this part of the world.  Too many parents have not vaccinated their children, allowing the virus to take hold.

Meanwhile my organization of several thousand employees has decided that employees who have direct contact with patients must either receive the flu vaccine or wear a face mask.  One of our receptionists has selected the latter.  After a few days of stuffy breathing and difficulty making herself understand, she has allowed the mask to slip; it now just covers her chin. Her rebellion stands unchallenged.

Sure, I understand true needle phobia, and initial parental concerns about the many vaccines kids are subjected to.  But shouldn't rational decision-making also play a role?

107. Pelvic Relaxation

Think of a hammock that's been outside for a number of years and subject to a lot of kids jumping in and out.  The hammock and the ropes that hold it up will stretch with time and sag.

Now take that image to the pelvic opening.  The connective tissue across that opening keep the bladder and the uterus where they are supposed to be, despite lots of kids and lots of jumping (the jumping can be lifting, chronic cough, constipation; you get the idea).  We call the subsequent sagging pelvic relaxation.

Last night a woman presented to the ER worried that everything was going to "fall out, just like a baby."
No question but that it feels that way.  Too bad that the urologist that she had seen the day hadn't spent a few minutes explaining that though very uncomfortable, this conditioning is not life threatening.

We complain about patients filling up the ER with non-urgent problems, but a proactive minute of teaching would prevent a lot of it.

106. Law and Order

A patient recounts her 90-yr old mother's exchange with her cardiologist who was proposing to place a cardiac stent.  "I know I have to be careful," he told her, "since your daughter is a cardiologist."
Not missing a beat, she replied, "She's not the one you should be worried about, it's my three daughters who are lawyers."

This story was told while I was preparing this patient (one of the lawyer daughters) for major surgery.

Yes,  I got the message.

105. San Lucas: Resolution

Locked out of the OR, I instead went to the regional government hospital in Solola, about 1- 2 hours from San Lucas (depending on public or private transportation).  Talked to the second in command and to the head of Gyn, who confirmed their reluctance (even refusal?) to care for postop complications from surgery done at San Lucas.  But then the gyn guy went on to tell me I could bring patients from San Lucas and operate at Solola, provided that I bring my own supplies, and anesthesiologist as well.  Transfusion availability and back-up would be part of the deal.

I figure day one: unpack, visit Solola, lay of the land.
day two: general ob/gyn clinic; interview pre-screened patients
day three and four: gyn surgery at Solola
day five: postop care and minor surgery at San Lucas
day six. final post op care.

I need a sponsoring organization from U.S., help from the San Lucas parish (have already started on this), final go-ahead from Solola once dates are settled on, maybe March 2013?