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Saturday Surgery: $150

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My primary care physician has a cash-only medical practice, and he is paid by the hour for whatever he does – be it a phone call, email, office visit, house call, or outpatient surgical procedure. He doesn’t charge higher prices for procedure complexity – that’s factored into the time it takes to complete the procedure. It’s a wonderful model for those of us who’ve chosen high deductible health insurance plans, and pay cash for primary care services. My husband and I save thousands of dollars/year with our plan, and spend a few hundred of that savings to cover our primary care needs. We also have our family physician available to us 24-7 via phone/email, and can generally see him for an in-person visit within hours of a request for one.

Yesterday was a perfect example of the incredible convenience of this model of care – I called Dr. Dappen at 10:30am and asked if we could come in to have a sebaceous cyst removed from my husband’s back. Dr. Dappen said he’d be happy to see us at 11:30am that day, so we hopped in a car and were finished with the procedure by 12:00. I even had fun taking photos for the blog (see below)…

Cost of the procedure: (surgery plus supplies): $150

Days spent waiting for an appointment: 0

Time spent in a waiting room: 0 minutes

Convenience of having a cash-only family physician: priceless

*For more information, check out: Doctokr Family Medicine, Vienna, Virginia*

Pearly appearance of small sebaceous cyst

Pearly appearance of small sebaceous cyst

Excision of sebaceous cyst

Excision of sebaceous cyst

Wound closure with simple sutures

Wound closure with simple sutures

Sometimes It’s Better To Amputate

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There’s no technological substitute for the human hand. Manual dexterity is incredibly hard to replicate, and so surgeons will go to great lengths to save injured hands. Unfortunately, sometimes the injury is too severe to allow for any meaningful functional recovery.

In these two cases, well-meaning surgeons refused to amputate the unsalvageable hands, thus delaying recovery and adaptation of prostheses.

This is a photo of a trauma victim who underwent extensive reconstruction of the hand, including transplantation of a toe to the thumb’s position. Gangrene set in and tracked up one of the tendon sheaths.

toehand

Photo Credit: Dr. Heikki Uustal

In this case, a burn victim was hoping to have some fingers reconstructed from his fist. He declined amputation and fitting with a prosthesis, despite the potential for enhanced function.

mithand

Photo Credit: Dr. Heikki Uustal

In both cases, a wrist disarticulation (amputation at the wrist) and prosthetic fitting (such as this myo-electric device with a self-suspending socket) might have provided a better functional and cosmetic outcome:

Photo Credit: Dr. Heikki Uustal

Photo Credit: Dr. Heikki Uustal

Sometimes, it’s better to amputate.

Weird X-Ray Of The Week

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Can anyone tell me what this is? (I’ll post the answer in the comments section).

Film Credit: Dr. Michael Armento

Film Credit: Dr. Michael Armento

Function Versus Aesthetic: Arm Reconstruction After Land Mine Explosion

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Tragically, land mines injure between 15,000 to 20,000 people each year. Some civilians see a metal object sticking out of the ground and attempt to pick it up and inspect it – the result is often loss of both hands and eyes.

The goal of rehabilitation after trauma is to restore as much independence as possible to patients. With loss of vision and no hands, self care, feeding, and donning/doffing arm prostheses can be very challenging. There is a procedure, known as the Krukenberg operation (named after Hermann Von Krukenberg, who first described it in 1917), that allows the forearm bones to be separated, using the muscle rotators that exist between them to create a pincer grasp. This procedure is not uncommonly used in India and Pakistan and does indeed return some degree of functional use to the arms.

At a recent Physical Medicine and Rehabilitation conference, this photograph was used to illustrate arm function after the Krukenberg operation.

Photo Credit: Dr. Heikki Uustal

Photo Credit: Dr. Heikki Uustal

It certainly presents a conundrum – should function trump aesthetics in all cases?

I’m not sure that I’d want this procedure, even if I lost my vision and both hands.

Would you?

I’m No Superman

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essential-qualificationsI love this ad.

I was about this age when I decided to become a nurse.

Maybe a little older.

I was holding a book instead of a teddy bear.

I wouldn’t have been caught dead in that cap, though. Even in those days I knew how to make a totally cool nursing cap out of paper.

That looks like a pillowcase.

Sometimes it’s hard to remember why nursing sounded like a good idea.

********************

You don’t realize it’s happening.

You set a goal and you do what you have to do to get there.

For awhile, you manage to do it all.

Nine semester units.

Working 24 hours a week.

No sweat.

Been there, done that.

Lived through it.

*****

But things start piling up.

Work needs you to pick up some hours.  Coworkers on leave, folks needing time off.

You say yes, because when you need time off, they will make sure you get it.

Only your body isn’t cooperating.

You are in bed for the night at 1600.

And up at 0530.

Then you can’t fall asleep before you go in at 1900.

So you’re up for 28 hours. Straight.

Twice in one week.

That worked when you were eighteen.

It kills you at fifty-one.

*****

So you work, and work is uncharacteristically busy.

You start getting depressed four hours before you go in.

Then you start getting depressed because you have to work the next day.

Your coworkers are getting on your nerves.

You are really getting on their nerves.

You hit the ground and twelve hours later you sit for the first time. In the car. For the ride home.

To sleep for ten hours so you can go back and do it again.

Before your one day off.

That you sleep through.

*****

You fall behind in class; the professors are cool and allow you extra time for the assignments.

Which you need because you are so exhausted you cannot think.

But you won’t give less than an “A” effort so you stress and research and study and fine-tune and finally turn in the missive 48 hours after it is due.

Only to discover your classmates managed the assignment in two paragraphs.

How the hell did they do that?

*****

You start to lose it.

You don’t leave the house on your time off.

You stay in sweats all day and don’t bother to fix your hair.

Your husband thinks you are having a breakdown because he hears you laughing hysterically one minute and bursting into tears the next.

Except it’s not a breakdown, you are just watching “Scrubs”.

(Why the hell did they kill off LaVerne? Idiots.)

You start scanning the ads for a desk job. Part-time. Days. No weekends.

No blood. No pain.

No death.

*****

I’ve been here before.

The demon is back.

I’m in full blown burn-out.

But no major life changes.

Not this time.

I know what to do.

No more extra shifts.

The money is nice. Sanity is nicer.

No more twelve-hour shifts. Kudos to those who can do them.

I can’t.

No summer school.

I’m 12 units away from a BSN.  I can graduate in the Spring of 2010. I gain nothing by sacrificing my mental health to do it by December.

*****

I’m scaling back, I’m taking a break.

For the next few months, it’s all about me.

More visits to Starbucks to read blogs.

More visits to Starbucks to read novels.

More concerts.

More mini-vacations. Son’s graduation. Nascar race in Sonoma. BlogHer in Chicago.

*****

I wish I could do it all and be it all and have it all.

It’s hard to face the fact that I have limitations.

But, I know,

I’m no Superman.

And that is a major bummer.

I’m No Superman

*This blog post was originally published at Emergiblog*

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