Thursday, August 30, 2007

Scraped elbows, bruises, and other fun

This is the back of the DocSurgmobile:

The more observant of you may notice a little something is missing from the old Bike-o-Surg:

Yep. That would be the rear wheel, strangely absent, which experienced an event that can only be described as an event not unlike the creation of a taco yesterday.

Word to the wise: when a guy who won his age group national championship in the USA Cycling Marathon Mountain Bike Championship in Breckenridge, CO recommends a "fun afternoon mountain bike ride," trust your first instincts. Which, in my case, is abject fear.

Tuesday, August 28, 2007

Burnin' Love

I get about 6 medical journal delivered to my office each month. Quite honestly, many of the articles deliver little in the way of clinical impact, with hefty doses of basic science and reiterations of previous studies provided as filler. Occasionally, though, the title of an article will be enough to grab my attention and pull me straight in. Such was the case with a recent article in Surgical Endoscopy, authored by a large cohort of investigators from Napoli, Italy --- The Prevalence of Sexual Behavior Disorders in Patients with Treated and Untreated Gastroesophageal Reflux Disease.

OK. This can lead to all sorts of interesting questions. Such as, who exactly came up with the idea of studying sexual behavior in patients afflicted with GERD? And, does the "heartburn" associated with unrequited love leading to lack of sexual activity qualify one to participate in this study?

From the abstract:

Methods Upper GI endoscopy and 24-h ambulatory pH testing were performed to confirm GERD in symptomatic patients. GERD patients completed an anonymous questionnaire on sexual life before and after medical or surgical treatment.

Results Compared with HC (healthy controls), untreated patients with GERD (gastroesophageal reflux disease) showed more frequent difficulty in attaining orgasm and painful intercourse. GERD patients after surgical treatment had significantly more difficulty in attaining orgasm, while after continuous medical treatment GERD patients compared with HC had significantly more difficulty in attaining orgasm, higher painful intercourse, lower sexual desire, and perceived more frequently that the partner was unhelpful. When compared with untreated conditions, GERD patients after surgical treatment had a significant improvement in attaining orgasm and in painful intercourse but a significant decrease in sexual desire, a lower satisfaction with their sexual life, and a higher prevalence of an unhelpful partner, whereas GERD patients after medical treatment had a decrease in all indices of sexual behavior.

Whoa! Talk about putting the kibosh on the horizontal bop! Pouring cold ice on the situation. Turning the hose on the dogs. You get the point.

What is particularly interesting to me is that even patients who had what we would consider to be optimal treatment --- either an antireflux procedure or proton pump inhibitor therapy --- had a worse sense of sexual quality of life than normal control subjects. Surgical therapy did seem provide a slightly better result, but this was a relatively small study (111 GERD patients and 32 controls). And, not to be indelicate, what exactly does an "unhelpful partner" mean --- I mean, really, what kind of questions were in this survey?!

"Burning Love?" Sounds like that's sort of out of the question, if you look at this study. I suppose that it makes sense, if you look at GERD in the context of other medical problems that cause patients to have a diminution in their sense of overall well-being --- inflammatory bowel disease, coronary artery disease, diabetes, malignancy, just to name a few. If you spend a fair number of your nights sitting up in an easy chair fighting a burning sensation in your chest and throat that feels like somebody poured battery acid down your esophagus, I think it's fair to assume that getting your groove on isn't high on your priority list.

Sort of makes you wonder about one of our former presidents, a famous GERD sufferer, and what his sexual appetites would have been like if he wasn't held back by reflux....

Friday, August 24, 2007

Closing Time

"Closing" in the OR was a quiet affair, without the usual chatter and relief of tension that accompanies the last stage of an emergent operation. It was late, and so the surgical waiting room was deserted save for an elderly gentleman and his son. I approached with the familiar but profoundly uncomfortable feeling in my chest that comes when I'm not quite sure how to phrase something. For the past 30 minutes or so, my mind has been doing flip flops, seeking the right combination of words to express what we have found in the operating room, and what it means. I have been doing this for 13 years post-residency, but this part of surgery only gets harder with each passing year.

As I draw near, he looks up with faint hope but eyes that tell me he already knows what news I bring. It is not good. His wife of more than 6 decades is dying quickly, and there is nothing I can do about it. While I sit with the two of them, my mouth droning on about the "how," the "why," and the "what we did," it is clear that what I am saying is drifting away in Brownian motion without landing on a single eardrum. And that's OK with me, because I would rather not say a whole lot.

I explain that she will leave the OR and go to the intensive care unit; while there are many things we can do to prolong her life, the time gained would be negligible and the discomfort could be great. Making her comfortable, we agree, is the right thing to do until the inevitable end.

"She will be there in a few minutes, and I would be happy to take you in to see her," I say. It is a chance, I think, to hold her hand one last time, to smile and remember. But I am wrong with my assumption. "No," he says. "It's late, and I think I'll go home. She's not really in that ICU, anyway."

We shake hands, and he gives me his thanks --- an appreciation that I don't feel worthy of, given the outcome of my efforts. But as I have grown older, I have grown to understand his sentiments. His wife really isn't present in the ICU. The woman he loves is not lying in a bed with tubes and wires and strange people draped all around her. He is going home, where she lingers for a little while longer. She resides there in a way that a man never can, in the drapes that just match the pillows on the couch; in the pot of her cherished geraniums; in her collection of figurines, dishcloths, and little pictures all festooned with cherubic mice; in the smiling faces of their children in countless photographs on the wall; in the trailing scent of her favorite perfume. "I was lucky to have her," he tells me. I believe him.

Thursday, August 09, 2007

Back in the (or out of the) Saddle

Back to work --- and reentry, as they say, is a b*&$@h! Out of the bike saddle, and back at it in the office and OR all week. Oh, well, gotta pay the bills to get set for next year's bike trip. Here's a photo of yours truly, Fat Bastard himself, at Navajo Lake with the littlest surgling (on the right) and his buddy that went with us.

Note the utter lack of cleanliness --- mountain bike riding during a season with daily rain showers and camping at sites without showers leaves one rather ripe, to say the least!

A few days later on, we had the chance to ride our bikes into Zion Canyon proper (the only -- I mean the only -- way to see it if you can) and then hike a few miles up the Virgin River. Here are the boys with their coordinating, fantastically non-PC T-Shirts.

We had a fantastic time, and although I took my share of spills in the mud, we all came out of it unscathed. The only thing left to do now is to decide where to go to next year!