Category Archives: Uncategorized

Got a Cold?

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We’ve all been there.  We’re stuffed up, nose-dripping all over the place, leaving a trail of Kleenex as we peer through puffy eyes at the Over-the-Counter Aisle that stretches from Portland to Pittsburgh.  “Cough plus Decongestant.”  “cold and flu.”  “Nighttime symptoms.”  “Runny nose and sore throat.” “Headache and ingrown toenail.”  “Stuffy nose and lazy eye.”  “Phlegm and ear wax.”  I mean, it’s so overwhelming it’s ridiculous.  And there’s a good reason why: Common cold is big business!

$2 billion annual over-the-counter sales

$3 billion annually in doctor visits and prescription medications

$16.6 billion in annual lost productivity

189 million lost school days

110,000 visits to the doctor’s office

I’m really seeing those office visits now that I’m in clinics.  Sore throat.  Body aches.  Fever.  No fever.  Muscle pain.  Muscle stiffness.  Swollen lymph nodes.  Sinus pressure.  I look in the ears, may be some swelling and redness.  Look in the nose, maybe some swelling and redness.  Look in the mouth, maybe some swelling and redness.  Feel the lymph nodes,. maybe some swelling and tenderness.  And I know the whole time that the vast majority of the time it’s viral, and antibiotics will not help.  And we will send that person home perhaps feeling like they wasted their time coming in.  But, that’s the reality of it.  Common colds last 7-10 days.  Well in this day and age, we’re only willing to wait a couple days before we swear we have a massive case of strep throat or some kind of horrible bacterial infection and we want drugs pronto.  So far, here’s who’s gotten antibiotics: people who after several days are WORSE.  The fever’s increased.  Their symptoms have advanced.  Or they got better for a few days, and then worse.  People with a family member at home who has an impaired immune system and we can’t afford them getting the cold.  People who have some other under-lying health condition that increases their risks if it is bacterial (like recent asthma exacerbations).  A viral infection can lead to a bacterial infection later, like ear infection (otitis media) sinusitis, or pneumonia, but keep in mind that these three are still more often caused by viruses than bacteria.  The game changes a little bit for infants and toddlers, but still, it’s most often viral.

Here’s another kicker: there are so many different viruses that cause colds that we don’t even know them all.  So why do you keep getting sick?  Well, it’s probably a slightly different virus each time.  And my best advice is to get more sleep and wash your hands more.  Oh and get the flu shot.  Really.  Because colds suck, but the legitimate flu will knock you flat and has more severe symptoms and complications.  It is a virus, but we do have antivirals for that one.  So how to tell whether it’s a cold or the flu?

Flu: comes on very fast- start feeling crappy at 1pm and by 7 pm, you are feeling the whole doozy: your whole body hurts, you have a bad fever, headache, and you feel like crap.  Respiratory symptoms to follow.  Go to the PA now, and see about antivirals.  Or, prepare to weather a nasty storm.

Cold: Scratchy or sore throat, then nasal congestion or runny nose then congestion, watery eyes, lethargy, aches, pains.

Hope that helps.

Since it’s probably a cold, here’s how best to tackle your symptoms:

First of all, rest, hydrate, turn on mom’s humidifier, eat, wash your hands a LOT.

Congestion: topical decongestion like Afrin.  But don’t take it more than 3-5 days or you could experience “rebound congestion” when you stop it.  How to avoid that?  Slowly stop using it one nostril at a time.  Replace it with a nasal saline spray or oral decongestant.  May take 1-2 weeks for your nose to get back to normal.  Oral decongestants are a second-line choice, but run the risk of insomnia, nervousness and headache.  So stick to the Afrin first.

Productive cough: Guaifensin (Mucinex and Humabid), hydration and humidifier.  So look on the label for Guaifensin, it’s the only FDA approved drug for this.

Non-productive cough: look for the drug Dextromethorphan (it’s in Delsum, etc).  You can consider an antihistamine, but try Brompheniramine (Bromfed, Dimetapp, etc) or Chlorpheniramine (Ahist, Aller-Chlor, etc) before Benadryl (diphenhydramine) because they are much less sedating.  Consider adding an NSAID like Naproxen (Alleve, etc) for pain relief.

Runny nose: can try one of the above antihistamines (Brompheniramine, Chlorpheniramine, benadryl at night) because of their drying effects.  Otherwise, Ipratropium is a prescription drug that your PA or doc may consider.

Sore Throat: topical anesthetic Benzocaine (Cepacol Sore Throat and Chloraseptic), NSAID (ibuprofen, alleve, etc).

Fever: acetaminophen or NSAID.

Sneezing: oral non-sedating antihistamine like claritin or zyrtec.  Really!

Conjunctivitis: same as above.

Cough AND cold: evidence shows that a combo of antihistamine WITH decongestant is better than just a cough suppressant.  So look for something with brompheniramine or chlorpheniramine and pseudoephedrine.

A few notes:

Pseudoephedrine alone for congestion: slower onset than nasal decongestant like Afrin, less intense effects.  So,.. try the nasal products first.

If you automatically reach for benadryl to dry up your runny nose and sneezing, try a 2nd generation non-sedating antihistamine instead: Allegra, zyrtec, or claritin.  Really!  Benadryl is too sedating!

Vitamin C is controversial, sorry.  It “MAY” shorten your symtoms by 10-20%.  Which is not much.  And, if you exceed 4,000 mg/day you could get kidney stones.  Ow.

Zinc: May shorten the duration of symptoms if you start it immediately, but by less than half a day.  And you have to take it multiple times per day.  May not be worth it.

PS- people on Benadryl fared worse on a driving test than those who were legally drunk.  So,. only take it at night if you’re going to take it.  Otherwise, use Claritin, Zyrtec, or Allegra.

Here’s a big one with kids: data shows that the use of pediatric cough/cold medications is unsafe at this time for children under 2.  Age 2-6 is a gray area.  So, avoid meds for kids under six.  Instead, keep them hydrated, rested, and use nasal saline to clean out the noses.  Sorry, moms, I realize how much that stinks. But, if your kid is having trouble breathing (flaring nose, skin between ribs/under ribs retracting,) is dramatically less active/alert, or anything that you are overly concerned with, do take them in.

A final few notes: heartburn can lead to asthma and cough.  So if you have a cough that is just NOT going away, consider discussing other causes with your doc besides the cold that won’t quit.

Please don’t ask for antibiotics or storm out if you don’t get them.  I realize that your life is your world, but we have to reduce giving out Z-packs on a massive scale otherwise our drugs simply won’t work anymore when there is a REAL bacterial infection.  If your symptoms and the time-frame really point to bacterial infection, that’s one thing.  Otherwise, please be patient.

Wash your hands, get enough sleep, get your immunizations, immunize your kids according to the REGULAR schedule, and we could massively reduce healthcare costs across the country.

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The First Day of the Rest of My Life

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A week ago I sat here trembling in worry that I would fail majestically on my first day in Clinic.  I did not fail majestically.  Or fail at all for that matter.  It turns out that they were right, I know more than I think I know.  I saw five patients with my preceptor, and unlike some of my frantic compadres that chased their preceptors around all day at hectic urgent care and community clinics, my day was rather pleasant!  We had time to debrief every patient visit.  I got all my questions answered.  I wrote up my first official “note” which is doctorspeak for synopsis of problem+exam+solution of patient visit.  I tried out some of the apps on my loathed Android.  Half worked.  I looked stuff up, read, wrote notes, asked more questions, and went home thinking,

I can do this.  There’s no reason any other PA can do it and not me.  In fact, dammit, I WILL do this!

There’s a LOT I still don’t know, and a LOT I’ve already forgotten, but I felt a sensation of peace when I walked out the door.  I am headed back tomorrow morning, white coat in tow.  I really do feel an enormous sense of respect for the power I will have as a provider.  It’s not that having a fancy coat is the be-all-end-all, it’s that people will be entrusting their lives and bodies to my own knowledge, judgment, resources, and character.  That’s a big deal.  It’s more forgivable to have a bad day as a third grade teacher.  Heck, the kids could play games and I could go on the internet.  Not that I ever did that. 🙂  But it’s not so cool to have a bad day as a medical provider.  I’m sure I will, but the stakes are higher now.  Incompetence is all around us, and usually we can just roll our eyes, write a strongly-worded letter,.. maybe even chew out customer service,… not that I would ever do that,.. but incompetence in the medical field costs people their lives.  So, I’m thankful to be in a program where I get this added blessing of Friday clinicals and the mentorship/apprenticeship it provides.  I can say “I don’t know, I’m going to go look that up,” and it’s ok.  As the months go along, I will gain more confidence, and I’ll start remembering more things because I’ll have actual patients to attach things to.  So, that’s where things stand, a week after my trepidatious rant last Thursday.  Wish I could gab about all the cool stuff I learned and the patients I had but I think there’s probably a law somewhere about that………. But the finale of this mini-story is that last Friday was FUN.  Which is a good thing, since this is what I’ve signed on for?  Fun.  Interesting.  Intriguing.  Challenging.  Strangely comfortable.  Fun.  Phew!

White Coated

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So the moment has come in which I have a white coat on my shoulders and I look down, and realize in some sort of mixture of amazement and terror that there’s a name tag on it with my name on it,.. this isn’t some sort of sick joke or mistake, someone actually thinks it’s a good idea to send me out into masses of poor unsuspecting patients tomorrow, assuming that something other than nausea/mayhem/confusion/stupor will result. Something resembling a legitimate patient encounter in which a patient presents a problem, and leaves with some sort of appropriate plan in place. Orchestrated in part…. by me.

Sorry I had to take a moment to hunt down that barf bag I saved from my last plane flight for just such an occasion….

It’s true that I have been spending hours too numerous to count in the classroom and on my couch and at my desk under a pile of syllabi, tissue, coffee mugs and cats,… and it’s also true that I have some grades to show for it,. but here’s the rub: I now have to REMEMBER everything I’ve learned. Maybe not tomorrow exactly, unless I have a patient who comes in with a rash and upon examination is also found to have glaucoma, murmur, kidney stones, bunions, nose polyps, stomach parasite, and hemorrhoids at age 7 which would just about cover the classes I have had,… but chances are the patients I see will have something I know nothing about, and won’t know about until April, which by then will be far too late to impress my apparently “incredibly smart” preceptor, Alex, who will surely shake his head muttering something in Russian (he speaks Russian) and call our program to see if they sent the right person, or if they were just seeking revenge on him for something he did when he was in the program in the recent past.
Despite the angst and vexation I feel, I do intend to hold up my end of the bargain and show up with my stethoscope in tow. Alex seems to be a nice enough chap who may not send me to my death on the first day, but I’m pretty sure that over the next, oh,..say six months’ worth of Fridays the most common sentences you will hear coming out of my mouth will be a mixture of: “I don’t know.” “I forgot to ask them that.” “I’m going to go look that up.” “huh?” “Nope,.. I don’t know.”
I’ve actually gone to Costco, there was a coupon in their monthly deals so I stocked up on 10-packs of Humble Pie, I intend to indulge myself readily this spring. Care to join me? Just go to PA school.
Well,.. I think I have adequately expressed the joy and trepidation I feel at this moment,… Friday clinicals were one of the main reasons why I wanted to come to Utah,.. I’m not sure what I was thinking but here I am! Our faculty has assured us that we’re ready, and perhaps they’re right,. you never feel ready for any major endeavor you undertake,.. think I ever felt “ready” to teach third grade each year that I taught? I was excited if I went home thinking, “yep,. I knew what I was doing today.” So perhaps it’s going to be overwhelming for a while, and then slowly I will be able to wean myself off the Dramamine and be able to sit through a whole office visit with a patient without peeing my pants.
Thanks for the support,. I’m a stress eater so if you feel sorry enough you can send anything chocolate my way! Anyway, here’s to making it far enough in PA school to earn the coat, and to 18 more months of effort to ensure that I get to keep it! Blessings.

World AIDS Day: A rebuttal to the Notion that It’s about Promoting Homosexuality

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This comment by “alteredego” followed a news story highlighting women who shared how they celebrate the lives of their lost loved ones to AIDS on World AIDS Day.

Why are we celebrating the gay/lesbian lifestyle in our society when it is such a contributing factor in this epidemic? Yes, abstinence is a necessary thing for gays…and straights, in today’s world. The saddest thing about this disease in our country where we are educated about its consequences and spread, is our lack of discipline and self control and a lack of caring about the next person. If you’ve got it…keep it to yourself.

To which I had to reply.  Really.  How could I resist addressing this rampant, ignorant but widely accepted idea that AIDS is all about gay people, and it’s their problem, and if they’d just stop spreading it around to other people, this little problem would just go away?  OOOH man.  This is how I get fired up.

My reply (Still awaiting approval from my good friend, Barney the moderator):

You are missing the entire point about World AIDS day.  AIDS is a global disease: 33.4 million HIV positive (globally), they are NOT just homosexuals.  They are mostly heterosexual.  One of the fastest populations acquiring HIV TODAY IN AMERICA is heterosexual couples, and the majority between the ages of teen through late twenties.  These are our kids becoming sexually active in high school and continuing into adulthood, thinking that “it won’t be me.”  These are also injection drug users, another high-risk population.   There are approximately 32,000 new cases annually and half of them have no idea they are infected, so they pass it to others unknowingly.  These are the statistics, I heard them last week in a lecture by an AIDS expert and professor.
Also, AIDS internationally is a heterosexual disease.  Your attitude is a remnant from the eighties, when we were first learning about the disease.  It’s true, the gay community was ravaged by it and still is, and they paid for it and pay for it still through discrimination.  However, this is not about celebrating an alternative lifestyle.   This is not about celebrating a disease.  This is about celebrating the progress we’ve made in drugs and treatment, the fact that if you acquire it, it may not be a death sentence as it once was.  This is about awareness that unless you have gross exposure to bodily fluids such as blood/semen, it is perfectly OK to be around people with the disease.  I just heard on NPR yesterday about a girl in the eighties who acquired it (probably via blood transfusion) and the school she went to required that she stay inside a glass container.  We have come a LONG way from those days, and that is a good thing for our society.  AIDS is not a “gay” disease.  It is a global disease.  There are millions of AIDS orphans in Africa alone, a continent ravaged by disease (24 million living with AIDS, approximately).  Whether you individually care about Africa, I don’t know, but we are all humans, we live on this planet, I feel that we should care about eradicating diseases such as HIV/AIDS, malaria, tuberculosis, measles, etc from the entire world.  This is attainable.
So I really wish instead of just scoffing it off as a political conspiracy by the gay community to push for acceptance of alternative lifestyles, that you would be supportive of the GLOBAL progress we’ve made in tackling this disease.  No innocent person, regardless of their lifestyle choices deserves to die from a terrible disease.
I agree, we do need to ramp up prevention, but let’s be real here- there are probably very few people out there actively infecting other people on purpose.  Most people just don’t get tested and don’t think they’re at risk.  The statistics say otherwise.  If you are sexually active with multiple partners, or with partners who are sexually active with other people, GET TESTED.  Educate your kids about the risks of acquiring HIV from sex and injection drug use.  And finally, please note that this is WORLD AIDS Day.  This is not just about AIDS in America.  Many innocent women and girls are infected in other countries by their husbands, rapists, or consensual partners, horribly enough, even by men in cultures where the rumor is rampant that if you have sex with a virgin, you can be healed.  This problem is much bigger than your opinions on homosexuality, which you are entitled to have.  Please consider these thoughts, and these statistics.

“So, you’re having sex, right?”

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“So, you’re having sex, right?”  “Well, why not??”

This is how our adolescent medicine doctor/professor opens that conversation with the teens that she sees in her office on a regular basis.  Ballsy, right?  A little uncomfortable?  As in, what on earth is she getting at?!  Why would you assume that they are having sex, and then ask why not if they say “no?”  Before you freak out, I have to say, it’s pretty brilliant.  See, most of us in our PA class are thinking to ourselves “how on earth am I going to talk to teenagers about drugs, sex and rock’n roll in a way that isn’t school-marmy, authoritative, wrist-slappy, awkward,. nausea or cricket noise inducing….” and I feel like after listening to this particular professor share how she communicates with them, I actually may not need to take a benzo before walking into the room.  The fact is, she says she rarely has kids lie to her (concern #14 on my list,) and asking this way is disarming because it shows that you have a realistic grasp on current adolescent behavior, and are not going to judge them.

So read below, the statistics are also unsettling.  I was a teen not too long ago, and I’m not sure how much has really changed in youth behavior- when your noggin isn’t fully developed until your twenties, you will do stupid thing after stupid thing. The following statistics are from surveys taken in schools.  So that disregards how drop outs, private school attendees and homeschoolers would respond.  I have a hunch that these numbers are actually HIGHER in reality.

  • 17% of female HS students have seriously considered suicide in the prior 12 months before being surveyed
  • 13.2% actually made a plan
  • 10.5% male students considered it
  • 9.6% actually made a plan
  • 11.4% 12-17 year olds reported using cigarettes in the prior month, that would be 6.5% 8th graders and 20.1% 12th graders
  • 14.6% 12-17 year olds consumed at least one alcoholic drink in the prior month, 8.8% had binged
  • 10.9% 8th graders, 23.9% 10th graders, 32.4% of 12th graders had abused marijuana at least once in the year prior
  • 1.9% 8th graders, 6.7% 10th graders, 9.7% 12th graders had abused vicodin in the prior year
  • 20% of high school students who drank or did drugs before sex (same stats since 1991!)
  • 46% of high schoolers who admitted to having ever had sex
  • 40% are not using condoms, 80% are not using birth control pills
  • 34% (the largest proportion) of NEW HIV INFECTIONS annually are aged 13-29

So, if your kid’s senior high school class has 200 kids in it, 34 girls and 20 boys are considering suicide, over 40 are using tobacco, thirty or so are drinking every month (probably way more than that), sixty are smoking pot (that’s right- SIXTY), twenty are abusing prescription pills, FORTY are using drugs and/or drinking before sex, half the whole class is or has been sexually active, most of them are not using protection from STDs or pregnancy, and many of them will obtain HIV transmission because of their sexual behavior.  WHAT?!!!!

Would you want your kid to go to that school?  Unfortunately, this is reality.  So, is it really that inappropriate to ask,

“So you’re having sex, right?”

But there’s follow up there, if they say “no,” and I ask “why not?”  I can get a sense of that young person’s courage, moral decisions, family involvement, concerns, education, and I can ENCOURAGE them in their choices.  If they say “Yes,” well then it doesn’t take much time looking at the above risks to see where our conversation will go next, as in, “let’s talk about how to protect yourself from STDs and pregnancy!”  There’s still a LOT of work to be done out there, obviously.  Sure we wish that everyone would make safe sexual choices, but when half the kids are having sex, a bunch are using drugs or alcohol at the same time (you’re not using condoms if you’re drunk or high,) and a huge percentage are using no protection at all, we need to wake up and smell the coffee, People.  Folgers hasn’t changed, and neither has kids’ behavior.  Not to mention all the risks of abusing drugs, alcohol, prescription meds, etc.

I think my major take-home message is I MUST ASK ABOUT EVERYTHING.  If perfect-looking soccer moms are abusing crystal meth and benzos, then you can be damn sure that high honors star lacrosse player Suzy is sleeping with her boyfriends and smoking pot, and maybe has contemplated ending her life.  ASK, ASK, ASK.  Because if I make an assumption about someone’s behavior based on my impression of them, I may miss one of the most important conversations I need to have with them.  Like how much they’re at risk for HIV or other STDs, and how we can prevent it.  Or how to avoid a scholarship-ruining pregnancy.  The stats show that they’re doing these things, so I better be prepared to ask about it in a way that is less “you’re not doing drugs, are you???” and more “So tell me about your drug use.”  Here’s hoping that our whole society will be more open and frank with our adolescent population, so that I’m not the only person they are talking about it with.

Medical Fear-Factor: Cross Cultural Patient Care-Muslims

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Well if you know me, then you know my history-raised in the mysterious, chaotic, lively and noisy land of Egypt, far away,… where I was immersed in Egyptian culture, comprised predominantly (but not completely) of Muslims.  I went to school with them, played sports with them, argued politics with them, bought vegetables from them, rode in their taxis, rode on their camels, ran the mile in PE with them, was a third grade teacher for a few dozen of them, shared many treasured memories of life with them.  Although Muslims make up a large portion of the population in major cities across the United States, there exists a significant void in understanding and communication between…. what shall I call it,… traditional America? and Muslims; peoples from other cultures that share a common religion, seen as a foreign and suspect.  Now that I’m in PA school, I feel that this “void of understanding” is unacceptable, if we are to provide excellent patient care to whomever walks through the door.  So, I decided to do something about it.

As you may know, Global Health is my passion, and I hope that I will be heavily involved in the alleviation of Global Health maladies as a career and life-pursuit.  Thus, I joined the University of Utah Student Global Health Initiative, a group of students from various health colleges that share similar interests with me.  I had been sort of bouncing around ideas with one of my PA classmates, an amazing woman by the name of Wagma, born in Germany to Afghani parents, raised in the United States, and one of the most intelligent, motivated, organized and impassioned Muslim women I’ve ever met, which evolved into holding a panel discussion event, hosted by the SGHI, that would feature members of our local Muslim community, people who are working in healthcare or Public Health who could share about their faith, dispel rumors and stereotypes, and provide pertinent information to the attendees about how to take care of Muslim patients.  It was occurring to me that most people, even in my class, had very little experience or knowledge about Islam or people from cultures that practice Islam.  And yet, they would be taking care of patients from these cultures, wading into the bogs of cultural ignorance, terrified to offend someone or aloof due to their own misconceptions.  With two Muslim women in our own program, one would think that surely people would feel comfortable just asking them their questions, but, this doesn’t happen very much.  The Panel discussion, however, was the perfect medium for people to come and learn, ask those questions and gain a sense of confidence in how to approach, say, a woman who wears Hijab, or a patient who’s fasting for Ramadan, or can we/should we/is it allowed to perform a pelvic exam on an unmarried woman?  This is heavy stuff.

Suffice it to say, we held the event, and about 50 people came.  I thought the panelists were wonderful, and addressed so many issues I can’t even remember them all.  We plan to hold a series of these talks, each time featuring a new cultural group or religious group.  SO, if you are interested, here is the video of the event, I am so proud and pleased at how successful it was.  There’s no way that in one hour, you can achieve complete vulnerability, transparency, and understanding.  But you can at least START the conversation.

 

 

 

A year Ago This Weekend,..

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A year ago, this weekend or so, I was beyond nervous as an interviewee here at the University of Utah, two days after interviewing at OHSU and a week after interviewing at Pacific.  It’s hard to describe that sense of anguish, desire, hope, uncertainty, and wonder about the future possibilities.  I definitely re-experienced it last night as I stood in front of this year’s crop of interviewees on the Q&A panel, answering questions that I remember asking a year ago.  I reassured a bevy of polished, intelligent, accomplished and terrified women who were just as worried about their interview performance yesterday as I was a year ago.  I tried with all my might to persuade them that they ARE indeed capable, otherwise they wouldn’t be here, and that there won’t be a really good reason why if they’re not admitted this year, because they weed out hundreds to interview eighty-eight, of whom they will choose forty-four,. and yet all eighty-eight are qualified.  I can’t express how happy I am to have made it.  I can’t believe it’s been six and a half months of intense learning, and I’ve made it so far.  I can’t believe the incredible ways that God has paved the way for us here in Salt Lake, the friends he’s brought into our lives, the spiritual lessons he’s teaching us, the unbelievable learning experience I’m having.  I really am one of those people who over-reflect on everything,… so it really is intriguing for me to stop and consider all that has taken place in the past year that has so dramatically changed our lives.  If you had told me, even as a senior at Westmont where I’d be today, I’d be freaking excited, and dumbfounded!  Really?!!  I get to be a teacher AND have an amazing medical career???  Even though I’m freezing my butt off right now, because I moved from a winter climate to a winter climate, there’s a blanket wrapped around me, two mugs empty of hot chocolate on my desk, a cat in my lap, and my little space heater on overdrive under my feet, watching the snow fall outside,… I am jazzed beyond belief.  Just as jazzed to be here as I was listening to an amazing lecture on Chronic Fatigue Syndrome and Fibromyalgia yesterday, but one of our nation’s experts.  This is just beyond cool.  So, here’s to a year from now, where I’ll be in the middle of my clinicals, putting all of this information together, staring down the end of my schooling towards the horizon of possibilities.  Giddy is how I would describe my feelings towards all of this.  Giddy, and overwhelmed by the love of a God who blows my mind everyday.  Peace.

late night studying: Salmonella or Shigella?

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I haven’t exactly blogged about the ins and outs of how this is all happening,.. I try to stay fairly balanced as a grad student (dinner with Friends Fri night, volunteer at health fun run Sat morning, BBQ at other friends Sat night,. church,.. see there are some fun and games involved!)  With, a whole lot of studying in between.  Like today, with my long-suffering (because he has to put up with me) study partner Darrin.  At some point, however, one really has to ask oneself:

How many hours of differentiating between intestinal diarrheal disease can a girl take?  Especially when considering the color and texture of said diarrhea, as well as the exact way the responsible vermin is damaging the inside of the poor sod’s intestinal lining? 

Many hours, in fact, you can ask him.. and Marcus, who mostly tried to tune out our descriptive discussion.  And I’m still up late making sure I’ve packed every last gram negative rod into my egg-scrambled brain.  Moral of this particular story called “infectious disease,” is that if you want to avoid bacteria/viruses/squirmy parasites, there’s a simple solution: don’t be born.  If that’s not a good option for you, I advise that you just strap in for the ride because sometimes things can get,.. well,…. explosive.  (think Cryptosporidium).

Multicultural Women’s Health Fair :) Medicaid Presentation :(

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I’m going to try really hard to not get political here, But I felt that my experience was worth sharing about!  I volunteered for a Multicultural Women’s Health Fair that they needed volunteers for, and spent about five hours there last Saturday.  The goal was to target women from different refugee or otherwise non-native ethnicities and provide information to them through four or five presenters.  The organization did a great job organizing it- the women were grouped according to language and provided with translators for Nepali, Swahili, Karen (Cambodia), Arabic, French and a few others.  The first presenter spoke about breast, ovarian, colon and skin cancers and included how and when to get screened, etc.  The second was a midwife, and she did a great job talking about general women’s health issues (menstruation, nutrition, cancers, when to see a health provider,. etc) although she said that “midwife” and “doctor” are interchangeable, which was very confusing to me.  I’ve never heard of midwives being considered general practitioners, but apparently in some states they can diagnose and prescribe,… I’ll have to look into that more!  I wish she would have used “nurse practitioner” and “PA,” because this particular population of women and their family members are more likely to see a midlevel provider at low cost clinics than MDs.  Anyway,… Then a gal talked about nutrition and finally, a representative from Medicaid spoke.

So, I have never heard a presentation on Medicaid, nor do I feel like I have an adequate understanding about who qualifies, their services,. etc etc.  But, I have to tell you, if I were to walk away from that presentation, the message that I would take is to go home and get pregnant.  Because, as she repetitively stated, pregnant women and children will not pay anything for any service at any time, if they are on Medicaid.  Period.  She seemed to be well meaning and knowledgeable of their system and services, but I was dismayed by her lack of “thinking outside the medicaid box” for this population of people.  She spent the whole time talking about how to apply (ok,. fine,) and listing off slide after slide of all the things that they will cover and pay for.  Now, to her credit, she could justify her talk as being about how to apply and what they cover and that she did just that, but I felt it was an enormously incomplete picture of reality.  Come to find out, it’s really difficult to qualify for Medicaid, even if you do not have a lot of money.  So, many of the women there don’t qualify anyway because they don’t have kids, or whatever else (go get pregnant).. And it just seemed like she was dangling this enormous carrot in front of a bunch of starved bunnies with the message that this particular carrot is the one you want, and the only way to it is through Medicaid!  If you want to be truly helpful, think big picture here.  Utah accepts any and all refugees.  But obviously, the hope is that they are responsible for finding jobs once they get here.  They get help, mentoring (thank you, Marcus) classes, and a lot of support, but eventually they are turned loose to join our society like everyone else.  Most of them, obviously, want to come here to start a new life, provide for their kids, and get jobs.  Most of them, are very hard working people.  So why on earth are Medicaid reps out there encouraging people to rely on social services like Medicaid, that many of them don’t even qualify for because they’re on the track towards self sufficiency?  Is this truly helpful?  If you would just be poor enough and go get pregnant, look at all the great services you will have!  I’m sorry, but that should not be the message we are sending.

She never said anything about private insurance companies, and that with education and good employment, insurance can be gained.  Obviously, she’s not licensed to represent private companies, but if many of these women don’t qualify for Medicaid, why aren’t we encouraging them to go to low-cost clinics, and explore private company options?  I’m sorry, I will not accept that there are no other options out there!  I have to give her credit, she did encourage them to not go to the ER unless it was an absolute emergency, but then again if you’re on Medicaid you won’t pay anything! or will pay just a few dollars!

We already have enough people in our country who are lazy, do not want to provide for themselves and expect the rest of America to foot their bill.  We should not be inviting refugees to our country and then encouraging them to join that group.  Instead, we should be encouraging people to move into the private sector with jobs, education and opportunity.   I doubt that Medicaid was ever intended to be a permanent solution for people.

Final thoughts… it was a disappointing first experience for me,… I felt like she misled them in thinking that they have a good chance of qualifying (how helpful is it to the rest of the women who don’t?)  In fact, a few women asked her questions about that- “my son turned 18 and was denied Medicaid, why?”  “we don’t qualify, what do we do?”  Her response was to point them towards other social services that might get them coverage.  It’s misleading because there are other options out there, there are low cost clinics, there are vaccination fairs, etc etc.  It’s misleading to send the message that here in America, people are entitled to free care, because as it stands, we do not have such a system in place.  Maybe we will someday, maybe not.  It’s discouraging them from being enterprising, and pursuing success through the work place. I felt like her goal was to steer people towards Medicaid, more than it was to educate and support refugee women.

And like I said, I would have walked out of there thinking to myself “I’m going to get pregnant, and then call all my relatives and tell them that if they come to America have enough kids (etc) they will never pay for health care!”

This message was a disservice to all of them, and to the rest of society.

And,. we’re back.

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Yes, indeed I haven’t posted for a while, finals and all but I’m well on my way into term two! So what do I think so far? I have got to say that PA school has been one of the best decisions I’ve made in my life. I was just asked recently why I didn’t just choose to “go all the way” and go to Medical School. First of all, I don’t believe that going to PA school will somehow leave me short-changed, or missing out on crucial and/or necessary skills. Second, I felt that the question indicated that becoming a PA doesn’t command the same level of respect or require the same amount of work or dedication. Finally, I know for a fact that there are those within the medical school community that do not believe that PAs have a role in healthcare in our country. I feel that all three couldn’t be further from the truth.
I think that we all will find that as we interact with PAs in doctors’ offices, clinics, and hospitals across the country that they are just as skilled and prepared to treat patients as doctors and nurse practitioners. Well how can I say that, given that doctors spend so many more years in school? Because our residency is on-the-job, and we are required to re-certify every six years. Doctors don’t have to do that. So you will always know that your PA is up-to-date on their skills and knowledge base in all areas of medicine, even if they are practicing in a specialty. Finally, if PAs were not adequately prepared to treat Joe Schmoe who comes through the door on a stretcher, they wouldn’t be working in ERs across America. Obviously, if I wanted to be a surgeon, I’d go to Medical school. But I don’t. I will be able to perform many smaller surgeries, I don’t need to remove brain tumors, or replace knees. As for the second argument, if it was about having a fancy name plate or “DM” next to my last name, I’d go to Medical school. But it’s not. And let’s be honest, there are good plumbers, and bad plumbers. Good dentists, and bad dentists. Good doctors, and bad doctors. Good PAs, and bad PAs. I’d rather go to a good PA over a bad doctor, any day. So, the argument that seeing a doctor is better than seeing a PA is invalid. I have absolutely no proof, but I bet more medical mistakes are made by docs than PAs. 😉 Another argument can be made that it’s HARDER to be a PA, than a doctor. One of our professors who is a local PA feels that patients are harder on PAs than the doc. If she makes a mistake on a diagnosis, even if her clinical diagnosis is the EXACT SAME as the doctor she works for would make, the patient is more likely to blame the mistake on the fact that she’s a PA, not an MD. And they will be more likely to give her doc a break, if he’s wrong. Interesting, huh! It would therefore be reasonable to surmise that the pressure is higher on the PA to convince the public that we are worthy of trust and respect as medical providers. That requires more work and dedication to excellence. The fact that we can work in different specialty areas and therefore need to acquire specialty skills when we move to a new area of medicine requires more work, and dedication to learning and excellence, given that doctors do not and cannot switch among specialties. Finally, as I said earlier, we are required to re-certify every six years, something that doctors and Nurse Practitioners are not required to do. Of course you hope your doc is keeping up on all the latest research. But you don’t know if they are going to accurately read your EKG in the clinic, or see that abnormality on your retina because they aren’t required to prove that they are up to date in their skills. So choose your doc wisely!! 🙂 Furthermore, if it’s all about prestige and money, we shouldn’t be in medicine anyway. If I can treat a patient with the same level of skill and discernment as the doc I work for, how exactly is what I do less valuable?
And for the final point, the concern that there are future physicians who don’t see how PAs fit into healthcare. I don’t know where that sentiment originates, perhaps they haven’t worked with PAs, have little experience with them, or knowledge of PA training and therefore make their judgment based on eight years versus 2. What I can say is that it demonstrates that they are out of touch with reality. We all know that healthcare is too expensive, and that there are rampant shortages. Doctors are not the answer; they cost too much money, and because we overload specialists and surgeons with ridiculous pay, many medical school students want to be specialists, rather than primary care practitioners (what our country really needs). So if they think that PAs don’t have a place in healthcare, I’m left to wonder who exactly they think will fill in our enormous gaps in providers. PAs are actually an amazing answer to our country’s needs. They are cost-effective, flexible, and team-oriented. They allow physicians to take care of more people by adding to their practices and clinics. They are often the only providers who will take jobs in rural and inner-city, or low income communities.
So why do I bother to take the time to rant about this on an afternoon where my books are calling my name? Because I wanted to share that four months in, I am more convinced than ever that becoming a PA is the right choice for me. I am so excited about the things I’m learning, and believe strongly in my program. The University of Utah has a great medical school, ranked in the twenties. Our PA program, however, is ranked second in the country, which speaks volumes to the dedication and hard work of those who have developed the program.
So why not med school? You’d have to come up with some good reasons why I SHOULD have spent six more years, hundreds of thousands more dollars I don’t have, etc. etc. in order to do, essentially, the same things.

This term has been sort of the launching into the “meat and potatoes” of our curriculum. In fact, I took my first cardiology exam yesterday. Let’s just say that I should probably understand the heart,. right? I also have courses in therapeutics (drugs), pediatrics, ENT, orthopedics, lab interpretations, surface anatomy, professional issues, physical exam, and I start radiology and something else tomorrow. Like the tagline at the top of my blog- it’s like trying to drink out of a fire hose, it’s crazy. So much to know, but it’s so rewarding. Well, it will be more rewarding when I get to take care of people, but right now, the learning is rewarding to me for all the hard work I put in to get here, and the trust I put in God to go to Grad school.
Finally, I just have to say that I love being here in Utah. Marcus and I are just having the best time! God has provided us with some amazing friends who enjoy spending time with us, great outdoor adventures nearby, and a wonderful faith community that we feel totally plugged into, and challenged by daily in a very good way. We enjoyed our break a few weeks ago- the whirlwind tour through Oregon, Washington and California, and now I’m right back at’em. So no regrets, no “I can’t do this” or “what was I thinking?!” moments (yet-stay tuned,) and no limits to the excitement and joy that I feel regarding my new career.

And no, I’m not hating on docs, it’s just that I’m biased now. 🙂