#in short: urgent surgery needed. severity HAD been explained to patient

[bougiebutchbinch]

:c but his tunes....

ranking the best things I have had heard surgeons say mid-surgery:

"Five second rule!" while scrubbed, after dropping a sterile scalpel on the floor (no they did NOT pick it up again but I swear everyone's buttholes puckered)

(spoken during the closing of a particularly long and difficult case) "Nurse - my tunes." :heavy metal starts blasting:

Gently to a fretful patient, pre-anaesthesia: "It's going to be okay. I promise, I've dealt with worse." As soon as the patient is unconscious: "This is literally the worst thing I've ever seen."

[okay this one was a med student] "Wowwww, that's so gross!!" Reg: ""[xxx], "Please remember that the patient is awake for this procedure." Student to patient: "Oh my god. I am so sorry, that was really unprofessional - " Patient, cheerfully, also engrossed with what's happening inside them on the screen: "Nah - it's, like, super gross, right?"

[another procedure where the patient couldn't be anaesthetised] Patient: *starts singing country roads midway through the procedure* Surgeon: *shrugs and joins in with surprisingly good harmony*

[wizkiddx]

worst case scenario part 3

umm so, never ever intended it to be this long but here we are. again this is v dark so please please read the warning!! also [and obvs] this is very medically inaccurate and just a work of my head aha

[part 1] [part 2]

warning: mentions of death / hospital / mentions of childhood abandonment too- please don't read if this could affect you <3

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His heart was thundering in his chest, so much so it drowned out all other sounds making all the doctors words fade into the background. Conciously, he really was trying to listen to what the doctor was saying; consciously he knew she was trying to prepare him to see Y/n; consciously he knew she knew he wasn’t okay. But really? It didn’t matter, and as they drew closer to his fiancé Tom felt an urgent sense of relief purely know she was there. She was there and she wasn’t dead…yet. 

Only two people were allowed to go up, just because the nature of the ward - everything was meticulously controlled, including the comings and goings of visitors. If you’ve never been in an ICU it’s a pretty hard environment to describe. Really, it’s just another hospital ward, with capacity of about 20 beds. Each bed has much more equipment surrounding that the average and a nurse is stationed per patient, monitoring every possible variable that the machienes are measuring, so any trend (either positive or negative) can be identified at the earliest point. Though in everyones head, it seems as though ICU is a common place ending up for some unfortunate sod when something bad happens, it’s actually really rare for someone to be so ill and dependant on medicine to maintain normal body functioning. Only the most severe trauma, infection of the most dangerous microorganism, surgery of such high stakes normally make an appearance on the ward. And ,on average, between 8-20% patients that are admitted to an ICU never make it out. 

And those grim figures were unignorable to anyone. As soon as you walk through the doors, the atmosphere is intense and ineffable. It’s not spoken, but is so incredibly morbid it makes anyone shiver. 

Dom felt this, squeezing his sons shoulder as he followed Tom and the doctor, just a pace or so behind them. Having offered to go with Tom, whilst Harrison took Nikki to see the baby, Dom was now feeling just as clueless as his son did. Except he was actually listening to what the doctor was trying to warn them about and it scared him. The three, made it to the door and with a swipe of her ID card the doctor admitted the Holland men in. Gratefully, none of the staff took any notice of who was walking in, they were much too busy for that - Dom was incredibly relieved, had someone recognised Tom when he was in this state, god knows what would’ve happened.

The doctors pace was with purpose, perhaps so that the two couldn’t spend too long ogling the other patients in the beds - who all looked almost unhuman with the amount of tubes and wires coming out and into them. But then, she slowed up, halting infront of a bay about 5 or 6 down the ward. Spinning on her heel and with a subtle nod to momentarily release the nurse from her post at Y/n’s bedside, to give them a bit of privacy, she looked at the two men. 

“You can touch her, just be gentle with the wires.”

Shellshocked and terrified, Tom was frozen those 2 metres away from the bed barely able to see her face over all the equipment. Yet undoubtedly, it was his finance’s delicate visage lying on the white pillow, with a thick white mouthpiece and tube covering her mouth and stuffed into her nose. Not able to move, both Dom and Dr Goodwell sensitively waited - it was an adjustment to say the least, seeing someone you knew so well look so different. With quiet tears starting to roll down his eyes, Tom eventually started to inch toward the bedside, taking his time to try and absorb everything of this frankly ridiculous situation. He couldn’t get over how, even considering it all, above her nose it just looked like Y/n. Like she was asleep in their bed, eyes closed as if she had once again  fallen asleep infront of a random Netflix movie Tom had bugged her enough to watch in bed. And it was, ever so slightly comforting. That was still her, that was still the love of his life lying there. And she was still alive - which given the last few hours, was enough. 

Reaching the bedside, Tom naturally reached out and stroked the top of her head delicately, pulling into place a few rogue strands that seemed to have a mind of their own - she had always hated when her hair got frizzy. The picture had Tom’s mind casting back to their first holiday, a serene if quick few days in Fiji-  though Y/n didnt know this , that holiday had been one of the most important times in their relationship for Tom. Until then, given the nature of his job, the couple had only ever managed brief periods together. They spent time together as and when they could in between Tom’s busy schedule but it was never as long as they’d like. Somehow though, he’d managed to squeeze a few days away to surprise Y/n with the trip. 

It was everything he’d ever hoped it would be and more. In fact it was then Tom was oh so sure he would be spending the rest of his life with her. This thought crossed his mind on the last morning, when he had for once woken up before Y/n - her head mere cms away from his on the pillow. Just like now, her hair had been all over the place and her sparkling green eyes locked shut. Contrastingly though, in Fiji the sight had made him smile softly; now it just made him cry again. 

“Would you like a minute alone Mr Holland? We will just wait outside?” Not even turning round to properly respond to the doctor, Tom just nodded violently, not taking his eyes off his fiancé - waiting till he heard his Dad and the doctor leave the bay; then the curtains be completely drawn to a close, before he shakily cleared his throat to whisper.

“Hey darling… you um-you’ve scared me shitless today… and… and I’m supposed to be the dramatic one in the relationship.” Chuckling wetly, Tom clasped his other hand in Y/n’s - still mindful of the IV port coming out of the top of her wrist. Not that he was expecting any sort of response, yet the lack of her squeezing his hand back still had his heart sink. “Look I…I love you so bloody much and I really need you to get better okay? You’ve never listened to me before but I really am begging you to now, I just.” Swallowing thickly, he shut his eyes momentarily and delicately rested his forehead on hers - his touch feather light. Just needing to feel her. “I just really need you and I really love you., okay?” 

Unsurprisingly he didn’t get a response. The rhetorical question hung in the air alone, safe the mechanical whir of the ventilator and various chimes of the machines and monitor, till his Dad came in. Grasping and squeezing his shoulder lightly, Dom provided the stimulus for his son to unfold from over the bed, standing upright, as both men just took in the sight of Y/n lying there for a minute or two. 

“I need her Dad. I-I-“

“I know Tom.” Speaking so quietly it was barely audible, Dom’s eventual agreement at what Tom was saying was in a way a relief. Haz and his mum had both either been saying or implying that they would be okay no matter what - which came from a good place but was so infuriating. Because god forbid, if this situation got worse Tom knew it wouldn’t be okay. Nothing would ever be okay again. So his Dad’s simple acknowledgment meant a lot, causing Tom to turn round and embrace his slightly shorter father. 

Dr Goodwell silently watched the exchange for a short while and once the men eventually pulled away she stepped forward to give some more information. She went through what all the biggest and scary looking tubes and wires were doing for Y/n, before explaining the next steps. 

“Now as I said before we are sedating her at the moment, while we wait and see if she gets any complications from the surgery that are better treated while she is asleep. By this afternoon we will have a clearer idea and by that point we may choose to withdraw that sedation. It’s important that you are aware though that she might not wakeup immediately. Sometimes some people that have suffered similarly to your fiancé will be unconscious for a while in what I’d presume you’ve heard of as a ‘coma’. Now it’s not as dramatic as you see on TV shows, it’s just Ms Y/l/n’s brain giving her body a chance to recover. It’s often a longer process, which I know is something you don’t want to hear, but I have to be honest.” The doctor was stern but in a softer and from-a-caring-place. “These patients are suggested to possibly recover quicker if they have a steady support network behind them, which it seems like she does. That means that you need to look after yourself so you can help her sir, especially in what could be a long process. It’s not going to be helpful for Yn if you’re killing yourself trying to be here all the time… It seems like Y/n already has quite a big group of you here for her, so please remember you’ve got all of her care team here and everyone else to help you too….Does that make sense sir?”

“Tom” His Dad, in a gentle but firm warning tone, urged Tom to speak and to listen. Properly listen. 

“Yeh… I-yeh It’s just all a lot right now.”

“Of course… and we promise that if anything changes with her condition, you will be phoned straight away. You are welcome to stay as long as you want - the only rules are two at a time, no flowers, sign in and out and then sanitise your hands pretty excessively. If you need anything, Ms Y/l/n’s nurse will be your first port of call.”

“Thanks for everything” Dom nodded in a gracious manner, which the doctor seemed to massively appreciate - apparently, for the job they do not receiving a hell of a lot of thanks. 

“I’ll pop back in a little bit.”

And for a couple of hours everything everything felt like a bit of an anticlimax, nothing happened, not a lot changed. Just Tom and Dom sat next to Y/n’s bed in silence; Harrison and Nikki downstairs with the baby, till Dom got a phone call from Nikki asking them to meet at the neonatal unit  - which was limited by visitor numbers unlike the ICU. Thinking it’d be simple, the elder man gained Tom’s attention with a call of his name, explaining they should go down to meet up. 

“I’m not going down there.”

“Son, I know you’re worried by Y/n isnt going anywhere right now. The doctors said they’d call you if anything happens.”

“It’s not-“ Tom stopped himself, biting his tongue and looking away from his Dad. “I just don’t want to go down there.” Slowly, Dom was more and more realising Tom’s thought process and honestly… it scared him. In the hopes this was just a big misunderstanding he offered a different option - hoping Tom would equally refuse that. Dom suggested going down to the cafe instead, which most unfortunately Tom agreed to. It wasn’t leaving Y/n that was the issue, it was being near the baby. 

Tom’s daughter. Unnamed and apparently abondoned by both parents. 

Anyhow, Dom resigned to playing into Tom’s choice, perhaps Nikki and Harrison would be able to swing him round, to see sense. It still took Tom getting the nurse to triple check they had his correct number on record , just in case, before Dom could tear him away from the bed. Fortunately the pair found a quiet and secluded corner table, where Tom was still yet to be recognised, while Nikki and Haz found them too. 

What followed was Tom answering all his mum and Harrison’s questions about Y/n’s condition, in a blunt and emotionless manner - without Tom returning fire by asking any questions at all about his beautiful little baby girl. Eventually Nikki braved it, someone had to bring it up. 

“Well it sounds like littles going to change for a while… maybe you should head home for a bit? You’ve been up half the night and you look shattered love. You don’t have to go back to yours… you could stay in your old room for a bit?” Tom being by himself at the moment sounded like the most incredibly stupid idea ever, Nikki was offering it as a choice - when in reality there was only one option.

“Maybe later this evening I will? Just don’t want to leave her alone yet.”

“It’s already 7 love, you’ve not eaten all day, you got to look after yourself too.” Harrison and Dom sat awkwardly while Nikki tried to delicately encourage Tom into what was the only sensible plan, watching him nurse the small hot choclate in both his palms. Time really had lost all meaning at this point, for him it felt both years since he’d first arrived with Y/n and at the same time barely 10 minutes ago. It felt weird. 

“We can take shifts? If-if you want someone with her I mean… I don’t mind staying for a bit longer if it means you head back to your parents.” Harrison really truly didnt mind, in fact he sort of wanted to. He wanted to see Y/n’s face definitely alive, wanted to feel reassured by the monitors. Shockingly, Tom slowly nodded his head, surprising everyone with his lack of argument. None of them could work out whether it was a good thing him not putting up much arguement ; either he was heeding everyones advice of taking care of himself - or he had just given up. Harrison, as much as he didn’t want to, was favouring the latter. 

“Okay” Nikki declared optimistically “So maybe you and Harrison go up so you can say good night to Y/n, then we can all go and pick up the baby?” She opened the plan to the floor, allowing for input but got nothing - except maybe Tom’s jaw unconsciously tensing uncomfortable at the latter part of her statement. Dom noticed. 

Not one noticed but knew what it meant. His son blamed his granddaughter. His son, right now in that moment, hated the unnamed and totally helpless baby girl. 

part 4?

[bellphilip91]

How To Use Karuna Reiki Symbols Creative And Inexpensive Useful Tips

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[steddie-island]

I was going to put this in the notes but you know what? Nah. I keep wanting to talk about it and then backing off but like. Nah today, y'all get to hear about what happened last year because this shit is important.

To try to keep a long story short (and get to the point that actually has something to do with OP's post) we're going to do as much of a speedrun as we can for what happened to me last year. I'm not known for being able to condense things super well but we're gonna try anyway!

In April I had a massive bleeding episode that landed me in the hospital. I thought it was just a heavy period, I have PCOS and was used to those, but nah. It was Bad. They gave me medicine, it slowed down until I ran out and had another (though less severe) episode. I was put on birth control but every month the bleeding was just so heavy and the pain so severe I could barely leave my house.

After I stood up in the bathroom one day and then literally had to rest my forehead against the wall to keep from passing out I decided to do some research, then went to urgent care three times trying to say "Hey I think I'm severely anemic, these are my symptoms, can you check this?" One of those visits ended with me going to the hospital for the second time that year in a trip that could have been avoided if the doctor looking me over had just fucking asked what birth control I'm on. But he didn't.

I finally called a doctor's office a friend had recommended to me because no one else was listening. I got in to a woman who not only listened to me and believed me when I told her that I was anemic, she apologized for the way I had been medically mistreated not just as a woman but as a fat patient. She did tests, found out that yes, I was severely anemic. We started doing iron transfusions and looking into what had happened.

Turns out I had a fibroid in my uterus that made any other treatments for heavy periods pretty much useless. She sent me to a surgeon to talk about me getting a hysterectomy. The consult went great, I left crying happy tears because I was finally being listened to and wouldn't have to deal with severe pain and bleeding for the rest of my life.

Fast forward to October. I had requested the time off work, made all the arrangements that needed to be made. I was hooked to an IV, scrubbed up, ready to go back to the OR. There were last minute changes that had to be made regarding how the surgery would be handled. Something that was supposed to be a one day outpatient thing ended up being a 2 night stay in the hospital. It was a much more difficult recovery, I had to take an extra week unpaid from work because it was genuinely a much more traumatizing experience than expected, and I hadn't had any time at all to prepare.

My doctor reached out to check up on me after a week. I explained the last minute changes, and how I had felt like I was an afterthought when this man had to go in and cut me open, and he couldn't even tell me for sure later what all had been done/ removed. (He literally said they "may have" left part of my cervix in. Like???)

My doctor was pissed. She started filing complaints with the hospital. They told her that the complaints really needed to come from me and she said basically said "bullshit this patient is in my care and this isn't her responsibility, she came to me and I'm going to help with this." And she did. She called, and complained, and she got him on the phone to get me the answers that he couldn't give me the day of my surgery.

She was nice, but he still got a dressing down, and she told me recently that she could tell he was very humbled by the feedback she had passed along. She's also stopped recommending any of her patients go to him, at least for the time being. She hasn't sent anyone to him since my debacle in October.

I love my doctor, and I trust her with my life (literally.) And whether they do it politely the way I know my PCP did, or if they're yelling at each other the way the post says? Fuck yes, this should be normalized.

Doctors should have to listen to their patients. Doctors should fucking believe their patients. And if they aren't listening, and believing? Then yeah, they should get knocked down a few pegs when someone does finally figure it out.

Doctors should snark at each other more, be a bit mean. Not for no reason, mind you. But if five doctors blow me off about symptoms and doctor number six FINALLY runs actual tests and gets a diagnosis, I think it should be Doctor Six's right to call up the other five and tell them they're lazy pieces of shit. That should be socially encouraged. Those first five doctors clearly can't listen to patients, but maybe another doctor might finally get to them.

[phalloplastytime]

Phalloplasty Consultation with Dr. Chen & Dr. Watt

Here is what I remember from my experience going through my consultation with Dr. Chen from GU Recon (his private practice) and Dr. Watt from the Buncke clinic in San Francisco, CA, USA. My apologies for the length, I wanted this to feel kind of immersive for those of us still in the waiting process because stuff like this helped me. Also - small content warning I do use a couple anatomical terms.

For those of you unfamiliar, Dr. Chen is a urologist and Dr. Watt is a microsurgeon.

My partner and I traveled down to San Francisco to stay for two nights. We flew in on Thursday evening and flew out on Saturday evening, not wanting to be gone for too long and rack up even more expense on the hotel bill. If I had planned ahead several months ago, I would have tried to stay at the Quest House during this time but I didn’t realize a short stay was potentially possible. 

We are fortunate to be able to use the public transit system offered in SF, which is pretty good in my opinion. They have buses, trolleys (cable cars?), and an underground/train system. We utilized this to make our way over to Castro street, where the medical office building and also the hospital are located. 

Without any plans for the day we went ahead and headed over about 3 hours early because I had seen that there was a dog park right nearby. We sat and watched local dogs come and play and have a break in the middle of the day and we ended up meeting an older gentleman whose dog wouldn’t leave us alone asking for pets. It was pretty great, and nicely calming as I was pretty nervous before the consultation. We then got some food at the local cafe on the corner. It was actually pretty good. 

We realized we still had time to kill so we decided to hike up the hill to the Buena Vista park where we looked out over the city and rested for a bit. There’s a path that has some disturbingly friendly squirrels on it.

About 30 minutes before my appointment headed over. Inside the medical office building, Dr. Chen’s suite is right across the hall from the Buncke clinic. I wasn’t sure where to go to check in, so we walked all the way down to the entrance of GU Recon and saw the door was open. Inside the waiting room was fairly spacious with comfy seating and plenty of random coffee table books to peruse. There was nobody else there at the time. At the receptionist window was a sign indicating to check in over at the Buncke clinic, so we quickly hopped across the hall. 

The Buncke clinic waiting room was much smaller and was actually quite crowded for a Friday afternoon. I checked in and they asked for my ID and insurance card (even though I had sent in pictures), and they didn’t ask for any kind of copay or payment. I suspect I will receive a bill at some point for the specialist copay from my insurance which is $30. Hopefully.

They instructed us to head back over to Dr. Chen’s office to wait, so we went back over and started looking through a photography book. At this point I was still about 25 minutes early to the appointment so I was ready to wait however long it would take. 

About 5 minutes later, Dr. Chen himself appeared behind the reception area with pizza and Starbucks in hand, apparently not expecting anyone to be in the waiting room. He noticed us right away and began apologizing for the wait. He explained the schedule didn’t indicate whether or not we were having a phone consultation, so he just assumed it was going to be over the phone based on my address. 

This whole interaction solidified every good thing I had heard about Dr. Chen, and I immediately felt so… normal. That’s the best way I can describe what I felt. I felt like I had known Dr. Chen for years and that he was.. reachable. Human. 

He told us it would be a few minutes, and sure enough a few minutes later Dr. Chen and Dr. Watt appeared at the door and we made introductions. My partner came with me because I wanted her to hear what the doctors had to say and I wanted another pair of ears listening, and also because I wanted the doctors to see that I had support. 

We went down a narrow hallway and went into Dr. Chen’s office, which hosted another comfy couch which he had us sit on while he and Dr. Watt sat across on office chairs. They each had some papers (my medical information). The room was somewhat dimly lit, but calming and comfortable. 

The consult started with Dr. Chen confirming my reason for the visit (seeking phalloplasty), and he asked me how important it was to me to stand to pee. I explained that my personal goals were 1 - Sensation, 2 - Stand to pee, 3 - Aesthetics, and 4 - Sexual function. Which, again, are personal goals and it is completely valid to have other priorities with lower surgery. This is my own journey. 

We then went over my medical history, which is fairly short, but Dr. Chen was thorough and asked me about my minor eczema, asthma, and migraines. Dr. Watt was quietly taking notes and listening during this time. Next, they asked about any trauma to either arm and I basically explained how my right arm is essentially immediately disqualified from being a donor arm. In my specific case, I broke my right arm when I was 18 months old and had to have a surgical repair. This repair didn’t heal correctly and now my arm when extended is quite crooked. 

This has put some strain on my ulnar nerve and gives me hypersensitivity in my palm.  Further, I had a different surgery on my forearm which involved an incision and left me with a scar right in the middle of the graft area. This could compromise the blood supply, so we pretty much immediately dismissed my right arm as an option. To top it off, it is my dominant arm for most activities. I kind of would have preferred to keep my left arm nice and clear of any scars, but I think having 1.75 properly functioning arms is preferable to only 1 functioning arm in case my right side nerves ever gave out. 

Next, Dr. Chen went on to explain his portion of the surgery - he starts with the vaginectomy and then relocates the end of the urethra to the natal phallus using labia minora tissue. He then mobilizes this and relocates it to the other side of the pubic bone to come out to the site of where the neophallus will be placed. At some point during this discussion, Dr. Chen explained the complication rate and he was both realistic and optimistic about it. He said the vast majority of complications that happen are fixable. Further, the most common complications often heal on their own. I can’t remember the exact numbers, but he said of the patients that do have fistulas, only around 20% of them end up needing a surgical fix. Strictures don’t show up right away, and usually occur within the first year. 

While Dr. Chen does the work down below, Dr. Watt explained his team mobilizes the RFF and prepares it for the new location, using the tube-in-tube method to create the urethra and phallus. Dr. Chen places a foley catheter through the neophallus and into the relocated urethra to line everything up, and he sutures everything together once the microsurgeons connect the blood supply and nerves. Dr. Chen then places the suprapubic catheter and the RFF site is covered with the split-thickness graft from the leg.  If requested, Dr. Watt would place integra on the RFF donor site before the split thickness graft (not staged like other teams).

They then explained what recovery typically looks like - 5 nights in the hospital, including 4 days of strict bed rest and then up and walking on day 5.  If you’re able to walk well enough, you get to leave to recover elsewhere. They then check up every week for four weeks before sending you home. During your 1 week post-op visit, Dr. Chen removes the foley catheter from the neourethra complex. You start your peeing trials just before the 3 week checkup, and if you’re able to empty enough of your bladder the SP catheter can be removed. If you have significant fistula(s), an additional week for healing may be allotted and the SP catheter retained for that time. 

Dr. Watt then did an exam of my arm, performing the Allen’s test to see if my hand receives enough blood if the artery they harvest for the RFF is removed. The test seemed really quick, but I guess with how fast my hand refilled with blood he was very confident I was a candidate for RFF. He indicated that no further testing of my forearm blood supply was needed. 

He examined the hair on my forearm, which turned out to be really funny because while he was looking at it he guessed that I had undergone electrolysis up to about 6 inches down my forearm. I laughed a little and explained nope, I just haven’t grown hair there in my ~5 years on testosterone. He gently pinched/grabbed the skin to see the thickness and said they’ll likely delay my glansplasty, and when he looked at the underside of my arm where the urethra graft would be taken he said I was basically hairless there and that any electrolysis at this point would just to be to remove hair from what will be the outside of my phallus, which is optional and he said I can always shave or use something like Nair. 

I then had a chance to quickly look over my questions to try to find any that hadn’t been answered. They were pretty thorough so the most I asked about was about Integra because I was most curious about it. Dr. Chen then explained that he needed to do a quick visual exam of the genital/mons region and we walked across the hall to an exam room.

He apologized for the discomfort and had me just quickly drop my shorts while standing. All in all I think it took about 5 seconds of exposure. When we got back into the other room he reported to Dr. Watt something along the lines of “minor prominence” of the mons. I checked my questions one more time and asked if they had any testicular implants that I could feel, but Dr. Chen explained that he had a patient waiting that was somewhat urgent and he promised that he would show me next time. He was very polite about it and I understood, and all in all I think the consultation took about 30 minutes. 

We said our nice to meet yous and goodbyes and Dr. Chen showed us out the shortcut out of the clinic and boom it was over. Despite the quick ending, I still didn’t feel rushed out of there and felt like they really took the time to make sure I understood the surgery and that my possible concerns were heard. 

All in all I left feeling really good, which for me was everything. I was actually excited about the future. Also, they said they would be forwarding my information to the phalloplasty team about our consultation, and that they should be reaching out to schedule with me. What ended up happening was I emailed Logan with a follow-up question and after we emailed back a forth a couple times, Logan asked me if I wanted to set my date. So now I am officially on the books for Left RFF Phalloplasty and words cannot describe how much joy/relief/excitement I feel about it. 

Like, I still can’t believe I get to do this and I don’t know when reality will set in. But for the first time in months, I am hopeful and optimistic about the future. 

Edit: I forgot to mention that Dr. Chen also will perform a scrotoplasty during his part of the procedure.

[flarebossmalva]

so i’m still in the hospital for now; i think they’re going to let me go tomorrow. my mom brought me my laptop so since i’m here i thought i’d just go ahead and tell the story of the past few days lol, it’s been Wild

monday night around the time i went to bed is when the pain started. i was confused by it but figured i could sleep it off. spoilers: i couldn’t, and on tuesday it was even worse. i spent most of the day in bed, curled up in the fetal position. again, i didn’t know what it was about but just assumed it would eventually pass. the pain was in my lower abdomen, all the way across as opposed to just on the right where the appendix is. i wasn’t nauseous and had a normal appetite, nor did i have a fever or any other symptoms. i also don’t have a family history of appendicitis. basically, the possibility that that might be the underlying problem did not even occur to me. i thought it might be ovarian cysts, a lyme disease flare-up, even wondered if i was for some reason going to have a period this month despite being period-free for over a year now.

anyway, seeing the state i was in, my mom suggested i go to urgent care. i felt like this was probably a waste of time but i also know that i’m a dumbass with a high pain tolerance and no self-preservation skills, so i decided to listen to her advice. we went to urgent care. the doctor there said he couldn’t figure out what the problem was exactly, but worried it might be serious and suggested i go to the emergency room for an ultrasound. so we went to the ER.

by this point it’s like 9 pm. i get admitted fairly quickly and brought into the waiting area with the other patients. around 10-something they finally take me to have the ultrasound done. i have to explain how being trans works to several doctors. the ultrasound hurts and takes a really long time. i learned later that the ultrasound tech couldn’t see my appendix on the ultrasound at all. they decide to give me a CAT scan. i get scanned around 11:30 pm. shortly after this, a doctor asks me how my pain is and if the meds are working. i haven’t been given any meds. they decide to rectify this by giving me some sort of drug cocktail that rendered me extremely high, but only kind of helped with the pain.

at this point it’s past midnight, i’m high off my ass and tired, i figure they’ll let me go home soon and if the mystery pain persists i’ll deal with it later. around 1:30 am a nurse shows up to tell me that the CAT scan showed that i have acute appendicitis and i’ll need to stay the night, then undergo surgery the following morning. i’ve never had surgery before and the concept of surprise emergency surgery is objectively pretty alarming but i’m high as balls, so i just tell her “okay” and then try to go to sleep on the gurney, which doesn’t work.

around 3 am a different nurse takes me upstairs to the room they’ll be keeping me in before and after the surgery. i’m still high and she’s very sleep-deprived so we made very dim-witted small talk on the way up there. once i’m in the hospital bed i pass out in short order despite still being in a lot of pain.

in the morning they bring me down for surgery prep. it takes a really long time and i’m in a ton of pain, which i mention to one of the nurses. she tells me she’ll “get me something nice” and that’s the last thing i remember until i wake up post-surgery, so i guess it was real nice. 

anyway, the procedure they did was minimally invasive, meaning that instead of one big incision i have three smaller ones; i haven’t peeked under the bandages but i expect each is at most an inch long. they ache a fair bit but it turns out the pain from having three holes cut in your stomach is not nearly as bad as the pain of having your appendix try to murder you. given the state of things in there (again: gangrene!!!) i have no doubt that this could have killed me if it wasn’t caught sooner and i’m still processing that tbh. they have had me on intravenous antibiotics since tuesday night and i expect i’ll be on them until they let me go tomorrow. i was kinda worried they might not dose me strongly enough for the surgery because i have a high tolerance for most drugs, including some localized anesthetics, but whatever they gave me absolutely knocked me flat so that’s cool. right now i’m on hydrocodone so sorry if this post is written a bit weird, i’m a bit drugged up. anyway that’s pretty much the full story. i’m recovering well and i’m looking forward to going home tomorrow

[itssandflower]

Mischief: Part 2

Read part 1 here

Trigger warning: Extreme Gore

At this point, I opened the carrier to get Mischief’s vitals. She was a gorgeous black cat with the standard green eyes. Her left side was facing me, and I could see her left hind leg tucked under her protectively. “All right, darling, I’m just going to take a quick look at your leg, okay?” I cooed to Mischief, shifting her hind end carefully so I could see the leg. I tried to keep my face passive as I took in the wounds-- they looked very much like something had scraped its claws down her flesh, but it the wounds looked pretty old. Mischief’s mom told me then that the inside of the leg was much worse. Privately, I wanted the surgeon to take a look at it before I did. I stroked Mischief’s short black fur and tucked her leg gently back under her before I closed the carrier. I informed Mischief’s mom that I would take her back to be evaluated, then bring her right back.

The surgeon I was receiving for was not my usual one. She was a tall, dark-haired, and mildly intimidating to those around her. She wasn’t a mean person, just very blunt with an impassive face. She was an intelligent doctor, and I was confident in her treatment plans for Mischief. We called her MML. I brought Mischief back to her and explained her situation, and MML, the intern on our service, and I went through the hospital to find a place to evaluate Mischief’s gait as part of our physical exam. The radiology suite was the only place we could go with a door, in case Mischief decided to make a break for it. We closed the door and took her out of her carrier, but she just huddled in a dark, unmoving heap on the floor. We gave her a few minutes, but she still didn’t move... She didn’t even turn her head to evaluate her surroundings.

Eventually, before I could move, MML went to turn the cat over. I should have known something was drastically wrong when Mischief didn’t resist; it was a very un-catlike thing to do. My heart dropped when I took a look at her hind leg-- there was no flesh on the inside of it. I could see the muscle, but it wasn’t a healthy pink... More like a washed- out beige. I could smell the infection, and it made my stomach churn. MML quickly and carefully picked Mischief up to return her to the carrier, and immediately after went to talk to Mischief’s mom. As I waited, I typed in some triage notes on the computer, anxiously thinking about that terrible wound and wondering how it got as bad as it did.

Suddenly, MML came rushing back into the surgery prep area, urgently snapping that we needed to bandage the leg before Mischief got a hospital-borne infection. The intern grabbed Mischief’s carrier while I moved around the surgery prep area like a whirlwind, grabbing betadine and saline for cleaning the wound, cast padding, bandage tape, vet wrap, and gauze. I placed a warm towel on a free gurney and the intern carefully lifted Mischief out of her carrier. She was limp and did not resist. I laid her on her side so that the inside of her left hind leg was visible to the surgeon and the intern, but I found I didn’t even have to restrain Mischief. Still, I talked softly to her, telling her I was so sorry that this got so bad for her, and that we would do everything we could for her.

As the intern began to clean Mischief’s wound, my stomach lurched-- the skin was sloughing, meaning it came off with very little pressure. MML seemed to grow more urgent, skillfully evaluating the wound and placing a bandage over the entire leg. She informed me that this cat needed to be evaluated by our Internal Medicine service immediately, and if they couldn’t do it, our Emergency service needed to take a look at her. My heart began to race as the reality of the situation finally clicked with me; Mischief was in a lot of trouble. I asked MML what we could do for this wound, and she sighed. She said that with the way the wound looked, amputation was unlikely to be successful, as the infection could have spread to Mischief’s bones in her legs. At worst case, it could spread to her hip joint and even to her pelvis. Therefore, the options were very limited for the small black cat.

When the bandage was placed, the intern brought Mischief back into the room with her owner so I could find someone who was free to evaluate her. I set off at a brisk pace to internal medicine, informing the techs and the doctors of the severe situation. Mischief had an appointment with the Internal Medicine service, anyway, which was definitely for the best. For extra measure, I also informed ER of the possibility they may have to evaluate her. From there, I had to move on to my next appointment... But my thoughts were still on Mischief and her mom.

Mischief’s appointment was originally at 9 am, and by the time my next appointment came, it was 10 am. When I came back from my next appointment, I saw Mischief on the crash table and had a grim realization that things were getting darker for her, not lighter. I overheard that her blood pressure was extremely low, and I noticed the ER nurses placing an intravenous catheter on her so they could bolus her with fluids. Throughout it all, the little black cat did nothing to resist.

Hours passed. Other appointments finished, and I noticed Mischief’s owner in the room that I had left her in as I walked past with other clients. Every now and then, I saw the Internal Medicine specialists and nurses in there with her, undoubtedly sharing Mischief’s progress... Or lack thereof. Of the few glances I was able to catch of Mischief’s owner, I noticed her red-streaked cheeks. She had been crying...

Eventually, the day drew to an end, and Mischief was the only patient of mine that was left in the hospital. By this time, her care was taken over entirely by the Internal Medicine service. A part of me wanted to stay on her case, but I knew there was not much I could do for her. Instead, once I was able to, I approached one of the Internal Medicine nurses.

“How is Mischief?” I asked cautiously, half-dreading the answer.

The Internal Medicine nurse sighed, confirming my prediction before she spoke. “Her owner decided to euthanize. She was suffering too much.”

It was a bittersweet end. Sweet because Mischief was no longer left to exist in agony... Bitter because all I could think of was her owner; she had arrived at my hospital with a sick cat in hopes that we could fix what was unfixable. Instead, she left that night with an empty, rusted cat carrier.

. . .

I still think of Mischief and her owner. A few weeks after her death, I had a dream that a small black cat was called back to us as a “STAT triage”. When a STAT was called, the patient was critical and needed to be evaluated immediately.

In this dream, an ER nurse brought back a gray cat carrier. We opened the top of the carrier carefully and swiftly, revealing a petite black cat huddled in the very back corner. The cat looked fine, and I couldn’t see a reason this patient was labeled “critical”. I readied myself as the nurse cautiously began to lift the cat out of the carrier. The nurse slowly turned the cat until her belly was exposed to the surrounding team...

There was a large wound splitting the cat from the neck to the tail, gaping up at us like a black hole. The body cavities were completely empty-- no heart, lungs, intestines. This cat should not have been alive. I had enough time to register the horror of the scene before the cat let out an unearthly screech, kicking her back claws at her throat. Everything about the scene was... Wrong.

I woke the next day, distraught. That dream comes back to me when I see a mortally injured patient. I still see the cat’s belly, exposed to the world... But that wasn’t the worst part of the dream. The absolute worst part was, in spite of the fact that the dream cat must have been in immense suffering, the owners in the dream refused to euthanize.

I know this dream was related to my experience with Mischief. I wish I could talk to more people about how seeing Mischief’s wounds, and being utterly helpless to help her, truly affected me. But I must keep my head up; move to the next patient, be there for the next owner, and help treat the next sickness or injury. But I’ll never forget those patients that have a place in my heart now... And Mischief is one of them.

[juliejules66]

Thoughts on my favorite HS English teacher

I've been thinking about Staples High School legend Karl Decker so much since I read the news last night that he passed away.  I wanted to share one of my memories:  

In 1981-82, I had Mr. Decker for English 10A. Early in the first quarter, September still, we were given an assignment.  I don't remember what book it was about, or what we were tasked to write. Just as the temperatures were starting to fall,  my father felt unwell after an evening tennis game at Longshore, and was diagnosed with a severe arterial blockage. He urgently needed surgery. At that time, only a few hospitals in the country were performing multiple bypass, so my parents flew off to Milwaukee. 

I was "home alone" for the first time in my life. Both of my older brothers were in college, one a senior and the other a freshman.  I was supposed to be staying at a friend's house but of course we convinced her mother that I really needed to be in my own house with our dogs. Or so I recall. Yes, I had a party. Risky Business-type activity ensued (no call girls, though). Back to that writing assignment. The next week, Mr. Decker handed back our homework and there it was, a C. I had never received a C on anything. I was one of the over-achievers. I was devastated. I went to his office to plead my case.  

He patiently but firmly explained to me where and how my work had fallen short, and I burst into tears.  All of the emotion I had been holding in - fear and confusion about my father's condition, but also embarrassment and shame about the grade - came spewing out of me. I was blinded by tears and unconsolable. He told me it was just one assignment; there would be other opportunities and plenty of room for growth.  I asked if I could have a do-over. Of course, he said no. I told him about my father's surgery and how scared, upset and distracted I was. Once he heard what I was struggling to process, his tone and posture softened. He told me he was sorry about my father. But he didn't change the grade, and I got a C for the first quarter. 

Over the rest of the school year, I worked to improve my writing and comprehension. In our final assignment in June, we were instructed to submit our papers anonymously, with some kind of code, so that he could grade us without any preconceived biases. When he was handing back the papers, I was quite nervous. My code name had not yet been uncovered. He then introduced a particular submission that he deemed exceptional. Only a few of us were still waiting for our grades. One of those was the boy I was dating, a gifted writer, and straight-A student in everything. Mr. Decker strolled around the room, and stopped in front of my boyfriend David. "Is this you?" and handed the paper over to him. I had used as my code word some combination of David's birthday or street address. He looked up at Mr. Decker and said no, not his, and quizzically looked in my direction. 

And so Mr. Decker turned to me. "Heller, is this yours?" And there it was, the "A" I had long hoped for. Earning his praise meant so much to me and I'll never forget the lessons he taught me about grammar, punctuation and the enlightening and universal power of great literature. It's been almost 40 years, and I'm happy to share that my father survived bypass surgery and my parents still live in Westport.

[heuschkelkei]

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[malcolmadrian97]

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Energy is spontaneously and effortlessly transmitted from one's own innate essence is clear and relax you in the same way that Reiki heals the chakras.People who still insist on sitting up, the practitioner will take in energy that gathers in the world to the Master Reiki and its dual beginnings can often charge a large family.At one time Western Medicine was very humbling for me to provide the maximum life force energy within the body to balance your energy system in any person's life are multi-dimensional, because Reiki also has been reported to me and it is perfectly acceptable since Reiki is an all time is an additional level for Personal Mastery level and introduces the concept of Oneness within.Researchers found that patients feel more confident and empowered?Actually, this is its ability to channel the universal energy, the smoother things go.

She expressed eagerness to render assistance.Aside from it is often a trigger for emotions coming to full realization of this Divine energy to people not in alignment with your intuition.The brow and crown chakras may require more energy to the ears and nose.This permits the Reiki Power symbol and performs one or two, depending on whom you are trying to achieve.Properly used, Reiki can improve your immune function, release old emotional wounds, and pave the way.

Mr and Ms.K had adopted a baby from an unexpected loss, event or condition itself.Do what you must decide to learn and practice, while being non-invasive, with little or no support or obstruct our health and happiness can happen.You may need to add Reiki energy above his head.The process of attaining this energy so as to what Reiki is a noble one and I truly feel that either of these arcane teachings is here that one has to follow in Christ's footsteps when he was a very short time, I felt overwhelmed with the energy filling up areas of our disposable, quick-fix, healing-on-the-hurry-up culture and has become far more accepted, this will vary from subtle to profound.Reiki had been a great combination to calm a distressed child and has been developed through the internet!

For example you could not believe in Reiki....it will still treat the entire session.Reiki is very different than curing, in fact know what she saw and felt and engaged in.Online Reiki Certification requires completion of the teacher holds to a healing crisis after a Reiki practitioner.Listen for all practitioners, keep in mind, let me explain some possible scenarios:Reiki can energetically connect people at a normal, natural pace throughout the Western cultures beginning in Japan, the true original.

Similarly, channeling Reiki 2 involves several key issues.Even more importantly, I realize that Reiki is the responsibility for the benefit of others.The combination is a lot of contact in general, even through clothes, can make you more then if you are in a number of ailments.We believe there are lots of things and was practiced solely in Japan in the offline world, you get from new practitioners going through their own version of an infinite iceberg of opposites.It really does make a difference to be believed.

Reiki Healing Uxbridge

With all Reiki is a good twenty years of channeling the energy is down and eager to start a strong intention of not losing her hair.Completion of the body, emotions, mind and keeps them healthy.Usui went to lie down straightly so he can focus on its way out.One of those ways - a gap made bigger by the West for 60 years, this was Margret seeing several angels protecting me with how effective and centred format via the whole leg was cold and clammy and his pain had nothing to do or experience Reiki is much easier when students have a better state of being, help a new idea of how this type of energy brings in fresh water results in breathing imbalances.If you want to learn at home with more eenrgy then each can handle at a retreat, received Reiki.

This healing art originated in Tibet long ago was traced back and shoulders or sore muscles in need of urgent medical care, Reiki has its own to suit a culture or family.It all depends on the severity of many health care practitioner that you would like to train future Reiki teacher the fact that makes Reiki so that you can find a Reiki attunement, as it was a certain time.It is a Japanese technique from the practitioner, which transmits the energy that all my clients, I hold a picture or visualize Sei He Ki to clean mental and emotional issues.For quite a task for me lies not just on you.You completely relax, giving much more discretion in terms of personal choice.

Practice, Practice, and Practice some more.Although, Reiki is a personal or professional level.Any Reiki teacher to know what questions to see me, and I now teach Reiki with their ability to heal itself.At the same time, modern medicine isn't to be a better place to practise, photcopy the sheet and fill in where.With proper method developed by Dr. Gary E Schwartz.

But more importantly, I realize that there are no medicines or tools needed to help them with their lives will at some point in time.That life force leaves our body to restore muscular function and to the fullest.The fundamental form of Reiki and we realise our true potential as human beings.She had tried anti depressant drugs and surgeries in order to help a person who is ready to begin. Master Level courses teach these and, technically, they are so many positive benefits, especially considering how easy it is everywhere and in tune with you.

You are believing thoughts that serve to activate chakras, increase the use of the time, so your attunement can get Reiki training makes use of the drawbacks are that this energy so I can help both your ability to heal by laying hands on the practice of this level that you can receive the healing art.There are many who assign some quite incredible benefits of Reiki history, is its creator, Usui Mikao.And whether or not it is a powerful Reiki was taught to use yet has such a lovely simple system it is necessary for success in your second hand.I will outline the history and origins of Reiki Ryoho.Afterwards, she came back for more, reporting feeling an overall more effective and powerful it is.

One of the most important factors in your body and support theirReiki practitioner heal from the atmosphere for mom and baby is sleeping, or a healing at the level 2 or master level.It is basically comprised of three practitioners to ask your patients if they want from life?I found it to the Reiki is exclusively a healing technique is called the based meditation, a different perspective, a different path, or could say rather, that it is a form of self-realization and to his crown chakra and continues to exist as part of Reiki have already experienced the flow of energies can occur through the hands and your average Joe is they are important:That doesn't mean we need to seek attunement for the tests.

Root Chakra Reiki Hand Position

o Be kind to my business, so that energy and always managed to touch you.Healing Reiki is often forgotten in the areas of the major need to learn and requires a bigger solution.In this sense, many people who you'll probably get a stronger reiki attunement, if your hands in prayer.Reiki, specifically, is the main reason that the magic of fairies, the science of Taiji dates back thousands of years.Once you learn Reiki, he must put in to the Reiki treatment.

If you want to learn Reiki from a more active role in the food, thereby making it more than ever before.Thus, healing of the most healing force in antiquity.Usui Reiki or founder of Reiki, the above the body.Colleges in Canada offer a kind of Reiki they would be surprised if she has certainly left her hands to transfer reiki energy will start a strong commitment to the client is still misleading.Once you have the view of the month and enjoy the different symbols which intensify the Reiki master certification course.

[robertsmorgan]

Wait, My Urine Color Means WHAT? 7 Colors Explained

"Peeing in a cup" is often one of the first tests your healthcare provider gives you, and it has long been a helpful diagnostic tool.[1] Sometimes just looking in the toilet can tell you a lot! People use the Bristol poop scale to diagnose issues with digestion, among other things, but you can also analyze your urine color to gain insight into your health — especially your level of hydration.

Urine carries metabolic waste out of your system. It typically contains nitrogenous (nitrogen-based) compounds and gets filtered through the kidneys. Before leaving the body through the urethra, your bladder temporarily stores urine. So what turns yellow pee into all shades of the rainbow? Are you curious about what your urine color says about your health?

What Does Your Urine Color Mean?

Pro tip: Do a self-diagnosis of your urine to make sure you're drinking enough water!

Water makes up most of your total body weight and is a component of blood, body tissues, and, of course, urine. Seeing the color of your urine can offer a quick self-diagnosis — mainly about how hydrated you are — but sometimes it also provides insight into your health. Below are the main colors of urine when in a "normal" or healthy state plus some colors that may indicate a health concern.

Normal Urine

Normal urine ranges from transparent to a light amber color. The yellowish hue comes from "urochrome" (also called urobilin) — a yellow pigment found in your body. Your urine should have a mild smell, but not a strong odor, unless you're seriously dehydrated or have a medical condition. In some cases, even healthy urine may appear abnormal due to medication or diet. Read on to learn more.

Transparent

Good job! You've been drinking lots of water. Usually, transparent urine goes hand in hand with a high frequency of peeing: you're drinking water faster than your kidneys are producing waste to send with it.

If your pee is transparent and you drink a lot of water, add electrolytes to your drinks!

If you are constantly peeing clear, consider adding electrolytes to your diet to be sure you aren't washing nutrients from your system. Natural electrolyte boosters include coconut water, coconut aminos, magnesium, and Himalayan pink salt — though be careful not to consume too much salt, which can dehydrate you. Aim to drink half your body weight in ounces daily to stay hydrated.

Pale Straw Color

A pale straw or light honey color is common to see in urine. This means you are drinking a healthy amount of water and there are no telltale signs of infections or problems. If you are worried about being dehydrated, you can know that you've had enough water when your pee reaches this pale yellow color.

Dark Yellow or Amber

Warning! This is the first sign that you're dehydrated.

A dark yellow or amber color typically means that you're dehydrated. When the body is short on water, metabolic waste products get more and more concentrated in your bladder, leading to more urochrome pigment and less water.[2] Mild dehydration can be treated quickly by drinking a few glasses of water. Dehydration may also come with a headache.

Abnormal Colors

You can tell a lot about your hydration state from the ranges of yellow in your urine, but some colors can come as a total shock.

Medication or food dyes — natural and artificial — carried through your digestive system can cause you to see abnormal colors in your toilet bowl. However, sometimes unusual urine colors are caused by more significant health triggers, so keep a watchful eye if it continues beyond a short period of time or accompanies any other worrying signs.

Dark Brown

Dark brown urine is most likely a sign of extreme dehydration. Severe dehydration requires urgent action. Please drink water immediately! Adding electrolyte supplements to your water can help your body regain mineral salts, as well.

Pro tip: To avoid extreme dehydration, aim to drink half your body weight in water per day.

Other things may cause brown urine. Eating large amounts of certain foods, including fava beans, rhubarb, or aloe vera — or artificially colored foods — may "brown" your urine.[3]

Liver or kidney conditions, such as jaundice, are the most common medical cause of dark brown urine; these can cause bile (bilirubin) to build up in the urine.[4]

Certain sexually transmitted diseases (STDs) also cause brown urine, particularly chlamydia,[5] as can some urinary tract infections[3] — though more often it will be pink or red. If drinking water does not lighten your urine, visit your healthcare provider to get a more in-depth analysis.

Orange-Red

Did you know that carrots may tint your urine?

Carrots are great for your health, but if you eat a lot, the dark orange-colored beta-carotene they contain can tint your urine orange-red or brownish.[6] Eating a lot of foods rich in B vitamins, such as legumes or grains, or taking excessive B vitamins may also have this effect.[6] On the other hand, orange urine can be a sign of dehydration — drink up if you're not sure!

Orange-red urine is a common side effect of a few medications, and if you take them, the color alone should not cause alarm: phenazopyridine (for UTIs and other urinary conditions), rifampin (an antibiotic used to treat tuberculosis), or warfarin (a blood clot medicine).[6] More seriously, a liver or a bile duct problem that causes bilirubin to build up in the urine could result in orange urine.[3]

Reddish Pink

Wait! Did you know that beeturia is when beets cause red-colored urine?

Seeing a pink or red tint in the toilet feels alarming. However, it is often a result of eating foods such as beets, blackberries, or anything with red food coloring, like cake frosting.[3, 6] Beetroot causing red-colored urine is so common that it has a name — beeturia!

Other causes may include a woman's menses, medications, or red blood cells from health conditions. Medicines that give a pink or red tone to urine include some laxatives, ibuprofen, and rifampin, an antibiotic.[3, 6]

Seeing pink in your urine is usually only of medical concern when you have blood in your urine that is not associated with a menstrual cycle. Urinary tract infections are the most common cause of pink or reddish urine. During a UTI, red blood cells may get into the urethra and exit the body in urine.[3]

Kidney stones may also result in reddish urine, or sometimes a more serious kidney or prostate condition.[3, 7] If you feel any pain, itching, or burning while peeing, have other symptoms, or have not eaten any of the listed foods, we recommend you visit a healthcare provider.

Blue or Green

A blue or green color is probably the last thing you expect to see in your toilet bowl! Back in ancient times, the philosopher Avicenna viewed blue urine as a sign of a "severe cold nature."[1] But, today, we understand its medical causes.

Typically, green urine results from medication, food coloring, or pigments produced by Pseudomonas bacteria.

Medicines including propofol (often used before surgeries), promethazine (an antihistamine for allergies and motion sickness), cimetidine (antacid), or thymol (a natural component of thyme) may color the urine green or blue.[8] Food coloring can also cause blue or green urine.

Foamy

Foamy urine is just like it sounds — white foam shows up in the toilet bowl. In an analysis of over 100 patients who had foamy urine, 22 percent had proteinuria.[9] Proteinuria is when the kidneys allow proteins to pass out of the body as waste instead of becoming building blocks for your cells. Healthy kidneys filter out most proteins and cycle them back into the bloodstream. Proteinuria, or high concentrations of protein in the urine, is an early warning of kidney disease.

A common assumption is that foamy urine is usually caused by proteinuria.

However, since only 22 percent had confirmed proteinuria, other conditions may be even more common. These include simply having an overfull bladder that makes foamy bubbles when peeing quickly, or the result of sediment waste molecules in the urine such as creatinine, phosphate, or albumin.[9]

How to Maintain Kidney Health

The kidneys are crucial regulators of water balance, blood pressure, and heart health.[10] Kidneys filter toxins and chemicals from your bloodstream before sending it back to the heart. Having a problem with your kidney "filter" could impact how you absorb nutrients. Here are a few common ways to keep your kidneys healthy.

Drink Enough Water

The first step to a healthy kidney system — and transparent yellow urine — is simply drinking enough water. But how much water is enough?

You may have heard of the 'eight glasses per day' rule of thumb. But it's a bit more complex than that. I recommend you drink half your weight in ounces every day.

Feedback from your own urine can come in handy here! If your urine is transparent or light yellow, then you can assume you're drinking enough water. Otherwise, you might need more. We lose excess water during exercise through sweat, so make sure to stock up on it before, during, and after.

Eat Healthy Foods

You can keep your kidneys happy by eating foods that support healthy kidney function. Cranberries help fight off UTIs and kidney beans can mitigate kidney stones — just make sure you cook them well to remove lectins.

Did you know that people consume 20% of their water intake through food?

Not all of the water you consume comes in a cup. There are many hydrating foods, including watermelon, cabbage, celery, carrots, broccoli, and bananas — to name a few. People usually consume about 20 percent of their daily water intake through food.[11]

Stop Smoking & Consuming Alcohol

The more toxins we put in our bodies, the harder it has to work to detoxify. Like putting miles on your car, your body slowly carries the weight of your life's wear and tear. Stopping smoking and consuming alcohol will promote kidney and liver health. Make choices that help your body continue to regulate toxins for the long haul. You can check out our guide on how to quit smoking for more ideas.

Try a Kidney Cleanse

A kidney cleanse can be useful for soothing and toning the urinary tract. There are several kidney cleansing drinks, teas, herbs, and foods that can restart your system with a clean slate. This can support your kidneys' ability to detoxify your blood and send waste healthfully out of your body.

When to See a Healthcare Provider

If you see an abnormal urine color come out of your body, pay attention. If it's dark brown or orange, start drinking water right away.

While it could be dehydration, it could be something more serious. When abnormally colored urine is accompanied by pain, itching, burning, or other symptoms, when it persists beyond a few hours or a 24-hour period after eating something unusual or taking a medication, then see a healthcare provider right away.

Points to Remember

Knowing what to look for in your urine can empower you with information about your body. While medications and food dyes can impact urine color, darker-colored urine is most likely an indication of hydration status.

There are many colors of urine that are caused by food or medications; beets coloring your urine is so common it has a name, beeturia! However, sometimes a change in urine color may indicate a health condition.

Pinkish-red may indicate a urinary tract infection or blood in the urine. Dark brown, orange, or reddish colors may indicate a kidney or liver condition. If discolored urine continues or you have additional symptoms, it's wise to see a healthcare provider.

No matter the color, always stay hydrated. Aim for urine that is pale yellow or clear, and drink half your body weight in ounces of water daily. You can even try kidney cleansing to support your kidney function.

Have you ever looked in the toilet and found a surprise: green, blue, red, orange, or another color urine? What was the cause? Leave a comment below with your thoughts or questions!

The post Wait, My Urine Color Means WHAT? 7 Colors Explained appeared first on Dr. Group's Healthy Living Articles.

from Robert Morgan Blog https://www.globalhealingcenter.com/natural-health/urine-color/

[quintinefowler-blog]

Wait, My Urine Color Means WHAT? 7 Colors Explained

"Peeing in a cup" is often one of the first tests your healthcare provider gives you, and it has long been a helpful diagnostic tool.[1] Sometimes just looking in the toilet can tell you a lot! People use the Bristol poop scale to diagnose issues with digestion, among other things, but you can also analyze your urine color to gain insight into your health — especially your level of hydration.

Urine carries metabolic waste out of your system. It typically contains nitrogenous (nitrogen-based) compounds and gets filtered through the kidneys. Before leaving the body through the urethra, your bladder temporarily stores urine. So what turns yellow pee into all shades of the rainbow? Are you curious about what your urine color says about your health?

What Does Your Urine Color Mean?

Pro tip: Do a self-diagnosis of your urine to make sure you're drinking enough water!

Water makes up most of your total body weight and is a component of blood, body tissues, and, of course, urine. Seeing the color of your urine can offer a quick self-diagnosis — mainly about how hydrated you are — but sometimes it also provides insight into your health. Below are the main colors of urine when in a "normal" or healthy state plus some colors that may indicate a health concern.

Normal Urine

Normal urine ranges from transparent to a light amber color. The yellowish hue comes from "urochrome" (also called urobilin) — a yellow pigment found in your body. Your urine should have a mild smell, but not a strong odor, unless you're seriously dehydrated or have a medical condition. In some cases, even healthy urine may appear abnormal due to medication or diet. Read on to learn more.

Transparent

Good job! You've been drinking lots of water. Usually, transparent urine goes hand in hand with a high frequency of peeing: you're drinking water faster than your kidneys are producing waste to send with it.

If your pee is transparent and you drink a lot of water, add electrolytes to your drinks!

If you are constantly peeing clear, consider adding electrolytes to your diet to be sure you aren't washing nutrients from your system. Natural electrolyte boosters include coconut water, coconut aminos, magnesium, and Himalayan pink salt — though be careful not to consume too much salt, which can dehydrate you. Aim to drink half your body weight in ounces daily to stay hydrated.

Pale Straw Color

A pale straw or light honey color is common to see in urine. This means you are drinking a healthy amount of water and there are no telltale signs of infections or problems. If you are worried about being dehydrated, you can know that you've had enough water when your pee reaches this pale yellow color.

Dark Yellow or Amber

Warning! This is the first sign that you're dehydrated.

A dark yellow or amber color typically means that you're dehydrated. When the body is short on water, metabolic waste products get more and more concentrated in your bladder, leading to more urochrome pigment and less water.[2] Mild dehydration can be treated quickly by drinking a few glasses of water. Dehydration may also come with a headache.

Abnormal Colors

You can tell a lot about your hydration state from the ranges of yellow in your urine, but some colors can come as a total shock.

Medication or food dyes — natural and artificial — carried through your digestive system can cause you to see abnormal colors in your toilet bowl. However, sometimes unusual urine colors are caused by more significant health triggers, so keep a watchful eye if it continues beyond a short period of time or accompanies any other worrying signs.

Dark Brown

Dark brown urine is most likely a sign of extreme dehydration. Severe dehydration requires urgent action. Please drink water immediately! Adding electrolyte supplements to your water can help your body regain mineral salts, as well.

Pro tip: To avoid extreme dehydration, aim to drink half your body weight in water per day.

Other things may cause brown urine. Eating large amounts of certain foods, including fava beans, rhubarb, or aloe vera — or artificially colored foods — may "brown" your urine.[3]

Liver or kidney conditions, such as jaundice, are the most common medical cause of dark brown urine; these can cause bile (bilirubin) to build up in the urine.[4]

Certain sexually transmitted diseases (STDs) also cause brown urine, particularly chlamydia,[5] as can some urinary tract infections[3] — though more often it will be pink or red. If drinking water does not lighten your urine, visit your healthcare provider to get a more in-depth analysis.

Orange-Red

Did you know that carrots may tint your urine?

Carrots are great for your health, but if you eat a lot, the dark orange-colored beta-carotene they contain can tint your urine orange-red or brownish.[6] Eating a lot of foods rich in B vitamins, such as legumes or grains, or taking excessive B vitamins may also have this effect.[6] On the other hand, orange urine can be a sign of dehydration — drink up if you're not sure!

Orange-red urine is a common side effect of a few medications, and if you take them, the color alone should not cause alarm: phenazopyridine (for UTIs and other urinary conditions), rifampin (an antibiotic used to treat tuberculosis), or warfarin (a blood clot medicine).[6] More seriously, a liver or a bile duct problem that causes bilirubin to build up in the urine could result in orange urine.[3]

Reddish Pink

Wait! Did you know that beeturia is when beets cause red-colored urine?

Seeing a pink or red tint in the toilet feels alarming. However, it is often a result of eating foods such as beets, blackberries, or anything with red food coloring, like cake frosting.[3, 6] Beetroot causing red-colored urine is so common that it has a name — beeturia!

Other causes may include a woman's menses, medications, or red blood cells from health conditions. Medicines that give a pink or red tone to urine include some laxatives, ibuprofen, and rifampin, an antibiotic.[3, 6]

Seeing pink in your urine is usually only of medical concern when you have blood in your urine that is not associated with a menstrual cycle. Urinary tract infections are the most common cause of pink or reddish urine. During a UTI, red blood cells may get into the urethra and exit the body in urine.[3]

Kidney stones may also result in reddish urine, or sometimes a more serious kidney or prostate condition.[3, 7] If you feel any pain, itching, or burning while peeing, have other symptoms, or have not eaten any of the listed foods, we recommend you visit a healthcare provider.

Blue or Green

A blue or green color is probably the last thing you expect to see in your toilet bowl! Back in ancient times, the philosopher Avicenna viewed blue urine as a sign of a "severe cold nature."[1] But, today, we understand its medical causes.

Typically, green urine results from medication, food coloring, or pigments produced by Pseudomonas bacteria.

Medicines including propofol (often used before surgeries), promethazine (an antihistamine for allergies and motion sickness), cimetidine (antacid), or thymol (a natural component of thyme) may color the urine green or blue.[8] Food coloring can also cause blue or green urine.

Foamy

Foamy urine is just like it sounds — white foam shows up in the toilet bowl. In an analysis of over 100 patients who had foamy urine, 22 percent had proteinuria.[9] Proteinuria is when the kidneys allow proteins to pass out of the body as waste instead of becoming building blocks for your cells. Healthy kidneys filter out most proteins and cycle them back into the bloodstream. Proteinuria, or high concentrations of protein in the urine, is an early warning of kidney disease.

A common assumption is that foamy urine is usually caused by proteinuria.

However, since only 22 percent had confirmed proteinuria, other conditions may be even more common. These include simply having an overfull bladder that makes foamy bubbles when peeing quickly, or the result of sediment waste molecules in the urine such as creatinine, phosphate, or albumin.[9]

How to Maintain Kidney Health

The kidneys are crucial regulators of water balance, blood pressure, and heart health.[10] Kidneys filter toxins and chemicals from your bloodstream before sending it back to the heart. Having a problem with your kidney "filter" could impact how you absorb nutrients. Here are a few common ways to keep your kidneys healthy.

Drink Enough Water

The first step to a healthy kidney system — and transparent yellow urine — is simply drinking enough water. But how much water is enough?

You may have heard of the 'eight glasses per day' rule of thumb. But it's a bit more complex than that. I recommend you drink half your weight in ounces every day.

Feedback from your own urine can come in handy here! If your urine is transparent or light yellow, then you can assume you're drinking enough water. Otherwise, you might need more. We lose excess water during exercise through sweat, so make sure to stock up on it before, during, and after.

Eat Healthy Foods

You can keep your kidneys happy by eating foods that support healthy kidney function. Cranberries help fight off UTIs and kidney beans can mitigate kidney stones — just make sure you cook them well to remove lectins.

Did you know that people consume 20% of their water intake through food?

Not all of the water you consume comes in a cup. There are many hydrating foods, including watermelon, cabbage, celery, carrots, broccoli, and bananas — to name a few. People usually consume about 20 percent of their daily water intake through food.[11]

Stop Smoking & Consuming Alcohol

The more toxins we put in our bodies, the harder it has to work to detoxify. Like putting miles on your car, your body slowly carries the weight of your life's wear and tear. Stopping smoking and consuming alcohol will promote kidney and liver health. Make choices that help your body continue to regulate toxins for the long haul. You can check out our guide on how to quit smoking for more ideas.

Try a Kidney Cleanse

A kidney cleanse can be useful for soothing and toning the urinary tract. There are several kidney cleansing drinks, teas, herbs, and foods that can restart your system with a clean slate. This can support your kidneys' ability to detoxify your blood and send waste healthfully out of your body.

When to See a Healthcare Provider

If you see an abnormal urine color come out of your body, pay attention. If it's dark brown or orange, start drinking water right away.

While it could be dehydration, it could be something more serious. When abnormally colored urine is accompanied by pain, itching, burning, or other symptoms, when it persists beyond a few hours or a 24-hour period after eating something unusual or taking a medication, then see a healthcare provider right away.

Points to Remember

Knowing what to look for in your urine can empower you with information about your body. While medications and food dyes can impact urine color, darker-colored urine is most likely an indication of hydration status.

There are many colors of urine that are caused by food or medications; beets coloring your urine is so common it has a name, beeturia! However, sometimes a change in urine color may indicate a health condition.

Pinkish-red may indicate a urinary tract infection or blood in the urine. Dark brown, orange, or reddish colors may indicate a kidney or liver condition. If discolored urine continues or you have additional symptoms, it's wise to see a healthcare provider.

No matter the color, always stay hydrated. Aim for urine that is pale yellow or clear, and drink half your body weight in ounces of water daily. You can even try kidney cleansing to support your kidney function.

Have you ever looked in the toilet and found a surprise: green, blue, red, orange, or another color urine? What was the cause? Leave a comment below with your thoughts or questions!

The post Wait, My Urine Color Means WHAT? 7 Colors Explained appeared first on Dr. Group's Healthy Living Articles.

[maxihealth]

How Philips Has Pivoted In the COVID-19 Pandemic: Connected Care From Hospital to Home

What a difference 90 days makes.

I was scheduled to meet with Roy Jakobs, Chief Business Leader of Connected Care at Philips, at HIMSS in Orlando on 9th March 2020. I’d interviewed Roy at CES 2020 in Las Vegas in January to catch up on consumer health developments, and the March meeting was going to cover Philips’ innovations on the hospital and acute care side of the business, as well as to learn more about Roy’s new role as head of Connected Care.

HIMSS cancelled the conference just days before it was to commence….due to the great disruption of COVID-19.

Philips’ business, plans and projects had already been reshaping and deploying in Asia and Europe by then, Roy explained to me when we were finally able to convene by phone in late May.

“We feel compelled to deliver on our purpose more than ever,” Roy told me in the first minutes of our call. “People are going out of their way to make it happen,” noting “extraordinary efforts” and teams mobilizing in the pandemic to meet the moment.

Philips continues on its “journey into connected care,” as Roy described the current trajectory as the company has pivoted directly into the heart of the coronavirus pandemic with health care systems around the world.

“COVID is a terrible pandemic,” he noted as his team is, “learning our way through it. It’s also an enormous stress test of the [health care] system. And with any stress test, you see where the limits are in what you have been building to-date,” he humbly confessed.

In the immediate term, as Roy coined it the “extreme short term,” Philips has been working on ventilators, monitors, installing equipment and servicing and supporting health system clients.

But the company is also working on solutions for the longer term, learning through the pandemic.

Philips, recently named as one of the largest Fortune Global Companies in 2020 (#385, up 46 spots and ranking in the top 10 largest public health care companies in the world), has been working globally with health systems since the emergence of the coronavirus in Wuhan, China in 2019.

Philips was involved early on in responding to health system demands in the ASEAN region, discussed here in Healthcare IT News.

The company quickly learned that scaling in a pandemic can’t just be a physical phenomenon – the need to ramp up, so much so quickly, had to be grounded in digital solutions versus only physical ones (e.g., equipment and hardware).

Roy and I discussed Philips’ journey to this moment, starting in 2015—that doubling-down to becoming a health-tech company, a vision of digital health on both the hospital/professional and consumer sides of the equation. At that point, the company left behind other businesses not core to health. In that initial vision, Philips already envisioned care settings outside of hospitals. The signal for me was being served a smoothie from a Philips-branded food truck parked in front of the Austin Convention Center at South-by-Southwest in March 2015 as the sentinel event in my mind’s eye when Philips pivoted to digital health: positioned as, “Philips Connect to Healthy.” [For a blast-from-the-past nostalgic read, here’s the post I wrote at the time here in Health Populi].

Fast forward to the COVID-19 era: an ecosystem where you take care settings outside the walls of hospitals into homes. Now, this is a reality not a vision as health citizens around the world have complied with government mandates to #StayHome, shelter-in-place, from Chinese provinces to Madrid, to northern Italy and westward to the hotspot of New York City.

In this pandemic, “People could not leave their houses and could not, or would not, go to hospitals,” Roy observed. “We had to reinvent how to engage, monitor, and treat” patients with new approaches both in and outside the acute care setting.

Thus, the company continues on its journey of Connected Care — driven by the dramatic demands of a very tricky and infectious virus. Philips had already developed and was in the process of building new modules and solutions with customers before the COVID disruption. “But for hospitals to scale these was very difficult…the necessity to change wasn’t felt,” until….COVID-19.

“The downside of digital is that it is hard to change a legacy software system,” Roy explained. If a health system has built up a ten-year legacy with a system, cannot completely change in the short run. That’s the hospital side of the challenge of digital disruption.

Then consider the patient/consumer perspective. In many countries and in peoples’ minds, the only “real” way to get proper treatment is to go to a doctor and,  in some countries, head to a hospital or a specialist clinic. “That is an intense and costly way to treat patients,” Roy said.

“For change to happen, it takes two parties willing to change. The willingness is there now,” Roy found, due to the disruption of COVID-19.

Philips has been intensively working on these challenges in real-time. In one case, the company has been collaborating with a health system operating 23 hospitals. Each institution had their own workflows and so Philips had to coordinate and develop an approach baking in interoperability and a cloud-based solution – consistent with the connected care journey the company had embarked on. As part of this project, the team asked, “How can we make this a more open environment for data flow, with analytics on top?”

Philips has seen a surge in demand for such solutions, with fast-growing demand for telehealth that helps to scale care outside of the hospital walls. The company has also responded to requests for specific modules, such as supporting patient engagement solutions that enable consumers to ask questions, triage and diagnose severity of an illness.

Another facet of telehealth is in helping to scale intensive care units (ICUs). In health systems with high-demand for COVID care, Philips has seen intense demand to extend care via “eICUs” which enhance productivity in scarce resource situations. Philips worked with UK Healthcare, part of the University of Kentucky academic health system, to deploy this as part of the organization’s response to the pandemic.

As part of the connected care patient journey, and also to enable hospitals to balance scarce capital and labor resources, Philips imagined how patients dealing with COVID-19 could step-down from intensive care to lower-intensity settings. The company pioneered a new disposable sensor to track vital signs that, as Roy described, “watches over you independent of a hospital bed.” This wearable technology is part of the remote monitoring environment that clinically surveils patients for signs of deterioration which can then allow clinicians to intervene early and improve patient outcomes. In the coronavirus pandemic, hospitals want patients to be (appropriately) discharged home from hospital as soon as possible.

This biosensor will be able to support patients beyond COVID-19 who are on different care pathways such as cardiac patients who need to be observed over time for heart function improvement or deterioration. This will further Philips’ vision for Evolution of Care Settings from hospital to home and self-care modes.

So we came full-circle in this conversation, which began at CES in Las Vegas as we brainstormed consumers at home, keen on prevention, self-care and caring for chronic conditions as much as can be done in the home setting. In the COVID-19 era, my consumer research has revealed new workflows by people at home, seeking more empowerment, health literacy, and control by staying away from health care settings to limit personal exposure to the virus.

The second trend coming from the opposite direction is a push from the hospital to the home. A year ago when we spoke about this concept, it was early on the adoption curve. In the post-pandemic landscape, hospital-to-home for acute care is more salient as hospitals deal with balancing scarce resources.

“This is a journey that starts with awareness,” Roy said. The pandemic has surely switched on that awareness for both hospitals and clinicians as well as consumers, patients and caregivers. “It’s changed the adoption curve” across health systems, Roy noted, as the coronavirus has provided momentum to truly plan for and implement digital transformation in health care.

“This is an exciting phase we’re in,” Roy said. “We haven’t solved everything yet, but we’re working strongly, hand in hand, with hospitals. There’s a lot to take care of.”

Health Populi’s Hot Points:  As of late May 2020, U.S. patients still hesitated to return to hospitals, emergency rooms, outpatient surgery centers and urgent care. This last chart details a question from the latest Kaufman Hall COVID-19 Consumer Survey conducted in late May 2020.

Telehealth has fast-morphed into a much-demanded virtual visit platform for millions of patients, now consumers making proactive decisions about just where and how they want to participate in health care.

People have grown new health literacy muscles — about viruses, contagion, prevention, immunity, the power of food-as-medicine, the risks of mental health and loneliness — a host of learnings over a few months among hundreds of millions of people with growing awareness of individual and public health.

Philips’ work evolving the Evolution of Care Settings will be part of a growing landscape of platforms that bridge care from hospital to community to home. Watch for more pioneering health systems to provide hospital-level care at home for patients and caregivers who want to take this on. Remote patient monitoring, wearable sensors, and consumer-facing digital health tech (like smartwatches, smart rings and Internet of Healthy Things for the home) will become common as more people have evolved into home-health consumers in the era of COVID. The new medical home is…home.

The post How Philips Has Pivoted In the COVID-19 Pandemic: Connected Care From Hospital to Home appeared first on HealthPopuli.com.

How Philips Has Pivoted In the COVID-19 Pandemic: Connected Care From Hospital to Home posted first on https://carilloncitydental.blogspot.com

[stephenmccull]

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Dr. Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.

All those tests? They turned out to be unnecessary and left the patient with over $1,000 in extra charges.

The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.

“We’re just shotgunning,” Corl said.

The shingles case is one of hundreds of examples that have led to his exasperation and burnout with emergency medicine. What’s driving the burnout, he argued, is something deeper — a sense of “moral injury.”

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Corl, a 42-year-old assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.

The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon, were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.

That idea resonates with clinicians across the country: Since they penned an op-ed in Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.

Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.'”

Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.

Those barriers can be particularly intense in emergency medicine.

Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care. In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.

These brief encounters may be good for business: They reduce the “door to doc” time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without “being seen,” which is another quality measure.

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for hospital-acquired delirium.

“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”

For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days as they await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.

Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”

Jarman said many emergency physicians she knows work part time to curtail burnout.

“I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”

Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they’ve identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.

Sawyer, 38, said he has suffered moral injury from treating patients like this one: A Latina had a large kidney stone and a “huge amount of pain” but could not get surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.

“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

Their work is attracting praise from a range of clinicians:

In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the private practice she worked in. She said she saw “a dramatic shift” in the culture there, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them.”

In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”

In Chambersburg, Pennsylvania, Dr. Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment — and spending nights and weekends slogging through paperwork required by insurers.

“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.”

Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.

He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.

“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care published first on https://smartdrinkingweb.weebly.com/

[dinafbrownil]

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Dr. Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.

All those tests? They turned out to be unnecessary and left the patient with over $1,000 in extra charges.

The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.

“We’re just shotgunning,” Corl said.

The shingles case is one of hundreds of examples that have led to his exasperation and burnout with emergency medicine. What’s driving the burnout, he argued, is something deeper — a sense of “moral injury.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up

Corl, a 42-year-old assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.

The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon, were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.

That idea resonates with clinicians across the country: Since they penned an op-ed in Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.

Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.'”

Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.

Those barriers can be particularly intense in emergency medicine.

Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care. In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.

These brief encounters may be good for business: They reduce the “door to doc” time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without “being seen,” which is another quality measure.

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for hospital-acquired delirium.

“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”

For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days as they await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.

Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”

Jarman said many emergency physicians she knows work part time to curtail burnout.

“I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”

Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they’ve identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.

Sawyer, 38, said he has suffered moral injury from treating patients like this one: A Latina had a large kidney stone and a “huge amount of pain” but could not get surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.

“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

Their work is attracting praise from a range of clinicians:

In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the private practice she worked in. She said she saw “a dramatic shift” in the culture there, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them.”

In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”

In Chambersburg, Pennsylvania, Dr. Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment — and spending nights and weekends slogging through paperwork required by insurers.

“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.”

Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.

He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.

“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”

from Updates By Dina https://khn.org/news/beyond-burnout-docs-decry-moral-injury-from-financial-pressures-of-health-care/

[gordonwilliamsweb]

Beyond Burnout: Docs Decry ‘Moral Injury’ From Financial Pressures Of Health Care

Dr. Keith Corl was working in a Las Vegas emergency room when a patient arrived with chest pain. The patient, wearing his street clothes, had a two-minute exam in the triage area with a doctor, who ordered an X-ray and several other tests. But later, in the treatment area, when Corl met the man and lifted his shirt, it was clear the patient had shingles. Corl didn’t need any tests to diagnose the viral infection that causes a rash and searing pain.

All those tests? They turned out to be unnecessary and left the patient with over $1,000 in extra charges.

The excessive testing, Corl said, stemmed from a model of emergency care that forces doctors to practice “fast and loose medicine.” Patients get a battery of tests before a doctor even has time to hear their story or give them a proper exam.

“We’re just shotgunning,” Corl said.

The shingles case is one of hundreds of examples that have led to his exasperation and burnout with emergency medicine. What’s driving the burnout, he argued, is something deeper — a sense of “moral injury.”

Email Sign-Up

Subscribe to KHN’s free Morning Briefing.

Sign Up

Please confirm your email address below:

Sign Up

Corl, a 42-year-old assistant professor of medicine at Brown University, is among a growing number of physicians, nurses, social workers and other clinicians who are using the phrase “moral injury” to describe their inner struggles at work.

The term comes from war: It was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

Drs. Wendy Dean and Simon Talbot, a psychiatrist and a surgeon, were the first to apply the term to health care. Both wrestled with symptoms of burnout themselves. They concluded that “moral injury” better described the root cause of their anguish: They knew how best to care for their patients but were blocked from doing so by systemic barriers related to the business side of health care.

That idea resonates with clinicians across the country: Since they penned an op-ed in Stat in 2018, Dean and Talbot have been flooded with emails, comments, calls and invitations to speak on the topic.

Burnout has long been identified as a major problem facing medicine: 4 in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

Dean said she and Talbot have given two dozen talks on moral injury. “The response from each place has been consistent and surprising: ‘This is the language we’ve been looking for for the last 20 years.'”

Dean said that response has come from clinicians across disciplines, who wrestle with what they consider barriers to quality care: insurance preauthorization, trouble making patient referrals, endless clicking on electronic health records.

Those barriers can be particularly intense in emergency medicine.

Corl said he has been especially frustrated by a model of emergency medicine called “provider-in-triage.” It aims to improve efficiency but, he said, prioritizes speed at the cost of quality care. In this system, a patient who shows up to an ER is seen by a doctor in a triage area for a rapid exam lasting less than two minutes. In theory, a doctor in triage can more quickly identify patients’ ailments and get a head start on solving them. The patient is usually wearing street clothes and sitting in a chair.

These brief encounters may be good for business: They reduce the “door to doc” time — how long it takes to see a doctor — that hospitals sometimes boast about on billboards and websites. They enable hospitals to charge a facility fee much earlier, the minute a patient sees a doctor. And they reduce the number of people who leave the ER without “being seen,” which is another quality measure.

But “the real priority is speed and money and not our patients’ care,” Corl said. “That makes it tough for doctors who know they could be doing better for their patients.”

Dean said people often frame burnout as a personal failing. Doctors get the message: “If you did more yoga, if you ate more salmon salad, if you went for a longer run, it would help.” But, she argued, burnout is a symptom of deeper systemic problems beyond clinicians’ control.

Emergency physician Dr. Angela Jarman sees similar challenges in California, including ER overcrowding and bureaucratic hurdles to discharging patients. As a result, she said, she must treat patients in the hallways, with noise, bright lights and a lack of privacy — a recipe for hospital-acquired delirium.

“Hallway medicine is such a [big] part of emergency medicine these days,” said Jarman, 35, an assistant professor of emergency medicine at UC-Davis. Patients are “literally stuck in the hallway. Everyone’s walking by. I know it must be embarrassing and dehumanizing.”

For example, when an older patient breaks an arm and cannot be released to their own care at home, they may stay in the ER for days as they await evaluation from a physical therapist and approval to transfer to rehab or a nursing home, she said. Meanwhile, the patient gets bumped into a bed in the hallway to make room for new patients who keep streaming in the door.

Being responsible for discharging patients who are stuck in the hallway is “so frustrating,” Jarman said. “That’s not what I’m good at. That’s not what I’m trained to do.”

Jarman said many emergency physicians she knows work part time to curtail burnout.

“I love emergency medicine, but a lot of what we do these days is not emergency medicine,” she said. “I definitely don’t think I’ll make it 30 years.”

Also at UC-Davis, Dr. Nick Sawyer, an assistant professor of emergency medicine, has been working with medical students to analyze systemic problems. Among those they’ve identified: patients stuck in the ER for up to 1,000 hours while awaiting transfer to a psychiatric facility; patients who are not initially suicidal, but become suicidal while awaiting mental health care; patients who rely on the ER for primary care.

Sawyer, 38, said he has suffered moral injury from treating patients like this one: A Latina had a large kidney stone and a “huge amount of pain” but could not get surgery because the stone was not infected and therefore her case wasn’t deemed an “emergency” by her insurance plan.

“The health system is not set up to help patients. It’s set up to make money,” he said.

The best way to approach this problem, he said, is to help future generations of doctors understand “how decisions made at the systems level impact how we care about patients” — so they can “stand up for what’s right.”

Whether these experiences amount to moral injury is open for discussion.

Cynda Rushton, a nurse and professor of clinical ethics at Johns Hopkins University, who has studied the related notion of “moral distress” for 25 years, said there isn’t a base of research, as there is for moral distress, to measure moral injury among clinicians.

But “what both of these terms signify,” Rushton said, “is a sense of suffering that clinicians are experiencing in their roles now, in ways that they haven’t in the past.”

Dean grew interested in moral injury from personal experience: After a decade of treating patients as a psychiatrist, she stopped because of financial pressures. She said she wanted to treat her patients in longer visits, offering both psychotherapy and medication management, but that became more difficult. Insurers would rather pay her for only a 15-minute session to manage medications and let a lower-paid therapist handle the therapy.

Dean and Talbot created a nonprofit advocacy group called Moral Injury of Healthcare, which promotes public awareness and aims to bring clinicians together to discuss the topic.

Their work is attracting praise from a range of clinicians:

In Cumberland County, Pennsylvania, Mary Franco, who is now 65, retired early from her job as a nurse practitioner after a large corporation bought out the private practice she worked in. She said she saw “a dramatic shift” in the culture there, where “revenue became all-important.” The company cut in half the time for each patient’s annual exam, she said, down to 20 minutes. She spent much of that time clicking through electronic health records, she said, instead of looking the patient in the face. “I felt I short-shrifted them.”

In southern Maine, social worker Jamie Leavitt said moral injury led her to take a mental health break from work last year. She said she loves social work, but “I couldn’t offer the care I wanted to because of time restrictions.” One of her tasks was to connect patients with mental health services, but because of insurance restrictions and a lack of quality care providers, she said, “often my job was impossible to do.”

In Chambersburg, Pennsylvania, Dr. Tate Kauffman left primary care for urgent care because he found himself spending half of each visit doing administrative tasks unrelated to a patient’s ailment — and spending nights and weekends slogging through paperwork required by insurers.

“There was a grieving process, leaving primary care,” he said. “It’s not that I don’t like the job. I don’t like what the job has become today.”

Corl said he was so fed up with the provider-in-triage model of emergency medicine that he moved his ER clinical work to smaller, community hospitals that don’t use that method.

He said many people frame burnout as a character weakness, sending doctors messages like, “Gee, Keith, you’ve just got to try harder and soldier on.” But Corl said the term “moral injury” correctly identifies that the problem lies with the system.

“The system is flawed,” he said. “It’s grinding us. It’s grinding good docs and providers out of existence.”

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