An Emerging Passion: Helping the Bullied.

Bully FistAbout twenty years ago, there was a movement in emergency medicine to screen patients at risk  for domestic violence.  The concept was simple – when a woman presented to the ER with injuries, they would be asked whether the injuries were as a result of domestic violence.   This concept quickly grew to include men who are at risk.  The results were shocking.  All that was needed to find and help these victims was to ask the right question, at the right time, in the right place.

Inspired by this game changer, I have embarked on something similar.  Whenever a child comes in to the ER with an injury, even if the cover story has nothing to do with being bullied, I ask.  I ask “is there a chance your injury was caused by a bully?”.  Even if they say “no”, I take the opportunity and ask them if they have ever been bullied or whether they know of a bully in their school.  I am hoping to do a formal study to quantify my results this year.  However, informally, there are a number of children being bullied at school.  What surprises me is the number of times the child’s parent has no idea.  There is this unspoken code of silence on the play ground.  It seems that most kids won’t speak up if they are being bullied.  This has got to change.  Once a child admits to being bullied, I counsel the parents and child on what to do next.  I give the parent a copy of my report and tell them to go to their child’s school administrator with the copy.  I tell the child that they need to speak to their parents and not keep being bullied silent.

I will keep talking about this on my blog and take the steps necessary to write a formal paper on this topic.  I am so passionate about stopping bullying.  The effects of this assault are permanent and often soul crushing.  We can change this starting with a conversation with our children.

Neglected Blogs.

Noah is our two week old baby boy.

Noah is our two week old baby boy,

The past few weeks have been insanely busy.  In the four week lead up to giving birth to our third child, my spouse was quite under the weather.  If I wasn’t at work, I was helping run the house hold.  Then Noah finally came to be.  Life is no less hectic.  However, I am loving it all because I am alive.

My outlook on life after cancer changed after learning my PET scan was all clear.  I never expected that.  It was the nicest surprise in this cancer journey.  I think the results took away the constant fear that I still had cancer in my body.  Now I am somehow able to better face the possibility that it may come back.  That fear was something that crushed me on a daily basis.  They say after cancer you are more grateful and live a fuller life.  My life was hampered by fear.  But, like I said, the PET scan changed that.  I still remain on the look out for any signs of badness but it doesn’t consume me the way it did before.  This is a great thing because I can give my full attention to the ones that mean the most to me.

Being Jan 1st I feel compelled to talk about the New Year.  This year my better half and I went wild.  We sat in bed trying to stay awake watching Anderson Cooper and Kathy Griffin ring in the new year.  My spouse bailed on me.  I made it but was asleep at 00:15 hrs.  I haven’t made a list of resolutions but do have a few.  I want to be even more environmentally conscious than I already am.  I think it is a good philosophy when trying to raise healthy kids.  My 23 month old and two week old boys are the center of my life right now.  And of course my beautiful spouse.

Although 2014 wasn’t an easy year, it was definitely one full of gifts.  I remain very grateful for all of the goodness in my life right now.  And with that, I will sign off on this much over due post.  May your 2015 be filled with joy, happiness, mindfulness, health, and a dash of luck.

An Injection of Knowledge.

The ER EntranceI just returned from a great conference called the Essentials of Emergency Medicine.  I had not been to a meeting of my peers for some time.  The reasons for this have to do with acquiring hermit-like tendencies as I have gotten older.  I also have a young family that I don’t like to stray too far from.  So, going to the conference was a change of pace for me.  I will admit, the 7:30am start time was a bit rough.  Even the marching bands did not take the weight off of my upper eye-lids.  And, yes, there were marching bands at the conference.

The lectures were brief, a nice length for a room full of people with ADHD.  Emergency physicians often have this disorder, or as I prefer to refer to it, a gift.  The only problem I found was taking in 6 hours of condensed material was a lot like having 6 shots of double espresso.  By the end of the day I was in pre-brain arrest – the mental equivalent of the state one is in just before going into cardiac arrest.  Between lectures there were interludes of jazz and other musical acts in segments called “The effects of music in lowering blood pressure.”  However, when I sit in a chair for too long and listen to a voice droning on and on, no matter how long or how dynamic, my blood pressure tanks and I start to look over the agenda in hopes of finding a talk that I can skip to go have a nap in my hotel room.

The biggest surprise in the conference was the sheer amount of people in attendance.  There must have been over a thousand people there.  I kept thinking about how lucky the Marriott in down town San Francisco was to have so many emergency medical personnel on hand.  I mean, if there was ever an ideal time to drop from a heart attack, November 6th to the 10th would have been it.  I was especially impressed by the quality of speakers.  I would love to aspire to join this group of elite educators.  I actually love giving presentations or performing comedy routines on stage.  What can I say, I like the microphone.  I wish I could be one of the speakers.

Being at the conference was truly a thrill.  I left feeling inspired.  I was in an exceptional mood already as I had recently found out that my PET scan was negative and that I no longer have cancer.  That is an unbeatable high right there.  Now if only my hair would grow back to the way it was before chemotherapy.  Regardless, it was nice to be back, sitting shoulder to shoulder with like-minded others.

Emergency physicians are a unique bunch.  We work hard but we live harder.  We appreciate how precious life is and how it can change in an instant.  We grasp how important it is to seize the day because no day should be wasted.  Sitting in the large conference room, listening to the rock stars in my profession, was a privilege.  Now I am charged up and ready to start my shift tomorrow morning with a new bag of tricks.  I would recommend this conference to anyone who is passionate about emergency medicine.  You won’t be disappointed!

How I dealt with my fear today.

My Little Man. I have a PET scan on Monday. It is my first one since being diagnosed with breast cancer Jan 2012. My tumor was Stage 1, Grade 2, triple positive. I have been having shoulder and hip pain for a few months now so my oncologist arranged the scan. I had an xray on the shoulder which showed an abnormality but my oncologist has been clear that she isn’t worried its cancer. Some blood work she ordered was also all fine, including my ALP (alkaline phosphotase) However, that hasn’t stopped me from going off the deep end. I drive myself crazy with fear. I am just a bundle of fun to be around.

Here is what I did to deal with my fear today.
1) Went to my favorite on-line support group and read some of the inspiring posts by women on the site.

2) Called my mom. She told me to get my head out of my ass and do something positive. She reminded me that I need to exercise more and eat better. So, to show the universe that I am serious about beating cancer, I took my dog out for a speed walk for 30 minutes.

3) I haven’t had an appetite for the past week on account of my fear. After my walk, I had one of my favorite things in the world – pizza. Not the greasy calorie laden kind, I ate two pieces of a thin crust vegetarian pizza.

4)I Escaped myself for a couple of hours by playing with Lego with my 20 month old little man, Nate.

5) I wrote in my journal. Specifically, I wrote down some positive affirmations.

While my hip is throbbing now, my overactive mind has calmed a fair bit. Overall, I am more comfortable and feeling positive. Tomorrow is another day. But for right now, for today, I am OK.

I hope this helps those of you who battle fear.


Time Meeting The Road“Where has the time gone?” is often something I hear.  I did not realize that over a week has passed since I last wrote.  I was doing my paperwork today and wondered why the stack was so large.  Like my blog, I had not attended to my paperwork for ten days.  Time flies and work builds up.  Time always seems incredibly long when doing something undesirable.  For example, patients often tell me how long they waited in the waiting room to get care.  “Do you know that I was in the waiting room for four hours?”.  Usually I just nod and disregard the comment.  Sometimes I will spit out an “oh really?” as though I wasn’t aware.  When someone is particularly obnoxious about it, I ask them “what do you expect?  This is an emergency department!  We deal with emergencies!”.

Sometimes I wonder if patients think the ER is a deli.  “Just take a number and you will be served in order”.  I am at times appalled that people with trivial issues, an ingrown toenail for example (yes some people actually come to the ER for that) will make a fuss when a sick child who has been waiting less than them goes in first.  I suppose I will be getting a stern letter from SPIT (Society of People with Ingrown Toenails) suggesting that I am unsympathetic to people suffering with this ailment.  In the ER, time is both the most important factor and the least important factor.

Time is the most important factor when dealing with dying cells or dying people.  We try to beat time when someone is having a heart attack.  We move fastest for patients who have been waiting the least.  When deciding who is seen next, the time someone has been waiting is not considered as heavily as the seriousness of their problem.  A heart attack may be seen by an ER doctor in minutes whereas a laceration on a finger may wait for hours.  Both issues need attention.  One of them can wait.  Time seems to take forever when we are waiting.

Time goes by quickly when we are living, thriving, enjoying.  My little boy is growing up so fast.  He is 19 months old.  It seems like it was only yesterday that I carried him into the house for the first time.  I remember that moment so vividly.  Time flies by when I am playing with him.  A couple of weeks ago he started to enjoy building with blocks.  I love building with blocks.  The two of us can spend hours creating towers and knocking them down.  Knowing how precious time can be, I take in every minute that I spend with Nate.  My mind is constantly set on “record”.  The “fast forward” button for my mind is collecting dust.  That is a good sign.

Given how much all of the aspects of time play into my day to day, it should not come as a surprise that my watch is one item that I cannot live without.  I want to monitor time closely to make sure I don’t waste a second.

Waiting is a form of torture.

Stop & WaitToday I had my routine follow up appointment at the Cancer Clinic here in town. I finally complained about this shoulder pain that I have had for months now. It seemed to start after reaching down for something in my car one night.  I didn’t think too much about it at the time.  However, as time has passed, the pain has become more obvious, especially with things like putting on my bra, washing my hair, and doing anything that involves raising my arm.  Were I to get my orthopedics text book out, my symptoms would match “rotator cuff tendonitis”.  However, this “rotator cuff tendonitis” is lasting a long time.  Up until today, I Have kept putting off getting an xray because I have been afraid of getting bad results; afraid I would learn my cancer is back.  But today, I succumbed to getting an xray and am now waiting for the results.

As I shook my oncologists hand at the end of my appointment, I asked her to call me if there is bad news. She replied that she would call me either way. It is now several hours later, and still no call. Being the nervous patient that I am, naturally, I am thinking the delay is because the xray is bad and my oncologist is lining up appointments before telling me the news.  That is a common practice when giving a patient bad news. Any normal patient would assume “no news is good news”.  Why can’t I be normal?

I confess that I made the mistake of trying to interpret the xray techs body language after he looked at the images of my shoulder. I got worried when after the first xray, in a thick Filipino accent, he asked “so what is wrong with your shoulder?”. I anxiously replied “why is there something wrong with the xray?”. He lied and said that he doesn’t look at the xrays. That is totally not true.  Most techs can read an xray better than most physicians.  Next, the second and third pictures were taken. After the third picture I couldn’t take it anymore and exclaimed “look, I am a doctor who is scared the shoulder pain is cancer. Do you see anything bad?”. He made this strange facial expression where stuckout his lower lip and nodded “no” in a “I am not supposed to say anything” manner. This is a good sign, isn’t it?  Then, why am I so scared?


Five Types of Pain That Might Be a Medical Emergency.

PainThis is a brief article on five types of pain that should prompt a person to go to an emergency department.

1) Sudden severe pain. Pain that occurs very suddenly and achieves a high intensity almost immediately, should be evaluated in an emergency department. For example, a sudden severe headache might be a sign of a ruptured vessel in your brain.

2) Pain that is accompanied with other worrisome symptoms. Pain that causes a person to loose consciousness, even for a few seconds, should always be evaluated in an ER. Further, pain that is associated with trouble breathing, profuse sweating, nausea, vomiting, or a fever, may mean something serious is going on.

3) Chest pain. There are many life threatening causes of chest pain including a heart attack, pulmonary embolism, aortic dissection, and pneumothorax. As a result, when it comes to chest pain, coming to the ER to get it checked out is a good thing to do. Most ER physicians would far rather deal with a patient who turns out to be a “false alarm” than to deal with a patient who has come in too late and there is little that can be done to help.

4) Chronic pain that suddenly cannot be managed at home and cannot wait for a family doctor’s appointment. Any chronic pain that suddenly becomes so severe that home remedies like icing or heat, over the counter pain medication, or prescribed pain medication, aren’t working, should be evaluated in an emergency department. Pain is something ER physicians are great at helping.

5) New pain that is severe. Any new pain that prevents you from sleeping, working, or doing the normal activities of daily living, might be a sign of a serious problem. For example, abdominal pain that prevents someone from getting out of bed because moving around hurts too much, might be a sign of a surgical emergency such as appendicitis.

Most communities have a health line that people can call if they are unsure whether their symptoms are anything to worry about. If you have a health-line and are unsure if an ER visit is needed, give them a call. Another thing you can do is call your doctor if you have one. Most doctor’s offices have an on-call physician that might be available by phone. If you don’t have a health-line or a doctor, and are experiencing pain, ask yourself if you have one of the five signs of serious pain. If you do, get to an emergency department or call 9-1-1.

Taking care of a blog is like taking care of a plant.

Before I get my hands on it.

Before I get my hands on it.

Taking care of a blog is a lot like taking care of a plant.  If you don’t write often on your blog, or water your plant more than once a month, it will die.  I actually often come up with great ideas for my web page but never remember to write them down.  One of the best pieces of advice I have ever come across, on finishing a written project, is to put empty boxes in a line in a room.  This is how J.K. Rowling is rumored to have written her books on Harry Potter.  I could do the same.  Whenever I have an idea for a piece on breast cancer, for example, I could jot down a few notes and put it in a box labeled “breast cancer”.  Eventually, the box would fill up enough to write an article.  Once this happens, all that needs to occur is putting the related pieces in order and typing the assembled product onto my web page.  Or, take a lot of small steps instead of an equivalent big step.

Maintaining a blog is not as easy as I thought it would be.  Under pressure to keep my content current, I sometimes write when I am not in the mood and churn out questionable material.  There have been several times I have started a post only to delete it when finished for one reason or another.  Perhaps the better thing to do is to sit on a questionable article for a day or two, and return to it with a fresh perspective.  I may decide it is worth keeping.

The other piece of advise I have deals with finding the time to manage one’s blog.  Some days I don’t feel like writing.  However, those days can still be productive if I focus on updating the programs that are relevant to my blog’s running.  I can also do the tedious job of sifting through the comments page and delete the spam.

Boy do I get a lot of spam and it often has to do with buying high end shoes in bulk. I am not sure why my blog is target for selling high end foot wear.  What does living with breast cancer, or being an ER physician, have to do with luxury high heels?  I can assure you that I would never wear a pair to work.  Scrubs and heels.  Nope.  Not a good match.

Perhaps the biggest hurdle I have to climb over is sleep, specifically,  getting a finished piece uploaded before I fall sleep.  You see, my best ideas come to me soon after I climb into bed.  But after a couple of hours, sometimes less, my eye lids start to feel real heavy – like now for example – and I surrender to sleep.  So, I will abruptly sign off here and close by saying short articles are better than no articles.  Hope the tips I gave were useful to you.  Until then, stay well.

Grateful to be home from the eternity shift.

Today was one of those shifts that seem to never end.  Every patient that I picked up required the use of just about every resource I had at my disposal – including my bladder control.  I didn’t feel great physically today thanks to a chest cold that a patient a couple of weeks ago gave me.  That’s ok.  That happens.  Although it seems to happen a heck of a lot more since chemo.  I have to say the highlight of this shift were the many patients who had waited at least five hours to be seen and were still pleasant and understanding.  In my years of practicing emergency medicine, I have noticed that often the patients who complain the most, are the ones that are in the ER for more minor reasons.  I can understand their perspective: “my problem is small and can be seen fast so see me before the dying man in the trauma room”.  These patients are the ones who are probably pissed off that we don’t have a drive through window.  Why not?  Everyone else has a driver through window.  The bank, pharmacy, restaurant all have drive through services, why not ERs?

I am going to stop here tonight because I am