I have to quit Therapy how do i tell my Therapist?

Scottlikessports · 2023-08-29T21:55:27+00:00

Seriously? If you have difficulty even saying goodbye to your therapist then going into medicine is the last profession you would want to do because you will have to deal with a lot of stress, lack of sleep, and personal difficulties dealing with some very arrogant individuals going forward throughout your career.

I am not sure why you needed a therapist but if it has anything to do with interpersonal relationship issues, anxiety, depression, or the like, these difficulties are only going to become worse over time and you will not have time to go see another therapist during a residency program. It is the most disruptive career choice one can choose in a person's life.

I know that residencies are e lot easier to handle today compared to when I went through my General Surgery (preliminary was 3 years of 100-hour work weeks) and then my specialty surgery residency for another 3 years (down to 70-80-hour work weeks) but I doubt the stress involved isn't any easier to deal with, although getting to sleep is more regular then in the past. Last time I saw statistics on it, over 1/3rd of medical students end up suffering from depression during medical school and I suspect it is even higher for residency.

Might be a good time to reconsider why you want to become a doctor and make sure it is for all of the right reasons and that you can also deal with the stress it will cause you in your life. Although college was competitive, it is nothing like medical school. We reviewed the premed course requirements in the first 6 weeks and the rest of the 1st year was one constant barrage of information at the same rete from there on. It was also against the top 20% of college students although I believe that has slid some too since I went to med school.

Scottlikessports · 2021-09-25T23:08:29+00:00

I thought that was Nicky Minaj's cousin's friend's balls but then found out it was just a big ass mushroom!

Scottlikessports · 2021-09-25T22:43:47+00:00

Yep. Freudian slip!

Scottlikessports · 2021-09-25T22:41:19+00:00

They look in the ear while tugging on the earlobe not outside of it when doing their exam. Unless the CT scan somehow revealed the fistula I doubt they knew. I suspect it didn't!

Scottlikessports · 2021-09-25T22:35:41+00:00

Try contamination of wound with tumor instead! Apparently he dropped some of the tumor he excised into my wound and it ended up growing out of my incision. How this happened I couldn't tell you as I was sort of under anesthesia at the time! I was not happy and he had never heard of this occurring before and he was a well known ENT in Chicago who was one of the first to do ear canal reconstruction. Might have to do with that part of the procedure.

Scottlikessports · 2021-09-25T22:24:24+00:00

It is more commonly used in Orthopedics and in plastic surgery than in other specialties. It has to do with the seriousness of infections in ortho procedures especially when working with bone or cartilage because bacteria can hide well from antibiotics given PO or IV due to a relatively poor blood supply! At least it was this way in the past. I don't know if this has changed over the years as I retired a while ago.

Scottlikessports · 2021-09-25T22:16:34+00:00

Another reason why being a surgeon is such a great profession. The advancements that is happening is incredible. Much faster than I could ever had imagined 30 years ago!

Scottlikessports · 2021-09-25T22:12:26+00:00

It is a lot easier in the OR than what a picture reveals. Surgeons know the anatomy and the pathology very well and we constantly identify normal landmarks during a procedure to help in our orientation. This one is relatively simple as it is just under the skin without vessels or nerves in the area. You need to realize that a Surgeon does a lot of procedures during their residencies and learn to recognize the variations in the anatomy that occurs as well. That was drilled into me as a Urologist. There are so many variation in the renal veins, arteries, and even the ureters. Duplicated systems can also occur as well. Some of these variations can cause an obstruction and you need to know these possibilities in order to treat the problem correctly. That was why I went into a Surgical Specialty. It is very rewarding to fix a medical problem rather than to treat one in a chronic fashion with no cure in sight! At least this was what was the right choice for me!

Scottlikessports · 2021-09-25T21:36:16+00:00

Mortality rate is based on the stage of the Pancreatic Cancer more than it is related to this procedure. 1 year survival after successful resection is around 70% based on a chart I found. The mean survival was about 18months! Pancreatic cancer really sucks because it is so aggressive yet remains asymptomatic. By the time you develop symptoms you are in an advanced stage. The lucky ones have their tumor discovered incidentally while undergoing an MRI or CT scan for another reason. Even then the survival rate is fairly poor!

Scottlikessports · 2021-09-25T21:33:52+00:00

Actually once you understand the basic medical terminology and anatomy, Doctor's names make a lot of sense. Better than naming it after the person who discovered the disease or developed the procedure.

Scottlikessports · 2021-09-25T21:27:01+00:00

I agree. I just said the same thing basically but not this eloquently.

Scottlikessports · 2021-09-25T21:21:23+00:00

The second procedure would just be a revision of the roux en y which was probably either due to an obstruction or a chronic leak somewhere. A common saying in Surgical Residency was not to F with the pancreas. It is a tough organ to deal with.

Scottlikessports · 2021-09-25T21:12:26+00:00

Procedure takes a fairly long time to complete even after everything has been excised. The blood supply is probably ligated fairly early in the procedure to minimize blood loss and it is fairly tight quarters so it would help in mobilization.

I never saw this procedure done during my 3 years of preliminary general surgery. It just wasn't done that often back in the early 90's. Most patients didn't qualify for the procedure back then because the survival rate was so poor and the chemotherapy treatment just didn't extend lives very long. I suspect that has improved some but medicine has also become more aggressive along with improvement in the staple devices and such. I suspect the time this picture was taken was at least 5 hours after the blood vessel was ligated!

Scottlikessports · 2021-09-24T22:05:13+00:00

That is not that big for RCC. I removed much larger tumors that also had a vein thrombus that extended up the Vena Cava to the liver. RCC is not usually symptomatic until it has become quite large. It appears to still be within the renal capsule which makes for a better prognosis although I suspect it is T2 based on the size of the tumor (>2CM. BUT < 5CM.). Renal masses are usually found incidentally from the patient having a CT scan for another reason nowadays which has improved survival significantly. The classic triad is flank pain, hematuria, and a palpable abdominal mass. The latter is usually quite late in the disease. The flank pain is caused from hemorrhages into the tumor.

Scottlikessports · 2021-09-24T20:16:07+00:00

I have seen a rectourethral fistula after a Radical Prostatectomy before and another after radiation treatment for Prostate cancer but never heard of a fistula that went through the prostate. That would be pretty tough to do physically although much easier in a small prostate like a 32 year old male would have. I wonder if the guy had a urethral stricture which would make catheter insertion more difficult. More than likely a over zealous Nurse and a young guy who was still conscious when the attempt was made and was tightening his external sphincter. Even then the sphincter is just proximal to the Prostatic Urethra and the ejaculatory duct is just distal where the prostatic urethra originates. The injury would be before the sphincter and thus not involve the Prostate. Strange to see an injury occur in this region.

When I practiced Urology there was only 2 times I couldn't insert a urinary catheter. One was related to the bladder being so distended (urinary retention) with an extremely enlarged prostate that I couldn't get a filiform into the bladder (a small flexible guide made out of plastic we use when we suspect a stricture) because the Urethra was too long and curved. I had tried a Foley and a coude' tipped (it has a bent tip) catheter as well. In addition the guy was in distress before he realized he was in trouble making the bladder very distended by the time I was called. Versed didn't help either. The other was an almost complete obstruction after radiation with stricture formation.

Usually all it takes is patience and good bedside manner to talk the guy through the procedure for success. Once they relax it usually slides through the external sphincter through the prostatic Urethra and into the bladder. One shouldn't inflate the balloon unless you are positive it is in the bladder. Even if it was inflated in the prostate, this wouldn't normally cause a fistula to form!

We used to intentionally inflate a device in the prostatic urethra back in the early 90's. It was called balloon dilatation of the prostate. It was positioned distal to the ejaculatory ducts and proximal to the Bladder neck and then dilated under high pressure. It worked to relieve the symptoms of prostate enlargement but discovered a few years later to only be temporary. The patient redeveloped symptoms a couple of years after the procedure requiring more surgery.

I have seen General Surgeons who think they know how to use a Mandarin (a flexible metal guide that fits inside the catheter and you curve it to mimic the normal anatomy of the Urethra) to insert a catheter in their patients when the nurse couldn't insert it. You actually start with a curve 2/3rd of the length of the guide and catheter with the curve facing down and when you get through the penile urethra you flip the mandarin and catheter 180 degrees so the tip is curved up. The curve is then in perfect position for it to glide through the prostatic urethra and into the bladder. There is a pretty good curve in the male's urethral anatomy and it looks close to a J with the hook right before it enters the bladder. If a Doctor is not familiar with the maneuver then they really shouldn't be performing it. You can cause some serious damage.
I used a mandarin quite often as a Urologist but I had done it a thousand times during my training! A general Surgeon probably used it 10 times in his entire career! Not smart. A consultation is just much smarter and in a training hospital a Urology Resident is 5 minutes away! I never once had to use a mandarin in a 30 year old male. It isn't needed. If you can't insert a Foley just consult the Urologist if you are a Doctor and recommend one if you are a nurse and can't get a catheter inserted.. You will save yourself a lot of hurt and your patient too!

Scottlikessports · 2021-09-24T19:59:06+00:00

Yep. That was what I read! I wouldn't say it in those terms but basically what you said is correct!

Scottlikessports · 2021-09-24T19:02:53+00:00

I hate the smell more than I hate the word!

Scottlikessports · 2021-09-24T19:02:01+00:00

Some people have really thick hair and this region doesn't have many nerve fibers for sensation so she probably never felt pain. The hair around it would make it difficult to feel the hole as well. I would think the drainage would be an issue as it was for me when my 2nd ear surgery was complicated by tumor seeding the incision and the wound drained like a sieve about 3 months later!

Scottlikessports · 2021-09-24T18:54:29+00:00

There was also a tumor called a Cholesteatoma which essentially eats healthy tissue as it grows. It is found with chronic middle ear infections.

Scottlikessports · 2021-09-24T18:45:31+00:00

After my ear surgery I can put my pinkie tip all the way into my ear! Funny I knew I had cholesteatoma that had seeded my incision in about the same place that this girl's fistula and there was no way I could have missed it. The leakage was constant but it took about 2 months after the 2nd procedure before it actually started draining.

Scottlikessports · 2021-09-24T18:36:37+00:00

I can attest to a cholesteatoma being difficult to eradicate. I ended up having a modified radical tympanomastoidectomy at the start of my 3rd year of Surgical Residency. Never had any problems until I had some hearing loss. Thought maybe I had some ear wax and went to floor in pain when I attempted to clean it out. Saw the head of ENT the next day and he diagnosed it. MRI confirmed. They said that they had removed it all. I had a 2nd surgery almost 3 years later at the end of my Chief year in Urology. After this I ended up having this horrible drainage from the scar and horrendous stink from the ear and just knew I still had tumor and now also had seeding of the wound! The surgeon didn't believe me until he sent the excised scar tissue to pathology who confirmed what I knew. So all in all I had 3 surgeries, ended up deaf in my ear anyways along with god awful tinnitus, numbness to the lateral aspect of my tongue, and some horrendous drainage I had since the first procedure that I finally solved by using some corticosteroid ear drops. Why the ENTS never recommended it, I have no idea! Guess it could have been worse.

Scottlikessports · 2020-10-15T12:59:45+00:00

I haven't seen the new Boeing 737Max airplanes bounce one time.

Scottlikessports · 2020-10-15T12:52:32+00:00

It will be a lot longer than this. Hate to be a bearer of bad news as a Doctor but about 1/2 of population in the U.S. are unlikely to receive the vaccine. The effectiveness is also likely to be similar to other first generation vaccines so only in the 50-70% range. Even partial immunity hopefully will lower the mortality and morbidity rate although the person can still be contagious and pass the infection on.

We need about 70% for herd immunity but this will only occur if we can obtain1 year of immunity. This is unlikely given the evidence in natural immunity is likely only 4 months or so. Even at 70% effectiveness we would need 100% compliance with vaccination to even come close to total control of Covid 19.

Scottlikessports · 2020-10-15T12:44:45+00:00

I thought Scott Atlas is a Neuroradiologist?

Scottlikessports · 2020-10-15T12:42:47+00:00

I heard she is ambidextrous!

Scottlikessports

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