Radiology & Gastroenterology

Diagnostic Radiology

I thought that my radiology rotation would involve sitting in a dark basement of a hospital reading x-rays, CT scans, and MRI's. It turned out that although that was part of it, there were also many procedures.

There were procedures that were CT or ultrasound guided, such as, chest tube placements and biopsies. There were procedures done under fluoroscopy (basically like an x-ray in video form) such as lumbar punctures and upper GI studies with small bowel follow throughs. There were also procedures in the Interventional Radiology suite like PICC lines and stenting of AV fistulas for dialysis. I didn't get assist very much on procedures, but I did put a bladder catheter in through the abdomen by myself!

Interesting to me that 6 out of 6 radiologists were male. I asked one of them about this and he gave a very diplomatic answer about how most programs want women in them and how they should do better outreach as a facility. The way he phrased it all made me wonder if he has someone in his life who is, or he is himself, a feminist. I like to think so.

There is so much physics involved in radiology. I never liked physics very much. But I do like when my attendings are excited enough about something to want to teach me about it.

I was also able to hang out with the techs in each department to get a feel for how the testing is done. I'm glad I did this because now I can more accurately prepare my patients for what to expect when I order a test for them. This is especially important for MRIs as they can often cause anxiety in patients.

Hospital had free housing, free gym passes, and access to the physician's lounge where there was free food so those are always nice perks.

Walking from the gym to the house, looking up at the hospital, and feeling the warm summer breeze fills me with so much joy and hope for next year and also for right now.

Do you ever notice that you can tell how healthy your mental space is by how productive you are? I'm finding myself cooking and cleaning more, eating healthier, and happy to stay (almost) as active as Craig.

While out shopping, we spotted this sign...

Guess where I found Craig when I was done.

Gastroenterology

Gastroenterology: the branch of medicine that deals with disorders of the stomach and intestines

So basically, my day consists of rounds, consults, scopes, scopes, and more scopes. Scopes include colonoscopies, EGDs, ERCPs, and endoscopic ultrasounds.

My preceptor likes making "women jokes." Yet, he invested a lot of his time teaching me, not unlike I'm sure he has done with male students, so maybe he is one of these guys with old school views who still manages to respect the work and potential of women. Maybe. Sigh. I get talked down by Craig on a daily basis so that I don't end up ranting back at my boss, but I do manage to throw out the odd comment in my own (and all other women's) defence.

We have a lot of discussions about psychologic issues like patients using up all of their coping reserves or about the body language displayed by family members. 

My preceptor also told me that I was very knowledgable and that he was impressed with Craig too. He said that Saba students must really know their stuff. I like to hear positive feedback about my school. And about myself (don't we all?).

Little town with big churches

Some intense 36 hole mini putt

I had the opportunity to work with a bariatric surgeon (who performs weight loss surgeries) who was extremely open to teaching. I didn't realize my interest in this field until we got talking and I asked him about a million questions. I will share some with you.

Which patients should get this surgery?

Literally anyone who is obese who qualifies for surgery should have it done.

Doesn't it change the way you eat for the rest of your life?

Not as much as you would think. Many symptoms can be prevented by sticking to a diet of lean meats and vegetables which is what we want patients to be eating anyway.

Do you require that patients lose weight before surgery?

We suggest patients lose 10% of their body weight, but it is not a requirement.

What is the Body Mass Index (BMI) required for surgery?

40, usually. 35 with comorbidities (fatty liver, diabetes, etc). I think that in the future we will even go as low as 30 if the patient has diabetes.

What determines whether patients keep off the weight of not?

Patients who have psychological, dietary, and exercise supports in place are much more likely to keep the weight off. We are still figuring out what exactly that entails.

How much weight do patients lose?

50-100% of their excess body fat

Is there a mortality benefit? 

Obesity alone cuts 9-12 years off a patients life. Getting rid of the obesity and also the diseases that come with it absolutely allows you to live longer. That is not even mentioning the morbidity benefit. An obese person will develop diabetes/fatty liver/vascular disease which can lead to heart attacks/strokes/kidney failure/liver failure/vision loss/foot amputations/etc and this surgery can prevent these type of complications from happening.

(Keep in mind that this is paraphrased advice from one doctor, his answers are biased towards the fact that he makes his living off of doing this surgery, and that this blog post is not a substitute for medical advice.)