Sunday, February 26, 2006

Caught the fever

I finally saw Fever Pitch last night.

(I obviously don't get out much, at least not to the movies. Invariably, when I pay to go to the local multicineplexopolis, I end up surrounded by people who either feel the need to narrate the entire goings-on, or who brought their own bag of Doritos from home and proceed to rustle the bag the whole time, or who are keeping their baby up way past its--well, you get the idea. So I gave up going to the movies long ago, and by the time something is out on DVD, usually my short attention span has kicked in and I just sort of forget to. . . .)

Anyway, saw Fever Pitch.


I am sooo Ben.

And the movie made that seem like a bad thing.

But even though I am going to Spring Training next month, I promise not to cavort on-camera for ESPN.

(Of course, if I did, nobody who reads this blog would recognize me anyway. . . .)

Sunday, February 19, 2006


Most of the patients that I deal with are quite pleasant. There are occasional exceptions, of course. Those folks that are a bit cranky often mention a lack of coffee (or breakfast, or whatever) as the reason for their irritability, having followed the pre-op instructions to not eat or drink after midnight.

So why DO we ask you to be NPO? (As this Wikipedia blurb notes, NPO is an abbreviation for the Latin nil per os, meaning nothing by mouth.)

Well, it's like this. When we induce general anesthesia, i.e., put you to sleep, you become instantly and profoundly unconscious. It's not like regular sleep, in which you continue to move, breathe, have reflexes, etc. No, general anesthesia creates a state in which you don't breathe, or have reflexes--and, most importantly, pretty much all muscle tone is lost. This includes the muscle tone to your stomach and esophagus. When that all relaxes, it's pretty easy for anything in your stomach to flow back up toward your mouth. Between your stomach and your mouth is your larynx, or the entrance to your lungs. Since it has lost muscle tone too, and you no longer have any reflexes like coughing, your stomach contents can also flow into your lungs. Small amounts generally don't have much effect, but if you have a lot of stuff in your stomach, or if it's very acidic, it's like pouring hydrochloric acid into your lungs.

Needless to say, your lungs don't like it.

People have died from aspiration pneumonitis. It's not a way I'd want to go.

But what about people who have unplanned procedures, you say--like a car wreck or something? Obviously, they didn't skip breakfast planning to get T-boned in their SUV later.

There are some things we can do as anesthesia providers to minimize the risk of aspiration, and/or to minimize the damage if aspiration does occur. Those types of things are utilized in patients who are at higher risk for aspiration. (Would you like a list? Here's a few: emergency surgeries are at the top, of course, but anyone whose stomach doesn't empty as well as is should, or has higher pressure on or in their stomach, can be at increased risk. Diabetes causes delayed gastric emptying, as does late pregnancy. Obese people have more pressure on their stomach than thin people because of the weight of their adipose tissue, and are at higher risk of aspiration than their thin counterparts. People who have fundamental problems with the connection between their stomach and esophagus--like say, hiatal hernia--are also at increased risk. These are just a few that we worry about.)

Anyway, like I said, there are things that we can do to minimize the risk of aspiration in our patients. But the very best way to keep your stomach contents from going in your lungs during induction of anesthesia is to have nothing in your stomach! And, I might mention, NPO means nothing by mouth. Even chewing gum and smoking cigarettes can stimulate your stomach to start secreting acid as a reflex.

Of course, I can understand when people don't know not to chew gum and so forth, because the pre-op nurses usually just say "don't eat or drink after midnight." But I had one woman tell me she'd had breakfast that morning--thankfully, she was honest--because she said she "just couldn't do that [not eating or drinking] thing." We had to tell her that we "just couldn't do" her surgery, either.

Most patients try really hard to follow the directions they're given. I think some would try harder if they knew the reason why we ask some of the things that we do. When it comes to NPO status, now you know!

Friday, February 17, 2006

Pitchers and catchers report, oh my!

Yippee! Today's the day! Which means spring training and opening day are not far away! (Approximately 13 days 7 hours for the first spring training game, I estimate.) Yay!

In keeping with the new season, a friend asked if I wanted to join a fantasy league.


I have a doctoral degree from Texas A & M University and a master's degree from possibly the top College of Medicine in the country. But I've never played Dungeons and Dragons or any of that stuff, nor paid enough attention to know what fantasy baseball entailed.


I always thought it was anything having to do with my crush on Morgan Ensberg.

So no doubt I will occupy the dungeon, er, cellar, of this new league. But at least now I'll know what it is!

Ain't education wonderful?

Tuesday, February 14, 2006


A long time ago, I mentioned that I would blog about my profession in the offseason. Well, considering that pitchers and catchers report on Friday, I'm thinking that maybe I'd better get a move on.

I am. . . (drum roll please) a certified registered nurse anesthetist, or CRNA.

What the hell is that, you ask?

I realized during my training that most people are clueless about nurse anesthesia. The profession has been called the "best-kept secret in healthcare" (although, so has hospice and chiropractic). Anyway, I can't tell you the number of times that I would introduce myself as a nurse, and yet within 30 seconds have the patient calling me "doc" or referring to me as an anesthesiologist. Allow me to prevent you, dear reader, from making such faux-pas (not to make you feel bad if you get it wrong, we're just all so much more impressed if you get it right). A nurse anesthetist is an advanced practice nurse with clinical training in anesthesiology. He/she holds a master's degree in science, nursing, or nurse anesthesia. An anesthesiologist is an MD or DO who has completed a residency in anesthesiology. Depending upon individual state law and health care facility policy, a nurse anesthetist and an anesthesiologist perform the same function, which is providing anesthesia services for surgery and other procedures.

Not surprisingly, because the professions essentially compete in the same market, there is a lot of conflict between the two. Much controversy has been generated over the roles that each profession envisions for its members. I work within one profession and with the other, so I don't want to really fan those flames here. However, if you are considering which type of anesthesia provider to choose, consider this: there has never been a single study showing a difference in outcome based on type of provider, and, nurse anesthetists are held to the same standard of care as an anesthesiologist (in other words, in a court of law, we get no slack because we're nurses instead of doctors). For more info click here.

This completes the educational portion of our programming. Thank you for your attention.

I'll periodically address health care issue here in this forum, although the focus will remain (as always) on baseball.

As far as healthcare issues, let me start with a simple directive: People, PLEASE! Clean your belly button!

Honestly, how long can it take to run a soapy finger in your dang navel while you're in the shower?!? And yet not a DAY goes by that we don't have people on the O.R. table who have CRUSTS in their umbilicus, with big chunks floating up when the circulating RN does the skin prep. And this is in people who otherwise appear to be fairly hygienic!

If it sounds disgusting, it pretty much is. But worse, it's an infection hazard. So many surgeries are done laparoscopically nowadays, in which small puncture wounds allow passage of specially built cameras and instruments. These surgeries allow quicker recuperation with less pain, and have basically made it possible for many procedures to be done on an outpatient basis, which before might have involved lengthy hospital stays. However, where is the first puncture wound made? Right through your navel. If stuff has been fermenting in there for months or years, there is only so much a skin prep can accomplish as far as infection prevention.

So break out the soap (or the SOS pads, if necessary) and scrub away! Your navel thanks you, as do I.

Thursday, February 09, 2006


Two hours.

That's how long I waited to get Brad Ausmus', Jason Lane's, and Phil Garner's autographs on my World Series ticket stub.

Not bad, I suppose. A few crazy people were in line at 8:30 a.m.

As in, you know, this morning.

So I guess I'm not quite the freak of a fan that I was afraid I was. That's good to know. I actually almost bailed a couple of times, as listening to the 20-somethings in front of me grew tiresome ("oh and I so love Brandon Backe and my cousin knows this guy who played against him in a tournament in high school and said he's cool and he's always been athletic and really a good baseball player and omigod he's so cute and he's the only one who's not married and I'm so going to fan fest this weekend to get his autograph and we're camping out or at least getting there at 4 in the morning to get in line and it's going to be cold but it'll be soo fun and so worth it because he's so cute and I can't hardly wait and I don't know if I'll be able to sleep but that's okay because we're getting there early anyway and he's soo cute. . . .").

Two hours of that, people.

Lord I'm old.

Two hours of waiting (and listening), culminating in 10 seconds to get the actual signatures. Ausmus first, then Lane, Phil Garner next, then finishing off with Dave Raymond, Brett Dolan (the latter two are Alan Ashby's replacements for road radio broadcasts) and finally Milo Hamilton. Ten seconds. Obviously, not a lot of time, and given that this was the last stop on the Winter Caravan (which has been going on for 9 days), everyone looked a bit tired.

But dude. Are you so tired you can't even look at your fans? Ausmus and Lane never made eye contact with me at all. Lane made eye contact with the 20-somethings (go figure, although I could have told him that they didn't even really know who he was). Phil Garner actually acknowledged my presence, which was appreciated, particularly since he was multi-tasking by participating in a phone interview at the same time.

Two hours. For 10 seconds.

I didn't get any autographs from the last three gentlemen--Raymond and Dolan have just joined the organization, and therefore weren't really a part of the Series, and I decided to hold off on Mr. Hamilton, as I'd like to get some of the other players' signatures on the rather smallish ticket stub first. But I shook their hands, and told the two new guys, "Welcome aboard! Good luck this year--looking forward to listening!" and I told Mr. Hamilton, "Congratulations on the book! Good luck with that!"

I dunno. Maybe the new guys are used to fans fawning over the players, and don't expect someone to say anything to them. Or maybe Raymond and Dolan have caught some of the fallout from the Alan Ashby falling-out. Or maybe they're just new enough to the big-leagues to not be jaded. Whatever--they seemed genuinely surprised and pleased that I extended well-wishes.

And on a totally girly note--they are both soooo cute!

(I may be old. . .er than some people, but I'm not blind or dead. Girlfriend's going to be listening to some radio this year!)

Saturday, February 04, 2006

Dude. I so need a life.

To the tune of "The Monkees:"

Hey, hey, we're the Astros,
You never know where we'll be found.
So you'd better get ready,
We may be comin' to your town.

Woo-hoo! I can hardly wait!

In the meantime, I guess I'll have to be content with the Brawny man (*snort*).

Thursday, February 02, 2006

And now for something completely different

So unlike some people, I am posting something here that I acknowledge is not my creation.

Of course, since it is obviously written by a man, I think the readers would have figured it out pretty quickly.

My poor friend Troy. He went and got hisself sterilized a while back. Routine, yes?


I have never heard of anyone with so many complications from a “simple” vasectomy. Mercy! And it continues. From the sounds of it, the blood supply to one of his ‘nads (the clinical term, of course) has been compromised, causing pain.

You know, sort of like a heart attack causes pain.

He went to see a urologist (the third one, I think?), thus the following missive:


Wanna hear all the fun details? Will I get some guy's
finger up my ass every time I go there? Can't these
guys share notes?

"Well last week when I had my finger up Troy’s ass it
felt kinda like the last prune in the box. You know,
kinda firm, but kinda small?"

But no. Each one has to have his turn in the prune
box. Do you think it's some kind of plan? If they
stick their finger up my ass every time I complain
that my nuts hurt, eventually I'll learn to keep my
mouth shut. We found a cure! Well let me tell you,
if they think that kind of simple-minded bullshit is
gonna work, they're just right. It works just fine for

Speaking of my asshole, when he told me to assume the
position, I told him that I was dealing with a severe
hemorrhoid flare-up right now, but thanks just the

I guess he'd heard that one before, but, sadly, I was
speaking the honest truth.

So this guy's got his finger up my ass and he says,
(everyone, now!) "Does this hurt?" And I said, "I
just TOLD YOU I'm having hemorrhoid problems!" (By the
way, I'm not making any of this up.)

This guy doesn't get it. So he says, "I mean besides
the hemorrhoid pain, do you feel anything else?"

"Anything else?" Listen, when you have a VERY angry
hemorrhoid, and some former collegiate line backer has
his Bum-Phillips-Bluebonnet-Sausage-sized-index-finger-

complete-with-NCAA-championship-ring up your ass,
could rupture my colon, pierce the abdominal wall, and
pin my kidney to my spine and I wouldn't feel any
thing but the fucking hemorrhoid!

But do you think I said that? No, because for once,
my brain was moving faster than my mouth. Possibly
because I had just swallowed my tongue. I quickly
realized that he was content to discuss the matter at
great length without a thought as to removing the
offending finger. The ball was clearly up my court

("up my court"--hee!). So at this point I began to
think that brevity trumped my contribution to
science, so I said,"No."

But I think I'll keep going back to the same doctor.
I think he's onto a cure. The entire time that we
were intimate, I didn't think about the pain in my
nuts! His methods may be crude, but the results are

If nothing else, my pain is a little more bearable if
it brings a smile to you ;)

I must be one sick beeyotch, because this didn't just make me smile, it made me laugh out loud. Bwahahahaha!