cshapiro

You have what is called a Mitral Regurgitation which is a type of Pansystolic Murmur.  In its most common form it is completely harmless but needs prophylaxis against endocarditis by taking antibiotics to keep bacteria from building up on the mitral  valve before dental procedures or any other procedure which leads to bacteria being released into the body.

I'm glad to hear you came through your trip to the dentist OK.

cshapiro

Good luck on the new semester.  I hope you have a good year.  Any chance on letting us know where you are now(City).  I found that the surroundings where I lived a very important part of the experience.  I was in Boston for med school and I really enjoyed the city.  It was a great place to live and study.

I can sympathize with what you are going through.  I lived in Israel for a little over 2 years and it was a big adjustment   when I came back.  Life was so different in North America from Israel in ways to numerous to mention in a post.  Israel today is very different, as well, to what it was like back then.  It was much less American.

[ Last edited by cshapiro at 6-25-2008 11:19 ]

[ Last edited by cshapiro at 6-25-2008 11:20 ]

cshapiro

It's nice to be able to have the option to visit even if you don't get the chance very often.  Sometimes I found I just got so run down I just needed to crash somewhere quiet.  I lived in Boston when I was in med school and mt parent were in Toronto and it was about a 10 hour drive.  I ended up having some issues with my green card application and couldn't visit my parents for three years until I got my green card.  It was kind of a downer but Boston was a great town to go to university in.  I wouldn't call it a college town, it's too big for that  but, university is a very big part of life there and is big enough to have everything.  I did always want to live somewhere that had warm winters though and Boston is as bad as Canada.  University of Florida sounds like a good place to go to school.  Good luck with your  term.

cshapiro

I hope the move is going well.  I saw your post about not having a GP  in your new area.  I do know how hard it is to find any doctor in Ontario.  It's hard to get a GP even in Toronto but I do know a few physicians  in northern Ontario.  If you give me an idea of the general area you will be living in (if you are comfortable to do so) I may be able to refer you to someone in your area.  At least closer than 7-12 hours away.  Do you know how far you will be from Toronto?  If it is much closer I could for sure find you someone here and even get you a choice of a few.

cshapiro

You said it.  When I was a kid(my son just asked me if that was in "the olden days") I was outside all day.  I left the house after breakfast and I didn't come back in until it was getting dark.  I roamed the neighborhood with my friends  on our bikes and we played hockey in the street and came home tired and dirty like a kid should be on a summer day.  We also watched very little TV and had no video games(Gasp!!)

cshapiro

Sodium is one of the basic cations that regulate electric impulses and fluids across various membranes in the body.  Sodium in particular regulates Extracellular Fluid Volume (ECF volume) which affects the central nervous system.  Low sodium is called Hypernatremia and causes ECF volume to expand which in turn prevents the cells of the nervous system from transmitting properly due to a process called Central Pontine Myelinosis.  Mild cases can cause spasms, cramps, weakness and fatigue.  More severe cases can cause loss of limb and motor control, paralysis, coma and even death.

cshapiro

I was just called a nerd in the free chatting thread that asked for favourite web sites (not to mention my own kids) so I figured I would embrace my inner nerdiness unless people start to object.  Generally I get more interest here than from my students.

cshapiro

Actually, Lyme disease is often mistaken for flu.  It usually takes about 30 days for the Erythema Migrans (the telltale rash associated withe Lyme) to manifest and it only appears in 75% of patients.  The other more serious symptoms can take months to show.  Arthritis can take as long as 2 years and some of the other neurological disorders from Lyme disease can take even longer .  In rare cases Lyme disease can cause lymphocytic meningitis which develops into meningoencephilitis, a potentially fatal type of brain swelling.  About 8% of patient who remain untreated for 3 months develop a heart condition called atrioventricular block.  One thing which is important to know is it takes around 48 hours for a tick to transmit the disease, so if you check you body regularly(or better yet have someone else check) after possible exposure  you can prevent the disease all together.

cshapiro

I'm sorry to hear about you illness and I wish you a speedy recovery.  I know Lyme disease can take a long time to recover from fully so please don' t try to push it.  I don't meant to interfere but maybe this can help.  I have seen the latest research on Lyme Disease and the newest recommendation for adults who have had multiple cases of Lyme is to be treated with Doxycycline 100mg twice daily for a full 30 days.  I don't know what you are taking now but most doctors don't prescribe this course of antibiotics and it might be worthwhile to discuss with your doctor.  I hope you don't feel I'm being nosy, I'm just trying to help.
I wish you the best of health.
Good luck.

cshapiro

Amoxicillin is the most commonly prescribed antibiotic for children.  It is actually a chemical that after being metabilised by the liver becomes just plain penicillin.  Before being metabilised it has no antibiotic properties at all.     In fact the reason some people don't respond to a course of Amoxil is because their bodies don't metabilise it properly into penicillin and not due to any resistance to the drug by the bacteria as is commonly assumed.  This is why it is better to prescribe regular penicillin to the elderly and people with liver issues instead of Amoxil.  The advantage of Amoxil is that it can be taken with food, unlike penicillin which has to be taken with an empty stomach, it only needs to be taken twice a day, unlike 4 times for penicillin, and for children penicillin has a vile taste and is almost impossible to get a kid to take it.

cshapiro

I work as a surgeon in Ontario , Canada.  I am Canadian but I went to med school and did my residency in Boston, so I saw a lot of Lyme Disease during my time their.  Apparently, even though Lyme Disease is found all over North America,  over 80% of all cases are in New England.

cshapiro

I'm so sorry about your tragic news.  I too have you and your family in my thoughts and prayers.  It's a terrible tragedy but you see, at least, you're not alone.  I wish I could help more but what I can offer is to answer any questions you might have and offer one small piece of advice.

Yale NH is a great hospital with one of the best cancer centres in the world and you can be assured your family will get excellent care.  But, it sounds like what your son in law (to be) has is, an osteo-sarcoma, a very aggressive and difficult to detect cancer, which is usually only found in later stages, since it really has no outward symptoms and is usually only caught if you, by chance, injure the limb and an astute  doctor picks it up.  The hospital I used to work at, Massachusetts General, has a new type of treatment called, Proton Beam Therapy, which is like radiation therapy and has been very effective at treating sarcomas.  This new treatment is only available at MGH.  Since you are in New England anyway, this might be an option for you.

cshapiro

I wouldn't worry too much about having everything ready in advance.  When my wife and I got married our apartment wasn't ready until the day of our wedding.  We moved in a week later without any furniture and slept in sleeping bags the first night until the bed was delivered the next day.  We got married in Toronto and from there we had to move our stuff from our parents' places to Boston where I was starting med school(not to mention the hassle of getting visas and bringing the stuff across the border since we were both Canadian citizens). We were both students and didn't have any money but we look back at those times as some of the best we ever had.  We were just young and in love.  20 years(almost) and 4 kids later and we are still young and in love and I never take for granted how lucky I am.  It seems people today don't do things that way anymore.  I think today most people prefer to be more established financially and in their careers before getting married.  I also find people are engaged much longer than we were back then.  Congratulations and try to relax and enjoy every minute.  Anything that isn't ready by the wedding you have your whole lives to finish.   I wish you a lifetime filled with happiness.

cshapiro

Welcome back.
The place isn't the same without you.

cshapiro

You are definitely getting the whole college experience, good for you.  I kind of missed out on a lot of it.  
even though I went to university in the US being from Canada I never really understood all the big deal about college football.  In Canada it just isn't a big deal.  Also in Canada the whole greek thing isn't very big and I just ignored it.  Not to mention the school I went to wasn't really a big football place.  I think now I missed out on something.  I do have a soft spot for the Gators though.  I remember going to a friend's house who was really into college football and he made me watch a Penn State, Gators game and it was one of the best games I've ever seen.  This actually was in '85 and the Gators lost but it was a very exciting game.  Hope they won this time.  Keep on getting all you can out of  college.  I was so worried about marks back then and I still didn't get a 4.0 GPA.

cshapiro

I am a surgeon so obviously I work in a hospital.  I work in a pediatric hospital so there is a huge psychiatric and counseling department.  When you deal with kids there has to be support for the families as much as for the patients.  There are also at least 10 full time social workers in the hospital.  The way it works here is that a therapist is assigned to each case and is part of the medical team.  All the therapists spend their mornings working with and meeting with the doctors to discuss the psychological and emotional issues relevant to the case and developing a family support strategy.  They also determined if any follow up support is needed at discharge.  For me this has been a very valuable tool to have the therapists on board from the beginning and have someone to discus the case with.  As far as actual therapy for the physicians in the hospital, there aren't any adult therapists.  The hospital will send us to one of several psychiatrists that they work with if they need an assessment or for therapy where deemed necessary.

Most people don't appreciate the difficulty of therapy.  The mind is so complex and a persons life and experiences, most of which are unknown to you, make everyone's situation complex.  To get someone to trust you with their deepest secrets takes tremendous skill and most of all, to provide the emotional support your patients need is very draining.  It's very easy to miss the smallest detail that, was actually a sign of a major issue and the stakes of being wrong is huge.  I really enjoyed my post grad work.  I loved being able to explore things independently and begin developing my own ideas.  There was also a great dynamic with the other students and the proffs.  We became quite a tight knit group and we all felt part of something important.

Good luck to you in your studies and I'm sure you will be a great therapist one day.

cshapiro

Working in a hospital is a much bigger challenge than PP.  In my  hospital the therapists are all basically on call 24/7.  In a way it's worse than being a doctor.  In theory I can get someone to cover for me but once a therapist had built up a bond with a patient you can't have someone else just take over.   If a patient needs you at 4am then you get paged.   Most hospitals don't have such an integrated approach to counseling but it is more common when dealing with children than adults.  Bedside manner is important with kids and most doctors are grateful for the support when dealing with kids.  I have kicked people out of the pediatric surgery residency program for not being able to relate to kids and work with the various therapists in the hospital.  With adults you can be a surgeon and a jerk (unfortunately) but not with children.  I am grateful for any support I can get in dealing with my patients.  I do get involved with my patients and I was never able to become impersonal and detached.  I personally think the best doctors and therapists are the ones who care, but it does take a toll on you personally.  You never forget the ones you lost.   Last Week I had to tell a 16 year old girl she wouldn't live to see her graduation.  What doctor wouldn't be grateful for help in delivering that news.  I have been a doctor for 14 years now and it is just as hard to give news like that as when I was an intern doing it for the first time.  I am sure you will get lots of satisfaction from being a therapist but it does affect you.  You will be able to do it as long as the satisfaction of helping people outweighs the emotional burden you have to bear.

cshapiro

I live in Canada and the health care system is socialized so, thankfully payment is never an issue for my patients.  Everyone gets free health care and we are not allowed to bill above what the government pays us (not that I would).  I try to give all my patients as much time as they feel they need and I never let anyone feel pressured to hurry up.  As I think I have mentioned before I went to med school and did my residency in Boston at one of the top hospitals in the US.  It was very hard for me to deal with how differently people were treated based on monetary issues.  I was always trying to find way to give access to some of the facilities that weren't available anywhere else, to people who couldn't afford it.

cshapiro

I'm off on Wednesday to NYC until Friday for a medical conference.  My hospital is sending me and aside from my presentation,(The use of lung sufacants in post operative infants less than 30 days of age....BOOORING!) and a couple of talks I need to hear, I basically have a free vacation to NY and I get to take my wife.  There have been a couple of interesting topics in here recently and I have some comments but they will have to wait until after my trip.

cshapiro

I doubt I will be able to catch a play.  We will only really have one free night and I'm looking forward to a nice long romantic(i.e. without kids) dinner with my wife.  It will be nice to have some quiet time together.   If you stand in the spot where your meez is standing I will see you from the window of my hotel but I will be spending a good part of my time at Mount Sinai Hospital all the way up at 98th street.  I will comment on public health care when I get back.  I may have come across as a blind devotee of public health but it's not the case.