An Imperfect End

This is a post of an Emergency Room Doctor
An imperfect end
Posted by GruntDoc on August 4th, 2007
Frankly, this is a bit gross. I’ll put the post below the fold, and read at your own risk. You’ve been warned.

Removal of a rectal foreign body is simple, really: Locate it, grasp it firmly, break the ’suction’, and pull. Seems simple, and like most seemingly simple tasks it’s harder to accomplish in real life.

The patient of a colleague had just such a complaint, and I willingly agreed to help remove the object, which we had an x-ray of, a common vibrator. On delegation of tasks my colleague would be in charge of the patients’ sedation, and I was on removal duty.
I had all I needed, a plastic and lit vaginal speculum, ring forceps, some nice plastic tubing (for suction relief), and lube.
The patient was suitably sedated, and it was time to proceed. The speculum was inserted, and no foreign body was visible until the anterior abdomen was compressed, and !viola!, it appeared. I saw a small area of man made black color, and the unmistakable edge of a condom on its edge. I carefully grabbed the rim of the condom (at the near-limit of the reach of the ring forceps, probably 8 inches in) and began to hopefully tug.

Hope may well float but condoms just break, and when they do they recoil in both directions with fervor and throw-off anything attached. In this case I protected the team by taking the hit squarely in the face. (This has become something of a topic of conversation in my ED).
No, I wasn’t wearing protection beyond beyond my usual spectacles. I did try another two times to grasp the end of the vibrator with the ring forceps, but could never get enough of a hold to even attempt to break the suction (due to the tapered design of the end of the vibrator) (which design I learned from reading the Internet).

In retrospect, a tenaculum might have allowed a better grip on the vibrator, but given our thorough attempts the surgeon on call took the patient in and the object out.
I washed my face at the sink for a nice, long time, and have thought about getting a tenaculum prior to the next time. Oh, and one of those face mask-shield things.

My comment:
Was the patient in some sort of serious pain? Was there some sort of impaction of feces, immovable obstruction, or other circumstance that posed some dangers? If not, I'm wondering if perhaps giving her instructions to try eating three or four bananas with a few bowls of all bran or oatmeal might be worth a try. From your description of the rambling device, there was no real impediment to it making a normal exit on its' own, particularly if you could apply some lubrication and perhaps even turn the device on.

And I ended it there. Did I play nice or what? Know what happened? My comment got stuck in a spam filter. Is that strange?

Anybody have any notion what the costs might have been? Must be a few grand anyway. Ooops. No, a lot more. They brought in the surgeon. It would have been a few grand if she had expelled it while the ER doctor watched and grabbed it at the end. Sure wish I knew what sort of surgery was performed. I do hope the poor lady is all right. With any luck at all it's just an unobtrusive scar, like an epesiotomy. Who knows? Maybe the surgeon did a tiny tune up while he was at it. What's the tab on that? Let's say in round numbers, $5000. I really don't have any idea. Leave that aside. A trifle.

What about the risk of post-operative infection? There must be some logical reason, some piece of essential information I have missed, that absolutely forced these doctors to cut her open right away in the area with the highest number of potentially pathogenic organisms in the body, instead of allowing nature to take its' course. Here is another question. That Xray. Is it possible that this young lady was unaware that it was a vibrator up there? Was she somehow incapable of describing it? And if so, why on Earth was the Xray needed? Ah, medicine is such a mystery.

Broken Fang

This post is about the upper right canine tooth. The thread "Biting the Dentist" is about a bridge on the lower jaw on the same side. The front tooth on the bridge which recently gave me some trouble that I have included in that thread is the lower canine, right below the tooth which is the subject of this thread.

About three weeks ago, about half of the posterior face of this tooth broke off, a ^ shaped segment which extended up to the gum line. No pain whatsoever attended this incident.

My sole concern was that this tooth takes a lot of ripping and chewing action, and that the structural integrity, the strength of the tooth, was probably sharply reduced, increasing the likelyhood of further breakage.

Perhaps a simple mercury amalgam filling could restore much of the strength of the tooth. I suppose that would cost 1 or 2 hundred dollars in total. Or even a plastic filling which would be more aesthetically pleasing, might also provide some additional structural support. Such a plastic filling would be a two component material, the plastic ingredients and a catalyst.

If I was guessing, I would say that the catalyst might be very similar to that used for an ordinary polyester resin; methyl ethyl ketone peroxide (MEKP) in some reduced strength form.

The trouble is, this dental material is entirely unavailable to me. I not only can't find it, it may be illegal for me to purchase it or use it myself. If I were able to acquire it, I could very likely make a filling that might last six months to ten years, or even for life.

What IS available to me are "temporary" fillings, specifically designed to self-destruct in a very short period of time. They are a one-component product. By comparison to a dentist, they are quite economical. Almost 2g for about three dollars. And if I am not too wasteful, this is enough for four or five fillings. Now, less than $1 per filling is not bad, unless you factor in that these fillings are DESIGNED with deliberately "planned obsolescence" in mind. They WILL begin eroding on the very first day applied.

Let us look at the ingredients of the first one I tried. Zinc Oxide Powder, Calcium Sulfate, Petroleum Jelly, Potassium Alum, Paraffin,Aluminum Sulphate, Aluminum Phosphate, Menthol Crystals, Eugenol, Yellow Iron Oxide.

By weight, the third and fifth most abundant ingredient, PETROLEUM JELLY and PARAFFIN are an oil and a wax. Given several hours to set, this material gives the impression that it is a solid, but in no sense does it confer any structural integrity or strength to the tooth. The engineers of this tooth repair material WANT IT TO BREAK DOWN in less than a week in a typical cavity. In my particular case, the broken portion of the tooth is a load-bearing surface. I can expect to get a day or two out of it, or three if I don't chew. I am fond of chewing.

Even the eugenol is from Oil of Clove, but at least it has an anesthetic purpose.

Now let's look at the other product I found. This one costs an extra thirty cents and is perhaps a smidgen better.
Ingredients: Zinc Oxide B.P., Calcium Sulphate, Synthetic Plasticizer, Potassium Sulphate, Glass Ionomer.

You might get an extra day or two of use out of this one, but it too is DESIGNED TO BREAK DOWN VERY QUICKLY. (This package reads "10x Longer Lasting." Perhaps they mean compared to using chewing gum.)

Now here is the punchline. Both of these products are have the same Brand Name on them. The first one is made in Italy. The second one is made in the USA and packaged in Vietnam. Both carry the same Information phone number. I am not even going to go into the absolute silliness in their directions for use (both products).

Both fillings are complete crap. I will have to make my own, but I will wait until I use these up. (Probably less than a month, even though I will tinker with them a bit to try to extend the product life a bit.)

Lurkers, Whores and Dunces

A few observations. Down through history writing has been a solitary activity. Occasionally you will see a book with two authors. Probably, for every one of these that makes it to print, a dozen fail to make it as far as chapter three.

I have done a certain amount of ghost writing and editing of the works of others over the decades. I have never allowed my name to be coupled to the originator of the work; not on the book jacket, not in the preface, introduction or the acknowledgement. The credit or blame for the work belong to the author. I have done nothing more than landscape the intellectual garden.

I don’t often pair up with the author and help hammer out the lines as they form. It is not because I don’t like the idea of writing cooperatively. I like it very much. It just doesn’t usually turn out to be a painless experience.

When I first started looking at the internet forums I had considerable hope that some dialogues and multi-logues would develop in which the various participants would contribute meaningfully to further understanding. I had not anticipated so much jibber and jabber, so little real structure and meaning.

That is not to say that on a health related forum for example, you can not get useful and practical information. You are just going to have to search through a great deal of material of no value whatsoever. Social chat. Illogic of substantial proportions. And things that are just patently irrefutably wrong.

Of the forums I visited, only one prompted me to stick around for more than a few weeks. Skin Cell Forum. In the past 600 days, I have posted on a wide variety of different subjects in some depth. Close to 1300 posts so far, mostly on general health , treatment and nutrition. Few of my posts were just chat.

Then early this year I thought that maybe if I put up Eureka Ideas Unlimited as a blog, I would increase the scope of the previously local think-tank of collegiate level intellectuals and innovators discussing pressing problems and potential solutions. Almost a year has gone by. Not a single meaningful extended dialogue has developed.

My early notion that forums and blogs might to some extent remedy the solitary element of writing did not pan out. That is probably in part due to my lack of internet skills with tags, meta-tags, attracting search engine spiders, and so on.

Another thing may contribute to the lack of participation, and this is my fault for sure. Although I deal with ideas, problems needing solution, invention or innovation and creativity, and other notions for which the facts are still not entirely known, my opinions are sometimes strongly held, and rather sharply expressed.

I am not always successful in toning this down. For me, a certain amount of debate sharpens the wits and keeps us on our toes. I will sometimes even defend a working hypothesis almost as if it were an entirely self-evident proven fact. My opponent/colleague should go for the throat anytime I do this.

On the good side, the blog is a good place for me to further polish some of the ideas I am currently working on , and is also a convenient place for me to expose the ideas and discoveries that no longer seem speculative, in which the potential for harm is nil. One such solution is the prevention of airborne viral infections like colds and flu, and the reduction of allergic symptoms of exposure to airborne allergens. I could just put the link to it right here. It has a thread on Skin Cell and an essay here as well. But if you are not motivated to look through my archives here, or find the thread in the General Health section on Skin Cell Forum, you would not actually engage in the two minutes or less per day that it would take to protect yourself.

My most active work these days is in less well developed and long standing form. My ideas on alternatives to surgical intervention for cataracts, and in the alternative treatment of periodontal disease and other issues such as immunology and ageing are still in development.

In cataracts, my ideas show early indicators of success. My enthusiasm has grown with these subtle improvements, but not to the point that I am ready to shout from the rooftops that I have the answer. I am simply very encouraged about how things are going.

In immunology and ageing, my ideas also seem to be working well, but my activities in this field have only accelerated recently. The results I have already experienced seem quite favorable. But it is easy to jump to conclusions. I might conceivably have been just as robustly healthy at the age of 66 without the variety of interventions I have been employing. No way to know. Could be just placebo effect or the power of positive thinking. I have deep suspicion and caution about the medical/pharmaceutical/governmental structures which damage our health as often as they enhance it. These things all muddy up the water.

I will only talk about these working solutions to problems when I am confident that their value is unambiguous, and have considered the unexpected social consequences of their use on a large scale.

Almost half a century ago President Eisenhower gave a dire warning about the “military-industrial complex.” (This speech is in my archives here.) It was a notably prescient warning And considering his political party, even though Eisenhower was leaving the Presidency and seemingly had nothing more to lose, considering those volatile political times, the speech was a very courageous one, and deserves another look, particularly in view of present events.

But I would like to paraphrase that one term, military-industrial complex, broadening it to encompass the real scope of the enemy. It should be called the Regulatory-Industrial Complex. The evils go well beyond the military.

The tentacles of this cancer are strangling us just as effectively in the fields of medicine, the pharmaceutical industry, and the insurance business as well. Our legislators pay “lip service” to these industries and are paid for their efforts far better than our ladies of the evening get for oral ministrations to their clients.