I scored a day off today. Anybody want to hang out?

[Aristus]

I'm going to chill for a while, then go get some breakfast. But I'll take my laptop along so I can keep up with what's happening in the Lounge.

Have a good day, everybody!

[sarge43]

1. You only think you have a day off.

I need some medical info: What's the skinny on a biopsy on the thyroid gland? I have one coming up in the near future. I've never had a biop and wondering which Defcon level should I prep for.

[Aristus]

2. Are they biopsying a thyroid nodule?

If so, chances of cancer are relatively low, aound 5%. It's a pretty easy fix - thyroidectomy. This would give you surgically-induced hypothyroidism, and they'd put you on levothyroxine. Post-surgical monitoring includes a thyroid panel every 12 weeks or so, and any necessary adjustments to your med dosage.

Hope all goes well, sarge...

[sarge43]

3. Thank you.

/on edit/Yup. Thyroid with lumps and bumps on it. Had a CT run last week.

I know the chances of cancer are very low. Whatever, I'll deal accordingly. Needlephobic that I am, I'm more concerned about the biop. What goes on? Knocked out, get a Be Happy pill, tough it out or .... ?

I'll be fine. Only the good check out too soon.

[Aristus]

5. I haven't assisted in any fine-needle aspiration biopsies of the thyroid.

I've sat in on a few liver biopsies, and the liver is a much bigger organ. Those were all done under local anaesthesia, and took about 15 minutes. That's 15 minutes from the time the gastroenterologist walks into the procedure room. Prior to that, prep is about 30-45 minutes, mostly getting the ultrasound rig set up and getting a good image of your liver.

[sarge43]

10. Thanks again.

I suppose I'll get a local to keep me off the ceiling and away we go.

OK, I'll get out of your face and let you enjoy your freebie. I'm going to putter around in the garden. Finally having decent weather.

Sweetie.

[Aristus]

12. Aw, shucks! thanks, sarge!

[Bertha Venation]

16. My liver biopsies terrified me.

I never even got a valium. Local - yes. Psychic help - no. My first biopsy, I was so scared that he refused to put the needle in until I calmed down, and still they didn't give me anything. The second, I knew they wouldn't give me anything so I took two of my own emergency xanax. It helped a little.

I hope you're enjoying your day off!

[Aristus]

17. The optimum place to insert the needle is determined by the location of your liver

during the respiratory cycle. The liver is located just under the diaphragm, and moves inferiorly on inspiration. If you are breathing rapidly due to anxiety, that can make it tough for the provider doing the procedure.

[Bertha Venation]

19. Thanks for telling me why!

The doctor may have explained it at the time, but I clearly didn't retain a memory of his doing so.

[CaliforniaPeggy]

4. Enjoy your day off, my dear Aristus!

How did you manage that? It's a good feeling, that's for sure...

I'll be around for a bit, and then I need my breakfast too.

[Aristus]

6. The company I work for has a large Hispanic patient population, and takes Cinco De Mayo off.

Since that was yesterday, we get today off. Tomorrow, back to the grind...

[CaliforniaPeggy]

7. Ah, very cool!

Yay for holidays!

[magical thyme]

8. I'd love to, but don't have a day off until tomorrow

So I'm chilling right now, until I get ready to leave for my 2nd shift job.

I have 3 part-time jobs right now. One is financial company CSR. One is med lab tech.

Third is growing as much of my own veggies as I can drive myself to do. I should be working on the garden, but I'm still tired and sore from yesterday, so I'll write about it instead. I won't be planting the next round until the new moon anyway, so still have a few days of preparation left. I've got the new strawberry patch area ready to go. Now must get the new onion patch area set, and then the fancy potato area ready. I'll be trying carolas (yum) and Incan purples (???). Meantime, the eggplants popped up on May day, and the beets, orange cauliflower and tomatoes are growing strong under the lights. And at some point I've got to get the blueberry bush area prepped, too.

[Aristus]

9. That sounds really cool!

Your food-chain is one link long!

Keep up the good work.

[magical thyme]

11. Oooh, and I have 2 medical questions for you -- but not free advice

Aren't you glad you have a day off to hang in the Lounge?

1. Why does our ER doc hate me? I most certainly did NOT remove the CRP from his orders yesterday. And I resulted the damn urine test within 15 minutes of the patient peeing. Why does he not try looking up results in the system instead of assuming I didn't result a test for 2 hours? And I'm sorry there was a test that was 1 1/2 hours late last year, but when they put the orders in incorrectly, they don't show up in my pending list or print out for the LAs...so how are we to know there are orders pending in cyberspace somewhere?

2. Why does this ER doc always order both ESRs and C-RPs? They both measure non-specific inflammation, do they not? None of the other doctors orders both. Just the ED doc that hates me...

[Aristus]

13. Both are acute-phase reactants, and, as you said, measure non-specific inflammation.

But sed rate has a larger differential than CRP, which makes narrowing down to the specific underlying cause more difficult, but more likely that you'll get the right one, all other clinical factors being equal. But sed rate is also affected by more medications than CRP. Find out which meds your patient is on, and then select the test you believe will be least affected by your patient's profile.

I can't speak for your ED provider, except to say that emergency medicine can be stressful, irritating, frustrating, and can induce burn-out fairly quickly.

It could be he's also just a grump. When I was a medical assistant, I was always asking myself: "Why are providers such idiots?"

Now that I'm a provider, I'm sure my assistants are saying the same about me.

One has to look at the big picture. For example, last week, I did an evaluation of an upper extremity injury that was flawless; perfect in every way. I feel confident that my supervising physician would have marveled over my keen insight, exam skills, and deductive medical logic. Except for one thing: It was the patient's right arm, and not the left as I had charted. My MA came in with my injury care order, and with masterful diplomacy, asked: "I'm not sure about this. Isn't this supposed to read 'right arm', instead of left?"



I amended the order, and the mistake wouldn't have affected the patient's care in any way. But if the patient had followed up with another provider, it might have caused some confusion...

[fizzgig]

14. biscuits and gravy for breakfast again today?

i just pulled my happy ass out of bed and am desperately trying to pry my eyes open and get my brain defogged.

[Aristus]

15. Yep. It was good!...

I'm going to have to do a blockbuster hour on the elliptical walker to work it off; plus weight-lifting...

[Aristus]

18. Kick.

So I can hang out with the afternoon crowd...