Friday, August 31, 2012

Quest Stool Sample, Part 2: Technical difficulties.

It turns out that if you're taking stool samples for an occult blood test, you can't eat red meat three days before sampling. You also can't eat citrus or vitamin C supplements. They screw up the test results. So I had to put the test off for a few days because the day I opened that baby up, ready to go...I had just cooked spaghetti sauce. So no go.

Two or three days pass and I forget...and ate tacos. Somewhat questionable tacos. So I figured that set me back to the beginning too. Then of course, there's what I like to call the "inappropriate pooping times" problem. Because the GI tract waits for no one. And apparently my subconscious likes to hold onto such things for the most convenient time for itself. Which means...if must prepare myself to poop in an odd place, I suppose it's just going to clamp down that little sphincter and suck everything back up inside of me three feet.

You know, I don't normally have pooping problems. Well, no that's a LIE. I developed pooping problems in grad school that are directly tied to my moods and how much fiber I'm eating. They're very predictable. If we need to have a ctest where we are filmed with patient actors, I'm going to poop three times before it happens. Some kind of sympathetic response to prepare for fight or flight. Or clinical exams.

But these are the kinds of problems that shouldn't be a problem when you're trying to collect poop right? You can never have too much when you're actually trying to fitter it away right?

Well, I guess that emotional response is a smart one. Nope, not gonna poop now. Yes...Wait till school when it is impossible to take a sample. Yes....

Fast forward, one week later from my appointment. I'M SORRY DR. G. I'M SO SORRY. I STILL HAVEN'T POOPED FOR YOU.

Ahem. One week later, something magical is happening to my schedule. A three day weekend. If I'm going to poop, I must do it NOW. I've read all the directions, I've been thinking about my container, hell, I've almost pooped in it twice. My mental fortitude has resolved to do this.

But my body still wants no part. She, my GI that is, is going to sabotage me as though her life depended on it. Why she's become a primadonna now, I'll never know. You have pooped in the woods. You have squatted over very questionable toilets and still managed a bowel movement. You have pooped in the Peruvian mountains behind a rock while a bunch of men and caballos where literally passing by into view. And you had to do acrobatics around other poops to complete this task as well! So what's the problem.

Oh yeah, I'm collecting this. Yeah, that makes things different.

But she can't weasel herself out of this now! I'm on guard, round the clock. There is no schedule, no school, no reason to actually be around people, and no pathetic attempts to see if I can hold it.

Lock down isolation. Let's do this.

Thursday, August 23, 2012

Doctors orders #1: Poop in a take out box.

The title says it all. I am not shitting you. It's this ridiculous mess that has inspired me to write in the first place. Pooping in a take out box. I had to mull over whether I was going to write about this for a little while, so you much forgive me for back posting from the past few days. I assure you, the memories are fresh.

Let's start with the why. As in Why did I get into a predicament where my doctor requested that I poop in a take out box?

This last summer, I spent a month in a foreign free clinic working with a population who had basically been discarded by their society. It was a wonderful, learning experience. Naturally, I was exposed to a variety of disease, some expected and some not. The parasites were expected. The tuberculosis, not so much, though I should have known better.

When we were done and it was time to leave the country, we couldn't ignore that the pharmacies would prescribe you just about anything you requested. It just made sense to purchase your albendazole, a parasite medication, right up front, and then take it as it would be prescribed once you got to the states. It certainly was cheaper and saved a considerable amount of time. We've certainly heard enough stories of so and so coming back from X mission trip with a worm that was X inches long. These things need to be addressed.

I hate taking medications and I will not take them if I don't have to. Trust me, I took enough as a child. While on this trip, I looked a doctor nun straight in the eye and nodded my head when she said I had to take ibuprophen for a fever I developed. Then I took it once and never took it again. I LIED TO A NUN. Which seems like a horrible thing to do even though I wasn't raised Catholic.

Let's just say my aversion to needless meds is pretty strong. Saving myself a trip to the doctor was pretty tempting, but it wasn't enough. And I'll admit it, a large part of me felt that it wasn't the right thing to do.

Fast forward to another month later, when I've given my phantom worms some time to develop. I'm not feeling any different, but for my sanity, I need to go to the doctor, and I can't put it off much longer. The truth is, I have lost weight this summer and it wasn't on purpose. The school year is starting, and after some running around I get myself an appointment for a week out. I figure I might as well check in on my cholesterol and thyroid levels too. Family history things. I'm trying to be good this year.

The appointment at the student clinic goes well. The nurse offers me condoms and we have a good laugh that I'm too picky about brands to take them. The doctor comes in and is concerned that I've fasted for 12 hours, which I was told I needed to do if I wanted cholesterol testing by the registrar the day before. Can't make an appointment when there's class, so I fasted all day. I fill her in on all the details since she last saw me. 3 years ago.

It's decided that I need to take 9 stool samples over the course of 3 days. 6 for potential parasites, and three for occult blood. The parasite ones are tubes and the occult blood ones are these little paper cards.

Now I'm only a second year medical student. We're still in the basic science courses. I have never learned how to officially give a stool samples. This is what I was told.

1. Don't poop in the toilet.
2. Don't get urine on your poop.
3. Don't eat rare meat.
4. You are going to need to take samples from the front end and the back end.
5. Please read the directions, because it's really complicated and I know I'm missing something.
6. You might need to put this in the refrigerator but please read the directions to check on that.
7. Here's some extra Popsicle sticks to help you.

Honesty is always good. I like this woman. Though she never said the word poop. I have paraphrased.

So I'm sitting there, getting my arm wrapped up for my blood draw, trying to figure out what the hell I'm going to put my poop in. I think I heard the word cup. A cup? A container? What container is going to be big enough for this and my high fiber diet?! How am I supposed to dispose of that damn thing properly without completely grossing out my roommates? I'm still getting to know one of them. I'm not sure if I want to bring this into our relationship people. It's time to break the silence.

"So uh...I'm just trying to figure out what um...I can put that in. With out...making a mess."

Because my ideas are all out. I have some disposable syrofoam cups and dessert plates from a orientation event I helped out with, but I'm pretty sure those cups will runeth over if I attempt this. And let's say I do manage to make a dainty little lady poop that fits nicely. HOW am I supposed to get to samples from both ends?

My health care provider thinks on this and perks up a little. She's having some kind of eureka moment.

"Do you have take out boxes? You could get some takeout food boxes and go in there".

What. I'm pretty sure my face has done all the talking it needs to. So she continues.

"Yeah! They would work great! Split them in half and catch it in there."

Catch. That word really bothers me for some reason. "Um ok then. I'll figure it out".

Now I really wish I just said screw it, and bought drugs from a third world country. If it wasn't for my damn pride and inherent guilt to do the right thing. I really do want to do the right thing though. If I'm above collecting my poop for medicine, then how can I expect patients to do the same?

So here's the quest.
1. Pick three pooping days in the next week. 

2. Find something to poop on: Do I order crappy Chinese takeout just to poop in the box? Or should I just walk in and ask for empty take out boxes because I need to poop in them? Dare I try the styrofoam plates?

3. Figure out how to poop on it: I'm not sure exactly how this is going to work, because I can't poop in the toilet, and I certainly can't put my hands in there to hold a friggen TAKE OUT BOX if the seat is occupied by my butt. I guess I'm going to have to squat. And squatting toilets suck. Do you know how hard it is to squat and poop at the same time? I do. I became very familiar with this over the summer in a country where half the toilets don't have seats. Or maybe it's the weight lifting training, but my body doesn't relax in the position of peak strain.

4. Store the poop (from both ends!) in the specified containers: Easy enough. They gave me a brown paper bag to cover that up too. And I LEFT that damn bag at the hospital when I got distracted by an acquaintance. They had to call me and tell me I had a bag of meds left behind. So I got to choose between letting them think I'm on 6 different types of medications or give them the visual image that I need to poop in take out boxes. Figured the truth was easier. It makes much less interesting gossip.

5. Return poop to hospital. Final step!

I think...that I don't care if this is for my physical health. This is a challenge of mental resilience ALL the way, baby.

Wednesday, August 22, 2012

Hello. I am a medical student... and I am a horrible patient.

I want to get two things out of the way.

1. I am a medical student.
2. I am a horrible patient.

Allow me to explain. Despite that I am going to be a doctor, I HATE going to the doctor. Pretty hypocritical to me, I know.

However, I do know this. I've learned a long time ago that no one follows a leader who doesn't walk the walk themselves. And even if you think you're capable of doing something, if you haven't actually accomplished it, fat chance in teaching someone else how to do it. You can't pretend imagine what it's like to be in someone else's shoes when you have yet to dance their dance in your own.

Now it's no mystery that patient compliance is a big issue for doctors. Personally I think there are a lot of reasons for this, such as time limitations, but I can't ignore that maybe some of it has to do with coming to someone who really has no idea what you're going through. Or maybe they know exactly what you're going through but they've never found their own way out, and they're a terrible example of how to cope with it. I can't tell you how many times my mom has come home from the doctor to say something like this:

"Yeah, she wants me to loose weight. She's three hundred pounds! Three Hundred Pounds! You should look at this woman. She must be 5 foot 2, carrying 300 pounds. Comes into the room panting and heads straight for the chair. Three hundred pounds."

My mom will go on like this for quite some length, repeating in as many variations as possible that her doctor needs to lose weight. And then feeling nice and vindicated, my mom will completely write off her own weight problems, and her weakening heart. I'm sure there's a term for this in psychology. "Screw you, I'm going home"

My mom really isn't any more difficult than any other patient. At least she feels average to me because I've known her all my life.

What I need to do is obvious. If I want good patients, I need to be a good patient.

That's how this blog is starting. I am going to track my attempts to actually follow a "doctor's good advice", but in the absence of that, I'll just go with what the media claims a "doctor's good advice" is. I figure I've got another 3 years left of medical school to figure this out before I'm actually responsible for human lives, so lets start now.

But first, let's lay some ground rules.

1. I'm allowed to screw up royally. In return, you're allowed to guilt me for it in the comments. Just don't attack other people, I won't tolerate it.

2. I will only add one challenge at a time. Obviously there is a lot we are told to do. Sometimes they even conflict. Wear sunscreen every day. Floss twice a day and brush after every meal. Drink 8 cups of water. Eat 2000 calories. Exercise 5 times a week at at least 30 minutes each. No exercise 3 times a week at 20 minutes each session but make it vigorous. Juggle 15+ prescriptions and take them all at the prescribed times. Let me crank open your vagina with a car jack once every 3 years to look at your cervix, while asking about what your sexual practices are. etc. Look, it's a long list. And I know you are expected to do this all at once. Please understand that if I want to do this right, I can only attempt one thing at a time.

3. I have to adapt the challenges to my own personal health and financial situation. Can I take 15+ prescriptions to figure out what it's like to juggle that load? No. But I could take one of those supremely overloaded vitamin packs and break it up. Can I prick my finger multiple times a day to read my glucose levels? I actually want to. But it's not financially feasible for me at this point in my life. Give it time, and let me wring some of the cheaper challenges out first.

4. I have to maintain my personal work load. Because you know, work never gets in the way of your health goals.

I'm not saying that doctor's orders shouldn't be followed. They all make sense! But I am saying that I'm not sure if managing them is ridiculous or not. And I'm going to find that out.

Wish me luck.