Friday, July 31, 2009

Injuries and x-rays

Summer has a lot of injuries, which makes a nice change from cold and flu season, except of coarse for the patient. When should you take your kid to get an x-ray of their injury? General speaking; pin point pain is more likely a fracture whereas pain over an area is most likely not. Wrists are much more likely to be fractured then ankles. Twisted ankles nine times out of ten are not fractured, but pin point wrist pain 9 times out of ten is a fracture. If your child can walk on their twisted ankle it is most likely not broken. Twisted ankles hurt below the lateral malleolous, the bone on the outside of the ankle. Pain over the bone or further up the leg is more concerning for a fracture. Most sprains should be improving in 2-3 days, if they are not please come get an x-ray. I have seen recently dislocations and fractures that are 2 weeks old. It's much easier to treat those early on and cheaper to boot.

We treat fractures in the acute setting most of the time with a splint. We don't cast right away. Most of the time there is swelling within the first few days of the injury. The swelling needs to subside before a cast is placed.
The initial treatment for any injury should be ice and ibuprofen and compression if available. A fracture has to heel on its own, the cast is simply there to hold the bone in place while it repairs.

Saturday, July 25, 2009

Thoughts, doctors and patients

I was encourage by a friend today to blog about my current situation. I was diagnosed on pathology, meaning on examination of the tissue, after my thyroglossal duct cyst removal with papillary carcinoma. Thyroid cancer. I have since had a partial neck dissection and removal of my thyroid. I had 2 lymph nodes with cancer involvement.

People ask me if it is better or worse to be a doctor and go through this; my answer is both. I see a lot of bad things happen to people, it's just the nature of the job. I figure, pessimistically of coarse, that bad things happen to everyone. So when the call came my first thought was "well this is my bad thing", but then my next thought is "wait, that's cancer!". When I went to have an ultrasound of my neck to see if there was anything more involvement then the tissue already removed, the instant I saw the big lymph node on the screen, I started to get scared. When the endocrinologist who did the procedure looked at tissue from the lymph node and declared it thyroid tissue, everyone in the room knew that it was cancer, she didn't have to say it, there is no other reason for thyroid tissue to be in a lymph node other then cancer. My family kept saying "so when you get the results back you'll know" While it's true that we were waiting for official results from the pathologist, I knew it wasn't going to change anything. That's the problem with being a doctor, you can't shield the patient.

The good part is while it still is scary that I have thyroid cancer, it could be a lot worse. Not all cancers are created equal, some are a lllllooooottttt worse then others. Papillary carcinoma, as far as things go, is really on the good side of things. It's hard to explain to those around me that "I'm going to be fine" really means "I'm going to be fine". I say that with all of the medical statistics behind me. Papillary carcinoma has a 99% 20 year survival rate. That is fantastic. I will still have to constantly be checked to see if it is recurring, but really I'm going to be fine. I know that but those around me don't necessarily understand it and look at me like I'm dying.

Still it was very helpful when a college shared his personal experience with a different type of cancer, he didn't offer any advise, just shared. It's hard not to know what I want people to say and I'm sure it's hard to not know what to say.