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wathe

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Posts posted by wathe

  1. 5 hours ago, Laura Corin said:

    Do you think that some of this comes from the international movement and education of doctors? I believe all those pronunciations are common in different countries.  For example, in the UK I grew up saying CERvical and ECS'ma, but I  think cerVIcal is common in the US.

    Historically maybe?  I think these special doctor pronunciations originally came about from historical British influence in medical culture.   But mostly it's just copying one's elders in order to fit in to the medical culture. Canadian-born-and-raised residents and medical students suddenly shift to these pronunciations. (Not everyone does it.  When it happens, though, the transformation is slightly funny to behold, as though putting on a white coat causes it).  Much of medical professional education is informally absorbing the professional culture* - indoctrination, so to speak.

    *ETA - while sleep deprived and ever-competing with peers for that residency spot/fellowship spot/staff position.  Medical education systems can cause some weird behaviours.

     

    • Like 1
  2. 29 minutes ago, Tanaqui said:

    When my mother had breast cancer, at one point she had to be debrided. Which means the dead skin had to be removed, not that the doctor who called me about scheduling this bothered to define the word - I had to guess from context and ask him! But I digress.

    He said "Debrade". The next doctor said "What? No. Debreeeeeed." The third doctor, who actually did the procedure, said "Debride", as in "here comes de bride".

    At this point my mother and I were keeping a tally, and I finally looked it up. The second pronunciation is considered standard, however, the third is more widespread in the speech of the only people who use the word, doctors, who are by definition well-educated and usually speaking somewhat carefully when they use it as well. (No idea where the first came from. That young man gets no cookies. It is exceedingly strange to me that my mother has doctors younger than I am.)

    But this is how language changes. Debreed is the pronunciation we got from French, but it's such a niche word it's not surprising that many people use a "spelling pronunciation" instead. Within a generation or perhaps two, I bet the dictionaries will all be updating their entries.

    Next, I'll tell you about my favorite rock related word.

    Oh, medicine is full of all kinds of fancy special doctor pronunciations.  It's ridiculous, really. 

    Debride become deBREED.  Centimetre becomes SAWNtimetre.  CERvical vs cerVIcal, umBILicus becomes umbiLICus.  EczEEma becomes ECSema, which then becomes atopic dermatitis..... 🙂

    • Like 1
  3. Mostly medical stuff by patients, especially drug names, which is usually fine, and not a problem as long as I can figure out what they actually mean.

    They say "metro-pole", I say "metoprolol?", they say "yes, that!", and we're good.

    More problematic is when patients pick the wrong medical word altogether when giving a history. It happens a lot.  Either substituting the wrong word (ie an aneurysm is quite a different thing than an embolism, even thought they sound a little alike), or using diagnoses they don't actually have to describe symptoms, or using medical words to mean things that those particular words don't actually mean.  It makes it hard to take an accurate history and can be quite dangerous.  Usually I can figure out what people are trying to tell me by using context (prostate vs prostrate as an obvious example) but sometimes I really can't.  I have to walk the fine line of delicately asking people what they mean in plain language when they say x,y,z medical term (because the history as they've related doesn't make medical sense) without making them feel silly or like I don't believe them or like I'm condescending etc - it's sometimes a lot harder than you'd think it should be.

    • Like 14
  4.  

    DH had his first dose last week.  12 hours later had headache, chills, nausea, fatigue, and low-grade fever.  Bad enough to interfere with sleep.  He felt mostly better by morning, and completely back to normal the next day - about 24 hours of symptoms.

    (He can't fill out your poll, because he's only had his first dose.  Next his dose isn't until four months after the first.)

    • Like 1
  5. Poor kid.

    Ibuprofen (Advil or Motrin) or Naproxen (Aleve) can decrease flow, and, as a bonus, decrease cramping.  There are different protocols - children's hospital websites are a good place to start.  Most of them advise starting at the first sign of bleeding on the first day of the period, and continuing until last day.  It's a low risk and accessible (over the counter) therapy with good evidence behind it.

     

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  6. I saw that.  They also decorated their dam with the "Caution Cable" tape. 

    Beavers really are amazing creatures.  Around here they mostly cause flooding damage. 

    They cause amazing changes to their environments:  turn a forest stream into a pond or lake, that eventually fills in with sediment and becomes a meadow.

    They also have super-durable teeth.  They incorporate iron into their bright orange tooth enamel.  Their teeth literally "wear like iron".  They can chew through just about anything.

    • Like 1
  7. No advice.

    One of my family sold their house at a garage sale:  they had a garage sale/moving sale before they put the house up for sale.  Got to talking, and one of the garage sale attendees expressed interest in buying the house, put in a offer, and that was that.

    ETA:  all the lawyer stuff got done properly later, but basically they sold their house at their garage sale.  The ultimate sale-by-owner.

    • Like 2
  8. 33 minutes ago, Junie said:

    The LOTR is one story sold in three volumes.  They should definitely all be read in order.

    I think the Hobbit is a good place to start.  If the kids enjoy it, then you can move on the LOTR.

    I would skip the Hobbit movies.  I watched part of the first one and I'm done.  

    I am, however, a fan of the LOTR movies (even if they aren't perfect).  They are close (enough, for me) and they are beautifully made.

    I usually am a read-the-book-first kind of girl, but I make an exception with LOTR.  I enjoyed the LOTR books, but I didn't really grasp them until I watched the movies.  I had a hard time visualizing what was going on since there are multiple sub-plots happening simultaneously.  

     

    Agree. 

    When I posted upthread, I was thinking of the LoTR movies. 

    The Hobbit movies were terrible.  

    • Like 4
  9. So I've skimmed the papers I linked to above.  It looks like the longest studies end at 8 weeks, and show good immunity.

    Ontario moved to extended dosing intervals (16 weeks) on March 10.  So real-world data beyond 8 weeks from my province doesn't exist just yet, but will very soon (those due for second shots March 10 got extended, that's those who had their first dose Feb 17 or later; they are just beyond 9 weeks post-first dose right now). 

    Anecdotally, we're (personally and colleagues) not seeing covid cases in folks who've been vaxxed even with just one dose.  And we're seeing an awful lot of covid.  I actually feel pretty good about the extended dosing scheme.  It's the only real choice here, really, given that our vaccines are in such short supply.

     

    • Like 5
  10. 35 minutes ago, Plum said:

    I bought each of us a copy of the illustrated version of The Hobbit. Start there. I’m glad I got a copy for each of us to follow along to the audiobook with. The audiobook makes all of the songs and poetry so much better. Rob Inglis as the narrator does a really good job. The Hobbit turned out to be dd13’s favorite book. She’s happy to have her own book. 
     

    We are using LLfTLotR and they refer to page numbers from an all in one volume. I wouldn’t recommend that all in one volume book unless you are using LLfTLotR. I’d get a set rather than an all in one. 
     

    It’s been a wonderful year reading Tolkien and works that inspired him. It’s their favorite part of school. We watch the movie after reading the book. 

    Re the bolded, agreed. 

    We might sometimes sing "chip the glasses and crack the plates"  while we are cleaning up the kitchen.

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  11. You don't have to read The Hobbit first; the LoTR will still make sense if you don't.  But LoTR will be much richer and better if you do read The Hobbit first.  The Hobbit is the easiest and most readable of the books too.  It's quite fun. 

    Our favourite edition of The Hobbit is the one illustrated by Jemima Catlin.  There is an illustration on almost every page, and they are all very detailed and meticulously accurate with respect to the text (the dwarves all have the correct colored cloaks etc)

    Yes, you have to read all of the LoTR books, and read them in order - it's one continuous story.  Well, of course, you don't have to do anything, but I would definitely recommend reading them all.

    My kids loved these on audio.  They actually prefer Kara Shallenberg's recording of her reading them to her kids.

    The movies are worth watching, but they did go quite far "off-book".  Some of the changes we liked, and some we really, really didn't.  We made a school assignment out of comparing movie Eowyn with book Eowyn , from a feminist perspective.

    • Like 5
  12. 2 minutes ago, Not_a_Number said:

    Do you know what the numbers are looking like? Maybe I'll start a new thread on this. 

    I really don't.  Good enough that they aren't even offering HCW a second dose before 4 months.

    I've been pretty distracted by this disaster of a third wave.

    • Sad 2
  13. Just now, Not_a_Number said:

    I hope we keep track of all those people and see how long the immunity from one dose lasts and how well it works. 

    I'm realizing that it's been quite hard to study the mRNA vaccines after 1 dose so far, because if you do it too early, it doesn't work very well, but there are only 3 weeks between doses! So you have exactly one week in which to measure things, lol. Not super reliable... 

    Second doses are being given at 4 months here (with very limited exceptions).  We'll have a sample size of millions. 

    • Like 1
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  14. 3 minutes ago, Not_a_Number said:

    True, although I think a fair number of people send kids to high school. 

    True enough.  Maybe even me.  One kid thinks he might like to go to high-school, the other wants to school at home forever and ever......  We'll see.

    • Like 1
  15. 1 hour ago, Not_a_Number said:

    It's a nice round number? 😄 

    No real reason. I just wanted to distinguish people who were close-ish to done and people who were still in the thick of it. I should have really added an option for someone ALL of whose kids are under 10, though. 

    My kids are 11 and 13.  No where near close to done, though.  We're still very much in the thick of it, I think.  I mean, you'd have to be finished 6th grade to be even halfway to 12th, right? 🙂

    • Like 3
  16. 3 hours ago, TCB said:

    I couldn’t interpret the legal jargon in that order. It doesn’t seem to make it clear how far they will expand someone’s role. When the surge was happening in New Jersey a cardiologist friend of one of our ICU Drs was put in charge of a floor of ventilated patients as there weren’t enough intensivists. And in a city in our state, they quickly trained med/surg nurses to run the continuous dialysis machines that many Covid patients were on. Both of those things are pretty far out from normal practice for those people, and I can’t imagine the stress.

    I’m so sorry this is happening. I hope you are managing to get some rest. 

    I think that this is exactly where this is going to go. 

    • Sad 3
  17. 1 hour ago, kbutton said:

    I don't necessarily read legalese, but I think you'd have to know more about this part:

    That regulation might delineate better how far out of the scope of practice people are expected to stretch. 

    I am sorry this is not being talked about more openly--you should have better information if you're expected to vary from your scope of practice. The wording makes me think that someone thought through a lot of scenarios last year, documented them in a proposal in case it was needed, and that proposal was signed into law, but not into effect. Then, this newer thing is making it effective. 

    My DH got a survey from his (now former) health system last year asking how far outside his scope of practice he would be willing to go. I think everyone got these. I don't know if the state was asking the system to do this or not, but it was pretty sobering just to see the questions. 

    I hope additional guidance arrives soon and is not as scary.

    I did look at both of those.

    One seems to outline the governments powers to override rules and standards in various different sectors (basically setting themselves up to be able to make the regulation published April 21), and the other activates the ability of healthcare institutions to move workers around between facilities and to ignore work contracts with respect to things like shift times, vacations etc.  Nothing to do with scope of practice, as far as I can tell.

    We filled out the how-far -will-you-push-your-scope of practice surveys last spring.

    I really do think it's going to come to that for some of us.  Surgeons and anethesiologists are under-used right now (OR's shut down for all but emergency surgery).  I think they are going to find themselves asked to do other work.  I know some are working vaccine clinics - but that's not really the best use of their skills.  OR nursing staff are all over the hospital in alternate assignments already.

    • Sad 1
  18. 42 minutes ago, Starr said:

    I was reading something about medical staff being moved around but I thought it said they were qualified on paper but not necessarily comfortable with their staffing situation. Like I was an RN but never worked in the ER and I was never really comfortable going to the ER for a code. I'm not sure where I read it. I started to google and there are many articles. It sounds totally desperate. I so sorry! And then I heard people on CBC complaining about restrictions. 

    That's what's actually happening on the ground where I am (that I'm seeing IRL), so far at least. 

    ETA: that fact that a regulation like this could go into effect without any announcement or news reporting is really amazing to me.  Not in a good way.

     

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  19. I think we are officially in crisis standards.  The province quietly enacted this regulation April 21.

    The gist of it is that a hospital can now assign any health professional to do the job of any other health professional despite any statute, regulation, order, policy, agreement or collective agreement, regulatory college policy, practice standard or guideline, so long as it is necessary in order to respond to the pandemic.

    So a nurse can be assigned doctor duties.  Or a doctor can be assigned nurse duties.  Or a PSW assigned RN duties.  Or any number of health care professionals doing the jobs of other regulated health care professionals without the usual training or meeting the usual standards.  

    This was not announced (anywhere that I can find, at least), and hasn't been in the news.

    This is a very serious thing.  Bleak.  Dire.  Pick your adjective.

    WTM peeps who read legalese, please tell me if I'm wrong here.  But I don't think I am.

    • Sad 16
  20. The third wave here is stressing health care resources to the max.

    The good news: 

    • Daily case counts seem to have plateaued in the last week or so
    • The lower age limit for AZ vaccine was lowered to 40, and I was able to score a dose for DH!  I'm so grateful to have him vaxxed. 

    The bad news:

    • ICU admissions and hospital admissions are climbing and not likely to stop for at least another 2 weeks.  We are at 833 ICU admits province-wide (peak of 410 last wave)
    • ICUs in the Greater Toronto Area are full, and have been for weeks.  They've been shipping further and further afield.  Transfers are at an all-time high (800+ so far in April, with 2nd wave monthly numbers in the 200's for March, Feb, and Jan, for comparison.) Transfers do not require consent, as per emergency order.
    • My local hospital has taken more than 60 transfers from the GTA in the past 2 weeks.  We've filled three wards, filled our ICU and now rapidly filling the make-shift, improvised second ICU.  We've got a ward in a tent in the parking lot.
    • All non-essential/non-emergent surgery cancelled, province-wide, to create capacity.
    • Lower acuity "alternate level of care" hospital patient are being transferred to nursing homes, consent not required, as per emergency order.
    • Staff are being moved all over the place to fill gaps.  Community and homecare nurses are being pulled into hospitals, many hospital staff are being pushed up an acuity level.  While no-one is being placed anywhere were they aren't technically competent on paper, lots and lots of staff are outside their comfort-zone with their new assignments.  This on top of a year's worth of pandemic burnout.
    • The provincial coroner has reported 25 deaths at home from covid since April 1, in people who didn't seek medical care.  These were covid cases that deteriorated suddenly and died, found dead by roommates or family.  Many were young.
    • Percent fully vaxxed in the province remains at just over 2%.  Percent with a first dose has increased to 28%.  The problem remains supply.  We have the infrastructure to mass vaccinate, but we don't have the vaccines on hand to do it.  (The mood regarding the US export ban is somewhat sour right now.  The news today that the recent AZ shipment from the US was manufactured at the Emergent plant isn't helping, even though the particular doses we got are officially just fine; there is public doubt.  Too late anyway, they are mostly already in arms. One of those arms belongs to my DH.)
    • We are still vaxxing 60+ and those with high risk medical conditions.  AZ for 40+ at select pharrmacies, though those doses are pretty much all "sold out" - there was a massive rush Monday when the age limit was lowered and now the wait-lists are a mile long, with no more supply on the horizon.

    I think we've got about four more weeks of this.   Our stay-at-home order is due to expire May 20.  I hope it give us enough time.

     

    • Sad 13
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