LISTS! I LOVE LISTS!

I am a list maker.  

I suspect I must have a touch of ADD or OCD or some other letter soup. I've ALWAYS made lists.
My mantra during college was, "What's the plan?"  If there wasn't a coherent and cohesive plan for something, anything, I always felt out to sea.  My Mother-in-law made fun of me one day, saying, "You can't plan everything, Michele." 

One of the things magazines tell you to do before a doctor's visit is to "make a list of questions to ask your doctor."
 
In my experience, most doctors HATE lists. They find them to be...overwhelming.

 I, on the other hand, LOVE lists.  Lists are wonderful.  I have a PLAN when I have a list.  I don't have the last minute, hand on the doorknob as I'm leaving the room, "Oh, doc, I forgot to ask you about this crushing chest pain" experience that totally blows my schedule to bits. 

Just because you have a list, doesn't mean we need to deal with all of the questions at that visit. 

A list gives me a road map.  It allows me to triage a patient's concerns.
BUT....Be prepared to hand over the list to me.  It works better if I can look at the list and get an idea of the following:

1. What are the three most important things on this list? In fact, please highlight those for me beforehand.

2. Are there some super SCARY things that need to take priority, putting everything else on the back burner? 

 3. Are there some super simple things I can deal with in one or two seconds?  Like looking at a mole?


You see, doctors think differently than other people.  We think about what can kill you, first;  what can really mess you up, second; and what is annoying but not likely to do major harm, third.  
Lastly we think about problems that are not concerning at all.  

We want to address problems in that order, too. But, we need your agenda, first. A lot of times people save the worst for last, trying to talk themselves into bringing up the topic they're most afraid to broach.

 It's magical thinking. "If I don't talk about it, nothing bad will happen."  

WRONG!

Burying your head in the sand and ignoring things is always a bad idea.

Telling your doc the biggest problem when your appointment time is almost over is always a bad idea.

You don't want an annoyed, rushed person dealing with a potentially life threatening issue at the end of an appointment!  You want a laser focused, un-distracted, un-rushed physician, using all of their skills to deal with your problems.

So, screw up your strength and courage.  Write down your list of problems and complaints.  List them in the order you're most concerned about, highlighting the top three concerns.  
Don't expect to get through a list of 10 complaints in one visit. Have realistic expectations of time management. 

Don't be afraid to tell your doctor that you are terrified that you have cancer.  Or a brain tumor.  Or heart disease.  If we don't know your concerns, we can't address them.  

And BRING THAT LIST!!!







  

READING ON THE INTERNET AND MEDICAL STUDENT SYNDROME

 http://www.thejanedough.com/diagnosis-via-the-internet/dr-google/

People come to the office all of the time apologizing for looking on the Internet and reading about medical conditions. I must be a weirdo amongst doctors, but I don't mind it when people try to learn about their health problems.

BUT, one of the more difficult problems I have is getting people to understand that many medical problems have the same symptoms and that having a cough does not necessarily mean that you have lung cancer or Goodpasture's syndrome.

In medical school and residency, it is pounded into to us that:

 "Common things are common. When you hear the sound of hoof beats think horses not zebras. "

 Photo credit:
 http://www.madwolf.com/News/Blog/entryid/15.aspx

When people look things up on the Internet, they often think zebra not horses.

In order for doctors to learn how to differentiate  symptoms into disease states or illnesses, it takes a long period of training. There are four years of medical school and then anywhere from 3 to 10 years of residency training, depending on what field you go into.

The First year of medical school is learning all about normal. You dissect the human body, breaking it down into every single nerve, artery, vein, lymph vessel, muscle, organ, and fluid. Then you look at all of it under a microscope, learning what "normal" looks like. You  learn the normal functions of every part of the human body in Physiology.

The Second year of medical school is learning about all that can go wrong in the body. You learn about "abnormal".
 We learn about infectious diseases, cancers, autoimmune diseases where the body stops recognizing itself and attacks normal tissues, making one sick.  We learn about how these diseases affect every organ system.  We learn what theses diseases look like under a microscope, and what people who have these diseases look like.

In the twenty first century, second year students also start learning how to talk to patients.  They learn how to ask open ended questions.  They learn how to do a "Review of systems" so they don't forget anything.  A Second year student  has a limited fund of knowledge so in order to get enough clues to make a diagnosis, they need to ask about every single system.  One will find that all well trained physicians do this same thing so they don't miss any clues.

In the Third year of medical school, you are handed a white coat and a stethoscope, taught how to take a complete history and physical, and then are expected to go out and learn. You learn to take a whole bunch of symptoms and make a diagnosis . Unless you have a really good attending or resident teacher, it's very hard to learn how to do this.

Part of the training is being exposed to a large number of sick people, usually in the hospital, sometimes in the office setting.  The student takes a history and physical, tries to put it all together, presents his findings to an attending or senior resident, and gets shot down.  Getting shot down is not a failure.  It is a learning experience.  

 Learning  how to interpret the story of a patient into a correct diagnosis is a skill.   It isn't magic. 

It requires a deep fund of knowledge acquired by reading and memorizing, and it requires  deductive reasoning.  

 It requires one to ask "WHY?" a lot. 

 "Why is the potassium low?" "Why is his skin yellow?"

Asking "Why" instead of just treating things as they pop up, often is the difference between an adequate and an excellent physician. 

A student spends time working in most general specialties in third year.  Internal Medicine, Surgery, Family Medicine, OB/Gyn, Psychiatry, Pediatrics are some of the main specialties in third year.

Fourth Year is spent in sub-specialties like ENT, urology, cardiology or pulmonary, learning in greater depth, and often one on one with an attending, or fully trained, physician.

Peptic ulcers, gallbladder disease, hepatitis, pancreatitis, pancreatic cancer, stomach cancer, colon cancer, heart attacks, collapsed lungs, fluid around the heart or lung--All  can cause the exact same symptoms. 

The trick is knowing which questions to ask, which tests to do, and which physical exam findings to look for, and then to properly interpret what you have found. 

Proper interpretation is learned through medical school training, residency training, and experience.

You hear people say, "Dr. so-and-so is a great diagnostician."

 That means that Dr. So-and-So is extremely good at doing a very thorough history and physical, and then going through all of the possible diagnoses that could be wrong and figuring out the right one.  

It is a skill and it can be learned.

Reading on the internet about your diseases or symptoms is a great place to start.

 Many of my patients have come in BECAUSE they read up on their symptoms and realized that something might be seriously wrong, and often, they were right.   

I find it helpful, also, for people to do reading on reputable web sites AFTER given a diagnosis.

They learn how to take care of their diseases, how to stay healthy, how to eat right and exercise, etc.

One of the challenges I face is "Medical Student Syndrome." 

ALL medical students become convinced at some point that they have cancer or some horrible illness.  Usually it is something they are learning about at that time.

"But DOC!  I have all of the symptoms of (put terrible life changing illness here)!"  

Don't succumb to Medical Student syndrome.  Patients who read about an illness, often get "stuck" on a diagnosis, for the same reason Medical students do.


They don't know enough about ALL of the illnesses that can cause the SAME EXACT symptoms.  If you have symptoms, come in and tell me about them so we can interpret them in a framework that comes from a deep fund of knowledge and experience!  

VISUALIZATION---SCHMIZUALIZATION!

Insomnia--Part Two

http://careergirlnetwork.com/wp-content/uploads/2011/12/visualization3.s600x600.jpg

One of the things that bothers me the most is reading about sleep hygiene is how the articles always talk about relaxation techniques or visualization but then leave you on your own to figure out how to do that.

Basically, it's all about distraction. The goal is to get your brain to focus, not allow it to ruminate on the bills, tomorrow's tasks, your OCD, etc.

I remember doing Jane Fonda's yoga (yes I'm that old). At the end of the work-out you would lie on your back on a mat and do progressive relaxation and deep breathing. I never understood the command to follow your breathing. What the heck does that mean?

I could however, Tighten and relax muscle groups starting at my toes and working my way up.  The problem was, here I was ALL RELAXED and then my brain would say, "OKAY, Now what?"
 And the racing thoughts would LUNGE forward into my consciousness again.

So... I taught myself to be on a beach in Hawaii in my mind.  I didn't know it at the time but I had taught myself visualization.

"What is visualization, DoctorDiva?" 

 GOOD QUESTION!

Visualization is a way to imagine yourself someplace calm and quiet and to fully engage your brain in the process.  That way, that pile of bills on the table, and the list of stuff you have to do, has no where to go in your brain, but to be squashed up against your skull while you listen to the waves, and feel the sun, and ...Oh.  yeah.  I digress.

http://equalitynews.files.wordpress.com/2012/11/sleep-talking1.jpg

The best teacher I ever had for this was a surgeon turned psychiatrist. Can you imagine--- a surgical approach to psychiatry? She was magnificent. She didn't use much of the touchy-feely approach, but taught problem oriented solutions that worked.

She taught us a visualization technique by taking us through it. By the end, all of the old geezers in the class were SOUND asleep.

READY? 

Close your eyes.  

(Oh Wait. You can't read this with your eyes closed)

Okay, after you read this, CLOSE YOUR EYES.  

Picture a blackboard. Picture the number 10 and try to relax your body 10 times more than it is at this moment.

Picture the number five. Relax your body five times more than it is right now.

Picture the number two on the blackboard and relax your body two times more than it is right now.

Now picture yourself in a hallway. My hallway is in a castle with suits of armor and paintings along the walls and a wooden floor with a runner down the middle.  Make it what make whatever you want. But you need to actually put yourself in the hall.

http://www.disneyfoodblog.com/wp-content/uploads/2012/11/suits-of-armor-1.jpg

Walk down the hall.  Feel your feet on the floor or the carpeting with each step.
 Focus on what's around you.









At the end of the hallway there's an escalator.

 http://taufidius.files.wordpress.com/2010/04/underground-escalator.jpg

Put your hand on the banister and your feet on the top step and actually feel yourself going down. As you are going down the escalator relax.

Get off and go down another escalator, again concentrating on how it feels to be on the escalator and as you go down, relax even more.

Get off and go down a third escalator, and relax even more.

 At the bottom of the third escalator, you enter another hallway.

Walk down the hallway to the end where there will be a set of double doors.

 http://realpages.com/sites/fpgdoors/images/2e.jpg

Throw open the doors to your relaxation place.

 One of my patients likes swimming with the dolphins.

http://www.peterrussell.com/Dolphin/swim1.jpg

 I like to be on a beach in Hawaii. Pick what works for you and then BE THERE.

http://sweet-wallpapers.weebly.com/uploads/1/9/2/8/1928676/4528137_orig.jpg

Feel the sand under your feet.  Concentrate on the warmth and brightness of the sun.
Hear the waves and the seagulls.

Look around.  What do you see?          Be there.



 By this point you should be incredibly relaxed or completely comatose.

If at any point during the process your brain turns on and thoughts invade,  visualize yourself shoving the thoughts up against the walls of the hallway where they disappear.

 Sometimes, if my thoughts invade and I can't relax,  I have to start at the beginning again.

  Eventually, I get to my visualization place.

 It's a rare night where this does not work. It takes about 10 minutes in total. It also takes about  
six months of regular practice and then you will be able to skip the whole chalkboard/hallway thing and can go directly to your visualization place.

You will have trained your body to relax to the point where you can just open the doors and feel yourself relax.

Good night and Good Dreaming.

Let Sleeping Dogs Lie. ALONE. GO to BED!

My son, as of late, has taken to sleeping on the couch. 

With our dog. 

Who smells.  Like a dog.  And now, so does the couch, the blankets, and my son.

(Okay, this isn't a couch, but they're together...like all the time)






WHY?  You ask,  is he sleeping there?  And more importantly, why is this a problem?

He claims his mattress is old and uncomfortable.  He wants a new one.

I think he just wants to sleep with the dog.

The problem is, now my DAUGHTER has started to sleep downstairs.  With the dog.  Not in her bed. 

I want my privacy back.

You see, the kid's rooms are upstairs, and ours is downstairs.  Lots of privacy.  NOT.  Because they aren't sleeping up there.  AND they're crabby because they're not sleeping well. 

Let sleeping dogs lie.  ALONE!


 Yes, I am a light sleeper. By light, I mean I need a completely dark room and absolute silence. I can hear a mouse fart in the wall. 
When I was an intern and resident, it was a badge of honor to be up all night long taking care of emergencies and putting out fires(Literally. Once. Another story).

http://www.fireonline.com.au/resources/products/howtooperateanextinguisher.jpg










I was not very good at staying up all night. Once, I  fell asleep holding a retractor when I was a student during a gallbladder surgery. I was on my feet pulling as hard as I could on the retractor and I fell asleep. I had been up the whole night doing EKGs and taking care of post-operative patients. That's what third-year medical students did then. We were scut monkeys.

http://cdn3.iosnoops.com/wp-content/uploads/appsicons/359680662x356.jpg

We used a book like this.  It weighed 400 lbs in our short white coats. 







I had never heard the word "scut monkey" until I became a medical student. "Scut" is all of the work that  interns and residents feel is "below" them.

Scut included drawing all of the morning bloods, changing all of the wound dressings, doing the EKGs and blood gases, drawing the blood cultures, and starting IV lines. Scut was delegated to the students and the interns. The second and third year residents  slept and studied. We were to call them only in the event of an emergency or with a question that we couldn't figure out on our own by going to the library and looking it up.

(Oh SO many things have changed...for one, Library?  What library?  Go look it up on line, scut monkey!)

The head of surgery told me that surgeons should only need to sleep for two hours a night and should feel rested. "Don't go into surgery..."  was loudly implied.

I self-selected myself out of Obstetrics and gynecology. Those residents were sleep deprived miserable human beings and were mean to the medical students. They made the medical students stay up all night long watching the women in labor. I mean really Watching.  Sitting in the room with a woman screaming while she had contractions.  To punish us. 

That's when I discovered that I needed sleep. Lots of it. I needed eight hours of sleep a night every night, all the time. 

 I craved it and coveted sleep. I would sneak off to sleep in the afternoons, following my surgical residents advice, "EAT when you can.  SLEEP when you can.  And don't F*^k around with the PANCREAS." 

 I learned all of the following:

 drinking caffeine after noon disrupts sleep.

 One glass of alcohol  wakes me up four hours after falling asleep.

 Exercising within two hours of sleep is a bad idea.
Reading in bed or having a TV in the bedroom disrupts sleep, makes it hard to fall asleep, and trains the mind to think of bed as an entertainment unit

Having the room too hot or sleeping with pets disrupts sleep.

Keeping odd hours messes with me.

Odd hours are the bread-and-butter of being a physician. We are awakened at all hours by the phone ringing.
A phone ringing at three in the morning to me is just routine. The phone ringing at three in the morning for my sister means someone is dying.

(This is a gratuitous photo of David Tennant because he IS the best Doctor Who.  You're welcome. )





http://25.media.tumblr.com/tumblr_mkeutwV1rL1s0of1to1_1364541332_cover.jpg

As a result of having all of these interruptions to my sleep, I got really good at relaxation and visualization  techniques. 

 I learned how to partition off that part of my brain that was going 900 miles an hour with racing thoughts and worries. It was survival. As a physician you have to learn how to shut off in order to function.

Doctors learn how to shut off the part of the brain that makes you PANIC when you see something totally GROSS.  You HAVE to in order to function.  SO, I used that to help me sleep.  I learned how to SHUT OFF THE RACING THOUGHTS.

Next blog, I'll teach YOU how to do it too.

Just the Facts, M'aam, or Born To Run ALWAYS Sounds Fabulous in the Shower.

  

 

 http://languagelog.ldc.upenn.edu/~bgzimmer/itwasnt.gif 

  With Jimmy Fallon's and Bruce Springsteen's latest parody of Born to Run making the rounds on the internet, the song got STUCK in my head.  They call this an "earworm".  I call it AWESOME!  What better song to get stuck on replay?  It's high energy. It gets you going in the morning.  I feel FABULOUS.

 CREDIT:  http://media.heavy.com/media/2014/01/bruce-springsteen-christie-spoof-1-14.jpg

     Naturally I started singing it in the shower.  I sang it in my natural alto tenor, in falsetto, loudly, softly, and of course with great feeling. I sounded SPECTACULAR.

     When I got out of the shower, I said to my husband, "Did you hear me singing in the shower? BRUCE!"
     He said, (with a straight face I might add), "Oh.  Was that what it was?  The words were the same but the tune was different!" 

BITE ME! 

Good thing I was in an amped up mood from singing Bruce and was able to laugh at myself. 

I replied, "EVERYTHING sounds better in the shower when you sing it.  It's like magic!  I sounded GREAT." 
He just smiled. 

Juan has mastered the art of deflating my bubble without insulting me. 

Once, when I had gained a little weight, I put on a pair of pants that were a little...snug.  I asked him,

 "Are these pants too tight?"

He replied,

"Clothing always looks better when it fits well."  

'Nough said.  I got on line and ordered myself some new pants a size up.  I figured it was his fault when the credit card bill came in.

So HOW do I tell my patients that they are fat, or out of shape, or need to bathe, or smell like urine, or have built up dead skin between their toes that smells just awful, or have really bad breath, all without hurting their feelings? 

I take a page out of my husbands book of getting his point across with grace and kindness.  

Just the facts, m'aam.  No embellishment.  No commentary.  No gross face.  No passing out or dry heaving  (although I almost did that when maggots fell out of a bandage on a wound after the patient hadn't changed it for a week).


Occasionally, when I know a patient has a good sense of humor, I calls 'em as I sees 'em. 

 CREDIT:  http://fitnessandfeta.files.wordpress.com/2012/01/water-weight.jpg

Here's a real conversation.

"I've gained a few pounds doc.  See this on my belly?" She squeezed a handful of fat. "I think it's all water weight."

Me:  "Oh, REALLY?  C'mon.  I hate to break it to you, but THAT is FAT.  THAT is not water."  

I only do that when I know someone has a good sense of humor.  Otherwise, I have to resort to:

"Water weight normally causes ankle swelling.  It goes where gravity takes it, the lowest point on your body.  That is adipose, or fatty tissue on your abdomen..."  and so on.  

 OR:

"I noticed that your breath has a foul anaerobic odor to it.  When was the last time you saw your dentist?  Do you have recurrent sinus infections?"

NOT...

"Hoooey!  That's some stickin' breath you have there. When was the last time you brushed those teeth?  Please turn your face away when you talk because I'm having a hard time seeing through the haze here!"

 OR

"You have a Body Mass Index that puts you in the Super Obese Range.  This puts you at huge risk for diabetes, hypertension, sleep apnea, arthritis, and early death.  Oh, no one ever told you that you were obese before?  You thought you were just a little overweight?  No.  I'm sorry to tell you this but our society is now 60% overweight or obese and the people around you that you think are 'normal' are likely overweight or Obese.  Three hundred and ninety four pounds at Five foot two inches tall is almost 180 pounds overweight."

NOT:

 "Seriously?  Are you kidding me?  You didn't know you were obese?"  

It's hard.  You can't get people to change if you insult them.  You have to tread that fine line between pointing out painful truths that they have closed their eyes to, and hitting them over the head with it.  Sometimes the options are not good. 

But I DO sing in tune.  ESPECIALLY in the shower.  I DO!! 
(Okay.  Maybe I'll take voice lessons.)

My Husband is an Evil Genius-OR-I'm EATING Your Cinnabons

Today I had an epiphany---My husband is an evil genius.

Every single morning, battle lines are drawn:

6:00 a.m.  I've been up for half an hour.  I call upstairs to my 15 year old son who has 45 minutes to get up, get dressed, eat, and get ready for me to take him to school.

6:10 a.m.  I call again.  "Tom, get UP!"
               "I'm UP. Leave me alone."   Deafening silence ensues.

6: 15 a.m  "GET UP!" I'm leaving in 30 minutes WITH OR WITHOUT YOU."
                                             Nothing.

6:30 a.m.  I'm out of the shower, fed, caffeinated and putting the final touches on my makeup, searching for my cell phone and keys, and putting on my boots.
          "I'm leaving in 10 minutes!"

Sudden crashing of feet on the floor, a flurry of activity with a smattering of cursing which I pretend not to hear, and IT IS ALIVE and IT is in a foul mood completely directed towards me.  IT is mad because IT doesn't have time to eat and we end up in an argument because I'm super irritated that IT has the GALL to be mad at me.

************

THIS morning was different. It went like this:
I got up at 5:00 a.m. so I could do some paperwork for work.  I decided to make Pillsbury Cinnabons.  

6:00 a.m.  I call to get my son up.  I tell him about the Cinnabons. (yummy!)  I figured it would be magical bribery and would rouse him from his sleep. The wafting of the cinnamon-y goodness had already gotten my husband out of bed.

6:10 a.m.   Still no movement and now I'm peeved.  "Get your butt down here right now!"




Husband intervenes.
"That's not the way to do it.  Watch this."  He grinned evilly and I swear he said, "Muuahhaawww!"

"Hey Tom.  If you don't come down right now, I'm going to eat your Cinnabons."
CRASH. BAM. BOOM!  I'll be darned, but it WORKED.  Down he came, at light speed, dressed and ready to take on any potential Cinnabon thief.

"You gotta know what motivates your audience!" is my husbands response to my  raised eyebrow and query as to how he worked this strange magic.

Now I can hear you thinking, "He wouldn't really eat the Cinnabons, would he?"

"Darned straight, I would!" replies my husband to your well thought out question. "It's the Hereña rules."

Let me explain. Early on in our marriage, I learned that since my husband grew up in family with five children,  there were no leftovers--EVER.  If you didn't make it to the table in time for dinner, your portion would disappear. Vanish.  GONE.  Adios.  Make a PB and J and call it a day. 
If you tried to save something in the refrigerator for later enjoyment,  good luck with that because one of the other members of the family would eat it.

"How," you ask, "Did you learn this?"

WELL,  early in our marriage, I left some leftovers in the fridge for three or four days, went to retrieve them and--they were GONE.

"I thought you didn't want it.  You hadn't eaten it, so it was fair game," stated my husband.

We stored our Anniversary Wedding Cake in my mother-in-law's freezer after our wedding. Juan went to retrieve it and it was gone.  Rob, his brother, thought it was fair game and ATE THE WHOLE THING (not that I hold grudges or anything).  I was mad. Juan was philosophical. It was the Hereña Rules at work.

It got me thinking.  How do I motivate my PATIENTS to do the things I need them to do, like SHOW UP for appointments, take their medications, exercise, cut out salt and sugar?
Heck, How do I motivate anyone to do anything?  It was clear, my husband had a leg up on me on this point.

Some of my attempts at improving compliance with treatment included the following:

 Education,  often met by a glazed sheen in my patient's eyes. Come to think of it, it's the same look Tom and El get when I'm off on a "lecture."

Cheerleading--Instead of fussing at people because they haven't reached their goals, I  encourage them to keep trying.  Often this tactic works. It makes people more likely to come back too, since it's positive reinforcement instead of fussing at people and making them feel bad.  I consider a return visit a coup in and of itself.  I actually do a "Happy Dance" if they reach a goal.  It makes people smile.


Negative reinforcement or"yelling" at people.  I point out all of the bad things that will happen to them if they don't do what they should for their health.  For example, the end of the world as we know it, fire and brimstone, cats and dogs living together, etc. Sometimes that works.  When I point out to women that smoking causes premature wrinkling, that motivates them to stop. Cancer? Not so much.  Wrinkles? Yup.  Go figure.

Sometimes, all that will work are the Hereña Rules.

If a patient has not followed up, I threaten to hold their medications hostage.  Then, if they still don't come in for follow up, I do it.  I won't refill their meds.  It's a last ditch effort, after phone calls, letters, and plain old begging  haven't worked to get someone in for their follow up appointment.

I HATE doing it.  I will do everything in my power to avoid it.  I don't WANT people to run out of medications, but I HAVE to monitor their meds, and their side effects.  If someone doesn't come in for followup, I don't know if the meds are working, or if their kidneys or livers are in trouble, or ANYTHING!  It's really scary.  I'm responsible for my patient and I want them to be healthy.

Soon a frantic phone call will come in.  "DoctorDiva won't renew my meds!"

I say, "Tell them to schedule an appointment and I'll give them enough until they come in."

Works every time.   Take away their Cinnabon, and Voila! 
Hereña Rules. 
My husband is an Evil Genius.

Frostbite, STDs and Teenage Butthead-ery

I was thinking about how incredibly cold it's been here in Chicago, (No, I will NOT call it Chiberia).  A post on hypothermia and frostbite came to mind, specifically because my teenaged son was being a butthead and refusing to heed our warnings about flash frozen fingers and frostbitten faces and ears.  My husband showed him some photos of gangrenous fingers, toes and ears and he got the message and wore gloves, a hat, and a scarf, but not without some gross pictures..

Then I saw Alexander Skarsgard in all his naked glory on the portable toilet in Antarctica.  What a great segue!  I heard it was warmer in Antarctica than it was in Chicago earlier this week.  Go figure.

 

 So I asked my husband how he thought of showing my progeny pictures to convince him to use gloves, and he said, "A picture is worth a thousand words."  He told me about how when he was a kid, his father, a surgeon, had a medical textbook with a picture of Pian disease or Yaws in it.  It so terrified my husband, he was so affected by it,  that he wouldn't go within 10 feet of his father's textbooks of medicine for years. (And yet, he became a pulmonary and critical care subspecialist.  Go figure.)

Tertiary YAWS/Pian disease:

THAT got me thinking.  Boys do not heed adult advice.  At least, that's been my experience.  They have to make their own mistakes, or make up their own minds about something.  All my kid hears from me is:  "Blah, blah, blah, Are you listening to me?  I'm telling you to blah, blah, blah..." and so on.

Pictures.  That's the ticket.

So, here's what I'm going to show him to prevent him from having unprotected sex and getting STDs.

Tertiary syphilis causes horrible disfigurement, and some of the pics were even too gross for me to show.  I plan to show him pictures of primary syphilis with ulcers on the penis, secondary syphilis with the rash all over, and pictures like this with the nose disfigured.


Lymphogranuloma venereum or Chancroid:
A lovely little infection caused by a chlamydia that causes massive swelling of the lymph nodes in the groin, which can open up and ulcerate.

And speaking of chlamydia (and gonorrhea):

The pictures of the penile drip are too gross to put here.  But trust me.  He'll see them.

Then there's GENITAL WARTS.
I've gotten him vaccinated against HPV, the virus that causes them, and I'm hoping that it works, but just in case he's attempted to go scuba diving without a wetsuit, I'll show him this, but on the penis:

I'VE seen this too many times to number.  It is devastating and difficult to treat.  The topical medications hurt, and the aftermath of surgery to remove large accumulations is painful too.  Plus, these lovely little warts cause cancer of the cervix, cancer of the anal-rectal area, cancer of the throat and mouth and voicebox.

Herpes Happens.
Herpes can happen ANYWHERE on the body.  Cold sores are from herpes.  Herpetic whitlow is a herpes infection of the finger.  Imagine if this was your penis or vaginal area instead.  Ugh. That's gotta hurt.

Of course, there is the big Momma of STD's, HIV/AIDS.  There is no one picture to show the horror of that disease.  I was a resident and student in the late 1980's early 1990's and I saw entirely too many people die from horrible awful complications of that disease.  I wouldn't wish that on my worst enemy.  I saw brain and lung lymphoma from it, Kaposi's sarcoma, blindness, terrible secondary infections from PCP pneumonia or even run of the mill bacterial pneumonia that decimated the patients who had no immune system left to fight off the diseases that ordinary people either wouldn't get, or could fight off.  

That will be a whole topic unto itself of photos and stories to prevent his not wearing a raincoat on his johnson. 

So, somehow my blog on hypothermia morphed.  But Hopefully, some other mom somewhere will show her kid gross memorable pictures of the reality of sexually transmitted diseases, and prevent it from happening to their child.