Queen Victoria’s Birthday

Hat’s off to you healthcare personnel working May 24th. In Canada we celebrate the birthday of Britian’s Queen Victoria, who was the British Monarch from 1837-1901. Her Birthdate was May 24, 1819, so the Monday closest to May 24 is a statutory holiday in the U.K., Canada and most former British Colonies. She must have been quite a world leader as there was  an alleged assassination attempt. (We all know that you really haven’t made it on the world stage of politics until you’ve peaved off enough people that someone wants you dead.) Apparently, there was a big hooplah when she had reigned for 50 years, “The famed golden jubilee” (Aye,  t’was a party indeed, I can ‘member it like it twer yesterday.)  Rumour has it, at least my Irish friends say  “t’was nothing but rumour and heresay”, that a group of Irish rebels plotted to set off an explosion at the heretofore mentioned jubilee.  I suspect the rumour started something like this:  an Irish lad named Danny, yes the one the famed Danny Boy song is named after, was enroute from Ireland to Paris.  Now why he was off to Paris is a long and sordid tale, but here it is in a nutshell. He had been seeing a young lass named Colleen, a local girl who tended her father’s sheep in meadows not to far from where Danny tended his father’s sheep.  One day when Danny was tending to Colleen , rather then his sheep, and her likewise I might add, the sheep went astray, as did Colleen and Danny according to the local priest. Whilst the sheep were astraying, a wolf, no not Danny, came in amongst them. Whilst the wolf was viciously attacking the sheep the others ran off in great fear following each other, as only sheep and members of the Liberal party of Canada will, and ran right off a cliff into a wild and turbulent river. (All the sheep drowned except for Fluffy, who had always secretly dreamed of being a dolphin and had been taking swimming lessons on the sly.) In any event Danny knew he would be held responsible for the loss of both herds of sheep and without any recourse he did what any brave, godfearing lad of his age would do, he ran. Now, he knew his father’s collie, Rex, would find him wherever he might go if he remained within the British isles, so off to gay Paris, (though Colleen would attest that term certainly did not apply to her Danny boy)  he did flee. He stopped in London and whilst there he was having a Guinness in one of the local pubs. Whilst rehydrating himself he overhead another lad comment on the big Jubilee event for the said queen. Danny, not being in the best of moods, and having thus far consumed sufficient ale one could bathe a full grown ram in, and being a good Irish farm boy who had yet to have had the priviledge of demonstrating his superior brawling tactics to a snotty nosed London lad made the following comment. “Someone should just blowup the old tart,” referring to the queen. While his intent was just to cause some ire and start a fight, he was overheard by an off duty copper.  The said copper was just denied a promotion, again, and thought that “preventing” the queens assassination just might facilitate his quest for a promotion. And from there he ran with it and there’s the history of the supposed attempt on the queen. (Oh, by the way a brawl did break out, Danny did his homeland proud and also escaped without being apprehended.) So here’s the question. Why in the world does the old gal, Queen Vickie, look so cantankerous  in all her photos?May I suggest the following.

Top 10 reasons Queen Victoria looks Cantankerous

10. Corsette too tight. “It fit me when I got married I can still squeeze into it.”

9. Her Majesty’s rule of etiquette #43, “Queens do not flatulate, ever.” Can become unbearable.

8. European menu embargo. The poor girl was resigned to only eat British Fare to promote local industry.

7. Had been beaten out at “Dancing with the stars” by that upstart American President’s wife, Mary Lincoln.

6. Her Corgi’s were infested with fleas and as they slept with her, so was she.

5. She had hypertension and the royal physician had forbade her to eat one of her favorites, Marmite.

4. Because of poor dental hygiene her dentist, and subjects, preferred non smiling poses.

3. The photographer was also the court jester and to be quite honest she was sick and tired of his silly squeaky toys trying to make her smile.

2. Was trying to do the Mona Lisa thing but hadn’t quite nailed it.

1. She was a woman with dreams and visions and she was frightened to death with the reocuring dream of the future empire, when led by her future great, great, great, grandson Charles.

Floyd’s allegations about Lance Armstrong

Here’s the question I have, and have yet to see answered. As we know Mr. Armstrong was diagnosed with testicular cancer in 1996. Not only that but it was far advanced and very aggressive. It was not just medical treatment, but in my opinion, Mr. Armstrong’s incredible mental fortitude that allowed him to not only beat the odds but to return to being the premier world cyclist/athlete he was. Now I don’t personally know Lance, I have never treated him, but as a physician I recognize that part of his cancer treatment would likely have included what’s referred to as a “radical orchidectomy”, or in other words surgical castration (Yes, guys I hear you saying ouch!) Subsequently, the patient is unable to produce testosterone. After a period of time, the cancer survivor is able to replace his testosterone with synthetic testosterone. Now normally this synthetic testosterone is banned for athletes but I would speculate that Mr. Armstrong has been given permission to use replacement testosterone as long as his blood levels remain in the “normal range.” Now here’s the kicker, what’s the normal range? The normal range for what’s referred to as “free testosterone” in a normal post pubescent 20-40 year old male is 15-40pg/ml (U.S. units) or 520-1387pmol/L (SI units) Total testosterone for the same age is 270-1070 ng/dl U.S. units or 9.36-37.10 ng/L SI units. You may not understand these units but what is obvious is the range is quite broad. In a normal male our levels fluctuate a great deal, even within a 24 hour period. If Lance Armstrong is  eligible to take synthetic testosterone, which he most certainly should be, he may be able to remain in the high normal range all the time. Whereas his competitors, with natural testosterone production may have much broader swings in their testosterone levels. So possibly, key word is possibly, did Mr. Armstrong’s life altering diagnosis of metastatic testicular carcinoma in fact provide him with an advantage in his already amazing cycling career? Don’t be mistaken, I am not suggesting Lance Armstrong is not an incredible athlete, with an amazing mental and physical ability to win. It’s just a physiological question I think merits discussion.

Family Docs Rock

For most of us our first physician we have  contact with is a family physician. Up until the late 1970’s they were know as GP’s, (general practitioners), or simply ” the doc”.  They were, and still are, the foundation of medical care whether in the United States, Canada, Australia, New Zealand, etc.. Unfortunately, over the past 25 years more and more medical students, upon graduation, select another area to train rather then family medicine.  For some it may be that they believe that family medicine isn’t as lucrative, or isn’t as prestigious or as sexy as say neurosurgery, orthopedics, or cardiology, etc..

Although, in many urban areas the income may be less then some of their peers in specialty medicine, it’s not always the case in more rural areas. One of my colleagues bills for $500,000/yr., and many others $250-350,000/yr.

More importantly, in my opinion, is what they do. They are like the night watchmen of a city of medieval times. By this I mean they must be on the alert for anything, of any size with little or no warning. Although, 80% of what comes through the door of the clinic is likely benign and will resolve itself with time, these hero’s and heroine’s must be always on the alert for potentially life threatening pathology. That infant with a fever, malaise, and irritability may have a benign URTI, or may be in early stages of meningitis.  That probably benign headache could be a tumor with gradual increasing intracranial pressure.  I recall one of my colleagues who had treated one of his pt’s. for years for migraines. This ind. now was experiencing more frequent headaches then was typical for him. It was because of the fact his Dr. knew him well, and his astuteness that led to further investigations revealing an intracranial tumour that was still treatable.

So hats off to you Family Physicians and those pursuing this direction. Yes we need specialists and their expertise, but we need your general knowledge, and you’re huge box of general medical tools that you provide to our communities.

Now what?

I think it was after Elizabeth Taylor’s 7th wedding that she said “Of course I love getting married, weddings are so much fun!” I guess she and the groom would ask each other the next day “So now what?” For those of you family medicine residents who just completed the College of Family Physicians of Canada exams, congratulations but now what? (And for those of you who are training/working elsewhere listen in, us Canadians are relatively friendly. After all, how threatening can we be if our national symbol is the beaver, only those with wooden prosthesis need fear.)  Although, you may not have completed your residency training yet, and you don’t have your results, what a great relief. I know when I completed my royal college exams, a great sense of relief seemed to permeate our group.

As you know approx. 4-6 weeks from now you’ll have your results sent from the Coll. of Family Physicians, and yes they’ll forward those results to each of the medical licensing authorities in Canada. (No, they won’t automatically forward those results to authorities outside Canada because they want you to stay.) Some of you have everything lined up for the summer, some for the next year, and some of you for the next 40 years. The choices really are endless, well almost. So here’s some advice from myself and some of your aged physician peers, (yes I know for many of you anyone older then 40 is an aged peer.)

Top 10 things to Consider in your next step as a physician

10. List all the factors to consider, (well maybe not all like you don’t need to worry about snow tires yet.)

9. Prioritize them for your current situation,  things will change but you need to prioritize for this phase of your medical career and life.

8. Consider steps in your medical career, the choice you make first is not likely to be your final destination but will it provide an experience you haven’t had yet?

7. Money, money, money. There are some great incentives offered out there that will help pay off any student debt, but after your debt is eliminated what ever income you earn will be substantial. Don’t let it be the #1 priority for the long run.

6. If you really want to go somewhere to explore, for a month or longer, yes do it now. It may be sometime before you can take a large chunk of time away from your medical career again.

5. Balance your life. It will be very easy to let your work suck you into a vortex that never stops spinning. If you don’t protect your time, no one else will.

4. Laugh at yourself, why not we’re all laughing at you. Seriously, don’t take yourself too seriously, you will make errors, most will be minor, acknowledge them and laugh at them.

3. Look for those daily gifts, they’re there but we don’t always see them. It might be the 4 yr. old with substantial sinus drainage who says in the middle of a swamped day “Thanks doctoh.” Or the 85 year old you’re reviewing labs with and he/she asks “So, is it still OK to buy unripe bananas?”

2. Trust your instincts, if something doesn’t seem right something isn’t, either that or you left your fly down again.

1. Sleep

Can Canadian Family Medicine residents sleep tonight?

Tomorrow, Apr. 30-May 2, 2010 family medicine residents, and a few International medical grad’s. will be taking their Canadian Family Medicine exams. All in, about 1050 will be anxiously awaiting in 11 cities between Halifax and Vancouver to complete their qualifying exam. Nervous, well yeah, even Syd the kid gets nervous before a game even if it’s a preseason game against the Leafs. So what to do to ease the nerves, what not to do. Let’s start with the Top 10 what not’s:

10. Stay up late reviewing texts

9. Texting that know it all person in your group, you know who I mean we all have one, asking some rare histopathology question

8. Staying up late playing on line poker.

7. Going out on the street and asking for volunteers to administer ACLS to or starting central lines.

6. Calling your bro. in law’s, best friend’s, uncle’s, golf partner’s, sister’s, neighbor to see if they’re still hiring for tree planters in Northern Ontario.

5. Checking the college of family physicians of canada website to see if the date has been changed.

4. Consuming one alcoholic beverage for every year you’ve spent in school.

3. Consuming one alcoholic beverage for every time you heard or read “Best clinical practice guidelines.”

2. Checking the Canadian Armed forces website to see if their still recruiting for tank drivers.

1. Consume large quantities of B.C. bud to help sleep. In spite what most snowboarders may report, it’s not a performance enhancing drug.

Top 10 things to do:

10. Get some sleep

9. Don’t study anything tonight.

8. Get some sleep

7. Do something relaxing with someone

6. Get some sleep

5. Remember over 90% of people pass

4. Get some sleep

3. Eat a good meal the night before, and in the AM

2. Awake early enough to go for a short walk, or incorporate that into where you park and take your exam. (You thought I was going to say get some sleep didn’t you.)

1. Remember the examiner’s are your colleagues, they want you to pass, they need your help out in the trenches.