Tuesday, December 18, 2007

am i glowing?

I'm still on vascular. Been sprayed a few more times. If it's not blood, it's contrast that we use for the endovascular stuff. Which, by the way, there is a lot of. Five or ten years ago, a chief resident's experience on vascular surgery meant a lot of complicated "re-plumbing" jobs: extra-anatomic bypasses like axillary-axillary-femoral-femoral bypasses, in situ bypasses like femoral-popliteal bypasses or femoral-anterior tibial bypasses, elective open AAA repairs, and access for hemodialysis.

The access hasn't changed much; there are still just as many people getting into renal failure from hypertension or diabetes than there ever were. Maybe even more. But most of those big bypasses have fallen out of favor now that we have endovascular techniques. When I explain it to people, I tell them that we are trying to fix their pipes from the inside instead of laying new pipes. Roto-rootering and stenting whenever possible. No big incisions for these guys to heal, which often never healed anyway and ultimately ended up in amputation.

That means we have to use contrast and x-ray to see our work and to tell us which vessels to fix. Which means that I'm getting exposed to tons of radiation. I didn't realize just how much until last week when we tried to fix a leaking AAA with endovascular techniques. Yes, I know it's an emergency and an argument can be made that we should have just done an open rapair to begin with, but this guy was hemodynamically stable when we started and my attending thought this would be the best thing for him... provided it worked. (It didn't, by the way. He started to crash, we opened, repaired it, and he died in recovery.)

The drive in total for that one case was over 90 minutes of x-ray exposure. That's more than the recommended exposure in one month, someone told me. Not to mention the fact that the hospital does not provide leaded glasses to protect our lenses from developing cataracts, which is a known long-term consequence of x-ray exposure. How is that even allowed?

I have another combined open/endovascular case tomorrow. With an attending who says that for endovascular work, "Time should stand still." Easy for him to say, he's old and he's already had his kids. Not to mention the fact that he's an older attending and is himself still trying to master the various endovascular techniques that are available and does most of the case himself. Not to toot my own horn (and if you knew this attending, you'd know I'm *not*), but *I'm* much faster at endovascular procedures than he is.


The Angry Medic said...

Wowsers. I got sucked into your post - you're a really engaging writer (that, and my Grey's Anatomy craving has only increased since the strike began) ;)I've got surgical aspirations someday but for now I'm just a liddle-widdle baby medic across the pond. So I'm gonna be coming here for my daily surgical fix. More...MORE! FEED ME!

(Uhm, no, I'm not a junkie at all. Why are you looking at me like that?)

I'm adding you to my blogroll. Hope you don't mind the heading I've given you :)

lights n steel said...

Thanks so much! I've been a little caught up in the holidays to post much, but I feel the muse returning soon...

Hildy said...

don't forget your thyroid shield! and never stand with your back to the machine. these are the two lessons that got drilled into me.

lights n steel said...

Thyroid shield... check! And whenever possible, I wear the lead that covers the back, too. I spend a lot of time turning around to the back table to get a lap, wire, contrast, etc.