Worth Losing Friends Over — Doctor Enough

Today, I hurt. I’ve been talking about this pandemic for well over a month. My friend list is dwindling, and there are several people I don’t plan on catching up with when this pandemic is over—and now entire communities. America’s privilege is showing, in a terrible way. Rural areas that have been luckily unaffected are […]

via Worth Losing Friends Over — Doctor Enough

What the COVID Era Means — Doctor Enough

Did you know? I am blessed to be based at a hospital that has had a decent supply of PPE this entire time. And when we got close to getting too short, friends of mine donated N95s and made cloth masks, button headbands, face shields, and scrub caps in a matter of days. Our hospital…

via What the COVID Era Means — Doctor Enough

The Bad Guys in Healthcare Aren’t Who You Think They Are — Doctor Enough

I’m going to take a stand on something that really gets my blood boiling… health insurance companies. People want to blame physicians for bad outcomes (I’m looking at you NRA supporters that are claiming we, as physicians, need to fix our own lane first). They want to blame hospitals for long wait times, they want […]

via The Bad Guys in Healthcare Aren’t Who You Think They Are — Doctor Enough

Toxins

Who knew that toxins exist EVERYWHERE? I certainly wasn’t cognizant of my exposure to toxins. Teflon, PABAs, air, water, food, etc. But, I have learned so much and am constantly learning of the dangers of these toxins in our everyday lives. Most recently, all the soaps, lotions, and cleaning products have been updated in our house.

From Union-Bulletin.com

We use (all can be found on Amazon):

  • Puracy natural dish soap
  • Everyone Soap: hand soap and lotion
  • Nature Clean dishwasher detergent
  • Everyone 3 in 1 soap (adult and kids)
  • Everyone lotion
  • Attitude natural shampoo

EWG:

EWG: Skin DEEP:

  • ThinkSport spf 50+ sunscreen
  • Super Goop Play 50+ spf face sunscreen (currently a 3; would consider a better option)
  • Ilia, RMS Beauty, Lawless, Aether Beauty makeups

EWG: Food Scores:

  • Baby purees: Beech Nut, Earth’s Best Organic
From The Good Human

Profound Documentaries on Toxins/Food Industry:

Current Favorite Reads Regarding Health:

Whole Food Plant-Based Diet

I’ve been hearing more and more about a whole food plant-based diet. There’s definitely data out there that shows this lifestyle is the key to longevity and protective from illness and disease. My curiosity first started when I had our first child. It was important to me to learn more about nutrition because I wanted to learn how and what to prepare food for my kids. From this curiosity, I stumbled upon a book called Genius Foods. Then, I listened to the Audible version of The Obesity Code. Most recently, I’ve been embracing How Not to Die and Eat to Live.

Am I vegan? No. Am I a vegetarian? No. Am I here to save the animals? If saving the animals is a positive side effect, then absolutely! My main goal is to have the l o n g e s t quality of time with my kids as well as teach them how to incorporate nutrition into their lives. As a parent, I want to make my kids’ lives easier, more meaningful, and more fun. Aside from financial freedom and responsible parenting, the next best gift I can give to my kids is the power of nutrition. I wish I knew this information when I was a kid and grew up knowing what was helpful to fuel my body.

Continuous Regional Anesthesia Catheters

We’re setting up continuous regional anesthesia catheters in our hospital. It hasn’t been easy, but I’ve learned a lot along the way.

From Essentials of Pain Medicine (Fourth Edition)
2018, Pages 135-140.e2

Update on Continuous peripheral nerve block techniques


The Cleveland Clinic Experience with Supraclavicular and Popliteal Ambulatory Nerve Catheters. The Scientific World Journal
Volume 2014, Article ID 572507, 9 pages

  • Arrow, StimuCath continuous, nerve block procedural kit ASK 05060-cch 19 Ga, 60 cm catheter, insulated needle, 18 g 3.81 inch
  • The catheter was advanced 3–5 cm beyond the needle tip. During supraclavicular catheter insertion, the catheters were placed dorsolateral to the nerve plexus.
  • During popliteal catheter insertion, the catheters were placed next to the nerve with the needle coming from the lateral side of the thigh. The catheter was advanced 3–5 cm beyond the tip of the needle to end within the space between the semitendinosus and semimembranosus muscles medially and biceps femoris muscle laterally.
  • AmbIT pump (Summit Medical Production, Inc., Salt Lake city, UT, USA)
  • After catheter placement, an initial bolus dose of 20 mL ropivacaine 0.75% was administered. All patients were evaluated for sensory and motor block prior to surgery. Before discharge, the catheters were connected to AmbIT pumps infusing ropivacaine 0.2% with an 8 mL/hour basal rate and a 12 mL demand dose once per hour.
  • On the fifth day, patients were instructed to stop the infusion for 6 hours and then remove the catheter if their pain scores were less than 5 and well tolerated by the patients. If pain was more than or equal to 5 we asked patients to restart their infusions and we did the same every day until the catheter was removed.
  • The results of study demonstrate that the prolonged use of ambulatory catheters for a period up to 5 days did not lead to an increased incidence of complications as compared to other studies. Main complications were minor infections and pharmacological symptoms, which resolved with catheter removal and without the need for additional medical intervention.

Case Report: Continuous Erector Spinae Plane Catheter for Analgesia After Infant Thoracotomy. A&A Practice: November 1, 2018 – Volume 11 – Issue 9 – p 250–252


Erector Spinae Plane Block Catheter Insertion under Ultrasound Guidance for Thoracic Surgery: Case Series of Three Patients. Eurasian J Med. 2018 Oct; 50(3): 204–206.

  • epidural catheter (Perifix® Complete Set, B-Braun, Germany)
  • LA solution (a 1:1:1 mixture of 30 mL of 0.5% bupivacaine, 2% lidocaine, and 0.9% saline)
  • Block placed about 3 cm lateral to T spine
  • Rescue dose of LA mixture (15 mL of 0.5% bupivacaine and 15 mL of 0.9% saline) was injected through the catheter.
  • In addition, we used a 30 ml volume of LA, and we believe that plane blocks, such as ESP, need more volume, and that these blocks are volume dependent.