tag:blogger.com,1999:blog-4968787219619380438.post7511569018735582453..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: "Stealing" the thyroid glandSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-4968787219619380438.post-32067043606895178082013-12-23T13:22:00.560-05:002013-12-23T13:22:00.560-05:00Big Jim, nice comments. We did some things back in...Big Jim, nice comments. We did some things back in the 70s that would curl the hair of a risk manager today. I agree with you about the EMRs and have written about that topic. Here are two links among others http://skepticalscalpel.blogspot.com/2011/04/emr-follies.html and http://skepticalscalpel.blogspot.com/2011/04/emr-follies-part-2.htmlSkeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-27727292678868165122013-12-23T11:00:17.890-05:002013-12-23T11:00:17.890-05:00When I was in college in the mid 70's I volunt...When I was in college in the mid 70's I volunteered at a NYC hospital ICU basically stocking shelves. One day, a resident or junior attending asked me(a college junior) to help him place an internal jugular line on an intubated ICU patient. He had me put sterile gloves on and I held one end of the guide wire while he placed the needle and then the wire etc. It seemed like it took an hour and as if we were doing brain surgery. Imagine the controversy today if a volunteer helped a resident place a central line!!! As far as thyroid storm, I think it is the anesthetic itself rather than patients anxiety that you have to worry about. I had one 30 year old male with acute appendicitis have thyroid storm post op. Once in a lifetime was enough for me. He survived but it was pretty frightening. I wonder sometimes why medicine costs so much more today, when we are so much more efficient in many ways. In the old days a hernia, varicose vein, breast biopsy etc came in the day before surgery. In house colon preps for 2 days, hemorrhoidectomies stayed 4-5 days, open cholcystectomies stayed 5-7 days. I guess now we have robots that cost 2 million dollars that may actually be doing more harm than good, multiple eighth generation antibiotics, and lets not forget electronic medical records--which I call "where's Waldo" because there is so much useless and wrong information you get lost trying to figure it out. In the old days, the medical student wrote the 5 page note, then the intern resident and attending wrote progressively shorter notes. Now, the attending has to document a hole bunch of crap to satisfy some bureaucrat. I remember some of my old attendings who were great clinicians---they often wrote a 3 or 4 line note--very succinct, that was all you needed to know.bigjimricottahttps://www.blogger.com/profile/04476836197646644643noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-46898235226046136142013-12-19T21:43:12.244-05:002013-12-19T21:43:12.244-05:00Thank you for sharing this. I love hearing about t...Thank you for sharing this. I love hearing about the surgery of the past.Anonymoushttps://www.blogger.com/profile/00748403564779915691noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-6583414559406128462013-12-19T08:29:54.105-05:002013-12-19T08:29:54.105-05:00Libby, I agree that it would be impossible to do t...Libby, I agree that it would be impossible to do today due to the paperwork, patient ombudsman, ethics committee and others.<br /><br />Korhomme, I don't think you'll ever see someone steal a thyroid either.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-75352720479252030852013-12-19T07:43:41.296-05:002013-12-19T07:43:41.296-05:00That's a new one to me. I've heard of a th...That's a new one to me. I've heard of a thyroidectomy under local anaestheia to minimise the risks of a thyroid storm, but never I've never seen it done. Thanks.Korhommehttps://www.blogger.com/profile/02290764661952746389noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-2382441554439017182013-12-18T19:01:49.618-05:002013-12-18T19:01:49.618-05:00I'm sure if it was tried now someone would que...I'm sure if it was tried now someone would question the ethics of it...definitely a paper trail of consent forms would be needed. I know a few people who would sign up for a 'stealing' of whatever was going to be removed just so they don't get all worked up prior to going under.Libbyhttps://www.blogger.com/profile/09274573439351833726noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-44063796201453106542013-12-18T17:16:18.198-05:002013-12-18T17:16:18.198-05:00Les, I can't recall if her nose was twitching ...Les, I can't recall if her nose was twitching or not. It might have been.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-79992856979708489802013-12-18T17:06:19.580-05:002013-12-18T17:06:19.580-05:00I laughed a little while reading this. We used a s...I laughed a little while reading this. We used a similar habituation technique with lab rats before doing any experiment involving the hypothalamus-pituitary-adrenal axis when I was a graduate student. I hope her nose wasn't twitching or anything. Lesnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-40290874135879363642013-12-18T12:16:35.757-05:002013-12-18T12:16:35.757-05:00Anon, thanks for commenting. A thyroid storm can b...Anon, thanks for commenting. A thyroid storm can be an impressive and scary thing to see.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-24842671644058792822013-12-18T12:13:16.089-05:002013-12-18T12:13:16.089-05:00Ganesh, when I did that type of surgery. I left a ...Ganesh, when I did that type of surgery. I left a little portion of the thyroid gland in place in hope that it would be sufficient to maintain the patient in a euthyroid state. Some surgeons advocate a total thyroidectomy which minimizes the risk of recurrent hyperthyroidism but increases the risk of complications.<br /><br />One tries to leave all four parathyroid glands in place during any thyroid surgery. Removing all the parathyroid glands is a serious complication leaving the patient chronically hypocalcemic, which can be difficult to treat.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-21203288960086545362013-12-18T12:12:05.691-05:002013-12-18T12:12:05.691-05:00What a great story. Unfortunately, I once had a p...What a great story. Unfortunately, I once had a patient, young 20'ish year-old female, who had thyroid storm in the recovery room. She hadn't been taken her medications pre-op. I learned a valuable lesson that day. Thanks for the story.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-8081831298254065022013-12-18T11:22:13.491-05:002013-12-18T11:22:13.491-05:00do you still prefer to do total thyroidectomy or ...do you still prefer to do total thyroidectomy or do you leave some of the tissue behind? (as some modern theorists advice us to do? ) also do you remove parathyroids along with the total thyroidtectomy? jus curiousGanesh Puttuhttps://www.blogger.com/profile/13208083828467510958noreply@blogger.com