A letter to a father whose son was diagnosed with cancer

One of my colleagues’ son was diagnosed with cancer last week, and was started urgently on chemotherapy. When I found out, I wrote my colleague an email which I have pasted below (with identifying details removed).

I heard about your son through XXXX. I know from recent personal experience how overwhelming this all can be. The disease process is obviously different, but if there is any way that I can give help or advice to you, your son, or your family please let me know. Chemo is rough, but there is light at the end of the tunnel. I had my chemo as an outpatient – 8 hours a day, 40 hours a week, 1 week in 3. I can’t say enough good things about the oncology nurses. They are fantastic, loving people and will take good care of your son.

My best advice for dealing with the chemo is bad television (I watched a lot of junk) – an iPad, headphones, and a netflix subscription would be a big help. I wasn’t able to read or concentrate, and I was too weak to do much else. I did find that massage helped – especially when I developed somatic pain and weird sensory issues from the chemo. Once his blood counts improve and he is cleared to go out in public, you might want to get a prescription for massage. They had to use light pressure, as I bruised too easily for deep tissue. My massage therapist is fantastic – Corinne at Dreamclinic on 65th.

During the bad weeks, my family made me take a walk once a day, even if it was only a slow shuffle to the end of the block and back. During the good weeks I still wasn’t up to strenuous exercise, but my family did make sure that I got out of the house on occasion. In the good weeks I also tried to do very gentle yoga, just to keep my body stretched out. I would only go to a “slow hatha” or “recovery” class, and just explain to the instructor that I would only do what I could.

I had a lot of nausea, even on 4-5 different anti-emetics. I did end up using medical marijuana during the worst of it. It sounds odd, as I don’t use drugs and had only used marijuana once or twice in college, but I found that there were times that it was the only thing that helped, even on zofran, steroids, compazine, benedryl, and ativan. I didn’t want to smoke, so I used edible brownies or rice krispy treats. I only used it 3-4 times, but when I needed it, it really helped.

Depending on the chemo regimen that he is on, there may ways to prevent long-term side effects. I developed peripheral neuropathy secondary to cisplatin. In retrospect, it turns out that Vitamin E has been shown to minimize the risk of this, but I didn’t do this research and no one brought it up until I developed the symptoms and by then it was too late. Obviously, the first priority is getting the lymphoma under control. After that you may want to research the most common long-term side effects of his regimen, and research or ask about ways to mitigate the risks.

I personally found it therapeutic to blog about my treatment. It may not be for everyone, but it allowed me a chance to reflect on what I was going through and what I was thinking about. I think I used it in lieu of therapy. Blogging may not be for everyone, but he may want to keep a journal. If he does want to blog, I used wordpress.com.

Once he is getting towards the end of the chemo, realize that there will be a long recovery process before he is back to full strength. Every day gets better, but it truly was about 6 months before I was up to almost full energy and strength and there are physical and psychological impacts that still last a year and a half later. For about 3 of those months I worked with a personal trainer to get my endurance back (my lowest crit was 26, which I could really feel).

The good news is that he is in the best possible place – the physicians and nurses at the UW and the SCCA are fantastic, and he is with a supportive and loving family. Again, let me know if there is anything that Stacy and I can do.

Andy

The Values of a Surgeon

A video from my boss, Dr. Carlos Pellegrini. The values of a surgeon, providing a moral compass for us all: Professionalism, Excellence, Innovation, Introspection, Inclusion.

Of those, I think we all could use more introspection.

Inner Geek: Surgeon Still Playing Video Games After 25+ Years of Schooling

Brian Caulfield wrote up a really nice piece for nVidia’s blog based on the talk I gave last month on Video Games and Medicine. I especially love the title.

Inner Geek: Surgeon Still Playing Video Games After 25+ Years of Schooling

Driven

A great video from the American College of Surgeons. Inspiring message about why we surgeons do what we do, and how we are driven to provide the highest level of patient care. Featured in Dr. Carlos Pellegrini’s inaugural address at the 2013 American College of Surgeons Clinical Congress.

Surgeons as Educators

This year I attended the Surgeons as Educators course put on by the American College of Surgeons. By far this was the single best professional development activity that I have ever attended. A solid week (8 am – 9pm) of great sessions on how to teach, leadership, and career development. I would highly recommend this to anyone involved in educational leadership.

Because I am a huge geek, I tweeted my notes throughout the meeting, including great tips and pearls as well as links to articles and videos I found particularly interesting. For folks who might be interested, I collected all of these tweets in one place using Storify.

[View the story “2013 Surgeons as Educators” on Storify]

Video Games and Medicine

Over Labor Day weekend I had the opportunity to run a panel on Video Games and Medicine at Pax Prime  – the largest video game convention in the world. It was a really fun panel (and a great convention). We brought SimMan and LapSim with us and after the presentations pulled up volunteers from the audience to be a surgeon for the day. One of my daughters was in the audience, who had never heard me speak publicly before. I was especially happy about the panel because she told me afterwards “Dad, I never knew you were so funny.” That’s the kind of feedback you like to hear from your teenager.

The video of the presentation is below, and the presentation itself is available as a Prezi.

I was interviewed about the panel by All Things D, which resulted in a nice feature: “Why the University of Washington Wants Its Surgeons to Play Videogames.”

Videogames in Medicine at PAX Prime!

Just heard that our submission to Pax Prime 2013 (the world’s largest videogame convention) got accepted as a panel! Description below, panel will be on Saturday 8/31 at 12:30. Now I just have to figure out how to put the show on the road…

http://prime.paxsite.com/

Videogames in Medicine

You’ve seen Trauma Center and Surgeon Simulator 2013, but can videogames really simulate what happens in the operating room? Do you want your surgeon to study in his or her off-hours, or play the latest FPS instead? Gaming technology is helping train the next generation of physicians. We’ll have expert surgeons and developers from the world of healthcare simulation to demonstrate some of the latest tech and to discuss how gaming may make your next operation safer. Join us on stage – we’ll pick some lucky audience members to (virtually) become a surgeon for the day.

The University of Washington Central Venous Catheter Project

I am presenting this week at Surgicon in Gothenburg, Sweden on the University of Washington Central Venous Catheter Project. Over the past 4 years we have trained and credentialed over 1400 providers in ultrasound-guided central line placement, and have cut our institution’s complication rate by over 200%, saving an estimated $1,050,000 annually. I’ll post a video of the talk later this week, but for now, here is a PDF copy of a white paper on the project:

PDF: University of Washington CVC Project

Little Free Library

My crazy family with our crazy dog and our crazy Little Free Library. Gotta love public access television. Better than Portlandia.

My daughters and I built our Little Free Library last summer – ours is the 1st library in the video, and my wife Stacy is the one with dark curly hair and the beagle that likes to watch over passers-by. Our daughters show up late in the video (I was out of town during filming).

 

Instrument Handling: Scalpels

Authors: Andrew S Wright MD, Aaron Jensen MD, Sara Kim PhD, Karen Horvath MD, from the Institute for Simulation and Interprofessional Studies at the University of Washington

The scalpel is the most precise tool for tissue dissection and, in comparison to scissors or blunt dissection, causes the least trauma to surrounding tissue. The scalpel usually consists of a disposable scalpel blade and a reusable handle, but may be a disposable one-piece unit. There are several different scalpel blades available, of which three are the most commonly used.

Disposable one-piece Scalpel with a #10 blade

#10 Blade

The #10 blade is commonly used for large, straight incisions. It is held like a violin bow, allowing the most efficient use of largest cutting surface of the blade.  This also allows the surgeon to modulate the depth of incision by feel as well as by vision. Finally, this grasp encourages straight incisions, as the arm moves as a unit from the shoulder.

Proper grip for holding a #10 blade scalpel

When making a skin incision, it is best to use one smooth stroke, rather than multiple small strokes, causing less trauma to the tissue. The scalpel should be perpendicular to the skin and equal tension should be applied to both edges of the skin to prevent beveling of the skin edges.

A common error is to hold the #10 blade like a pencil. This forces the tip of the blade against the skin, instead of using the belly of the blade to make the incision, making harder to cut in a straight, even line.

Incorrect grip for holding a #10 blade. This forces the tip of the blade against the skin, making it more difficult to cut in a straight, even line.

15 Blade

The #15 blade is most often used for short or curved incisions. In contrast to the #10 blade, the #15 blade is held like a pencil, allowing the curve of the blade to come in contact with the skin.  In this grasp, control of the scalpel is with the wrist, allowing more precise cutting. In order to stabilize the scalpel, the heel of the hand may be rested on the patient.

Correct grip for a #15 blade.

When making a curved incision, it is especially important to keep the scalpel perpendicular to the skin, as it is easy to inadvertently bevel the skin edges in this setting. In making an elliptical incision, make sure to draw the scalpel away from the corners in order to prevent cross-hatching of the incision.

11 Blade

The #11 blade is most often used to make stab incisions. It is held like a pencil and is often held upside down. If the wound needs to be extended, the scalpel is moved in a sawing motion. The blade has a back bevel which may be placed against a guide, such as the guidewire used in central venous catheterization, to ensure accurate placement of a stab incision. The #11 blade is extremely sharp and may inadvertently be passed too deep. To prevent this, the hand may be stabilized with the heel of the hand on the skin, preventing undue advance of the scalpel.

There are a number of other specialty blades that are used in unusual situations. Use of these blades is outside the scope of this tutorial.

How to Practice This Skill: 

Using a tissue pad make three incisions using the appropriate scalpel blade, using the self-assessment criteria below.