Hi everyone! It’s round two for being Grand Rounds host here at Mexico Medical Student next week. Wheee!
Because this week’s illustrious host, Dr. Anonymous, has pulled a fast one (and a very cool one, I might add) by unveiling Grand Rounds 4:08 live on Internet radio the night before (one hour behind Eastern time, it was 11:00pm Monday for me, but it was 12:00am Tuesday Eastern…), my little submission guidelines post is a bit, um…behind because I participated in the radio broadcast. 
I’ll update the site with the relevant info tomorrow. Right now I’m need sleeeeep…
So, welcome Dr. Anonymous’ readers, and congrats to him for both hosting this week and breaking new ground w/Grand Rounds (no easy feat, given the incredible editions as of late) by incorporating LIVE RADIO. Awesome!
Update 13 Nov, 16:10: The archived radio show of Dr. A’s unveiling is now up! Yay!
You’d think I was speaking figuratively, but actually, that’s precisely what happened. I had an EGD (endoscopy) the other day. It represented my first actual “procedure” here in Mexico which actually carried some risk/doubt about it. I had no qualms about my doctor per se, but previous (minor) experience as a patient and what I’ve seen as a trainee had already cemented the fear regarding crappy pain/analgesic management here. The reasons why are very complex and include cultural factors and a bit of severe government retardation in the way of what/how “controlled” substances are controlled. I don’t want to say something incorrect, about it so I won’t, but trust me–acceptable pain management standards are not a given everywhere and is highly stratified by economics as well. So when my Dr. finally arrived at the hospital, I asked about the sedation (something I took for granted when we had the office visit), and he said two words that made me just sink back in my pillow and know I was in good hands: midazolam and fentanyl. “Do what thou wilst, Dr. RotoRooter; I am thy faithful servant.”
The endoscopy room was big enough for two patients to fit, but since I was wheeled (already in the bed) after they started an EGD before me, they just parked me out in the hall for a bit. I got to listen to the banter (there was an actual anesthesiologist working the sedation) about the weekend, etc., and it wasn’t long before I heard that they were done. I made the mistake of peeking behind my shoulder into the room just in time for the doctor to be holding the ’scope handle practically above his head. A long black, striped metal (or some hard polymer) fiberoptic snake ominously dangled almost to the floor. It reminded me of those Sentinel tentacles from The Matrix movies. Seeing this thing in person isn’t the same thing as seeing it on pictures, TV, etc. The article above says it’s about “the width of a finger” — sure, if you’re Mike Ditka, maybe.
In the end (and since this wasn’t a colonoscopy, that wasn’t a pun), it was a totally painless, non-traumatic experience. The crap they sprayed in the back of my throat to numb the gag reflex was the most foul thing about the whole process. I’ve experienced the ugly banana-tasting Hurricane(tm) spray, but this was like an un-natrual product of an organic chemistry lab experiment. It might very well have simply been lidocaine in ether for all I know, but it worked. Into the lateral decubitus position I went (I’d have worried if it was the jackknife position), and in went the Happy Juice.
Some minutes of prep later, (and time enough for the appropriate receptors to kick back and chillax on their little Barcaloungers) in went the scope. I remember being told to swallow, and a brief “WTF!” moment, but I guess once well past the upper 1/3 of the esophagus, it was a done deal. I remember bits and pieces of the video screen images, but not a complete whole (hardly “Ah, I see we’ve arrived at the lower esophageal sphincter” — not even close. More like, “Ooh, mucosa.” *drool*). Embarrassingly, the most numerous individual memories I have are of me burping. You see, they insufflate you with gas, sort of like laparoscopy so the camera has some visualization room, but it’s done as needed. Knowing this beforehand and burping uncontrollably, half-awake with a metal tube down your throat are two different worlds of experience, trust me.
After the deed was done, I just lay there and sort of semi-watched them type stuff on the computer screen and flip through images, selecting the ones they wanted to print. Still dazed, I remember talking to the nurse and had enough consciousness to realize 1) I was talking and what I was talking about, and 2) I was just talking random shit like a drunk who’s about to pass out, which is appropriate because that’s about what I was except, thankfully, I was coming to, not going out. At least I wasn’t trying to hit on her (so I recall). After more time passed, and some quick checks, questions, and so forth, I was led (on my feet–no wheelchair) carefully and directly to…THE BILLING ROOM.
Yes, my friends, this is where the account is settled before you leave. I had left a deposit before the procedure, but now it was time to pay the piper. It’s just totally different here, that’s all I’ll say. I knew all the costs beforehand, so there was no real surprise, but it was kinda “rude” to be still drugged-but-functioning, but settle your account first before leaving. I’m not OK to drive (and they verified I had transportation taken care of), but I’m OK to hand over cash and/or a credit card and sign financial forms. Riiiight….
Anyway, that’s my story. I found out that there was nothing wrong with me except for generically useless observations, such as probable chronic inflammation (pending histopathology of a couple of biopsy specimens), mild gastritis, and generalized esophageal mucosal edema. No Barrett’s, no ulcers, no nothin’. “Pale mucosa noted throughout.” Duh. My Hgb is actually up at 10.2, but my MCV is still in the mid-60s. My serum iron is low-normal, and TIBC is not elevated. Totally atypical presentation of iron-deficiency anemia. No, it’s not like I need transfusions or anything, nor am I unable to get out and about, but the fatigue does catch up with me, as does the reactive compensatory tachycardia, etc. which has severely hampered my trying to exercise more. We’ll see. I won’t go into more details of my personal bloodwork, but it’s a head-scratcher. I just wanted to share my EGD experience here in Mexico. Total cost for everything, including hospital, anesthesiologist and GI doc was just under $500 cash. As a point of reference for those who may be traveling here, mine was a nice private hospital so this procedure can certainly be found for cheaper, but for those used to US-based care, I wouldn’t recommend it. Oh, and the icing on the cake: I got a DVD of the whole thing! (and no, my esophagus will not be going on YouTube :P)
Good GI (and hematologic) health to all!
Since my last post was “Meltdown,” I guess that’s an apropos title, since everything is back up and running. The final diagnosis for the desktop: simple drive corruption. Thankfully, I don’t have to buy a new drive! I have no idea how it got corrupted, since as it was going south, I was in front of it doing nothing special, but I ran several utilities that stressed the hell out of the drive (writing 1s and 0s randomly in all sorts of patterns covering the disk multiple times) and nary an error was reported.
Unfortunately, I was not able to recover all the data. Between data recovery efforts and backups, I got more than 80-90% of everything, and I’d say that almost everything that was important (since I backup that stuff more often) is still with me. It was a classic case of diminishing returns: the first day of full-on effort yielded by far the most data, the second day a bit more stuff but at far greater time and effort, and by Day 3, I had to just chalk the remainder up as a loss. I had a HUGE project at work that required me to work almost all day this last Sunday (another reason I hadn’t updated), so I didn’t have oodles of time to burn with my system in lala land.
The laptop was obviously fine from the start after I wiped it clean since its problems were always more superficial and was a result of my being overcautious than anything. It was “home base” for everything and turned out to be a trooper. What was massively cool is that my MPB has an 80G drive–adequate but small by laptop standards nowadays. It has one Firewire port which was connected to my desktop, which has two physical internal drives. The freaking awesome cool thing I had never tried in target mode is hot-connecting more physical drives to the slave machine. In this case, I added two more external FW drives to the G5, so my wittle bitty Macbook now had 5 physical drives mounted for a total of 880G of total raw space at its disposal!! Mwahahaha!
Ok, enough geekery, I promise. I just wanted to post a quick update before the posts that are about to go up because I got some comments (thank you) and wanted to bring the minimelodrama full circle. 
