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Archive for the ‘Mexicali’ Category

Hospital de Simon Bolivar

Good week this week.  Spent Wednesday in the operating room at Simon Bolivar with my professor for an altitude-related condition.  As soon as I finish writing up the case I will post it at the sister site.

Then – yesterday – at Cardioinfantil with Dr. Garzon and Dr. Tellez .  They are preparing to start a new lung transplant program – one of just a few at elevated altitude.

Dr. Tellez, Director of Thoracic Surgery at Cardioinfantil

(Hopefully, I can interview Dr. Tellez more about the program in the future..)

Getting ready to take a trip to talk to some more surgeons about thoracic surgery soon.

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First day with my new professor, Dr. Ricardo Buitrago and everything went well.  (He is supernice – and a total expert (but really humble about it.)  Had a great case – a VATS lobectomy.. (for my thoracic experts out there – no, no utility incision..)

Rounded on patients with the residents; reviewed labs and films..

VATS – yes, the whole room is green (except for the white towel covering the patient..)

 

 

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As I get ready to leave Mexicali, I am posting several old postcards of the city.  Today’s post is more reflective of the many changes going on now – but we’ll be back to our usual topics soon..

this one is just a few years old

I’m sure that my regular readers can tell that parting is ‘such bittersweet sorrow’.. How could it not be  – when I have met such wonderful people, learned so much and made some great friends?

Mexicali – Av..Revolucion – circa 1960’s

At the same time, I am excited about moving forward – school, studying in Bogotá, and working on my research.

Governmental Palace (now part of UABC) circa 1960’s

Hard to leave the hospital in particular.  I went back there yesterday and got to see some of the people who were so welcoming, starting on my very first day.  (When I was still struggling – particularly with the regional accent here – which differs from the Spanish I was used to hearing.)

Av. Lopez Mateos

It was great to be back in the operating room with Dr. Ochoa.  With classes in Nashville, and my homework assignments, I hadn’t seen him for a couple of weeks.

I know I will miss him most of all even if I am embarrassed to admit it.  He will always rank up there as one of the world’s great “bosses”; he was great to be around; day after day after day- which is not something you can say about most people.   I know I’ve talked about what a good (and patient!) professor he has been, but this last month, when we’ve been collaborating on the book, has changed the dynamic a bit.  He’ll still always be ‘my professor’ and a surgical colleague – but now that we have worked together in a different capacity – he is more of a friend too.  (I’ve actually called him by his first name a couple of times, which is a hard thing for me to do..)

I think, too, that is was a little-bit eye-opening for him to be more involved on the writing (and researching) side of things.  I hope he enjoyed it as much as I have.  (He should – he did all the research on Mexicali’s nightlife.. )

and Joanna – who has become one of my best friends.. (Not just my best friend in Mexicali – but someone I consider a really close friend – anytime, anywhere..)  It just seems like we connect and communicate on that level that only really close friends ever do.. Despite different backgrounds, I feel like I’ve known her my whole life..  So it’s hard to say “see you later” to Joanna.. (“See you later” is so much better than goodbye, don’t you think?)

So of course, as you can imagine – I spent my last day at the hospital – in the place I love the most: the operating room.

Dr. Rivera (left) and Dr. Ochoa

I’m going to miss my ‘movie star’ surgeon too – Dr. Rivera has been great about being in all my pictures and film clips..  He’s a nice young resident – (still grounded)  and I think he’s be a great surgeon when he finishes his training..  He’s interested in surgical oncology – so we might be writing about him again in a few years..

 

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Long time readers (and former patients) will be familiar with my aspirin mantra but now Medscape has published a CME course by Dr. Desiree Lie for health care providers in primary practice, general surgery (and other areas that may not be familiar with post-cardiac patient recommendations.)  As I may have mentioned before, in cardiac surgery – we routinely start aspirin in our patients prior to bypass surgery.

Don’t stop Aspirin before surgery

I’ve converted the CME course, Don’t stop Aspirin before surgery into a pdf – but if you want credit – you will have to go to Medscape and log in.  (For everyone else – it’s a nice read – and explains the importance of continuing aspirin in patients who are taking it for “secondary prevention” or are at high risk of cardiovascular events.

That’s because the complications of discontinuing aspirin therapy in these patients are WORSE than the minor risk of bleeding.  (Bleeding issues for most patients taking aspirin are fairly minor.. Now, clopidogrel (Plavix) and prasugrel (Effient) are another story!)

Wait a second… What’s secondary prevention?

They way to think about secondary prevention is “closing the barn after the cows are loose,” as one of my colleagues explains it.  This means that Aspirin has been prescribed to these patients after something has already happened – like a stroke, a heart attack, stents or cardiac surgery.  So in these patients – secondary prevention can be thought of as preventing a second event or further complications from a disease process we already know about.

Now, patients that are at high risk for cardiovascular events like diabetics or people with other kinds of blockages (peripheral vascular disease, renal artery stenosis) haven’t had a heart attack yet – but we think that they are at a high risk of this happening – so they take aspirin to prevent this (primary prevention).

In people who are at low or moderate risk – low cholesterol, nonobese, normal glucose, nonsmokers:  these people may take aspirin, but (probably not prescribed) and it is safe for them to discontinue aspirin before surgery.

But in the first two classes of patients (secondary prevention group/ high risk group) – stopping aspirin may actually INCREASE the risk of having a heart attack, stroke or other thrombotic event during surgery.  But if you are having surgery – be sure to check with your cardiologist or cardiac surgeon before.  Don’t rely on your PCP or general surgeon (it’s not their area of expertise) and they may not be up-to-date on the latest recommendations [hence the continuing education course].

A new chapter at Cartagena Surgery: the DNP program

Nashville, Tennessee

Back in Mexicali, MX after spending a week in Nashville, Tennessee for the start of my doctoral program in nursing.  It felt weird to be back in Nashville after so long (I lived there while attending Vanderbilt for my masters degree).  It was surprising how much had changed – the medical center and the university campus just continue to grow and grow!

But then again – with 70 people in the Fall 2012 DNP class, I guess it’s no surprise that the campus is growing.  About 15 of us are full-time students.  I’ll be heading off to Bogotá in a week to start some specialized study there – so between the DNP program and Bogotá – I might be posting a bit less often.

Fall 2012 class for DNP (doctorate of nursing practice) at Vanderbilt University

The DNP is a new degree that takes the place of the DNSc (doctorate of nursing science) or the ND (nursing doctorate) – depending on who you ask.  I know that sounds like alphabet soup to many people, so I’ll post some more information about the degree soon.  But the main thing to think about when thinking about doctoral degrees – is the focus behind the degree.

PhD – or a doctorate in Philosophy are Research degrees. (research with a capital ‘R’)  Think about labs, nursing theories and hard-core research..so think ‘nurse-scientists’.. I tell people to picture a nurse with a beaker and a bunsen burner.. Not entirely accurate but a good mental picture.

DNP – is a clinical doctorate – used to translate much of this research into improved clinical practice.  Clinical, clinical, clinical.. This is the degree for people who are still planning on working in the clinical (hospital-based or clinic-based) setting, seeing patients.  The courses in this program are designed to promote evidence-based practice – or using all of that research that our nurse-scientists (and other researchers) are publishing.

So the hope is that the DNP will be able to improve the care of patients by creating protocols and such.  As it is still a fairly new degree – there is currently a lot of cross-over among PhD trained nurses, and I suspect there always will be – it’s more a matter of preference in what a nurse wants to focus on during her doctorate education. (So don’t be surprised if your nurse practitioner has a PhD.)

There are still plenty of doctorates in education and other fields as well like administration because it takes all types of nurses to serve as faculty, deans of educational programs, and hospital administrators.

There are even a few doctorate of nursing science programs left – in Louisiana and Puerto Rico..

Now I apologize because this is a simplistic explanation that leaves out a lot of nuance but I’ll provide more information soon.  But now, I better get back to the books!

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As I mentioned previously – the ‘unauthorized’ use of celebrity images is pretty common around here.  We talked about this before in conjunction to Kim Kardashian and Rhianna – and today, while driving around Mexicali taking pictures for a section of the book on architecture, we saw yet another example of this.  (Sorry, Kim – we were in traffic, and seeing it was unexpected, so the photo is blurry – and I know, my window is filthy) – but it’s undeniably you hawking clothing up on a sign outside a clothing store on Blvd Anahuac..  Just thought you should know..

Kim Kardashian hawking cheap clothing in Mexico

In other news – spent the day trying to find the elusive “casa de Louis Vuitton” which is a house of the outskirts of Mexicali painted brown with symbols to look like a Louis Vuitton bag.  I know the house is still there – yesterday one of the people who lived near the house was lamenting being a neighbor – but the address and directions were far from correct..

I did get some more great photos of Mexicali.. including one of the fancy car dealerships down here.. (I like to remind people that Mexicali has one of the highest standards of living, and income in all of Baja)..  There is a growing middle-class here (and just like most of us), they like nice things..  It’s another side of the road photos since I wasn’t planning on taking pictures of car dealerships..

Mercedes Benz dealership

A lot more photos but I haven’t gotten around to sorting of all them yet..More architectural adventures tomorrow..

 

 

 

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into the 110’s (and higher) it’s been an interesting week in Mexicali.  I’ve definitely entered new territory in my book writing venture.  In the last books, I basically didn’t see the forest for the trees – meaning that even as I raced around, and enjoyed the cities I was living in – I didn’t include any of the information about the cities themselves.. Just the surgeons, and surgery.

In retrospect – I think that was a mistake.  While I know the beautiful multifaceted Bogotá, my readers don’t.  At the time, I didn’t want to duplicate the efforts of the many talented travel writers out there.  But on consideration – living in a city is so much different from visiting one.   It takes months to see and fully appreciate the nuance of many locations – especially cities..  Anyone can talk about the historic church built in 19 whatever, but it takes time and familiarity to see the beauty of Mexicali’s Graceland, or the changing canvas of the UABC museum.  It takes time to collect the stories that bring the city to life.  So now, I am trying to do that – in a small fashion with everything I’ve collected since coming here in March.

I am not Frommer’s.. I am more like his awkward, quirky little cousin. I don’t have the manpower or the resources to talk about the hundreds of restaurants here (more than 100 Chinese restaurants alone!) but I can tell you some of my favorite places; for a casual lunch with friends, or a night on the town.  I can’t give exhaustive listings on all there is to see and do in this thriving city, but I can show you the heart of it.  I can tell you about the things that make Mexicali more than just spot in the hard-baked earth; the things that make this city real, and make it a fascinating place to be.  I can make your stay; whether just a few days, weeks or months; interesting and informative.

It’s been a fascinating and amazing journey to discover these ‘pockets of life’ and living history – and now that I am outside my realm (of medicine and surgery) one that would have been impossible without the numerous people who have embraced me, and shared their wisdom.  (It’s becoming quite the list – and I’ll share it with you all soon.)

But I certainly hope that my future readers enjoy the journey as much as I have.

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I was in the United States most of last week (at my reunion) but I didn’t stop working.  While a reunion may not seem like the most ideal situation for a medical writer – it’s actually a great opportunity to talk to people and get their opinions about health care, medicine and surgery.  After the first few minutes of catching up – talk naturally turns to everyday life, and for many of us – ‘everyday life’ involves worrying about the health of our families.. Also, many of my classmates – and old friends have been some of my biggest supporters of the blog (and my other work) so it was good to get some critical feedback.

Bret Harte class reunion

The book is coming along – almost continuous writing at this point.  While I (always!) want more interviews with more surgeons, I am now at the point where I am filling in some gaps  – talking about the city of Mexicali itself.  So I am visiting museums, archives, and talking to residents about Mexicali so I can provide a more complete picture to readers.  Right now, I would really like some information about 1920’s -30’s Mexicali – I can find a lot of interesting stuff about Tijuana, but Mexicali is proving more elusive.

It’s a bit of a change from my usual research – finding out about decades old scandals (even local haunted houses), visiting restaurants and nightclubs, but it’s been a lot of fun., even if it seems frivolous or silly at times.  I hope readers enjoy this glimpse into Mexicali’s rich history as much as I have.

Finished the cover – which to me, is critical at this point.  (I use the cover to inspire me when it comes to the less than thrilling stage of copy editing) so I am posting an image here.

cover for the new book

Meeting with an architect later this week – to learn about, and write about some of the variety of styles here in Mexicali.  (There is such a surprising array – I thought it would be nice for readers to have a chance to know a bit more.)

Now there’s one house I’ve dubbed “Mexicali’s Graceland.”  I don’t know why Graceland comes to mind every time I go past this home (it looks nothing like Elvis’ home in Memphis) but the term has stuck.  I am hoping to get some of the history on this house because it just looks like a place where even the walls have stories to tell.

The pictures aren’t the most flattering – but I’ll post one so you can tell me what you think.  (It’s actually far more lovely in person – with the contrast between the pink walls and the white scrollwork, as well as some of the more classic design features.) I guess my imagination tends to run away with me – with images of grandeur and elegant ladies sipping champagne in the marbled halls of the past – but then – most of my usual writing is technical in nature, so I have few outlets for my creativity.

Mexicali’s Graceland

Meeting with my co-writer today to go back to the archives..

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