Photo Shoot (Day 67)

11/19

Urbano No.1, Round 2 (Day 39)

10/22

Back to Centro de Salud Urbano No.1 for clinic this week. I felt a little bit like a rejected puppy when I was the last one being assigned to a position in the clinic and all the doctors didn’t want me to shadow them. Eventually, just as I guessed, I was put with the nutritionist, Sandra. I learned a lot!

• Fill in tarjetilla
• for 6th grade, it is mandated to see a nutritionist and do blood tests (lipid panel, CBC, etc…)
• most kids of any age usually see the nutritionist anyways
• Everyone has a “poliza de afiliacion” from Seguro Popular. It’s like an insurance card, except it’s a huge laminated piece of paper
• Nutritionist writes out a sample daily diet for the patient, usually telling them to eat how many servings of which food groups, at what time
• Apparently, not enough water could be a cause of urinary infection
• the “escolares” patients were children that are mandated to meet with the nutritionist; they usually come with their mother, who is more familiar with the kid’s diet
• when you increase sugar in your diet, the body would be used to excess resources leading to insulin resistance
• sometimes parents would lie about the child’s diet, but the children would rebut and usually say that it’s not true or tell the nutritionist what they actually do eat
• physical exam:
  • raise arms to check for “acantosis nigricans”, Acanthosis nigricans in English, “brown to black, poorly defined, velvety hyperpigmentation of the skin” (Wikipedia), possible indication of insulin resistance
  • look at hands to check capillaries; usually if you press on the skin, it takes two seconds to return to original color
  • look at nails to see if there are any grooves, gritadas, machidas
• many kids buy stuff at school like takis and doritos
• Normal values: 60 HCO, 15 PROT, 25 LIP
• Nutritionist recommends to eat more meals; when people go hours without eating, their glucose levels are uncontrolled and long term, the acid’s prolonged stay in the stomach can cause acid reflux or gastritis
• 60% of population in Mexico is overweight/obese, but I usually couldn’t tell. I realized that most of the time, especially if the person is petite or short, much of abcisceral fat can be hidden
• elders rely on sons/daughters for food supply; so if they don’t bring healthy food (fruits and vegetables), then the elder would not be able to have those as a part of their diet
• rice, tortilla, or pasta can be exchanged for a serving of “cereales” or grains
• no insurance means you can’t get your blood tests done, though if the patient pays for the consultation, that can cover the medications
• when taking calcium supplements, take it about two hours after meal
• long-term uncontrolled glucose levels can cause teeth to fall out
• nutritionist can prescribe vitamins and supplements
• hit around the bush: when the nutritionist asked the patient if they exercise, but the patient replied with “my legs and back hurt” and other physical conditions rather than just simply saying “no”
• heat oil in low flame to prevent oxidation and the change to saturated fat
• high triglyceride due to sugar intake
• would such specific diets start a bad habit of restrictive dieting or calorie counting, or make patients really conscious of what they eat?
• fiber is like gel, absorbing the nutrients that pass through the intestines

Later, after a several consultation, we went out for “desayuno”, or breakfast. We ate with other health staff: two other ladies in the statistics department and another man in administration. I found out that the nutritionist was a part of the delegation of the health union! Lady of power 😉

pan de los muertos – pan de yema with a sugar figurine

Restauran Tayo

Lovely ladies I met today

Surgery Rotation at Hospital ISSSTE (Day 32)

10/15

Because I am unfamiliar with medical ethics, from now on, I will be keeping most of my clinical notes private and publishing only public versions to avoid any conflicts.

When we got to Hopsital ISSSTE today, we found out that we wouldn’t start until 9AM. Around 9:15AM, an intern led us to the surgery floor. She seemed to be in a rush, so I’m assuming she had to be present at a specific surgery. I almost had to run to catch up with her!

Infrastructure notes

• four surgery rooms
• not as busy as Hospital Civil, which makes sense because Hospital Civil is available for the public, whereas Hospital ISSSTE is only for people with the ISSSTE insurance
• storage boxes in the hallways outside of surgery rooms
• there is air conditioning in the surgery rooms, unlike in Hospital Civil

Professionalism

• taking a phone call in the middle of surgery to make a consultation appointment

Surgery – “Artrodesis de columna” – Spondylodesis or Spinal Fusion

Anesthesiologist’s artwork, explaining to me one of the patient’s possible diagnosis

aligning the metallic screws

This surgeon is good! What you see is a side view of SIX perfectly aligned screws.

after surgery