Surgery and Low Blood sugar

megswinter82 · Aug 11, 2008

I've never been officially dx with hypoglycemia, but I have a lot of the classic signs and symptoms (ie nausea, confusion, tired, cranky, sweating) the biggest concern is that I get light headed and have passed out (i've been told that i have classic vasovagal tendencies) I'm just wondering what I can do during rotations like Surgery when I'll be in the OR retracting for 8+ hours...will I have a chance to grab a quick snack? I'm really worried about passing out and all the embarrassment that will follow.

Thanks!

Droopy Snoopy · Aug 11, 2008

megswinter82 said:
I've never been officially dx with hypoglycemia, but I have a lot of the classic signs and symptoms (ie nausea, confusion, tired, cranky, sweating) the biggest concern is that I get light headed and have passed out (i've been told that i have classic vasovagal tendencies) I'm just wondering what I can do during rotations like Surgery when I'll be in the OR retracting for 8+ hours...will I have a chance to grab a quick snack? I'm really worried about passing out and all the embarrassment that will follow.

Thanks!

Well it's not the norm to be retracting for 8 solid hours, most gensurg cases are 2-5 hours long. But yeah occasionally you will be in there for considerable periods of time. Try to eat 3-4 squares a day, carry around a couple of granola bars or something to munch on between cases, maybe a gatorade in your scrub locker. Above all though, in the OR don't try to be a hero. If you feel faint GTFO of the surgical field.

Jimmi · Aug 12, 2008

definitely agree with the last line, big time!

AmoryBlaine · Aug 12, 2008

You know one thing that is probably a real option if you are nice about it is to bring some hard candy in with you and talk to the circulator.

While some of them are heinous multi-headed demons from the 6th circle of Hell many of them are nice reasonable people.

If you tell him/her what's up they might be willing to take your mask down and feed you a candy...

It's worth a shot, and definitely better than having to just scrub out of a case.

45408 · Aug 12, 2008

well, for what it's worth, when I took biochem as an M1, we did a blood sugar lab, we all ate different meals and took our blood sugars. I had the high-fat, high-protein meal, and my blood sugar went higher and remained higher than anyone else's. Try something other than carbs.

SLUser11 · Aug 12, 2008

megswinter82 said:
I've never been officially dx with hypoglycemia, but I have a lot of the classic signs and symptoms (ie nausea, confusion, tired, cranky, sweating) the biggest concern is that I get light headed and have passed out (i've been told that i have classic vasovagal tendencies) I'm just wondering what I can do during rotations like Surgery when I'll be in the OR retracting for 8+ hours...will I have a chance to grab a quick snack? I'm really worried about passing out and all the embarrassment that will follow.

Thanks!

FYI, most surgical residents will think you are sort of a joke if you immediately point out to them that you have the serious self-made medical diagnoses of hypoglycemia and vasovagal syncope.

You may as well add fibromyalgia in as a diagnosis as well. Honestly, if I had a student use hypoglycemia as an excuse, I might make them do an accucheck to prove them wrong.........

I would recommend against advertising those (self-made) diagnoses on your rotation, as they will earn you a label of "whiner" and other similar but worse nicknames. Instead, make the small steps already described to minimize their effect on you.

Small meals throughout the day, with granola bars in your pocket, is an excellent idea. Hard candy in the OR itself, probably not, as they will say no, and it will bring negative attention to yourself.

Stay well hydrated, and don't over-do it on the caffeine, as this will lead to diuresis, causing another well-known intraoperative dilemma. Also, the caffeine will likely exacerbate whatever lightheadedness you're feeling.

If you're really worried about passing out in the OR, stay well hydrated and give it a test run on a shorter surgery. As mentioned, most surgeries will not be more than 2-3 hours long. If after that, you're feeling lightheaded and pre-syncopal, speak with your resident and say, "I tend to pass out easily when standing for a long time," and perhaps they will keep you stationed on the shorter surgeries.

Lastly, as someone mentioned, if you truly are about to pass out, back away from the table and sit down. It happens every year, and while it may cause you to get teased, it's better than faceplanting in the wound.

45408 · Aug 12, 2008

SLUser11 said:
You may as well add fibromyalgia in as a diagnosis as well. Honestly, if I had a student use hypoglycemia as an excuse, I might make them do an accucheck to prove them wrong.........

And then you'd look like a huge douche if they were right.

JaSam · Aug 12, 2008

TheProwler said:
And then you'd look like a huge douche if they were right.

yea seriously man, be nice to your students dude. I mean remember, we all are/were students at one point in our lives. How would you have like it if you got dickhead attendings/residents like that? try and walk in someone elses shoes every now and then.

SLUser11 · Aug 12, 2008

TheProwler said:
And then you'd look like a huge douche if they were right.

I'm not an expert, but I have yet to meet or treat anyone with hypoglycemia as a true primary diagnosis. It is almost always a result of another underlying condition, be it the meds someone is taking, too much insulin for a diabetic or critically ill patient, anorexia/bulimia, or some rare endocrine tumor.

I have, however, heard LOTS of people define themselves as hypoglycemic, and use it either for sympathy or as some BS excuse. This has occurred in the clinical setting, as well as in my personal/social life.

I also feel obligated to mention that the second year medical student is the world's largest hypochondriac, thanks to their daily studies, and hyperacuity to the slightest of physical symptoms. I was by no means exempt from this phenomenon, and I'm not speaking from a pedestal.

So which scenario is more likely? Is the student wrong about their diagnosis, or do they need a huge medical workup to determine what is causing this hypoglycemia? Either way I'm not going to simply accept it as a reason a student can't work hard in surgery, and leave it at that. It wouldn't be right. I should check their blood sugar to either a) give them peace of mind, or b) trigger the need for a further workup by their doctor (not me).

So, if it turns out that they have an insulinoma, maybe I'd feel like a douche, but only for a second....then I'd feel like a hero for discovering it.......

SLUser11 · Aug 12, 2008

JaSam said:
yea seriously man, be nice to your students dude. I mean remember, we all are/were students at one point in our lives. How would you have like it if you got dickhead attendings/residents like that? try and walk in someone elses shoes every now and then.

I promise you that I'm extremely nice and reasonable with my students. But, I'm not a pushover, and I expect them to work hard.

If someone claims to be hypoglycemic, without a true underlying cause, and wants some sort of exemption, it's not being a dickhead to check their sugars.

Honestly, having been both a student and a resident, I know what it's like to walk in both people's shoes. What I've discovered is that many residents that were condemned as being mean, or a douche or a dickhead as I've already been called in this thread, simply demanded hard work from their students, and didn't give out enough hugs.

As med students, our egos are huge, and when we don't perform well, we often look for someone (or something) else to blame. When we don't get enough warm, fuzzy hugs and congratulations from our residents, and instead are reprimanded, we begin to resent them, despite the fact that some of these residents have our best interests in mind.

So, I'm sorry if my initial post wasn't sympathetic enough, and made you guys feel that I'm out of touch, but hopefully the post did stop the OP from making a mistake that would affect her clerkship grade, and gave her some actually useful advice on how to deal with it. After all, which is more important: That you like your resident, or that you learn from them?

JaSam · Aug 12, 2008

SLUser11 said:
I'm not an expert, but I have yet to meet or treat anyone with hypoglycemia as a true primary diagnosis. It is almost always a result of another underlying condition, be it the meds someone is taking, too much insulin for a diabetic or critically ill patient, anorexia/bulimia, or some rare endocrine tumor.

I have, however, heard LOTS of people define themselves as hypoglycemic, and use it either for sympathy or as some BS excuse. This has occurred in the clinical setting, as well as in my personal/social life.

I also feel obligated to mention that the second year medical student is the world's largest hypochondriac, thanks to their daily studies, and hyperacuity to the slightest of physical symptoms. I was by no means exempt from this phenomenon, and I'm not speaking from a pedestal.

So which scenario is more likely? Is the student wrong about their diagnosis, or do they need a huge medical workup to determine what is causing this hypoglycemia? Either way I'm not going to simply accept it as a reason a student can't work hard in surgery, and leave it at that. It wouldn't be right. I should check their blood sugar to either a) give them peace of mind, or b) trigger the need for a further workup by their doctor (not me).

So, if it turns out that they have an insulinoma, maybe I'd feel like a douche, but only for a second....then I'd feel like a hero for discovering it.......

ok i see your intent, but still, you'd feel like a doucher. Cuz just by the simple fact that you're challenging them to take a glucose test to prove their validity your basically throwing it back in their face (throwing down the guantlet if you will ) and making this into more of a confrontation than it needs to be. They'd look like less of a man if they back down from the glucose test so in a way your saying "this is complete bs and I want you to prove me wrong." And if they weren't hypoglyc, then they'd look even worse. Why do that to a poor med student. They're here to learn and help you out the best they can and I have to say most MS3s and 4s work really hard. Theres no need to call em out like that or to question them like that. It shows a lack of respect and trust. How would you feel as a resident if you were the one with hypoglycemia and your MS3 asked you to do a fingerstick right now to prove it? I bet you'd be pissed as hell.

Safety first, learning second. IF your students gonna do a nosedive onto the ground or table or some sharp object during surgery is it really worth it?

45408 · Aug 12, 2008

SLUser11 said:
So which scenario is more likely? Is the student wrong about their diagnosis, or do they need a huge medical workup to determine what is causing this hypoglycemia? Either way I'm not going to simply accept it as a reason a student can't work hard in surgery, and leave it at that. It wouldn't be right. I should check their blood sugar to either a) give them peace of mind, or b) trigger the need for a further workup by their doctor (not me).

So what if it's not their actual blood glucose level, but they do feel weak and light-headed if they don't eat for a while? Something mysterious and unexplainable. It's not a problem for me, so I have no chips in the game, but I'm just saying. If someone says they can't come in early and have to leave before everyone else, and they're unable to do write-ups because of carpal tunnel, then yes, they sound like they're bluffing you to get out of doing hard work. Asking for some nourishment in a 6-hour case because they're going to faint seems a little different.

anon-y-mouse · Aug 13, 2008

SLUser11 said:
So, if it turns out that they have an insulinoma, maybe I'd feel like a douche, but only for a second....then I'd feel like a hero for discovering it.......

Okay, no, you just basically confirmed it. In my opinion, I, and many people would feel you ARE a douche for doing this. You have absolutely no business "verifying" students' personal health conditions- you are way overstepping your bounds as an educator. Wear your "MD" hat when you're seeing patients and not with your students (and future peers). If you have your doubts, you should be asking the student to speak with his/her dean and/or the clerkship director, rather than put them on the spot for an accuchek. HERO?! Unless it's some sort of medical emergency, (or if the student consults you on his/her medical problem- also inappropriate, but another story), there is no justifiable cause for you to be stepping over that boundary. Unfortunately that student would most probably comply with your ******ed demand for fear of being evaluated and having his dean's letter (and thus career) on the line. Completely and utterly inappropriate. You KNOW the hierarchy in medical education, *especially* in something like surgery, makes it awkward for anyone to speak up or say 'no'.

If you did this to me, not only would I file a registered complaint to your program director after my rotation, but I would formally initiate s*it hitting the fan by hiring a lawyer and investigating my legal options against you, the university, and the teaching hospital for harassment, coercion, creating a hostile environment and a potential violation of FERPA/HIPAA/whatever. If you would even consider doing this to your students, I wonder what other BS hoops you make your students hop through.

SLUser11 · Aug 13, 2008

TheProwler said:
So what if it's not their actual blood glucose level, but they do feel weak and light-headed if they don't eat for a while? Something mysterious and unexplainable....... Asking for some nourishment in a 6-hour case because they're going to faint seems a little different.

Please read the following quote from my first post:

SLUser11 said:
If you're really worried about passing out in the OR, stay well hydrated and give it a test run on a shorter surgery. As mentioned, most surgeries will not be more than 2-3 hours long. If after that, you're feeling lightheaded and pre-syncopal, speak with your resident and say, "I tend to pass out easily when standing for a long time," and perhaps they will keep you stationed on the shorter surgeries.

anon-y-mouse said:
Okay, no, you just basically confirmed it. In my opinion, I, and many people would feel you ARE a douche for doing this.

Well, that doesn't surprise me.

anon-y-mouse said:
Wear your "MD" hat when you're seeing patients and not with your students (and future peers). If you have your doubts, you should be asking the student to speak with his/her dean and/or the clerkship director....

Please read the following quote from my last post:

SLUser11 said:
I should check their blood sugar to either a) give them peace of mind, or b) trigger the need for a further workup by their doctor (not me).

anon-y-mouse said:
HERO?! Unless it's some sort of medical emergency, (or if the student consults you on his/her medical problem- also inappropriate, but another story), there is no justifiable cause for you to be stepping over that boundary.

I was only half serious about the accucheck thing to begin with, but you couldn't have picked a less serious quote to get your panties in a bunch than my statement about being a hero.

anon-y-mouse said:
Unfortunately that student would most probably comply with your ******ed demand for fear of being evaluated and having his dean's letter (and thus career) on the line. Completely and utterly inappropriate. You KNOW the hierarchy in medical education, *especially* in something like surgery, makes it awkward for anyone to speak up or say 'no'.

My knowledge of the hierarchy and absurdity of surgery is why I don't want the OP to parade her self-made diagnoses around. It will only hurt her.

anon-y-mouse said:
If you did this to me, not only would I file a registered complaint to your program director after my rotation, but I would formally initiate s*it hitting the fan by hiring a lawyer and investigating my legal options against you, the university, and the teaching hospital for harassment, coercion, creating a hostile environment and a potential violation of FERPA/HIPAA/whatever. If you would even consider doing this to your students, I wonder what other BS hoops you make your students hop through.

Now, wait, WHO is the douche?

smq123 · Aug 13, 2008

SLUser11 said:
I'm not an expert, but I have yet to meet or treat anyone with hypoglycemia as a true primary diagnosis. It is almost always a result of another underlying condition, be it the meds someone is taking, too much insulin for a diabetic or critically ill patient, anorexia/bulimia, or some rare endocrine tumor.

I have, however, heard LOTS of people define themselves as hypoglycemic, and use it either for sympathy or as some BS excuse. This has occurred in the clinical setting, as well as in my personal/social life.

I know that JaSam, TheProwler, and anon-y-mouse are all going to freak out about this, but I have to agree with the above.

The second fastest way to torpedo your grade on ANY third year rotation (NOT JUST SURGERY) is to make excuses. (The fastest is to complain incessantly.)

You may have "low blood sugar" problems, but that's not something to make an issue out of. Learn to deal with it as it comes up, or learn what things you can eat to make sure that it doesn't become an issue in the first place. If you feel pre-syncopal, excuse yourself, step back from the field and sit down. If needed, scrub out and get some juice or something.

MANY of us (maybe even all of us?) have had to step back from the surgical field at some point or another. If it happens, deal with it. It's not really something to stress about in advance.

Look, in many fields (not just surgery), complaining about some self-made diagnosis is NOT going to win you any points. If you're an ER physician, and one of your colleagues is always ducking out of work because of the "anxiety disorder" that they diagnosed themselves with, would you automatically accept that self-diagnosis? Wouldn't you expect them to actually get it worked up if it was such an issue, or to learn how to deal with it if it wasn't actually that serious?

Anytime anyone in the medical field (regardless of which specialty) has a self-made diagnosis that they don't pursue farther, NO ONE is going to take that "diagnosis" seriously.

smq123 · Aug 13, 2008

JaSam said:
Safety first, learning second. IF your students gonna do a nosedive onto the ground or table or some sharp object during surgery is it really worth it?

TheProwler said:
Asking for some nourishment in a 6-hour case because they're going to faint seems a little different.

1) SLUser never said that stepping back from the table once you start to feel dizzy is unacceptable. I think his point was not to excuse yourself from surgeries just because it *might* happen. If it happens, deal with it appropriately. If it doesn't happen, great!

2) Don't volunteer to scrub in on any Whipples or organ transplants. Those surgeries are LONG!

3) Bringing hard candy with you into the OR is usually not in accordance with hospital OR policies. Asking a circulating nurse to "feed" you candy during a surgery is also kind of weird, and might not go over so well.

Again, if you feel dizzy and lightheaded, there's no need to ask a nurse to feed candy to you. Just tell the attending surgeon/resident that you don't feel well (which will probably show in your paper-white, perspiring brow), step out, get some juice, and scrub back in. Problem solved.

MLT2MT2DO · Aug 13, 2008

megswinter82 said:
I've never been officially dx with hypoglycemia, but I have a lot of the classic signs and symptoms (ie nausea, confusion, tired, cranky, sweating) the biggest concern is that I get light headed and have passed out (i've been told that i have classic vasovagal tendencies) I'm just wondering what I can do during rotations like Surgery when I'll be in the OR retracting for 8+ hours...will I have a chance to grab a quick snack? I'm really worried about passing out and all the embarrassment that will follow.

Thanks!

To be on the safe side, both with your future rotations and your health. Go see an FP, and work toward a confirmed diagnosis whether it be hypoglycemia or not.

UCLAstudent · Aug 13, 2008

I'm at work, so I don't have time to write a huge response, but I agree 100% with SLUser11. You may not like what he had to say, but his post was spot on. Announcing your possible hypoglycemic problems prophylactically is a great way to get a poor clinical evaluation. You'll probably also be made fun of behind your back by the team. If you're really concerned about it, you should go to the doctor and get it checked out.

anon-y-mouse · Aug 13, 2008

smq123 said:
I know that JaSam, TheProwler, and anon-y-mouse are all going to freak out about this, but I have to agree with the above.

The second fastest way to torpedo your grade on ANY third year rotation (NOT JUST SURGERY) is to make excuses. (The fastest is to complain incessantly.)

Actually, I agree 100% with you. I go out of my way to be as easy-going as possible and get along with some of the most incompetent minds in medicine, just so I can be perceived as a 'team player' and do well on the rotation. My issue would be when some jerk resident decides to flex his muscle and overstep his boundaries. Again, as I said, I would only retaliate after all evals were in.

SLUser11 said:
I was only half serious about the accucheck thing to begin with, but you couldn't have picked a less serious quote to get your panties in a bunch than my statement about being a hero.

My knowledge of the hierarchy and absurdity of surgery is why I don't want the OP to parade her self-made diagnoses around. It will only hurt her.

Now, wait, WHO is the douche?

Even HALF serious is too serious in this case. You have a position of ridiculous responsibility where, if people don't do what you say, that can potentially result in heavy repercussions. I will begrudgingly and efficiently do all your scut and sit back as you teach me dick-all about medicine (you--generic), but I will not subject myself to that sort of personal invasion.

Reporting you and initiating action isn't being a douche, it's correcting a very serious violation of my privacy (if you were to do that to me). Abusing your position of power is not something you should take lightly at all.

megswinter82 · Aug 13, 2008

I think maybe I should've been much more specific in what I was asking. I appreciate ALL the posts, harsh or not. But let me clarify...I DO NOT have hypoglycemia. I've done the accucheck mutliple times and while I may be very close, I've never been low enough. I HAVE gone to the doctor...in fact in the past 2 years of medical school I have PASSED OUT twice in front of physicians (one was totally random and one was during a procedure...oops). I've also discussed my problems with my primary care physician. I have been told to eat every 2 hours and carry smelling salts in my pocket "just in case."

My concern was since my "treatment" invovles eating so often...how would I deal with this in terms of surgery and other rotations that require long hours w/o breaks? What snacks work for people with similar problems? Any particular brand of granola bar work? Any snacks that work and won't pack on the pounds in the process?

I HAVE NEVER and do not intend to advertise my problem to attendings or residents, unless it becomes necessary. I absolutely hope that I never pass out and never have to explain my problem. I simply want to do the best that I can and absolutely DO NOT intend to use this "as an excuse"...I expect to work my butt off during the next 2 years.

Thank you for the posts and advice. While it is always hard to hear "harsh" words, I would rather get it here and be prepared for the worst. Hopefully, I will have understanding attendings/residents...but in case I don't...I feel prepared to handle the issue.

So any other hints for how to shove in the most calories/protein/fat etc in the least amount of time and have it last the longest would be great!

AmoryBlaine · Aug 13, 2008

UCLAstudent said:
I'm at work, so I don't have time to write a huge response, but I agree 100% with SLUser11. You may not like what he had to say, but his post was spot on. Announcing your possible hypoglycemic problems prophylactically is a great way to get a poor clinical evaluation. You'll probably also be made fun of behind your back by the team. If you're really concerned about it, you should go to the doctor and get it checked out.

Good point. This is probably because in the experience of most of us those med students/residents who have mysterious ailments that prevent them from doing things tend not to be superstars in all other realms. It's usually more of a generalized weakness/whininess -- not something that goes over well in medicine.

I'm def giving the OP the benefit out the doubt, just making the observation that in my class the people who "got light headed during surgery" were the same ones who would cry bitterly if they had to *gasp* actually stay up on call.

SLUser11 · Aug 13, 2008

anon-y-mouse said:
Actually, I agree 100% with you. I go out of my way to be as easy-going as possible and get along with some of the most incompetent minds in medicine, just so I can be perceived as a 'team player' and do well on the rotation. My issue would be when some jerk resident decides to flex his muscle and overstep his boundaries. Again, as I said, I would only retaliate after all evals were in.

I don't know how you can call yourself easy-going and have a ridiculous over-reaction with threats to sue the resident/hospital/university in the same thread.

Also, I seriously question how convincing your thin facade of goodwill is to those "incompetent minds in medicine." I'm willing to bet that they see right through you to the weak, defensive, judgmental, inappropriately arrogant feelings you hold underneath.

Our personal argument aside, please don't advertise to your fellow students that you will get a lawyer and sue if things don't go your way in school. You'll get a label that you don't want, and nobody will want to work with you.

Anyway, I want to stop fighting. The more heated I get, the more likely I am to truly start acting like a douche. I'm a last-word freak.

anon-y-mouse · Aug 13, 2008

SLUser11 said:
I don't know how you can call yourself easy-going and have a ridiculous over-reaction with threats to sue the resident/hospital/university in the same thread.

Also, I seriously question how convincing your thin facade of goodwill is to those "incompetent minds in medicine." I'm willing to bet that they see right through you to the weak, defensive, judgmental, inappropriately arrogant feelings you hold underneath.

Our personal argument aside, please don't advertise to your fellow students that you will get a lawyer and sue if things don't go your way in school. You'll get a label that you don't want, and nobody will want to work with you.

Look, you fail to acknowledge how grossly WRONG it is for someone in your position of power to accuchek a student on the spot, and now you're looking to find fault in someone else? Something doesn't really add up here. This isn't about "things going my way" in medical school at all. That'd be like if I were to sue someone for making me stand for 8 hours or something, that's clearly ******ed. This issue is about someone (you) in a position of privilege who would do something to potentially violate my rights. So far, no one has violated my rights in medical school and I'm quite happy about that. Have things always gone my way? Clearly not, but I know when to put up and shut up. Now my personal health records/conditions? You're damn right I'm going to take them *extremely* seriously because that is a very clear line. It is your fault for being so short-sighted as to not realize what's wrong and what's right, and thus dismissing things that are of little relevance to you. What's next, punching my name into the medical records system to look at my A1C? My chest x-ray to prove I had pneumonia? If I *had* an insulinoma, it would be absolutely none of your business unless I talked to you about it. "I get hypoglycemic" is enough for you to say, "Okay, do what you have to today, but talk to your Dean and have him talk to me about it" without launching into your mental differential and evaluation of current medical literature about neuroglycopenia because I am not your patient.

"Easy going" does not mean pushover with respect to my rights. I am shocked that you are so grossly unaware of this line between right and wrong behavior. Yours is the same argument that sexual harassers use, though you and I both know that behavior is wrong.

Thanks for your advice- fortunately, I have received glowing evals already and don't think I will have too much of a problem succeeding in the medical world -- at the very least by virtue of personality.

45408 · Aug 14, 2008

smq123 said:
I know that JaSam, TheProwler, and anon-y-mouse are all going to freak out about this, but I have to agree with the above.

Thanks for bolding my name. I would've missed it otherwise.

UCLAstudent · Aug 14, 2008

anon-y-mouse said:
Look, you fail to acknowledge how grossly WRONG it is for someone in your position of power to accuchek a student on the spot, and now you're looking to find fault in someone else? Something doesn't really add up here. This isn't about "things going my way" in medical school at all. That'd be like if I were to sue someone for making me stand for 8 hours or something, that's clearly ******ed. This issue is about someone (you) in a position of privilege who would do something to potentially violate my rights. So far, no one has violated my rights in medical school and I'm quite happy about that. Have things always gone my way? Clearly not, but I know when to put up and shut up. Now my personal health records/conditions? You're damn right I'm going to take them *extremely* seriously because that is a very clear line. It is your fault for being so short-sighted as to not realize what's wrong and what's right, and thus dismissing things that are of little relevance to you. What's next, punching my name into the medical records system to look at my A1C? My chest x-ray to prove I had pneumonia? If I *had* an insulinoma, it would be absolutely none of your business unless I talked to you about it. "I get hypoglycemic" is enough for you to say, "Okay, do what you have to today, but talk to your Dean and have him talk to me about it" without launching into your mental differential and evaluation of current medical literature about neuroglycopenia because I am not your patient.

I think you're taking the accucheck comment a little too seriously. SLUser11 was just giving an extreme example to make a point about how annoying it is to deal with students with vague/touchy-feely physical complaints (hence the fibromyalgia comment in the sentence before). Unfortunately, it's not all that uncommon for medical students to exaggerate physical symptoms to have an "excuse" if they don't perform up to standards.

Note: I'm not referring to you at all, megswinter82 --- I read your second post. 🙂 Just addressing the topic in general.

SLUser11 · Aug 14, 2008

anon-y-mouse said:
"Easy going" does not mean pushover with respect to my rights. I am shocked that you are so grossly unaware of this line between right and wrong behavior. Yours is the same argument that sexual harassers use, though you and I both know that behavior is wrong.

Thanks for your advice- fortunately, I have received glowing evals already and don't think I will have too much of a problem succeeding in the medical world -- at the very least by virtue of personality.

Okay, I changed my mind. Tell your fellow students about how you would get a lawyer and sue my ass, etc. But don't tell that stupid, power-hungry resident.

Also, keep silently judging your coworkers and superiors. Don't worry, they're not as smart as you, and they'll never know what you're thinking. You'll keep getting glowing evals, because you're so awesome.

They know almost nothing, and you, now in the infancy of your third year of medical school, know pretty much everything. It's hilarious that they try to teach you. HA!! Just pretend to listen while they teach you "dick-all" about medicine, and then go home and post more "look how great I am" bullcrap on SDN.

45408 · Aug 14, 2008

SLUser11 said:
Okay, I changed my mind. Tell your fellow students about how you would get a lawyer and sue my ass, etc. But don't tell that stupid, power-hungry resident.

Also, keep silently judging your coworkers and superiors. Don't worry, they're not as smart as you, and they'll never know what you're thinking. You'll keep getting glowing evals, because you're so awesome.

They know almost nothing, and you, now in the infancy of your third year of medical school, know pretty much everything. It's hilarious that they try to teach you. HA!! Just pretend to listen while they teach you "dick-all" about medicine, and then go home and post more "look how great I am" bullcrap on SDN.

This is definitely not a passive-aggressive post that is attempting to get in the last word.

smq123 · Aug 14, 2008

megswinter82 said:
I've also discussed my problems with my primary care physician. I have been told to eat every 2 hours and carry smelling salts in my pocket "just in case."

My concern was since my "treatment" invovles eating so often...how would I deal with this in terms of surgery and other rotations that require long hours w/o breaks? What snacks work for people with similar problems? Any particular brand of granola bar work? Any snacks that work and won't pack on the pounds in the process?

Thanks for the clarification. I wish you the best of luck on your rotations.

Well, for starters, like I said, if you can choose, do not choose to scrub in to certain surgeries. Whipples are, at a minimum, 6 hours long. You don't have to retract usually (they tend to use a self-retracting ring for those - the Bookwalter), but you will have to stand there for a long time. Organ transplants can also easily take > 12 hours. Granted, you'll probably get a 10 minute bathroom break in there, but it won't be every two hours.

Some small plastic surgery cases (like lipoma removal) will be short. Sentinal lymph node biopsies are also short. Lap appys and lap choles are about an hour each....and, if you're lucky, you won't have to scrub in at all.

Keep some hard candy in your scrubs pocket. It might be useful to have some small form of concentrated sugar that you can shove in your mouth without drawing a lot of attention to yourself.

And...(this is going to sound draconian, but it's based on personal experience), if you eat a granola bar, try not to do it in front of your residents. Not for any "hierarchy" reasons, but because your residents are often very hungry, and are always ready to eat. The last thing you need as you eat a granola bar is to have 3 residents salivating as they watch you chew. 😀

TheProwler said:
Thanks for bolding my name. I would've missed it otherwise.

🙄

It's a habit that I picked up from one of the other SDN posters - Blade28, maybe.

SoCuteMD · Aug 14, 2008

megswinter82 said:
I think maybe I should've been much more specific in what I was asking. I appreciate ALL the posts, harsh or not. But let me clarify...I DO NOT have hypoglycemia. I've done the accucheck mutliple times and while I may be very close, I've never been low enough. I HAVE gone to the doctor...in fact in the past 2 years of medical school I have PASSED OUT twice in front of physicians (one was totally random and one was during a procedure...oops). I've also discussed my problems with my primary care physician. I have been told to eat every 2 hours and carry smelling salts in my pocket "just in case."

My concern was since my "treatment" invovles eating so often...how would I deal with this in terms of surgery and other rotations that require long hours w/o breaks? What snacks work for people with similar problems? Any particular brand of granola bar work? Any snacks that work and won't pack on the pounds in the process?

I HAVE NEVER and do not intend to advertise my problem to attendings or residents, unless it becomes necessary. I absolutely hope that I never pass out and never have to explain my problem. I simply want to do the best that I can and absolutely DO NOT intend to use this "as an excuse"...I expect to work my butt off during the next 2 years.

Thank you for the posts and advice. While it is always hard to hear "harsh" words, I would rather get it here and be prepared for the worst. Hopefully, I will have understanding attendings/residents...but in case I don't...I feel prepared to handle the issue.

So any other hints for how to shove in the most calories/protein/fat etc in the least amount of time and have it last the longest would be great!

What I'd suggest is NOT granola bars or hard candies. They are both high in simple sugar, which will precipitate an insulin surge and subsequent hypoglycemia. Stick to high protein items with complex rather than simple carbohydrates - some of the "diet" bars are actually pretty good for pocket-sized food. Triscuits are good. Triscuits with low sugar peanut butter are even better. There was a fridge in the surgeons lounge, so I'd toss some cheese cubes in there at the beginning of the week - those would be good if you had access to a fridge. Mixed nuts are another good choice, but avoid the salty ones because you'll either end up thirsty or having to pee while scrubbed in.

As far as eating in front of the residents, sometimes it's unavoidable and I've never had a resident hold it against me. They know what their day is like, they should plan ahead for hunger. Stick some extra snacks in your pocket and share, but if you're holding out for a moment when you are not in front of a resident, a patient, in the OR, or on the toilet - you'll end up being very hungry for most of your surgery rotation.

smq123 · Aug 14, 2008

SoCuteMD said:
As far as eating in front of the residents, sometimes it's unavoidable and I've never had a resident hold it against me. They know what their day is like, they should plan ahead for hunger. Stick some extra snacks in your pocket and share, but if you're holding out for a moment when you are not in front of a resident, a patient, in the OR, or on the toilet - you'll end up being very hungry for most of your surgery rotation.

I know - a lot of residents won't hold it against you.

But there ARE some who will. In any case, it doesn't hurt to be careful and considerate. (As WingedScapula has said, it's rude to eat in front of other people - regardless of where you are or who you are.)

I'm not saying that the OP should wait until she's totally alone. But just ducking around the corner (close enough to know when the team moves to another location, but not directly in front of the resident), and shoving in a couple of crackers is preferable to eating while the resident is right in front of you, putting in orders. Or, of course, bring enough to share.

AlternateSome1 · Aug 14, 2008

I agree with SLU. Do NOT tell a medical resident/attending that you can't do something due to a self made diagnosis of hypoglycemia. The only people who I have seen with "hypoglycemia" are patients taking insulin or oral hypoglycemics, or have an insulinoma. This is a red flag self-diagnosis similar to fibromyalgia, chronic fatigue, and chronic back pain.

AmoryBlaine · Aug 14, 2008

Just as a small thread hijack:

If there are any pre-meds/M1s/M2s reading this thread, sometimes scrubbing into surgery gets portrayed like going into a warzone. "Eat something with the right protein/carb/fat balance, try not to drink coffee beforehead, make sure you go to the bathroom beforehand, take pseudephed if your nose is running, stretch out your back."

Really it's not that big of deal. Yeah sometimes you might need to piss and not be able to a for about an hour. You might feel a little hungry or tired sometimes or your back might hurt. But usually it just aint that dramatic.

From reading SDN and talkng to my colleagues I thought you practically needed a Foley and a camelbak with gatorade just to get through an appy -- not the case.

SLUser11 · Aug 14, 2008

TheProwler said:
This is definitely not a passive-aggressive post that is attempting to get in the last word.

I have made no attempt to hide the fact that I'm a last-word freak.

45408 · Aug 14, 2008

SLUser11 said:
I have made no attempt to hide the fact that I'm a last-word freak.

In general, I'd recommend that you not practice medicine on your students. And I double dare you not to respond to this post.

PeepshowJohnny · Aug 14, 2008

AlternateSome1 said:
The only people who I have seen with "hypoglycemia" are patients taking insulin or oral hypoglycemics, or have an insulinoma. This is a red flag self-diagnosis similar to fibromyalgia, chronic fatigue, and chronic back pain.

Agree 100%.

And just a note for everyone, hypoglycemia causing passing out is very very rare in someone not on insulin/hypoglycemic therapy, an insulinoma, or some kind of glycogen disorder. It just doesn't happen.

Now, if you've got something like Lupus or MS diagnosed please for the love of God tell me about it if it thinks it'll affect your ability because I'll certainly respect that. But don't bring fake diseases into this.

187502 · Aug 14, 2008

I have run into the same problem, I have found some OTC slow-release glucose tablets that you can take quickly (literally if you just have 15 seconds) work wonders and keep my blood sugar up unti I can eat real food.

mepp · May 5, 2009

Sorry to bump this thread, but I'll be starting rotations soon and I have a question about this.

I have type 1 DM and I'm on a pump. I generally don't bring up my diabetes (because type 1 is so misunderstood by healthcare professionals) and rarely have problems.

So.... how should I handle my surgical rotation? Should I tell the circulating nurse beforehand in case there are any problems? Would it be awkward for me to walk him/her through turning down my pump infusion rate if I'm scrubbed in? Could I really have glucose tabs in the OR?

Sorry if these are dumb questions, but I'm not familiar with how things work in the OR.

TIA

nope80 · May 5, 2009

I was also wondering, if you have a diagnosed condition, do you bring it up or not? If its one of those things that MAY get in the way of your work (but may not) do you say anything so that you can be accomodated just in case? Or is this a sure fire way to start on a bad note?

Winged Scapula · May 6, 2009

I've worked with several residents with pumps and they all made it work without too much problem.

One used to just press the buttons through his gown when needed. They aren't terrifically hard to use, so I'm not sure they need an inservice. I'd get a sense of how often you need to bolus yourself/turn down the basal etc. and the length of the case; if you think it might be likely, then you might just give them a heads-up that you might need help.

I suggest you put the pump on the back of your scrubs so that if you do need to ask the circulator to adjust it, then he/she isn't reaching around under your gown near your genitalia. There's always some nurse who remembers the dirty old man surgeon who would purposely set off his pager and would wear it low, very low, on his scrub pants.🙄

SLUser11 · May 6, 2009

Awesome bump. I loved this thread during its infancy. Me against the world......😎

LovelyRita · May 6, 2009

SLUser11 said:
Awesome bump. I loved this thread during its infancy. Me against the world......😎

Arguing for argument's sake. The good ol days.

Anyway for the kids:

1. Eat breakfast, granola bar, fruit, peanut butter, something in the morning.

2. Drink a glass of water or two whenever you possibly can.

3. Before the OR, pee.

4. Hard candy before scrubbing in.

5. Serious medical condition + long surgery? Don't scrub in.
a. confide in a resident as to what's going on.

6. After surgery, glass of water, pee, eat lunch, dinner, breakfast, whatever.

Relax and enjoy. While I understand students' experiences vary, you will survive just fine. My attendings would never make fun of someone who got lightheaded or scrubbed out. It happens, everyone gets over it. Residents usually don't care either. Unless you are a PITA on many levels, you might end up the topic of discussion, but honestly we have bigger fish to fry for the most part. Like keeping our plot to kill the chief on the DL.

SouthernSurgeon · May 6, 2009

AmoryBlaine said:
Just as a small thread hijack:

If there are any pre-meds/M1s/M2s reading this thread, sometimes scrubbing into surgery gets portrayed like going into a warzone. "Eat something with the right protein/carb/fat balance, try not to drink coffee beforehead, make sure you go to the bathroom beforehand, take pseudephed if your nose is running, stretch out your back."

Really it's not that big of deal. Yeah sometimes you might need to piss and not be able to a for about an hour. You might feel a little hungry or tired sometimes or your back might hurt. But usually it just aint that dramatic.

From reading SDN and talkng to my colleagues I thought you practically needed a Foley and a camelbak with gatorade just to get through an appy -- not the case.

If this thread is getting bumped anyways, I'd like to draw everyone's attention to this post. Seriously, scrubbing into a surgery is NOT that big of a deal. It can even be (gasp) fun.

SugPlum · May 6, 2009

What do normal students, who aren't prone to hypoglycemia, eat before scrubbing in on 10 hour surgeries?

bioteach · May 7, 2009

This is an old thread, but it looks like people are still posting.

So .... what is your advice if you have a real diagnosis, not just a self made one? I am extremely prone to orthostatic hypotension, docs had me go in for a tilt table last year and was passed out in about 3 minutes. Literally. So it is verified by the docs here at our hospital that I have issues keeping blood in my head.

I don't want to whine about it to people, but I likely will have to back up from the surgical field more than once when I get pre-syncopal. I don't plan on going into surgery, it'll just be a rotation to get done and get out of the way.

I am fine sitting and walking, I flex the heck out of my calf muscles and do what I can to move in place and that helps, but standing stock still for a long time is not my forte.

So do I say something ahead of time because it will likely be a concern for me on a daily basis, or just wait until it happens and deal then? I don't want to make a scene and if I can get through without anyone knowing about my vasoconstriction issues, I'd be happier.

Whadda ya'll think?

SLUser11 · May 7, 2009

bioteach said:
This is an old thread, but it looks like people are still posting.

So .... what is your advice if you have a real diagnosis, not just a self made one? I am extremely prone to orthostatic hypotension, docs had me go in for a tilt table last year and was passed out in about 3 minutes. Literally. So it is verified by the docs here at our hospital that I have issues keeping blood in my head.

I don't want to whine about it to people, but I likely will have to back up from the surgical field more than once when I get pre-syncopal. I don't plan on going into surgery, it'll just be a rotation to get done and get out of the way.

I am fine sitting and walking, I flex the heck out of my calf muscles and do what I can to move in place and that helps, but standing stock still for a long time is not my forte.

So do I say something ahead of time because it will likely be a concern for me on a daily basis, or just wait until it happens and deal then? I don't want to make a scene and if I can get through without anyone knowing about my vasoconstriction issues, I'd be happier.

Whadda ya'll think?

My recommendation is to tell the resident whose scrubbing in with you on the surgery (depending on where you're at, telling the intern might be worthless). The conversation can be had with them personally, and then if there's a problem you can tell the attending, scrub tech, etc. You may turn out to do just fine.

Another viable option, which has been discussed here, is to tell your co-students, and the resident whose in charge of assigning you cases, and you can hopefully scrub the shorter cases.

.....and stay well hydrated obviously. I know that you know this, but it's very easy to get dehydrated on a busy surgery rotation, especially with numerous caffeinated drinks.

elr1983 · May 7, 2009

SLUser11 said:
Lastly, as someone mentioned, if you truly are about to pass out, back away from the table and sit down. It happens every year, and while it may cause you to get teased, it's better than faceplanting in the wound.

OMG, please, please do this. On my GYN rotation, I was standing on one of those little stool things during a long gyn-onc procedure. I hadn't eaten, hadn't really had much to drink, and started to feel lightheaded. Next thing I knew, I woke up in the ER, with a c-collar on, with 3 surgery residents and a med student over me! Turns out, I passed out, fell and hit my head on the floor, and the OR nurses called a trauma. I got a huge scalp lac and had to have stitches, but was fine otherwise (other than my bruised ego). So, let me be your cautionary tale....eat, drink, and if you feel like you're going to pass out, step away and sit down!

smq123 · May 7, 2009

SugPlum said:
What do normal students, who aren't prone to hypoglycemia, eat before scrubbing in on 10 hour surgeries?

A couple of granola bars, maybe with a little peanut butter on them. A half a glass of milk if I was REALLY thirsty.

It's nothing major. If you generally have no issues metabolizing sugar, then complex carbs (i.e. a granola bar) with some protein (i.e. peanut butter) will be fine. Just eat SOMETHING, and you'll probably be ok.

45408 · May 7, 2009

mepp said:
So.... how should I handle my surgical rotation? Should I tell the circulating nurse beforehand in case there are any problems? Would it be awkward for me to walk him/her through turning down my pump infusion rate if I'm scrubbed in? Could I really have glucose tabs in the OR?

Don't sign up for one of the rotations that's known for having really really long cases (CT surgery definitely being one of them, transplant being another - sometimes). I don't think I scrubbed in for over 4 hours during my entire 2 month rotation, and most cases were about 2 hours.

drdr2010 · May 7, 2009

i have neurocardiogenic syncope with an overactive vagal response. on my tilt table test i had 12 seconds of asystole (!).

i was really worried about my surgery rotation since i have a history of passing out when standing for even short periods of time. i told the clerskship director at the beginning of the rotation and then my attending (we don't have surg residents here). i always carried protein and granola bars in my white coat and made sure to drink a bunch of water in the morning before cases and in between each case. i also wore compression stockings, which i hated and made me feel like one of my geriatrics patients 🙂

i ended up not even ever getting pre-syncopal even while retracting during a 5 hour colon resection!

most residents/attendings are understanding. just do your part and be proactive, making sure to inform them and taking as many steps as you can to prevent it.

Buckeye(OH) · May 7, 2009

scrub into ortho cases. In my experience, they RARELY go over 1.5-2hrs.

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