Med students & residents living w/urologic & colon issues

[Guero]

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I've been growing more and more interested in the urology specialties since entering medical school and stumbled upon the following conversation that I found particularly interesting. Please be respectful and professional, as this is intended for the anon lurkers and those interested in the specific fields relevant to this student's dilemma. Please, no jokes. Mods, please help me on that end?

• AnonymousMS2:. . . I desperately need advice. I suffer from severe polyuria and nocturia secondary to chronic interstitial cystitis. How the hell will I manage this during Step 1 exam, working on wards, and during residency? Do I file for permission to leave frequently with a letter from my urologist? Or do I opt for...well...diapers? I've had to do that several times before. But if so, how do I deal with the logistics of changing, storing, and potential gossip among my peers? It's so f***** embarrassing. . . .

• Attending(FM): I think getting a letter form your doctor for frequent breaks would be best. Diapers may be the best option during step because they have set breaktimes and if you take other breaks it takes away from your test time. But once you’re on wards and in residency, you pretty much just slip out and go when you need to go. The only time it may be extra hard is on surgery, when you may be in the OR for several hours and unable to take a break. As for keeping supplies with you all the time, lots of med students carry a purse or small bag with them full of all of their stuff, so just put them in there and nobody has to know what you have in there or what you’re doing in the bathroom.

Despite the epi of CIC affecting mostly females, the student was male. This brought logistical issues forth, such as a lack of trash receptacles in male restroom stalls, making it highly likely that the student would be caught by peers if using public, multiple stall restrooms while disposing of undergarments. The attending suggested that he focus on utilizing unisex restrooms while in-house and consider bag-cath. Further discussion revealed anatomical issues that precluded both bag-cath and intra-urethral cath.

Although rare, it's unfortunate that both the public and medical professionals are largely unaware of this [condition] and unaware of those affected by incontinence and enuresis in the 18-40 year range. The focus is almost always on pediatrics and geriatrics. And the rarity of the issue lends to a relative dearth of literature, but especially when pts are in the demanding fields of medicine or surgery.

I'm curious as to what others think about this, both from a specialty perspective, research perspective, admin perspective, and student perspective. I thought I had my own issues to deal with, but couldn't imagine living with this student's condition and anxiety. Feel free to correct me on any of my info if you have sources saying otherwise. 🙂

EDIT: clarifications added and one change made to OP based on below:
"It's not unfortunate that the public and medical professionals are 'largely' unaware of this student's dilemma."
My own research pursuits are rather rare, but interesting topics that yield data relevant to more high impact pathology (e.g., Basal Ganglia DBS in catatonia interest ---> basal ganglia basic science pursuits ---> psychiatric DBS translations). I say "unfortunate" in terms of research/literature regarding epi and pathology rather than the specific student's dilemma. My bad, totally a misnomer.

". . . I don't think anyone is blown away that this (rarely) happens to people 18-40. . . . Apart from a rare and embarrassing ailment, there's nothing to see here."
You're absolutely correct, it is rare and it was dealt with very appropriately. So, why did I post? Because I care about the pt's well being. Because I find the pathology and Tx interesting. And because it's something that might also bring forth more implications, such as resources available to those suffering from similar, less rare conditions.

 

[Pacna]

Although rare, it's unfortunate that both the public and medical professionals are largely unaware of this student's dilemma and unaware of those affected by incontinence and enuresis in the 18-40 year range. The focus is almost always on pediatrics and geriatrics. And the rarity of the issue lends to a relative dearth of literature, but especially when pts are in the demanding fields of medicine or surgery.

I don't know what you're looking for. You said yourself that it was rare. That explains the situation to me unless I'm missing something. It's not unfortunate that the public and medical professionals are 'largely' unaware of this student's dilemma. He clearly wants to keep it that way, and I don't think anyone is blown away that this (rarely) happens to people 18-40. The MD handled it as expected. Apart from a rare and embarrassing ailment, there's nothing to see here. This seems like publicly sharing this person's story for no reason.

 

[Ismet]

? I don't see anything wrong with the attending's line of advice as you say it went. Doctors aren't walking encyclopedias of every possible illness/diagnosis/zebra under the sun, that's why it's a profession of lifelong learning. And he's exactly right, the only rotation that will really give the student trouble is surgery, and honestly a diaper would probably be his best bet. Most staff restrooms at least in the hospitals I've rotated at are single person unisex bathrooms. He can also just bring a plastic bag into the stall with him to conceal whatever he needs to throw away.

 

[Guero]

I don't know what you're looking for. You said yourself that it was rare. That explains the situation to me unless I'm missing something. It's not unfortunate that the public and medical professionals are 'largely' unaware of this student's dilemma. He clearly wants to keep it that way, and I don't think anyone is blown away that this (rarely) happens to people 18-40. The MD handled it as expected. Apart from a rare and embarrassing ailment, there's nothing to see here. This seems like publicly sharing this person's story for no reason.

Great points. I didn't realize the thread would come off that way. Your inferences were totally unintended on my part. I apologize. Please allow me to clarify some points.

"It's not unfortunate that the public and medical professionals are 'largely' unaware of this student's dilemma."
My own research pursuits are rather rare, but interesting topics that yield data relevant to more high impact pathology (e.g., Basal Ganglia DBS in catatonia interest ---> basal ganglia basic science pursuits ---> psychiatric DBS translations). I say "unfortunate" in terms of research/literature regarding epi and pathology rather than the specific student's dilemma. My bad, totally a misnomer.

". . . I don't think anyone is blown away that this (rarely) happens to people 18-40. . . . Apart from a rare and embarrassing ailment, there's nothing to see here."
You're absolutely correct, it is rare and it was dealt with very appropriately. So, why did I post? Because I care about the pt's well being. Because I find the pathology and Tx interesting. And because it's something that might also bring forth more implications, such as resources available to those suffering from similar, less rare conditions.

Does that help? Thanks again.

 

[awared2]

Condom cath is an option

 

[Guero]

Condom cath is an option

That was dealt with, too. In this case it wasn't an option (for reasons I don't think are relevant to the thread).

 

[awared2]

That was dealt with, too. In this case it wasn't an option (for reasons I don't think are relevant to the thread).

One of my patients on a rotation had this, maybe it is an option
http://www.vitalitymedical.com/bard-adjustable-cunningham-clamp.html

 

[Pacna]

Based on the title and the fact that this focused on someone with urological issues, I feel as though there is/are more general questions you're trying to get at unless the colon mention was a slip of more specifics about this person's condition (fistula?).

So, why did I post? Because I care about the pt's well being. Because I find the pathology and Tx interesting. And because it's something that might also bring forth more implications, such as resources available to those suffering from similar, less rare conditions.

Caring about the patient's well-being: Normal.
Finding this interesting: Normal (for someone interested in urology).
Bringing forth more implications/resources available to those suffering from similar [shi*]: I feel as though this is your only real question, and it's not clear what you're asking.

I'm trying to understand the question, so I'll try a summary of what I think you're asking, and you tell me if it's completely off base:
1. What are the resources available for med students and residents who have urinary/bowel disorders? More generally, how does medical training deal with people who have embarrassing medical conditions which prevent them from behaving as expected?
2. How/Should more research be done on urinary/bowel disorders in people 18-40 given their rarity and participation limitations related to reporting?

I see that this is important to you, and I want to help you get the type of responses you're looking for. I'm not the sharpest guy on this site by any stretch of the imagination, but if I needed to decode your post to figure out what you're asking, I think others will have to as well. The added work may very well dissuade them from responding.

 

[Guero]

One of my patients on a rotation had this, maybe it is an option
http://www.vitalitymedical.com/bard-adjustable-cunningham-clamp.html

Omg, thank you! See, I've not yet rotated and was entirely unaware of such a device.

Based on the title and the fact that this focused on someone with urological issues, I feel as though there is/are more general questions you're trying to get at unless the colon mention was a slip of more specifics about this person's condition (fistula?).



Caring about the patient's well-being: Normal.
Finding this interesting: Normal (for someone interested in urology).
Bringing forth more implications/resources available to those suffering from similar [shi*]: I feel as though this is your only real question, and it's not clear what you're asking.

I'm trying to understand the question, so I'll try a summary of what I think you're asking, and you tell me if it's completely off base:
1. What are the resources available for med students and residents who have urinary/bowel disorders? More generally, how does medical training deal with people who have embarrassing medical conditions which prevent them from behaving as expected?
2. How/Should more research be done on urinary/bowel disorders in people 18-40 given their rarity and participation limitations related to reporting?

I see that this is important to you, and I want to help you get the type of responses you're looking for. I'm not the sharpest guy on this site by any stretch of the imagination, but if I needed to decode your post to figure out what you're asking, I think others will have to as well. The added work may very well dissuade them from responding.

Much sincere thanks, I'll elaborate and respond to your questions soon. I must return to the grind considering the time left in my day.

 

[Guero]

Based on the title and the fact that this focused on someone with urological issues, I feel as though there is/are more general questions you're trying to get at unless the colon mention was a slip of more specifics about this person's condition (fistula?). No, it was meant as a relevant attempt to attract comments from those that might be suffering from similar issues since it relates to incontinence/frequency.



Caring about the patient's well-being: Normal.
Finding this interesting: Normal (for someone interested in urology).
Bringing forth more implications/resources available to those suffering from similar [shi*]: I feel as though this is your only real question, and it's not clear what you're asking.

I'm trying to understand the question, so I'll try a summary of what I think you're asking, and you tell me if it's completely off base:
1. What are the resources available for med students and residents who have urinary/bowel disorders? More generally, how does medical training deal with people who have embarrassing medical conditions which prevent them from behaving as expected? Exactly, thank you. I guess I'm a bit scatter brained while studying.

2. How/Should more research be done on urinary/bowel disorders in people 18-40 given their rarity and participation limitations related to reporting? Also correct, thank you. In addition, I'd like anyone suffering from these issues to see this post when they search, as I did an initial search on SDN *and* Google but found nothing specific to those studying or practicing medicine or related fields.

I see that this is important to you, and I want to help you get the type of responses you're looking for. I'm not the sharpest guy on this site by any stretch of the imagination, but if I needed to decode your post to figure out what you're asking, I think others will have to as well. The added work may very well dissuade them from responding.
No worries, I sincerely appreciate you taking the time to help and remain receptive. I've learned that I tend to initially take offense to certain things that I perceive as inflammatory, but are really just miscommunication. So I try very diligently to take each perceived criticism as perhaps a miscommunication rather than an inflammatory remark 🙂.

Replies above in bold. Corrections made from iPhone errors. Man, autocorrect really loves to screw with me. hahaha