Case Files: Orchidopexy

Presenting Scenario: A 7 year old boy presents to the outpatient surgeon due to a referral from the Primary Care Pediatrician. He has a suprapubic lump on the left side. Patient's mother denies pain, nausea, vomiting, diarrhea. On physical exam, there is a palpable lump, easily movable, located just above and lateral to the penis.

Diagnosis: Prepubic undescended testicle on the left side.

Surgical Procedure(s) Ordered: Orchidopexy; the surgeon first makes an incision near the site of the undescended testicle, similar to how he might make an incision to fix a hernia. We carefully dissect through the layers of the fascia and muscle until we reach the testicle. Next, through a series of maneuvers that see the gubernaculum (100 points to whoever defines what this is in the comments) released from the testicle and pushing back the perineum and other structures in order to free up more of the spermatic cord so we can pull the testicle down through the scrotal sac. Finally, we stitch the testicle into place and then stitch the outer skin of the scrotum over it to make it look like normal.


Results: This patient had no surgical complications and is fine post-operatively! However, it should be noted that patients with undescended testicles have an increased risk for testicular cancer - even after we fix the undescended testicle. Therefore, this patient will need to be followed closely for the rest of his life. If there are any signs of the cancer, removal of the testicle will become necessary immediately. Some signs of testicular cancer include:

• A lump or mass in either testicle
• Any enlargement or swelling of a testicle
• A collection of fluid in the scrotum
• A dull ache in the lower abdomen, back, or in the groin
• A feeling of heaviness in the scrotum
• Discomfort or pain in a testicle or in the scrotum
• Enlargement or tenderness of the breasts

Lecture on How to Give Lectures

I was invited by the Surgical Program Director at Staten Island University Hospital, an awesome man who puts student learning first, to deliver a lecture today to all the Surgical Resident. The topic? How to Lecture.

Quite the honor! I felt humbled to speak in front of all these super smart people. There were about 30 residents and a handful of Attendings were also present since our M&M Conference (Morbidity and Mortality) was right afterward. Of course, you gotta impress people with a shnazzy title, therefore I called my lecture: "Increasing the Effectiveness of the Lecture Modality of Teaching". Pretty shnazzy, eh?

The highlight of my presentation came after I was done; this room full of amazingly smart people was extremely thankful for the ideas! They thought I was offering absolutely earth-shattering suggestions that will indeed move the Earth off orbit. Little did they know that for all of us teachers out there, this is "Maintaining Sanity in a K-12 Classroom: 101".

Unfortunately, I don't know how to link the PowerPoint to this post. If you want to see the PowerPoint, let me know and I can email it to you. But really, most of what makes any presentation by me tolerable and interesting to listen to, is my goofiness whilst presenting.

Quickies: California Sunshine, Surgery Exhaustion, and Stupid Passengers

1. California Lovin': I was in California from May 1 to May 3 for a dear friend's wedding in LA. It was awesome. Being back in Cali really reminded me why I love California! I had not been back since October and, although I love NYC, there is no place like home. I can't wait to come back to Fresno on June 23...just in time for the ridiculously hot summer months!

2. Surgery Exhaustion: I was hoping to get a new post out before it happened, but alas, my good friend NK called me out for taking too long to post. I gotta tell you - having to report to the hospital by 6am really knocks the wind out of me for the entire day. I am NOT a morning person. Not trying to make excuses, just telling the honest truth: by the time I reach the end of the day, around 6pm, I'm totally and completely pooped! I haven't even gone to the gym for almost three weeks now. My weight loss goals are not being reached, my nutritional goals aren't being reached, and quite frankly, I can't even study as much as I would prefer. I would much rather work from 10am to 10pm rather than 6am to 5pm.

3. Stupid Passengers: OK, I absolutely CANNOT believe this. As you may know, a Southwest Airlines flight had to conduct an emergency evacuation after its right side tire caught on fire after landing. Luckily, all passengers made it off the airplane safely and nobody was harmed. All was good, thank God. BUT, UNFORTUNATELY STUPID PASSENGERS ARE ALLOWED TO TRAVEL. Take a look at the video below - feel free to fast forward to about minute 3:45 and then watch the back slide closely. That's right, it's a suitcase floating down the slide. And yes, that's right, there is a STUPID PERSON coming down and stopping to pick up the papers!!!!!!!!!!! Are you kidding me?!?! Really and truly - the TSA needs to add CT machines at the security check point just to make sure there aren't passengers loading the plane who are completely and totally missing a brain!

Pictures Are In!!!

HELLO ROOM 15!!!!!!!!!

How are my faaaaaaaaavorite 3rd and 2nd graders doing? I miss you guys! And I must ask you to forgive me for taking so long to add the promised updates - specifically, my pictures! I am currently rotating through Surgery and that means I have to be at work by 6 am and usually don't finish before five or six at night. Plus, I couldn't find the wire that connects my Blackberry phone to the computer. But, I finally found it this morning (at 545am before I leave for the airport) and wanted to post the pictures before I left! I hope you enjoy them.

Quick POINTS OPPORTUNITY: 100 points to the group who can find the answer to the following Surgery question: Where is your appendix found? What do we do if your appendix gets inflamed?

I heard one of the groups found the answer to the Empire State Building question! Congratulations!

REMEMBER: You guys are awesome and I can't wait to see all the amazing things you all will accomplish! Have a GREAT day in school!

Cheers, Hovig (Mr. A)

PICTURE LEGEND:
(Click on the pictures to enlarge them)
1 and 2: My FAVORITE toy store in America - this place is HUGE guys!
3: This is the Tiffany's store that Mrs. and Ms. A have often spoke about. Guys - stay away!
4: A huge skyscraper for you guys! There are TONS of them in NYC.
5: Me in the subway with a subway map behind me.
6: NYC skyline with big skyscrapers at night from the Staten Island ferry. (50 points: What is a ferry?)
7: Famous NYC Hot Dog Vendor.
8: Me at Bryant Park on a beautiful day with a skyscraper behind me.
9: Picture of a bridge and skyline while I was on a subway on another bridge.
10: From my DC trip - the Cherry Blossom Festival. (50 points: What monument is behind me in the picture?)

UPDATE: Favorite Airline - The Answer

UPDATE: Results are in! Many of you responded with some great ideas - I have now included the answers to my Favorite Airline List with some explanations - the results may surprise you!

1. American Airlines
2. Virgin America
3. Southwest
4. Air New Zealand
5. Continental
6. Delta

Surprised? If I guess correct, you are probably most surprised about my favorite airline of all - American Airlines. I must admit, it is a love/hate relationship. I hate that management at the airline has created a hostile place for its employees and that hostility sometimes seeps its way into how they treat us, the travelers. But for almost two decades, AA has reliably brought me home, sometimes even with a smile and kind, welcoming service. None of the other airlines on the list have as many convenient flights to my home airport, and for that, I am grateful to AA for never giving up on my airport. Therefore, the top spot in this list belongs to American. HOWEVER, take note Virgin America or Southwest - you start flying to my home airport and you have a great chance of taking over the top spot.

I also want to note that American's Frequest Flyer Program, "AAdvantage", is awesome! I have found it to be the most flexible with the greatest ease of reward redemption. While in St. Maarten for two years, I flew American Airlines every time, and was able to fly free with reward points almost every time...even first class once!

Most of you guessed that Delta would be last on my list. I want to point out that they are last not because I think they are bad, but because it is right next to impossible to book a reward flight with their SkyMiles Awards program.

After posting, I realized that Air New Zealand didn't really belong on the list - not because I don't like it (I LOVED it and it EASILY could be first on the list - good job 98 on your guess), but because it only offers limited service to very limited destinations that are useful to me.

Finally, many of you put SWA pretty high on the list. It is true that I'm infatuated with the airline - I almost worked for them! But I mostly love how well they treat their employees; in terms of flying them - they offer limited service to my desired airports and quite frankly, I'm not all that excited about non-assigned seating.

Thanks to all of you who participated! I am now convinced that I have at least six faithful readers every week!


The following was the first post from last week inviting you to respond: It has been a while since I have done an interactive feature on my blog. So, in order to see if ANYBODY is actually reading my blog, we are going to do something a little fun today. One of my favorite things EVER is flying. I love airplanes, airlines, airports, airplane food, airplane smell, airport lines. I love everything flying!

Therefore, I have included pictures from some of my favorite airlines above. Hit the comments and rank the airlines in the order you think I like them, from MOST favorite on top to LEAST favorite on the bottom. Have fun and I look forward to seeing what you all think! I will post answers in a few days!

PS: To leave a comment, click on "comments" at the bottom of this post. Then, choose the option that says "Name/URL" or "Anonymous", leave your comment, then click "Publish Your Comment".

Did You Hear About the Elephant and the Dog?

No, this is not the start of a joke. It is a beautiful story about an elephant and a dog that have somehow created the strongest of bonds with each other. If these beautiful creatures can accomplish harmony and peace and understanding, we, the self-proclaimed "smartest" of the species should be able to as well. One can hope!

Many thanks to my friend SA who posted this story on her blog - click here to see this and many of her other great posts!