How to Stop Sunburn Itch

My life was almost cut short by a terminal case of surburn itch this afternoon. In my desperate state I couldn't find a good source on the internet regarding how to stop sunburn itch. Because of this (and its remote connection to the medical nature of this blog) I decided to describe my own experience and create a "comment forum" on how to possibly remedy the condition.

Before I continue, let me clarify something: this is regarding the pain-from-getting-burned-just-stopped sunburn itch, not the my-skin-is-peeling sunburn itch.

Here is the backstory:

After spending some time near the equator, I developed a whopper of a sunburn. For a few days I had some difficulty sleeping secondary to the pain the I experienced any time that I moved. Lathering up my back with aloe and other mosturizers, by Sunburn Day 3 the pain was starting to abate and I figured that I was just about out of the wood. Then the unthinkable happened.

I was minding my own business (standing on the street corner when these two guys started to make trouble...wait that's another story), sitting by the computer when out of the blue my back starts to itch.

So naturally I reach around and scratch it. And would you believe it, that didn't seem to help. I keep scraching, but I'm quickly realizing that I need something bigger as I can't scratch my entire back at once, so I run into the bathroom and start frantically grinding my back up against one of the towels that we had hanging up. All this seemed to do was create a kind of itch/pain wherever I last scratched.

This seemed to help for a few minutes, but I was quickly leaving the this-is-mildly-annoying part and entering the I'm-at-risk-for-losing-my-mind phase.

I then tried laying face up in bed and moving up and down, but of course that didn't work. Then I tried arching my back as much as possible (is that decorticate or cerebrate?) as if I was going to do a backwards cartwheel, then curling up into the fetal position--zero help whatsoever.

All the while the itchiness was coming in ever greater waves. My heart was racing and my entire body began to pulsate with each heartbeat. You may think I am exaggerating, but until you have suffered through a good case of sunburn itch, you'll never understand. There were times where I actually considered going into the emergency room, I was that concerned that something serious might be going on.

So here was the one thing that helped: put about an inch of aloe vera gel on your back. I'm assuming it is your back that got burned because, unless your a nudist, chances are you went to the beach with skin white enough to make the Amish proud and decided to spend most of the day face down. Here's the important part: lie completely still, facedown on the bed. I'm sure that after a lot of itching you will be having some involuntary back spasms with how bad the pain is, but the only way to feel better is to keep from moving the burned part.

At first, putting gel on your back is only going to make the itching worse, and you'll still have some lingering itchiness, but it will pale in comparison to how miserable you were beforehand.

Addendum: My wife couldn't believe that I was in as much agony as I was letting on--feel free to point to the comments section of this post when your friend/parent/significant doesn't believe you. Also, feel free to leave comments in the forum if you would prefer. Thanks to everyone who has posted their own stories in the comments section, they always bring a smile to my face.

If you have a second, please click on a link. Every little bit counts when you have 200k in student loans.

Update: was interviewed by the National Post regarding my experience, it would seem that sunburn itch is still very rarely described and somewhat poorly understood now 5 years after this original post. You can find the whole story here.

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Health Care Reform: Medicine vs Surgery

Lost within the political debate over healthcare reform, is a battle currently going on within medicine itself. Although most if not all doctors agree that there needs to be significant changes to the health care system, there is significant debate as to what exacty this should entail. Before I get too far ahead of myself, let's go back to the opening salvos...



In response to this statement the American College of Surgeons released the following letter, which goes on to decry the gross exaggeration of what a surgeon makes on a given operation. In addition it states that misinformation regarding healthcare does nothing to further the debate, adn that the surgeon patient relationship could be damaged as a result. Also, interesting is the many surgical subspecialties that signed on to the letter. This was not just the American College of Surgeons (ACS), but it also included everything from the American College of Obstetricians and Gynecologists to most if not all of the surgical specialties (Urology, Orthopedics, ENT etc.).

More recently the American Medical Association (AMA) has come out in support of the current legislation that passed in the house relating to health care reform. In a letter to Speaker Pelosi, the AMA applauded many of the proposed changes that the bill would enact--specifically they stated that the bill would expand coverage, reform the insurance industry, and protect patient-physician decision making.

Not long afterwards the ACS shot back with this letter to the senate, cosigned by 21 other specialty organizations. It rebutted several of the points made by the AMA and focused on several key issues that it had with the bill.

Additionally they reaffirmed the need for Tort reform in this statement:

CHICAGO: The American College of Surgeons applauds Democrats – led by House Majority Leader Steny Hoyer (D-MD) – for recognizing the need for Congress to address medical liability reform as part of the overall health care reform bill currently under consideration. Over the past few weeks, we have been encouraged to have heard Democrats and Republicans across the country talking with constituents at town hall meetings about the need to address this important bipartisan issue.

The current climate in this country is one in which surgeons and other physicians are forced to practice in an environment of defensive medicine, sometimes ordering additional and possibly unnecessary tests in order to avoid lawsuits. Addressing medical liability reform as part of the overall health care reform bill will help to stem the tide of rising health care costs.

The American College of Surgeons urges President Obama to make medical liability reform a more central component of his call for overall health care reform. Further, we urge the leadership of both the House of Representatives and the Senate to include this important issue in the bills that they will take up in the coming weeks.

Here is President Obama speaking to the AMA regarding Tort reform.


Recently, the ACS has released a side by side chart of the House and Senate bills, along with what they view as some of the drawbacks.

The battle lines seem to have been drawn, with the AMA standing with the president and the majority of the Democrats (except Tort reform), while the ACS and most Republicans stand in opposition (although both groups support repealing the Sustainable Growth Rate provision--something opposed be most Republicans and some Democrats). It's interesting to me how this has happened, I wonder if the average surgeon would describe themselves as being right-leaning politically and the average medicine doctor would say they are left-leaning, or whether this is just how the chips fell in this one instance.

Shadowing

The past two days I have been shadowing a family practice doctor per the requirements of the medical school for completion of the first year, and I was struck with a number of things.

1. I'd like to think of myself as a pretty good communicator, and I don't mean that in a self-aggrandizing kind of way--just ask my fiancee, I'm not always the best at remembering things--but there is something of an art form to medicine. The doctor that I was shadowing absolutely has it down. He know's the "character" that he needs to play during the medical interview process. At times he pretends to be the aloof, almost clown-like character to put people at ease or to get a laugh.

But he also knows that there are times when he has to play the role of counselor, or father, or disciplinarian. There is so much more that goes into medicine than words and formats: he never strictly follows OPQRSTAA (Onset, Provocative/Palliative etc.) when talking about a condition, but he does have his own schpeel that he gives to parents of children under the age of one, e.g. "I like to remind parents to use a lot of sunscreen even if the baby is going to be under an umbrella..."

Moreover, you realize that there are a lot of patients who come in, that he could probably diagnose in a matter of seconds, but still he takes about 5 minutes to talk to the patient about their concerns. For instance, one of the patients who came in clearly was describing a simple pulled muscle, but he still took about 10mins to talk to her about it, before he even began to examine her. Part of it was a desire to rule anything out, but part of it was making sure that the patient felt like she was being heard by someone who cared to listen.

2. The Power of Human Touch. I've heard this a few times throughout medical school but it's important for doctors to touch their patients. Sadly, in this day and age, the first thing that many people would think if you said that was, "Doctor's touching their patients--there should be less of that." Perhaps because of the stigma of the few doctors who touch their patients innappropriately or perhaps due to our Politically Correct/lawsuit happy culture, I fear many doctors may keep their patients at arms length--which is truly sad.

Many patients that come off the streets may have been physically abused or mistreated for their whole lives, and the chance to touch someone in a loving way--e.g. rest one's hand on their shoulder, or even hold the stethescope so that one's fingers rest on their back--is often lost.

3. There's so much pain in this world. One of the women who came into the office had been put on large doses of inhaled steroids to treat a very bad asthma attack that she had had. Her face was the slightest bit edematous and perhaps a bit moon shaped (as is common with high glucocorticoids). And a few minutes into their discussion she said, "My face is so fat...I feel like a freak." And she began to cry. My heart just broke for her.

Maybe because I could empathize or maybe because it is just human nature, but I couldn't help but well up with emotion for her. I wonder if you need to remember how to respond to the patient, while not letting it affect you. Or maybe you just let it affect you and move on, I don't know.

More to come

The Free Clinic (The Importance of Speaking a Patient's Language)

(the details of this story have been altered)

Yesterday at the Clinic that I volunteer at periodically there was a man who came in who is a missionary to Detroit. Yes, that's right he has been sent from his home country of Venezuela to be a missionary to the Spanish speaking population of Southeastern Michigan--perhaps a sad commentary on the work that the local churches were doing to minister to those of the inner city.

So I went out into the waiting room and called Mr. Hernandez back into one of the rooms of the clinic. As we were walking, I asked him if he spoke any English, to which he responded in the negative.

I did my best to stumble through some of the basic spanish that I still remembered from undergrad combined with a few of the medical terms that I had picked up while working at a clinic whose patient population is 50% hispanic. Most of the sentances sounded something like, "Uh...necessito tocar...uh...su......pression." But as is the case most of the time, he was more than happpy to pretend like he understood every word I was saying rather than appear rude.

This guy had really high blood pressure, and I mean really high. 196/120 high, and I noticed from his chart that he had somewhat poorly controlled hyperlipidemia (high levels of "bad" cholesterol etc.). Once I had taken all of his vitals I told him that I would be right back with the "doctor," who is actually a nurse practitioner--but I didn't know how to say "nurse practicioner" in Spanish, and even if I did, I doubt that he would have any idea what the difference was between that and a doctor.

The next time we went back into the room, we brought one of the medical technologists from the clinic who was fluent in both Spanish and English. Here's how it went.

Sandra
"Ask him if he has been taking his medication"

Translator
"Yada yada yada (for the next minute)"

Patient
(Talks to the translator for around 45 secs)

Translator
"He says that he always takes his medication"

Really. That's all that he said in 30 seconds of talking? I take my medication. Tocarlo. It seems like he could have said that in a word or two, what did he use the other 40 seconds to talk about? And what were you saying the whole time? Neither me nor the LPN said anything (and I'm not sure if she even thought about it, but for me it was a bit of a disconcerting experience).

I realized then why the other doctor wanted me to do as much as I could without using a translator--especially when the only translators that we have available have very little background in medicine. A couple more examples:

Later on the translator kept saying that if he came back and talked to the nurse who specializes in diabetes, they could give him a meter for checking his blood sugar. But when the translator repeated the phrase in spanish she said we would give him a machina para pression (basically, a machine for checking his blood pressure).

I really knew that the message wasn't getting across when the translator didn't know the English word "testosterone," when she was explaining what the patient said to her.

So much of the medical interview can hinge on a single word. Did the patient say he checks his blood sugar occasionally or often. Has he had high blood pressure for 5 years or 14 years. What is the nature of the pain in his chest, is it stabbing or is it like someone is sitting on top of him. These difficulties are increased when you get a translator that fancies herself as a doctor and feels that what gets asked during the medical interview is her business.

The best translators that I have seen are those that take one sentance the doctor says in their native tongue and translates it into one sentance in the patients language. When the patient responds, the translator should stop the patient every sentance or so in order to translate back to the doctor. But in a larger sense, this experience has reminded me how important it is to learn as much as I can of Spanish, as it would be one of the most valuable foreign languages to learn as a future doctor in the United States.

Medical Hierarchy

Everyone in the medical field knows that there is a hierarchy in medicine. Those who are outside of the field of medicine may or may not have any idea. This is evidenced by experiences in the emergency room. When I was a kid and went to the ER, I had know idea that the guy in the white coat might have been fresh out of medical school, but not everyone is as blissfully ignorant as I was--I've heard many patients immediately ask for the "real doctor" (They must be frequent visitors to the ER).

But for those in the medical profession, there are countless points at which you are forced to realize exactly where you are on the totem pole. There are obvious things such as the ability or lack thereof of signing off a note on a patients chart. For medical students this means writing out what you think is a good note, then finding a doctor who will check it and sign at the bottom.

Aside from the more obvious things, there are a litany of lesser things by which people are kept in check. I would argue that whether they are intentional or not, they serve as an important check in keeping one from becoming too full of themselves or feeling that they had "arrived" and no longer needed to study.

One of the more commonly referenced is coat length. For those not indoctrinated, the white coat of a medical student only goes to the waist (if that), while the coat of an actual doctor (resident or attending physician) goes all the way to the knee. But I think that the hierarchy can be much more subtle, and even though it is not always recognized as such, those that step outside of it are punished in just as subtle of ways.

For the gunners, although people may tolerate them to their face, I would be surprised if anyone would go out of their way to help them. Say for instance someone knew of a chance to meet with several higher ups in the surgical world, I don't think that the first thing you would do is call them up to let them know about it. If someone wants to be a gunner to the point that everyone can see they're looking out for number 1, people will consciously or unconsciously punish them for it.

Although I personally can't speak to this, I've heard that the same principles apply to medical students on rotations. Don't make the residents look bad. It seems pretty straightforward, but I guess some people were never properly trained in the social graces. (bunny trail: a lot of people say things like "I just need to get past the basic science and start clinical rotations, then I'll really shine"--we can't all be right can we). I wouldn't have said a word when was at the Morbidity and Mortality conference, I don't care if they pointed at me and asked what my name was, I would have hoped someone else would have answered. Real or imagined, I've got a healthy (I think) fear of being blackballed.

Lastly I think there is an even more subtle component. Next time you are in a room, look at the seating arrangement. Say for instance you are in a room with a chair a couch and hardwood floors. I would venture to say that 9 out of 10 times, the most senior doctor will be in the chair, the three residents will be on the couch, and the medical student will be on the floor.