September 8 , 2003

Bears stink.

Dr. Hot Pants: Here with Answers to Your Questions, Anecdotes, and Hotness

Dear Dr Hot Pants
Will smoking while taking birth control pills really give me a heart attack? I like smoking, and I also like not getting pregnant...
Thanks,
Rambo

Dear Rambo,

Not necessarily, but it is a definite possibility. Oral contraceptive agents are associated with an increased incidence of stroke, acute myocardial infarction, and venous thrombosis including pulmonary embolism. That is because they cause elevation in most procoagulant proteins and at the same time decrease most fibrinolytic and inhibitor proteins, altering the hemostatic balance in favor of clotting. Add to that the massive endothelial damage and blood vessel trauma caused by the chemicals in cigarette smoke plus the independent cardiovascular (actually multisystem) risk factors associated with smoking, and you have a serious and potentially fatal problem. The risk of a heart attack is most increased in women who smoke more than 15 cigarettes per day and in women over the age of 35, but it is not a good idea for any woman on OCP's to also be a smoker, unless dying of a heart attack seems like a reasonable option. (On a side note smoking plus OCP's also increases your risk of liver cancer and gallbladder disease.) The best idea is to quit either smoking or the pill, with quitting smoking associated with increased health benefits and no increased risk of unwanted pregnancy. Until then, like the pill package says, you should notify your doctor immediately if you notice sharp or crushing chest pain, sudden shortness of breath, sudden severe head or leg pain, yellow skin or eyes, changes in vision, numbness of an arm or leg, or severe stomach pain. Then you will get to hear this lecture again, assuming that you don't die before your doctor gets to deliver it.

--Dr. Hot Pants

And on a lighter note, two missives from Dr. Hot Pants...

"Hi Claire,

I was just doing research for my presentation on pyelonephritis when I got distracted by scrotal abscesses and thought you might be interested in this case for DHP. It was reported recently in a French journal of urology, and basically has to do with a 54 year old man in Athens, Greece, who presented with dysuria (pain on urination) and scrotal pain. Physical exam revealed an edematous (swollen) scrotum with areas of inflammation and small abscesses. The patient described a long history of scrotal infections with multiple remissions and relapses. His testicles were impalpable due to pain. X-rays revealed multiple small metal fragments (pins etc.) buried in the wall of the scrotum and the testicular parenchyma. My favorite part of the abstract is this: "During a detailed, clear, and sincere conversation, the patient admitted to the violent introduction of these metal foreign bodies at the age of ten years while playing with other children."

The case report went on to detail the various risks of metal foreign body insertion into body parts and the successful removal of said objects via surgery. But it left the most important questions unanswered. First of all, what kinds of friends are going to encourage you to stick pins into your scrotum? And then what kind of person is going to actually do that, and then wait 44 years before dealing with the aftermath? This is a patient I would love to have seen! Good thing I am on call today, and you never know who is going to walk through the doors...

love,
Dr. Hot Pants"

AND

Hi Claire!

Did I tell you that yesterday we had a patient sign out AMA after getting busted smoking crack in her bed?

Anyway, here is the story, courtesy of my Brazilian neurosurgeon friend. Apparently when he first came to here as an intern, he was assigned to this hospital in the department of urology. His very first night on the job, the chief resident gave him a patient to work up and present to the chair of the department the next morning. When my friend went to see the patient, it was obvious that there was a serious problem since the man's scrotum had swollen to the size of a melon, but all the patient would say by way of explanation was "it was a blow job, man." When pressed further, he offered a crude gesture that did nothing to clarify the situation, but did demonstrate that surprisingly, there is no universal sign for blow job.

My friend,being from Brazil, had never heard such a term-- and naturally he assumed that the patient was a glassblower who had somehow managed to get shards of glass in his genitalia while blowing into a glass tube. (don't ask). So he wrote it up and presented it the next morning as a work-related injury, and when pressed for details, explained that the man had been involved in a blow job when he had this unfortunate accident!

Naturally the whole room just about died laughing, and when the chaos died down the chief resident took my friend aside and explained the true nature of a blow job. Turns out the real story was that the patient had contracted with a prostitute for a little glass-blowing action but had failed to negotiate a mutually satisfactory price until his glass tube, shall we say, was already engaged. Upon hearing the price he was prepared to pay, the lady became enraged and sank her teeth in, multiple times, resulting in a very bad infection which tracked into a scrotal abscess. So actually, depending on your point of view, I guess it was a work-related injury after all!

love,

Dr. Hot Pants