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Competent for surgery? watch

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    I am a T1DM BA MBBS FY1, and I don't believe my hatred for surgery has anything to do with my lifestyle-restricting illness.

    I would say your control would need to be spot on. Are you on a pump yet? This would help hugely. I was put on one in my final year of studies due to me shortly commencing work, despite being no-where near NICE criteria. Surgery of course is in theory a nightmare for diabetics. The unpredictable workload and working hours, the restrictive sterile environment and need for complete dedication to the task for hours on end. Sugars levels affect concentration and mood, but as long as you don't go a little low and get a bit agitated and stick the scalpel somewhere sensitive you should be fine.

    Being diabetic does not affect me being an FY1 in any way. I do think it is something to consider if aspiring to be a surgeon however.
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    (Original post by davey jones)
    The exams are a ****ing nightmare though.
    It guarantees that there's a certain quality of chat in the department office though.
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    (Original post by davey jones)
    I do think that in reality IDDM will affect a career as a sturgeon. Particularly is it was poorly controlled. Lunch breaks can be erratic and there will come many a time I am sure that you will not be able to effectively control your diabetes due to more pressing immediate concerns.

    If it can be assumed that failing to control your diabetes (in surgery) for prolonged periods is more likely to lead to consistent hyperglycaemic states; the long term affect of the diabetes is not going to lead to anything good. Forget for a moment the risk of going hypo because you haven't eaten enough or gone a bit happy go lucky on the insulin and consider a realistic 50-70 hour working week where there will be long period of time where you will not be able to stop and sort your diabetes out. >>> vascular disease, renal failure, neuropathy, retinopathy etc. Sure from an occupational health point of view it will be fine but the long term consequences of failing to control diabetes are severe.

    As for a career in anaesthetics, that is achievable without too much concern. The periods where an anaesthetist absolutely cannot leave a patient tends to be quite short with longer periods being much less frequent. You spend much less time involved in sterile procedures as well, so can nip off for a minute in theatre or on the ICU/HDU.

    I must also note that I am neither a doctor nor a medical student, so my post is purely speculative.
    For doctors, the main danger is hypoglycaemia. The fact that doctors know the need to control their glucose levels more than any other walk of life means they run their levels generally quite tightly. This means they have more hypos than other people and usually get to the stage when they can't detect their hypos coming on.

    In a career like surgery where you are more likely to go without food for a long time and where getting a hypo can be more devastating, this can be an issue.
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    I think it could be doable with supportive colleagues.

    Don't do neuro, 12 hour theatre sessions for a single op...routinely... *shrug*
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    (Original post by davey jones)
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    Thank you, that post was very helpful . At the moment I'm working (as an HCA, meh) on a medical ward that specalises in diabetes , so I'm constantly surrounded by reminders of the need for good control. However, rotating, irregular shift work does not sit happily with my blood sugars, and I know that it's not going to be much better when I'm an F1/F2. I'm currently on a basal/bolus regime that I hate, but there's not really another option while having to switch between nights/days. Come September I'll be going back on twice daily mixed injections, as my control was pretty damn good (HbA1Cs consistently between 5-6) when I was on that and I'll have a more 9-5 lifestyle.

    (Original post by Awesome-o)
    I am a T1DM BA MBBS FY1, and I don't believe my hatred for surgery has anything to do with my lifestyle-restricting illness.

    I would say your control would need to be spot on. Are you on a pump yet? This would help hugely. I was put on one in my final year of studies due to me shortly commencing work, despite being no-where near NICE criteria. Surgery of course is in theory a nightmare for diabetics. The unpredictable workload and working hours, the restrictive sterile environment and need for complete dedication to the task for hours on end. Sugars levels affect concentration and mood, but as long as you don't go a little low and get a bit agitated and stick the scalpel somewhere sensitive you should be fine.

    Being diabetic does not affect me being an FY1 in any way. I do think it is something to consider if aspiring to be a surgeon however.
    I'm sorry to hear you say it's a 'lifestyle-restricting illness' - do you mean in terms of your medical career, or just life in general? I was only diagnosed 4 years ago, but it's never stopped me from doing anything. Except maybe drinking Coke!

    I don't think (at this point in my life, at least) that I've got the patience for a pump, I barely motivate myself to test my BM once a day, so the thought of six or so (?) times needed on a pump fills me with horror!

    I've had very little experience of surgery other than an afternoon sat quietly in the corner of a hip revision, but it didn't really appeal to me that much, so at this stage I'm not going to be devestated if someone tells me that, realistically, a career as a surgeon is unlikely. I like the idea of anaesthetics, but I know the reality is probably far removed from what I imagine. I'm going in with an open mind.

    Anyway, I'll stop before I get ramble-y. You're the first T1DM doctor I've ever encountered, it's very exciting
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    (Original post by LaRoar)
    Thank you, that post was very helpful . At the moment I'm working (as an HCA, meh) on a medical ward that specalises in diabetes , so I'm constantly surrounded by reminders of the need for good control. However, rotating, irregular shift work does not sit happily with my blood sugars, and I know that it's not going to be much better when I'm an F1/F2. I'm currently on a basal/bolus regime that I hate, but there's not really another option while having to switch between nights/days. Come September I'll be going back on twice daily mixed injections, as my control was pretty damn good (HbA1Cs consistently between 5-6) when I was on that and I'll have a more 9-5 lifestyle.



    I'm sorry to hear you say it's a 'lifestyle-restricting illness' - do you mean in terms of your medical career, or just life in general? I was only diagnosed 4 years ago, but it's never stopped me from doing anything. Except maybe drinking Coke!

    I don't think (at this point in my life, at least) that I've got the patience for a pump, I barely motivate myself to test my BM once a day, so the thought of six or so (?) times needed on a pump fills me with horror!

    I've had very little experience of surgery other than an afternoon sat quietly in the corner of a hip revision, but it didn't really appeal to me that much, so at this stage I'm not going to be devestated if someone tells me that, realistically, a career as a surgeon is unlikely. I like the idea of anaesthetics, but I know the reality is probably far removed from what I imagine. I'm going in with an open mind.

    Anyway, I'll stop before I get ramble-y. You're the first T1DM doctor I've ever encountered, it's very exciting
    When I say life-restricting, it's more of a resentment than a truth. I've travelled on my own to the other sideof the world, I've hiked in the Swiss Alps, I've graduated from medicine

    I went from mixed insulin to basal-bolus to pump. The latter is certainly the best. It's a bit more high maintenance with the changing of the line every 3 days, but it really does give me extra freedom. In the social setting it is certainly much better. No more producing needles at formal dinners and noticing people staring, wondering if you should just say "Yes, I am diabetic, I inject myself".

    I test my BMs about twice a day in the morning and before bed. Ironically, my current job is endocrinology. Many diabetic feet. Not nice to see, but a good incentive to achieve good glycaemic control. I am bloody good at counselling newly diagnosed type I's though
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    (Original post by Captain Crash)
    For doctors, the main danger is hypoglycaemia. The fact that doctors know the need to control their glucose levels more than any other walk of life means they run their levels generally quite tightly. This means they have more hypos than other people and usually get to the stage when they can't detect their hypos coming on.

    In a career like surgery where you are more likely to go without food for a long time and where getting a hypo can be more devastating, this can be an issue.
    I think that is a little short sighted. Although there is probably some truth to knowing more about the consequences of poor management leading to much stricter glucose control in the medical profession; many diabetics will deliberately allow their glucose to run a little higher as their lifestyle or schedule demands. If they know they will be busy for a long time or will not find it easy to get food for some time, they will typically allow it to run a little higher.

    This is acceptable because there has to be be a trade off between glucose control and lifestyle. If your disease dominates your life, what are you treating it for? But realistically, when the risks to the patient and your occupation are so severe if you were to experience a hypo in O.T, you are unlikely to control it very tightly pre-op. Combine this with the unpredictability of the average sturgeon's work load, hyperglycaemia is the more likely outcome. As mentioned previously this is an acceptable trade off, but it is one which must be used sparingly. If you allow it to become your lifestyle choice and glucose control is poor for several years then sequela will become the reality. I wouldn't say that being a sturgeon is unachievable for a IDDM, but if it were me it simply would not be the choice I would make.
 
 
 
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