"I'm not cold!!"

I lost track of my subjunctive..

http://en.wikipedia.org/wiki/Uvula

The uvula (pronounced /ˈjuːvjələ/) is the conic projection from the posterior edge of the middle of the soft palate, composed of connective tissue containing a number of racemose glands, and some muscular fibers (musculus uvulae).[1] It is frequently confused with the epiglottis[2] and the tonsils.



Function in voice
The uvula plays a key role in the articulation of the sound of the human voice to form the sounds of speech.[3] Anita O'Day, a popular big band singer, had her uvula accidentally removed during a childhood surgery when only her tonsils were intended to be removed. This affected her voice by eliminating vibrato, she said, in an interview with Terry Gross of NPR's "Fresh Air" radio show, although the uvula is not responsible for vibrato (the vocal cords make this happen).


[edit] Function in languages
The uvula functions in tandem with the back of the throat, the palate, and air coming up from the lungs to create a number of guttural and other sounds. Uvular consonants are not found in most dialects of English, though they are found in many Semitic, Caucasian, and Turkic languages, as well as several languages of Western Europe such as German and French. Certain African languages use the uvula to produce click consonants as well, though other than that, uvular consonants are fairly uncommon in Sub-Saharan Africa. In English (as well as many other languages), it closes the nasal passage to prevent air escaping through the nose when making nasal consonants.


[edit] Pathology

[edit] Universal emetic
Massaging the uvula causes the gag reflex to initiate and expel stomach contents, providing a universal alternative to emetic drugs such as ipecac. This is often an issue for people who plan to get uvula piercings.


[edit] Velopharyngeal insufficiency
In a small number of people, the uvula does not close properly against the back of the throat, causing a condition known as velopharyngeal insufficiency or VPI. This causes "nasal" (or more properly "hyper-nasal") speech, where a lot of extra air comes down the nose, and the speaker is unable to say certain consonants, for example producing the sound /b/ like /m/.


[edit] Snoring and sleep apnea
The uvula can also contribute to snoring or heavy breathing during sleep; having an elongated uvula can cause vibrations which lead to snoring. In some cases this can lead to sleep apnea, which may be treated by removal of the uvula or part of it if necessary, an operation known as uvulopalatopharyngoplasty (commonly referred to as UPPP, or U3P). However, this operation can also cause sleep apnea if scar tissue forms and the airspace in the velopharnyx is decreased. The success of UPPP as a treatment for sleep apnea is unknown, but some research has shown 40"60% effectiveness in reducing symptoms.[4] Typically apnea subsides for the short term, but returns over the medium to long term, and sometimes is worse than it was before the UPPP.


[edit] Nasal regurgitation
During swallowing, the soft palate and the uvula move superiorly to close off the nasopharynx, preventing food from entering the nasal cavity. When this process fails, the result is called nasal regurgitation. It is common in people with VPI, the myositides and neuromuscular disorders.


[edit] Uvulitis

A child's swollen uvula with tonsils
An adult's swollen uvulaAt times, the mucous membrane around the uvula may swell, causing the uvula to expand 3"5 times its normal size. When the uvula touches the throat or tongue, it can cause sensations like gagging or choking, even though there is no foreign matter present. This can cause problems breathing, talking, and eating.

There are many theories about what causes the uvula to swell, including dehydration (e.g. from arid weather); excessive smoking or other inhaled irritants; snoring; allergic reaction; or a viral or bacterial infection. An aphthous ulcer which has formed on the uvula can also cause swelling and discomfort.[5]

If the swelling is caused by dehydration, drinking fluids may improve the condition. If the cause is a bacterial infection, gargling salt water may help. However, it can also be a sign of other problems. Some people with a history of recurring uvulitis have to carry an EpiPen containing Adrenaline (Epinephrine) to inject themselves whenever the uvulitis begins. A swollen uvula is normally not life threatening and subsides in a short time, typically within a day.[6]

Exactly.



I did actually:



I'm not going to sue for a number of reasons, but a major one is that it's so hard to prove because it's a communication issue and I'm deaf/ use interpreters to speak to him. It's too easy for him to say that he told me, and if I didn't get the information either the interpreter didn't interpret it, or the interpreter did interpret it and I just didn't understand the interpreter. Working interpreters rarely retain information -- they're just conduits -- so they couldn't really be called upon to testify one way or another. ("Yes, I definitely interpreted that information," or "no, that never came up.") And it is somewhat possible that he said something that was not interpreted clearly. There were a lot of motions for "surgery" and "cutting/ reducing/ removing" in the same general area and maybe when he was talking about the uvula I thought he was talking about the tonsils. Unlikely, but possible.

I could maybe do something about the apparently botched shortening, but I think I'd wait a bit (to see if it does "drop," among other things), and it doesn't seem like the stakes are high enough. Her recovery was uneventful, and not having a uvula doesn't seem to actually be a big deal. (It doesn't seem to "do" that much... people regularly get it removed to help with snoring issues and while the removal itself is extremely unpleasant for most adults [apparently less of an issue for kids], not having it doesn't cause any problems.) It would take a lot to make me want to go through the hassle of a suit, and I'm not sure this reaches the bar.

I think he's a good ENT who made mistakes, and I'm not happy about it but not to the point that I want to switch doctors, yet. (And of course already thought about that. Don't really need the prompt. ) He's very very good at what he does, generally -- whenever I mention the fact that he's our ENT to people in the field (audiologists, etc.), they say how great he is. He's won all kinds of awards, etc. His overall attitude during the appt. where this was discussed was satisfactory in terms of recognizing that I had a point and apologizing (not as much as I would like, but not staying in denial mode either). He also fit us in to his very busy schedule to address this right away, which he didn't have to do. (It usually takes 4-6 weeks to get an appt. with him.) And as osso indicates, I do get how it can be hard for a doctor to say "I screwed up" in so many words. Perhaps they even have orders from their lawyers not to do it. I dunno.

If I stay with him, then I don't think reporting him to the state board is a good idea, since I'd want to have a working relationship with him. Right now it's fine, if cooler. (I stayed cordial throughout. I backed him into a corner but in a calm, conversational way. ) If I report him, it immediately becomes much more adversarial.

She still has the eardrum issues and I'd want the surgeon who worked on it to be the one who follows up with it.

But of course there is a pretty major dent in my opinion of him, and I'll be ready to take further action if it seems necessary.

Thanks for listening and for the sympathy, everyone. It was definitely distressing. <sigh>

Totally get all your comments.

And thanks, bfn, for a uvula worksheet, that was helpful.

You know, I blame the crazed litigousness that blights the USA (and threatens to blight my country, too) and subsequent lawyer-power for a lot of this lack of immediate frankness that so complicates professional practice these days.

If a mistake is made, the insurer's/employer's lawyers often advise shutting the **** up, and this becomes part of the defensive mind-set of many practioners...or they are ORDERED to say nothing, at peril of not being given cover in any mal-practice suit. That's pretty damn scary.


So...a minor, in the scheme of things, uvula event, is not discussed...leading to perfectly understandable anger on the part of the now non-uvula's loving parents, when it is likely that, if the doctor had simply said what happened immediately after the op, explained why he did it, and what the likely outcomes might be, the uvula's loved ones would have been perfectly gruntled.

A lot of people who DO sue after medical mishaps (and, if you have ceased believing in the tooth fairy and Father Christmas and still expect perfection from doctors you need to go to a re-education camp for the terminally foolish) say that they only did so because they could not get a straight answer and an admission of responsibility and an apology...the very things the damn lawyers forbid doctors from giving!


Here's a perfect example of a doctor who defied the risk managers:

Some friends of mine delivered their baby in their local country hospital. There was a problem causing the baby to become distressed while still in utero, it was not picked up soon enough, and the baby died.

The obstetric registrar, who was on his first day of his rotation to this hospital, had done all his previous rotations in major metro teaching hospitals.

He came on as the labour was progressing normally. Then, a midwife informed him that there had been some fleeting signs of foetal distress. He was managing a serious haemmorhage in a woman who had given birth moments before....and instructed the midwife to initiate constant foetal monitoring on the other birth, and inform him immediately if there were any further signs of foetal distress.

He went to my friends as soon as the bleed was controlled...and immediately realized that the machinery for foetal monitoring was different, and inferior, to the machinery that he was familiar with, and that while the machinery was not registering dangerous levels of foetal distress, the foetus was, in fact, in bad shape.

He did a crash caesar, but the baby died shortly after birth.


Risk management would have advised to say nothing about any errors.

He sat down with the parents, and explained fully what had happened, taking complete responsibility for not having realised that the machinery was different, and apologising to them. He explained things to them for as long as they wanted, visited them repeatedly to ask if they had questions (people never take things in when first told such things) and made himself available to them free of charge when they were discharged as often as they wished to see him.

Far from suing him, they were so impressed with his courage and integrity, that he delivered their next two babies.

Nods.

Yeah. I've read too much Atul Gawande and Jerome Groopman to think that any doctors are infallible, even the really good ones.

One thing that jumped out at me from the Wikipedia article when I first found it was the relationship between dehydration and swollen uvulas. We may have identified the cause of "allergic to pie..." (Dehydration seemed to be a common thread, and if she had an abnormally large uvula that then swelled up when she got dehydrated, it'd make sense that she'd get gaggy.)

She has barfed once since she had surgery (well, after that first day), but her best friend barfed at the same time and BF's whole family (6 people) had dealt with sequential barfing (one Monday, the next Tuesday, etc.) so it seems likely it was a virus.

So maybe this really will end up being a net benefit.

A friend of ours is an ER doctor and heard the story and wanted to take a look -- he proclaimed her uvula "beautiful." (He agreed that the ENT should have told us what he planned to do and/ or explained afterwards ["or" if it was a mistake], but said that the actual reduction isn't a big deal in terms of her health.)

How about what Swimpy suggested, though -- report him to the medical board? That way you don't have to prove his guilt the way you'd have to in a lawsuit. But at least he wouldn't get completely off the hook, and the case would at least be documented in a "he said, she said" way. (Assuming he wants to get in a "he said" part with the medical board.)

It's your decision, of course, and you've given good arguments against it, but Swimpy's suggestion still makes very good sense to me. At the very least, I'd bring it up as a potential stick in a carrot-and-stick conversation about frankness. If I were you, the lack of forthrightness would concern me the most.

Well, this part:



"[the relationship]" added for clarity.

Perhaps one could report anonymously, but I doubt it. (As in, even if my name wasn't attached, "botched uvula shortening with patient whose mother is deaf and so probably wasn't told about it but since she used interpreters it's not completely clear" could be pretty easily ID'ed.)

This is definitely something I will keep in mind and I have documented this incident (here and elsewhere as well), and if something makes me think that this was not in fact a one-time anomaly, I'll take action at that point.

This thread has been so so so useful to me -- for example, during this last episode (more in a bit) E.G. and I were trying to remember if we'd taken her to urgent care and been told to just go home. I checked this and found that yes, that'd happened once.

OK so. On Saturday, we went to an event that was prime "allergic to pie" territory. She ran around for several hours with a pack of friends, got overheated (I took her sweatshirt off of her after she swung by and I could tell she was way too hot, she hadn't noticed), and ate junky food. (Pizza, chocolate, and root beer. Root beer keeps coming up. Er, in more ways than one.) (Though she doesn't get sick every time she has root beer.)

Saturday evening we were hanging around watching a movie. E.G. asked sozlet if she wanted popcorn. No. He didn't like the look on her face. I checked her out -- eek, not good. She just complained of tiredness though. Movie went off, and we hustled her to bed. Shortly thereafter -- barfed.

She then barfed every HOUR all night long. I sat against the foot of her bed so I could feel her stir -- I'd deal with the barf, blow her nose, brush her teeth, get her back to sleep, clean anything that needed cleaning, turn off the light, get settled at the foot of the bed, lay there wide-eyed and heartbeat racing, then calm down, then start to nod off, then bang, she'd stir and the whole thing would start all over again.

We got up for the day at about 8 AM and she was able to power through a few episodes (i.e. felt nauseous but was able to not barf), that took a lot of energy though and she was having a hard time. I tried to give her ice chips very slowly -- trying to find a balance between getting fluids into her and not causing more barfing. E.G. was sent to get Gatorade, ginger ale, chicken noodle soup and suchlike. She started dragging out the intervals better.

I don't remember exact timing but at several points it looked likely that we'd have to take her to the hospital -- she was quite dehydrated (nail beds took too long to pinken up after being pressed, very dry mouth, etc.) Each time she managed to rally.

Early afternoon I realized she had a fever, which was actually good news as it could be controlled and then she'd perk up. Gave her ibuprofren (usual). She did perk up after a bit and I got some chicken broth and more Gatorade et al into her. She did barf after that but it seemed like a corner had been turned.

Kept perking (mostly on fluids rather than food), then had some tapioca pudding which got her through the last stretch to bedtime. Then slept a good solid chunk Sunday night. Was pretty much normal by Monday morning, just weak and tired.

Gave her this and that, took her to Whole Foods and let her choose anything that looked good (that only resulted in one bag of food, not much appetite). She had some of that, perked up much further.

Went to bed early Monday, expected her to be up and go to school as usual Tuesday. Woke her up, or attempted to, Tuesday morning -- she was TIRED. That's not completely unusual, continued with the routine. She seemed basically fine. No appetite for breakfast. Hmm. Whiny and dramatic about not wanting to be late for school. Hmmmm. But seemed basically fine. Had her eat a little food and then sent her off.

Checked on her before lunch time -- wanted to be sure she'd eat her lunch and if not, take her home to give her something she would eat. She looked horrible. She said she didn't feel well. Argh. Took her home.

She looked close to starting the whole thing over again when she first came home. Moved slowly. Nothing sounded good to her. I casually made myself some meatloaf (the main thing she had craved on Monday though she never had any), she got a whiff and instantly WANTED some. Gave her some meatloaf. Instant perk. Then went up from there.

Seemed totally fine as of 2 PM or so yesterday, but she seemed fine on Monday too so I'm letting her sleep in today. And she's still sleeping. Will go check on her soon.

Main thing I want to get down for future reference -- tried the anti-nausea medicine and results were inconclusive. (Need to get the name, will do that when I check on her.) She hated the taste. It came back up. Didn't get a full dose into her at once so it's not completely clear if it does or doesn't work.


Other info:

- Fever was relatively low for her, 101-102 territory. Consistent with dehydration (dehydration can cause a fever)

- Three of her classmates were out with stomach troubles on Monday, too. (As in, "allergic to pie" may well be a red herring.)

OK, checked on her -- awake but still tired. Stuffy. (Ugh, that's a frequent secondary issue because she insists on barfing through her nose* which of course doesn't make her nose happy. At least she has tubes in terms of possible ear infection, which is how this sometimes goes... barf --> nose irritation --> sinus infection --> ear infection.) She seems mostly fine though. I let her have my Blackberry to play Brickbreaker, big smiles and wiggliness about that.

The anti-nausea medicine we tried is Ondansetron 4mg/ 5 ml. Syrup.


*not JUST her nose, but mouth and nose at the same time. TMI, I know.

That sounds like quite the ordeal.

You have my sympathies.

Thanks, DrewDad.

Picked her up from school, she was whiny and moody so might not be out of this all the way. Has calmed down though and said that school was good so we'll see.

Does she have any wheat allergies? If so, root beer is included in the no-no list for wheat allergies.

I believe she's been thoroughly checked for allergies.

So, "allergic to pie" syndrome actually exists! It has a different name, though, "Cyclic Vomiting Syndrome." Check out these causes:


http://www.mayoclinic.com/health/cyclic-vomiting-syndrome/DS00835/DSECTION=causes

Allergic to pie covers three and maybe four of those -- emotional stress or excitement, hot weather, physical exhaustion, and maybe foods such as chocolate or cheese. (Allergic to pie was so named because she'd frequently have vomiting episodes after the sort of party that we would bring a pie to -- even if she didn't actually have any pie.)

The Mayo site also mentions elsewhere that sleep is important in prevention, which is something else we've noticed.

I'm not sure how useful this diagnosis would be as there is no particular cure and the ways to control it are the things we are already doing. But that's interesting that there seems to be an actual syndrome that describes the weirdness that is allergic to pie so accurately.

(She just had another couple of severe episodes, kept her out of the ER this time though. Probably triggered by sinus problems.)

Tried it again, Ondansetron, it seemed to help this time especially in getting her to sleep, and sleeping is always the most effective way to stop the cycle. On Thursday she was nauseous when I woke her up for school, successfully fought through several waves of nausea and then finally vomited at about 10 AM and then was just going pretty much continuously until 2 PM. At 1:30 I gave her the Ondansetron (1/2 teaspoon), she nodded off (she was already sleepy but hadn't been able to fall asleep) and then 15-20 minutes later her eyes flew open and she vomited once more (small amount), then she finally conked out until 4 or so. The first hour or two was fitful, then she fell into a deep sleep for the last bit.

Once she woke up she was pretty much fine, just a matter of getting fluids into her (took it slowly). (I used Pedialyte electrolyte strips, too, a little tricky with the palate expander but she handled it well. She never seemed to be seriously dehydrated even though that 10-2 period was brutal.)

She then had another episode Friday night/ Saturday morning that was shorter. She fell back asleep and was mostly fine once she woke up for the day. She really toughed out several episodes though, some major willpower. Back at school now, fingers crossed.

Oh, there's also this!



She's "teething" for the first time in a long time. She typically has a new tooth come out very soon after the old one is lost, before the gum has even healed. But her adult canines haven't had room to emerge because her front teeth are so crowded. She has had a palate expander for the past couple of months and it is doing its job. Her right canine emerged a couple of weeks ago (brief barfing episode), and her left canine is emerging now. Coincidence? Maybe not.

She always had vomiting issues when she was a baby and was teething.

I think there was a discussion of vision somewhere but I can't find it back.

May 1st 2009, from this thread:



Actually not 20/400* (though I'm not sure what it really was in terms of 20/whatever), and actually -2.5 and -2.25 diopters.

Last year, right around this time (February), I noticed she was having a hard time seeing and scheduled an appt... -3.25 and -3.0 diopters, respectively.

And again, just noticed something was off (she was tilting her head back to look through her glasses at an angle when she was watching TV), had an annual appt. already scheduled for February 2nd, moved it up. Her vision has changed again, to -4.25 (in both eyes).

My vision is -3.25 in both eyes and I hoped that she would level off at about there.

We walked out with contacts in the correct prescription, tried them for the first time this morning, she was astounded anew at how clear everything is.

To those of you who have glasses -- do you remember how long it took for your eyesight to stabilize? Did you get new glasses/ prescriptions for a long time?

I don't remember. I think I maybe got my last new/changed prescription at 14 or so. I don't think it was an annual march of diopters though.

To those of you who have kids who wear glasses, same question.

Thanks.

(I'm not freaking out, I know that her vision can get much worse yet without it being that big of a deal, just stronger prescriptions, she already has glasses/ contacts. Just curious.)



* She misunderstood the instructions, she thought she was supposed to look for an egg for some reason. (??) So she couldn't see the egg (though she could see some of the big letters, she didn't realize she was supposed to be saying so).

I don't remember how often I had to have new prescriptions...maybe every two years or something like that?

My eyes are terrible and I STILL have to have new prescriptions from time to time. Much longer between though.

Seems she's taken to contacts very well!!

I think my eyes slowed down as it were when I was about twenty. I know I got contacts when I was 21 and I don't recall prescription changes in the 6 years I was actually able to wear them (MEASLES! Don't ask!)