Enclothed Cognition

The holiday season is a perfect time for miracles, and miracles that end up saving not one, but thousands of lives are especially deserving of celebration. On December 3rd, 1967 in South Africa - a far cry from a snowy New York 34th street - Dr. Christiaan Barnard performed a miracle, the first human-to-human heart transplant. Louis Washkansky, a retired grocer in his mid-fifties, had just weeks to live when he agreed to the controversial and risky surgery. The window of opportunity for a successful operation was closing, so when 24-year-old donor Denise Darvall was killed in a traffic accident, Dr. Barnard had to move quickly. On December 3rd at 2:32 A.M., Denise's heart stopped beating, and nearly three and a half hours later, a single electrical shock revived the heart within a new body. Though the operation was considered a success, Louis Washkansky unfortunately died 18 days later from pneumonia. Still, surgeons across the world recognized the potential, and this life-changing surgery was improved over the following years. Today post-operative survival for a heart transplant averages 15 years. What began as a miracle procedure in 1967 now saves thousands of lives every year.

The other night I woke to the sound of my 16 month old German Shepherd puppy named Dio clacking my Kiehl’s lip balm top around in his mouth & immediately thought, 'This would be a good Medelita blog topic: adverse drug reactions.' After I wrangled the punctured plastic from his mouth, I wondered how much pear lip balm an 82lb dog can eat. Mind you, this is 2am, on a Friday night after a long workday and I want to go back to bed. About an hour later, I hear the sound of ripping paper as I discover Dio tearing one of my bedside AAPA journal covers. Obviously, my brain is in overdrive because this second incident inspires an idea of ‘proper bowel regimen review with surgical patients’ & how THAT would be a good blog topic. I work at Sibley Memorial Hospital in Washington DC, 7 miles away from my home in Virginia. The DC Metro area is known for politics, education, traffic, and well-connected movers and shakers. As a Surgical Staff PA, I have the opportunity to work with amazing nurses, NPs, CRNAs, Physicians and Surgeons. Thanks to a great and flexible boss, I have been able to focus my clinical efforts primarily on preoperative medical care. I love interacting with patients and their families, and take great joy in offering them a sense of personal empowerment through patient education. Today, I was reminded that patients can also teach us great lessons. One of my patients was an add-on for a joint I&D. This patient had classic signs & symptoms of a septic joint: an exquisitely painful, hot, red, swollen joint, with limited range of motion. Despite these issues, the patient was extremely polite, articulate, and pleasant. As anyone who has ever had surgery can attest, surgery can be scary and can make patients react adversely to members of their medical team. Typically, their reactions aren’t personal - it's just fear, anxiety, and/or pain. My patient’s attitude was totally different, however, and told me, “My surgery can either make me better or not. Nothing I can do to make the odds any different.” Given that this patient was so helpful & the case, so interesting, I found one of our PA students and brought her in to see this patient. I still remember many of the 'Come here - you gotta see this!!' cases from my own clinical rotations in graduate school. Some of the most memorable include: the look (and smell) of necrotizing fasciitis, dental signs of methamphetamine abuse, metastatic cancers, and uncontrolled schizophrenia. Needless to say, my student was thrilled because she had never seen a textbook septic joint and furthermore, the patient was earnestly pleased to show her. During my student's exam, I thanked the patient for “teaching” in such an indelible way. Two days after midnight lip-balm massacre, I took Dio to the vet for his checkup & rabies shot. The vet assured me the only major damage the Kiehl’s could do to my young 4-legged thief was to 'grease his pump' so to speak; no major adverse drug reactions. I appreciated that his early morning mischief session had such a benign outcome. In truth, lessons can be learned anywhere, anytime, from anyone. So, I thanked my dog for being such a good teacher, rubbed his tummy and gave him a vet and PA-approved doggie treat. Charlotte Lemmert, MPAS, PA-C lives in Virginia & is on Surgical Staff at Sibley Memorial Hospital in Washington DC. The next big thing in her life will be moving, cross-country, to Northwestern Washington State in January 2012 with her husband, dog and plants in tow.

The burial chamber was cold as I stared wide-eyed at the golden mask beneath the glass. I was young, and though the artifacts were well-made replicas, The Tutankhamun Exhibition in Dorchester, England was magical and mysterious nonetheless. In that moment, my fascination with Ancient Egypt (and history as a whole) was born. While I could happily dedicate pages to Tutankhamun, it wasn't until approximately 1000 years after his death that the world's first Type A personality emerged in Imhotep. Imhotep served during the Third Dynasty as chancellor to the pharaoh and high priest of the sun god Ra at Heliopolis, though his list of roles and accomplishments extends far beyond that. In fact, the full list of his titles includes Chancellor of the King of Egypt, Doctor, First in line after the King of Upper Egypt, Administrator of the Great Palace, Hereditary nobleman, High Priest of Heliopolis, Builder, Chief Carpenter, Chief Sculptor, and Maker of Vases in Chief. How many of us can claim so versatile a skill set? While Imhotep is also recognized as the world's first named architect and credited with building Egypt's first pyramid, it is his role as history's first doctor that led me to choose him as a subject for today's post. In fact, our own William Osler named Imhotep the real "Father of Medicine" - "the first figure of a physician to stand out clearly from the mists of antiquity." As a physician, Imhotep is believed to have diagnosed and treated over 200 diseases, including tuberculosis, appendicitis, and gout. He also performed surgery and practiced dentistry. As the credited author of the Edwin Smith Papyrus in which more than 90 anatomical terms and 48 injuries are described, he is notable for being one of the first doctors in history to approach medical knowledge from a perspective void of magical overtones - a like-minded ancestor of Hippocrates, who would live some 2,200 years later. For all of us, the paths we walk in the modern world echo with the footsteps of our ancestors. While the forefathers of marketing likely involve loud men selling fish from stalls, for medical professionals, your proud path began with the sandy steps of this remarkable man.

This year, we wanted to do something extra special for the holiday season. Our annual holiday sale is a popular event, and this year was no different, but we know that not everyone was able to order during the sale. So whether you were busy with Thanksgiving festivities or just didn't start thinking about gifts until now, we're giving you another opportunity to save on your holiday gifts with a one-day Flash Sale. TODAY ONLY we're offering 15% off in addition to FREE gift-wrap and FREE name & title embroidery. If you own a clinic or practice, December/end of tax year is a perfect time to consider an office makeover. By outfitting your staff with professional, tailored scrubs for the holidays, you can save with our sale and increase your deductions for 2011 business related taxes. Please consult your financial advisor for further details. Free name & title embroidery will turn a professional uniform into a personal and cherished gift. Consider adding custom logo embroidery to your order as well, and display a constant message to your patients of thoughtfulness and attention to detail.

I'd like to take a moment to honor one of the employees here at Medelita, David Saldana. David is our Embroidery Lead & Logo Artist. He's directly responsible for designing and digitizing every beautiful custom logo, as well all school and association logos, but as I've discovered these past weeks, his dedication to quality extends beyond his official duties. After many months of sourcing and third party testing, we have acquired new snaps for our dental lab coats. These new snaps will be included in the production of our next batch of dental lab coats, but as I'm sure you've guessed, that wasn't enough for us. If we have something better, we want to give it to our customers as soon as possible. Our solution was to replace the snaps on every dental coat currently in inventory. This is a massive undertaking, but David stepped up to the challenge. For the past few weeks, I've seen him every day at the snap machine in our warehouse, carefully removing the old snaps and replacing them with the new ones. It's no easy task either! He practiced for a long time, wanting his work to be perfect. He even obliged me when I asked to try out the machine (to be honest, I thought it would be easy) and I immediately applied too much pressure and broke the snap I was trying to place on the test fabric. David's dedication and standard of excellence embody who we are as a company, and like all of our employees, we're proud that he's a member of the Medelita family.

I love to learn about the little known origins of everyday objects. After a while, extraordinary inventions become mundane aspects of everyday life, and all it takes sometimes is a little piece of history to give you new appreciation for the ordinary - and band-aids are about as ordinary as can be. Band-Aid is the Johnson & Johnson Company trademarked name for bandages. Prior to 1921, a bandage consisted on separate gauze and adhesive tape that was cut to size each time it was needed. Earle Dickson was a cotton buyer for Johnson & Johnson, and his wife was a passionate but clumsy culinary enthusiast. Josephine Dickson was always cutting her fingers in the kitchen, and Earle noticed that the gauze-and-tape bandages never stayed on very long. In an effort to help his wife, Earle invented a new bandage that would stay in place and protect small cuts. He took a piece of tape, attached gauze to the center, and covered it with crinoline to keep it sterile. When his boss, James Johnson, saw the invention, he decided to mass-produce the new band-aid - and he made Earle Dickson vice-president of the company. Sometimes good ideas just need the right opportunity, and the band-aid didn't become popular until Johnson & Johnson donated them to Boy Scout troops. So next time you're reaching for that mundane box of ordinary band-aids, remember Earle Dickson and his accident-prone wife.

We know that Rx (Rx) represents prescription medication, but do you know the origins of this everyday symbol? The origin of Rx is actually a subject of debate. A popular (but rather unromantic) theory suggests that it is an abbreviation for the Latin word 'recipere', which means recipe or 'take'. As such, when a medical practitioner writes a prescription beginning with " Rx ", he or she is completing the command to take whatever medication is recommended. Another theory suggests that Rx is derived from the ancient astrological symbol for Jupiter. The use of this sign originated in the Middle Ages, when doctors believed that the planets influenced Health. Jupiter, named after the Roman king of the gods, was thought to be the most powerful of all the heavenly bodies in curing disease. In 1910, William Osler wrote, “In a cursive form it is found in mediaeval translations of the works of Ptolemy the astrologer, as the sign of the planet Jupiter. As such it was placed upon horoscopes and upon formula containing drugs made for administration to the body, so that the harmful properties of these drugs might be removed under the influence of the lucky planet.” The final theory leaves the Romans in the dust, or rather sand, to take us to Ancient Egypt. Some claim that Rx has in fact evolved from the Eye of Horus. Horus was the son of two of the main gods in Egyptian mythology, Isis and Osiris. Horus had an evil uncle, Seth, who murdered Osiris, and Horus killed him to avenge his father's death. During the fight, Seth plucked out Horus' left eye and tore it apart. Thoth (the Egyptian god of wisdom and magic) found the eye, pieced it together, and added some magic. He returned the eye to Horus, who in turn gave it to his murdered father Osiris, thereby bringing him back to life. The Eye of Horus was therefore considered a powerful symbol, worn as an amulet to ensure good health and ward off sickness. The truth of the origins of the Rx symbol may never be proven without a doubt, with theories ranging from the practical to the mystical. What do you think?

At my house, Santa Claus didn't drink milk. Every year as a child, I'd leave a plate of cookies, a glass of scotch, and a carrot (for Rudolph). Every Christmas morning, there'd be a plate of crumbs, a missing carrot, and an empty glass. It didn't occur to me until later that if every child was doing that, then Santa must be driving his sleigh extremely drunk. Later even than that, I realized my grandfather was the one drinking the scotch. I was curious, therefore, when I discovered that both my inebriated version of Santa and my grandfather were choosing a liquor with a medical history. The word whiskey comes from the ancient Celtic word uisge beatha, which means water of life, and whiskey was actually known as aqua vitae during the Middle Ages. The first license for the production and sale of Scotch whiskey was granted to the Guild of Surgeon Barbers in Edinburgh by Royal charter of James IV in 1505. It was an exclusive monopoly, and they were the only organization that could produce and sell Scotch whiskey. Why the barber surgeons? At that time, a surgeon’s responsibilities were primarily limited to bleeding, amputations, and the drainage of pus - sounds pleasant, huh? Anesthetics like lidocaine, chloroform, and ether weren't available for another 350 some years, so whiskey was often used to dull the pain when performing an operation. For Santa, I imagine it would dull the pain of flying around in the snow all night. As for my grandfather . . . he simply made the most of his role. Ironically, he was a barber, but I assure you that no one in my family ever had a limb amputated on Christmas.

With a New Year comes New Year resolutions, and very often, resolutions include commitments to improve our health in some way. According to usa.gov, resolutions popular year after year include: • Drinking less alcohol • Losing weight • Exercising more • Quitting smoking • Managing stress The intention and an inherent desire to be healthier are there in all of us, and in your patients. Unfortunately, many resolutions fade after the first month or so. This year make a commitment to be true to your resolution - so that your patients can be inspired to be true to theirs. What is your promise for 2012?

As 2012 approaches, we wanted to end the year on a special note. We're so grateful for the community of enthusiastic, engaging, and caring health professionals that have joined us on Facebook, and so we decided to give one lucky Facebook fan a FREE Medelita lab coat. Entering is easy! 1. Post a picture of yourself on Facebook - wearing a Medelita garment (lab coat or scrubs) 2. 'Tag' Medelita in the photograph (or post it directly on our page) Post your picture by January 1st, 2012 and you will be placed in a random drawing for a free lab coat of your choice. In addition to a brand new Medelita lab coat, you will also receive free name & title embroidery. We'll be announcing the winner on January 6th - there's no better way to start a new year than with a free lab coat, so be sure to post a picture!