On Being ‘Dr. Dad’

  • hiermedia
  • June 5, 2017

I take my 10-year-old son to school as many school days as possible. We recap events from the prior day, and I give him early morning pep talks. It is a rarity, however, that I pick him up from school. During one of those rare occasions, he got into the car, smiling as he handed me a project he completed in class. It was an assignment in which he was asked to introduce his hero to his classmates. To my delight and surprise, he chose me as his hero. He explained that he looked up to me, in part, because I am a doctor.

This moment affirmed my belief that being a doctor compliments my role as a father. Being a doctor makes me a better father. Equally, being a father makes me a better doctor. While I’ve had a decade to establish a healthy relationship with my son, in clinic, I must establish a doctor-patient relationship in a relatively short amount of time. Many patients come into the clinical encounter with problems they would not share with their closest confidante. During these candid conversations, they trust I will listen and not only have solutions for their complaints but remain objective and unbiased in the process. I incorporate these same skills while instructing and nurturing my children.

One such opportunity arose after a recent track meet when my son came in 7th place during the 100-m dash run. I could see his disappointment in his performance. I could also see the embarrassment he felt. After listening to him share his feelings of being intimidated by his competition, we problem-solved and discussed ways to improve his performance for the next race. Our solutions included spending additional time after practice working on his technique. His effort paid off; he had a faster time and came in 2nd place during the following track meet. Years of listening, searching for, and offering methodical solutions to my patients subsequently have improved my problem solving as a father.

Just like my patients, my son does not follow all of my instructions. He has challenges getting homework done in a timely fashion and most definitely has challenges keeping his room clean. Guiding him through life’s challenges has taught me how to remain cool and level headed even when I am feeling anything but. Techniques that work in parenting translate to my professional responsibilities. For example, I rely on the ability to speak clearly in language the patient can understand to facilitate conversations about the medical and surgical management of various disease processes. Keeping cool and level headed in a wide range of clinical situations ranging from treating a noncompliant patient to proficiently and dexterously completing a tough surgical procedure is a necessity in my profession. Being a father of an energetic and active son has definitely equipped me for comparably challenging situations that require the same quiet resolve in my surgical practice.

Despite all the ways being a father and a doctor complement each other, it is a challenge to do them both well and give them both the time they require. I am intent to take full advantage of the time I have with each, whether in the car going to school or in the office and operating room. Time is fleeting and I recognize my son is growing older much too fast. My patients have many medical and surgical needs that continue even after the office has closed for the day. Clearly, I am not able to be present at all times for both. Nonetheless, when I am with family or with a patient, my goal is to be fully present. I know my son has a better father and my patients have a better doctor because of the experiences I have with each of them. Ultimately, I know the conversations with my son during our time in the car provides motivation, inspiration, and encouragement that will help mold him into a better version of himself that will benefit his future children and maybe, just maybe, his very own patients.

Your Top 10 Questions about Hemorrhoids Answered

  • hiermedia
  • May 2, 2017

Are you bleeding? Having pain? Any puffiness or swelling on the bottom? These could all be symptoms of hemorrhoids. But what are hemorrhoids and more importantly, how can they be prevented and treated? Here I answer your questions about this most common but dreaded malady.

  1. What is a hemorrhoid?

A hemorrhoid is an anal cushion of tissue containing blood vessels, muscle, and connective tissue. When this tissue is engorged or swollen, there is the possibility of discomfort or bleeding. Contrary to popular belief, a hemorrhoid is not a vein. Once the swelling from the hemorrhoid resolves, a skin tag may be left. There can be one or multiple tags present. Removal of the anal skin tag is not necessary unless they itch, bleed, or create difficulty maintaining proper perianal hygiene.

Anal Skin Tags

  1. What causes a hemorrhoid?

The exact cause of a hemorrhoid is unknown. Any action that increases pressure around the anus (such as straining to have a bowel movement, constipation, diarrhea, persistent heavy coughing, pregnancy, or lifting heavy objects) may lead to swelling or bleeding from the hemorrhoid.

  1. How common are hemorrhoids?

A report from the National Center for Health Statistics found that 10 million people in the US complained of troubles from hemorrhoids. Over 1 million prescriptions are written per year for medications for hemorrhoids. The peak age is 45-65 years of age, even though any age could potentially be affected.

  1. What are the symptoms of hemorrhoids?

Symptoms are dependent on the type of hemorrhoid.

The symptoms from internal hemorrhoids classically involve painless bright red bleeding that occurs during a bowel movement. Internal hemorrhoids may also prolapse or protrude outside of the anus when having bowel movements. They may reduce or go back in on their own; however, sometimes they require manual reduction (pushing them back into the anus). Pain is generally not a symptom of internal hemorrhoids, but if pain is present, it may be because of a prolapse or thrombosis of the internal hemorrhoid. A thrombosis occurs when the blood within the hemorrhoid clots and the hemorrhoid becomes very tender.

 

There are 4 grades of internal hemorrhoids:

Grade 1-hemorrhoids present but do not protrude

Grade 2-hemorrhoids protrude but reduce spontaneously

Grade 3-hemorrhoids protrude but require manual reduction (pushing them into the anus)

Grade 4-hemorrhoids protrude but cannot be reduced

Prolapsed internal hemorrhoids

 

The symptoms from external hemorrhoids involve swelling, discomfort, bleeding, and pain. They may become thrombosed. External hemorrhoids cannot be manually reduced. Struggling to “push them in” can cause more swelling and pain.

Thrombosed external hemorrhoid

  1. What can I do to prevent problems with hemorrhoids?

Drink adequate volumes of fluids each day and add bulk to the diet to eliminate straining. I recommend adding fruits, vegetables, and unprocessed wheat or oat bran to the diet. An alternative is to add psyllium seed or other fiber supplements, getting 20-35 g of fiber each day. Minimize extended periods of time on the toilet as doing so can increase strain and pressure around the anus. So that means put away the cellphone, magazines, and newspapers which may increase the amount of time spent on the toilet! Hemorrhoids may also be prevented by avoiding passing hard stools and avoiding straining with bowel movements or heavy lifting. The hemorrhoid itself may not go away. However, surgery may not be needed if there is no pain, bleeding, or swelling.

  1. So, I have a hemorrhoid. Now what?

Hydrocortisone creams may be helpful in improving symptoms of hemorrhoids.  If the over-the-counter versions do not provide relief, a stronger prescription from your doctor may be used. However, overuse of these products can make some symptoms like itching worse, which is why close follow up with the doctor is important. It is important to see an experienced physician. After a thorough examination, your doctor may conclude that symptoms reported from hemorrhoids could actually be from other anorectal diseases and conditions (i.e. anal fissures, anal abscesses, colorectal polyps, rectal prolapse).

  1. Do I need surgery for my hemorrhoids?

Not necessarily. The actual presence of the hemorrhoids or tags does not imply the need for surgery as long as symptoms are nonexistent, minimal, or tolerable. Your symptoms decide when and if surgery is needed.

  1. What are the most common procedures or surgeries for my hemorrhoids?

Internal hemorrhoids are most commonly treated with rubber band ligation, which is an in-office procedure to eliminate the symptomatic internal hemorrhoids. A ligation can also be performed in the operating room with suture. External hemorrhoids are excised in the office if a thrombosis is present (blood within the hemorrhoid clots and the hemorrhoid becomes very tender). If the external hemorrhoids are large, painful, bleeding, and not responding to medication, you may be a candidate for a surgical procedure called a hemorrhoidectomy. With this surgery, both large internal and external hemorrhoids are removed in the operating room with anesthesia.

  1. Do hemorrhoids lead to cancer?

No, they are not cancer and do not lead to cancer. However, symptoms from cancer may mimic those from hemorrhoids.

  1. So, what’s the bottom-line?

Just remember, there are a number of other potential causes of anorectal pain and bleeding. If you think you have hemorrhoids or have any of these symptoms, see a doctor. If bleeding and pain continue to be present despite treatment, definitely follow-up with your doctor to ensure you are getting the right treatment for the right problem.

A New Website: The Conversation Continues

  • hiermedia
  • February 28, 2017
At the start of medical school, I did not have preset notions about the field of medicine in which I wanted to work. I did not have specific desires to be called a “surgeon,” or an “obstetrician,” or a “pediatrician.” I did know, however, I wanted to become a physician who had the aptitude and competence to attack the pathology I had previously learned and to offer first-rate care to my patients. I also wanted a career where I could connect with people in a way that few are permitted.

Ultimately, I recognized surgery to be one of the most dynamic branches of medicine and have since devoted my professional energy toward it. I have been blessed to have a career where I have been able to educate not only my family and friends but also my colleagues and those coming behind me. I have searched for answers and continue to perfect my craft. I have studied the pathology to mend it, and have helped patients return to states of normalcy. Throughout this journey, I have been committed to become a physician dedicated to life-long learning and scholarship and a compassionate healer focused on the patient.

I have enjoyed opportunities to teach and speak to people about their health. These opportunities have ranged from impromptu 1-on-1 quick discussions in the hallways of various retail stores to larger more formal audiences at community health summits. I recently began writing on many of these topics, submitting them to national health blog sites, along with interviews and exposure in national media outlets. With the launch of this website, the discussion continues as the audience continues to grow.

Each month, I will publish a different blog along with updates of media outlets where the conversation extends. I expect this site to also address health information and messages I think are important for our community, one that reaches beyond age, race, gender, social class, or educational background. If I have learned one thing from the countless conversations I have had and questions I have been asked since I started this journey into medicine over 20 years ago, is that when it comes to health, we are all the same, with the same questions and fears about our health and the health of those we love.

The Hemorrhoid Talk

  • hiermedia
  • February 16, 2017

Hemorrhoids are not the only cause of anal pain. Find out why searching Google for solutions for this common complaint could be detrimental to your health.

Originally published by Eat This, Not That.

Should You Poop Everyday?

  • hiermedia
  • February 16, 2017

Many patients believe that you need to have a bowel movement every day and that afterwards, a moistened wipe should be used for cleansing. Dr. Cedrek McFadden answers these questions and gives answers you can use.

Originally published by Reader’s Digest.

Should You Eat Pork?

  • hiermedia
  • February 16, 2017

Should you eat pork? Many ask this question everyday! Read this article where Dr. Cedrek McFadden explores the benefits of the other white meat.

Originally published by BlackDoctor.org.

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