not sure if I should enter in here. Regarding circumcision, I'd like to ask. Is there a prefernce in technique out there? I am now working in an area where the gomco is used. I didn't think anyone used those anymore. >J. Hafeman, MSN, RN,
Subject: Re: Consents --> Circumcision Use them all the time. Mogan, Gomco and PlastiBell are the 3 with which I'm familiar. Garry
Garry E. Siegel, M.D.
Think that the Mogan is the best. Less time, less bleeding, better effect. IMHO. Now, I use a dorsal ring block and literally leave the nursery for 10 minutes. If I stay, I do the procedure too early. Works well Richard Chudacoff, MD, FACOG >
GA12L@aol.com writes: > You mean they don't always use anaesthesia? It must be painful for those poor little boys. And would you let a novice near your tackle with a sharp knife? The mind boggles..>
Being boggled and being careless WOULD interfere with the procedure. So I think you'd best leave it to some of the rest of us. Joe P. >
Curious as to why not the plastibell? Just curious.
Yuck...it stays on, it just seems wrong to leave the foreign body there to increase the risk of infection
Richard Chudacoff, MD, FACOG
>>> Garry E. Siegel 01/03/06 12:27 PM >>>
Gomco, and I place a ring block (as opposed to a dorsal penile nerve block) and do it within a couple of minutes with good results. I place the block, and then set up the tray, etc., while it is setting up.
Sometimes, depending on the geometry of the penis, or just because I want to stay proficient, I use a Mogan.
At Tue, 03 Jan 2006, Judith Hafeman wrote: > >I don't know the Mogan but I'll look it up. I agree with you re: the 10 mins. for the block. Good advocacy there. JHafeman, MSN, RN, WHNP >
Here in Illinois, at my hospital, circs are done by both OB's and peds, though most are actually done by FP's, since the FP residency does the majority of the low-income births, which seems to be a growing percentage. I have always done them with a gomco. Plastibells were introduced when I was a resident, but we decided to save ourselves a few phone calls from clinic patients by NOT sending the baby home with something that was going to fall off later. Have seen a Mogen clamp, never used one, though a partner I had briefly a few years back did use them. I gave up trying to talk people out of circs years ago. Decided I was wasting my breath. I was never impressed by the NoCirc people and always wondered what the president of that organization says when making small talk at cocktail parties and someone asks him/her "What do you do for a living?" (and hoping I never run into that person and unwittingly ask that question)
I always use a dorsal nerve block and wait at least 5 minutes before starting. That always works for me, and seems to cover the pain from breaking up the adhesions also. A resident taught me the nerve block technique. I'm never too old to learn new tricks.
An old doc i worked with when I was a student told me that OB's used to deliver the baby and then turn around, lay it on the table behind them, and do the circ while waiting for the placenta. Nowadays the baby has to be examined by the pediatrician or FP before the circ is done. I once did a circ on a baby at 12 hours of age. I did the newborn admit in the DR the night before so didn't re-examine the kid before the circ. Did discharge exam AFTER the circ and heard a LOUD murmur that wasn't there the night before. The kid started getting hypoxic within the hour and ended up in emergency cardiac surgery after crashing into CHF. Last time I ever circed a kid without listening to the heart right before.
I don't have too many parents request to watch. The two times I can remember having an audience (other than students), I had complications both times (bleeding that wouldn't stop and required extra sutures, as I recall). The scariest complication I had was in a kid with a really short little thingy and very loose skin on it. When I pulled the clamp off and the skin dropped back down, the whole ventral shaft was denuded, right down to the scrotum. Yikes! I called the urologist and he told me just tack the edge back up to the glans with some fine chromic and I did that. Then it was tethered down and I thought the kid would be peeing on his shoes the rest of his life but by his 2-week checkup he was fine (and I was a wreck from lack of sleep).
I have no problem letting students and residents do circs, because there really isn't much they can screw up if someone is watching. Once the Gomco is on, they can hack away at the foreskin without cutting anything else important.
And finally, to break the tension when i have a nervous student or resident doing his/her first one, I tell this joke: A Rabbi saved all the foreskins from all the circs he did and stitched them together to make a purse. If you rub it, it becomes a suitcase.
Anna Meenan, MD
P.S. I do believe babies shut down in response to overwhelming stimuli.
I read it somewhere, but don't ask me where.
Tallulah Dare 8-01, Marcos Gael 12-04, Cormac Mateo 9-09, Leonidas Ronan 11-11
So to actually be the one wielding the hemostats, scalpel, clamp, scissors? To know that the baby screams in fear and pain because of what you do? To slice and crush a baby's flesh without giving any pain relief? How can you be that insensitive to causing an innocent pain? How can you nonchalantly walk out of the room after strapping a newborn to a board? Walk back in and pick up your instruments, knowing the torturous agony you are about to inflict? How can you be so callous? What kind of person does that?
I know some doctors believe they are preventing health problems, despite the clear lack of evidence. But how to justify that most circumcisions are done without anesthesia? If they want to help, then how can they hurt so viciously? I suppose others are immune to what they are doing, having done it so often. It's just the usual, they no longer hear the screams. How did they get past the first few, when surely they were still able to experience emotion? Why did they keep doing it? There has to be something like the mind of a serial killer at work there, unable and unwilling to empathize with their victims.
Tallulah Dare 8-01, Marcos Gael 12-04, Cormac Mateo 9-09, Leonidas Ronan 11-11
JUST. SAY. NO. you pathetic excuse for a human being.
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|How can you be that insensitive to causing an innocent pain? How can you nonchalantly walk out of the room after strapping a newborn to a board? Walk back in and pick up your instruments, knowing the torturous agony you are about to inflict? How can you be so callous? What kind of person does that?|
I don't think the Hippocratic Oath is of any importance to those people other than perhaps a history lesson.
ETA: I just discovered that "First do no harm" is not actually in the Hippocratic Oath, and therefore NOT a requirement for doctors. Interesting. http://www.geocities.com/everwild7/noharm.html
Originally Posted by baybee
The scariest complication I had was in a kid with a really short little thingy and very loose skin on it. When I pulled the clamp off and the skin dropped back down, the whole ventral shaft was denuded, right down to the scrotum. Yikes! I called the urologist and he told me just tack the edge back up to the glans with some fine chromic and I did that. Then it was tethered down and I thought the kid would be peeing on his shoes the rest of his life but by his 2-week checkup he was fine (and I was a wreck from lack of sleep).
OMG! My first thought was, "That poor baby..." but after a minute all I thought was "That poor MAN!!!" Can you imagine how that little guy's penis will grow up to be? Can you say, hairy shaft? Buried penis? No shaft penis?????
(btw, what a PROFESSIONAL--- Calling a penis a "thingy"??)
Just goes to show the power of brainwashing and social conditioning...
I think that post needs to go to every nurses, midwife, and doula email list.
If just one poor boy could be saved this trauma by us alerting professionals to this kind of horror. That could have been one of the 200 boys who die each year from circ.
When I read the coroner's inquest report on the baby boy who died here in 2002 (Ryleigh McWillis), it was enough to stop your heart. The emergency room staff who admitted him after he had been bleeding out all night. . . them not realizing what they were dealing with. . . .starting massive antibx. . . transferring him to a bigger centre. . . you could just imagine being there and the sickening feeling of everyone that it was too far gone. Our local College of Physicians and Surgeons came out with a very strong statement against it after that. The only reason the story came out publicly was "whistle blowers" in the hosp. We have to open up the curtains of these autrocities. There is absolutely no reason to take these risks with our baby boys.
Vancouver, BC Canada
Was this comment supposed to be a 'sarcastic response' if it was but truely it has some darn tooting truth to it of crazy loony doctors who are truly in it for the Money .
Yes, males are probably victims of cutting themselves but that is no excuse.
I find it amazing that eventhough even I from cross the world can access to medical information provided by AAP, American doctors can't.:
My DS was born in a hospital with midwife who was supervised by an OB. When we told her we were not having DS circumcised, she said "Fortier (her supervising OB) will love you--he hates doing that." So I got the impression he did do the procedure, even though he didn't like to. He was not in an HMO or a big group practice either, so it is not like he had that kind of pressure.
Sorry for the OT post.
VERY informative posts!! Thanks much. Though I grew up in a hospital (dad was a med-tech who worked in the lab) and know how Drs can get, yet your posts confirmed again for me that for these Drs it is just a job. There is no emotion in it. Some of them question the practice--but my guess is that if challenged, they would become more entrenched on the 'circ' side of things.
Last night I read through this thread (and replied, but computer crashed)--and was concerned when someone said something about going to the Dr.s board and posting there.
I think that would be counter-productive unless one is well-educated and is able to write 'casually and without emotion' on this topic.(I know, pretty difficult since it is SO barbaric!)
Drs are 'god' to many and have a huge amt of influence and we need them on our side. From what you posted Baybee, one Dr. is leaning towards not-circing, but very much against a no-circ group. That tells me that he (like most Drs) was trained to be non-emotional and to accept only the facts. (is this a guy thing???)
I've talked two men out of circing their sons. In both cases, my casual question, (after they told me they were circing), was a "Can I talk you out of it?" In both cases, they acted surprised, but were open to simply-stated, basic facts.
I'd love to ask a Dr. "how do you feel about circing? Do they give you much evidence pro or con in med-school?" and engage them in a non-emotional, casual discussion and then ask, "would you be open to another point of view" (I would then share 'evidence')