Winter Blah's

it's cold and dark and cold and windy and cold. and we're not even into february yet. garh. but take heart! even though the long, boring, cold february month still lies before us (and this year with an extra day! i blame leap year on the communists), here are a few fun things to look forward to in the month of february:

*february is black history month, international friendship month, national snack food month, and, subsequently, national children's dental health month.

*february 1st- rick james' birthday, a day of recognition for the royal canadian mounted police

*february 2nd- groundhog day

*february 3rd- super bowl XLII (what is that? like 9?) , Glenddale, AZ, NY Giants vs. New England Patriots

*february 5th- mardi gras (fat tuesday)

*february 6th- ash wednesday, waitangi day (new zealand)

*february 7th- chinese new year, laura ingalls wilder's birthday

*february 9th- hershey's chocolate company founded (i might change my birthday to this day)

*february 11th- burt reynold's birthday (will be 72 years awesome)

*february 14th- my sister AND jimmy hoffa's bday, st. valentine's day, national organ donor day (oh, i get it! i give you my heart!)

*february 18th- president's day

*february 29th- leap day

**please note, not all of the above information was fact checked. however, it is FACT that burt reynolds is awesome. and so is dolly parton. (duh!)

Good Citizen, I'm a

so not to dissuade anyone from doing their part to save the universe or anything, but....i gave blood yesterday for the first time (never was able to earlier in life as i was an anemic starvin' marvin vegetarian....but now that i'm a beefcake, it's fair game.) and let me just tell you, the whole process sucks so much more than those red cross bastards let on. and the lady that did my orientation thing was extremely awkward and humorless and sort of treated me like i was a naughty girl who might be trying to sneak my hepatitis into the donor blood for my own anarchical purposes. and even though i explained that i was in health care, she all but said, "now we're going to have to use a n-e-e-d-l-e to do this, ok? do you know what a needle is?" sigh.

and then it took them FOREVER to get my blood out and the other lady kept fooling w/ it and disparaging me for not having had enough water that day and she squeezed the green right out of my arm w/ that BP cuff- it was uncomfortable and my fingers went numb.... so i started getting a little panicky toward the end that it would NEVER END and apparently this was revealed on my stricken face, because they came rushing over w/ ice packs for my neck and forehead and a brown paper bag to re-breath into, as if i was hyperventilating. then they threatened to make me lay on the cot provided for weenies like me instead of letting me go eat cookies and juice-in-a-can w/ my husband in the outer room.

but at least i'll get my blood type and a donor card by mail in 2-8 weeks!

Loving the Hospital Life

tra-la! what fun it is to be back in the hospital setting. i am really enjoying nephrology. the doc i'm with is an amazing teacher- he pimps me all day long (have i defined "pimp" before? it just means quizzes/drills w/ medical questions- does NOT mean sells sexual services for money). and i'm learning so much so fast. it's a really complicated science. acid-base balance, volume changes, drug doses all have to be altered considering efficiency of filtration through the kidneys, etc. but it's really interesting and challenging. intellectual-ish. so of course, i sound like a total stooge all the time... but it's not so bad. it's a great intro into internal medicine.

and this hospital is cool. i've been here before, so am familiar w/ some of the students, residents, doctors, and staff. it's in a pretty big city, but feels like a small town hospital. but unlike most small towns, it's very multicultural. i like it.

and i love the human moments you encounter in a hospital. people walking gleefully around w/ balloons for a new baby or exultant when they hear they're better and get to go home. and there's a lot of grief and sadness, too, of course. i was in the icu today, at the desk, working on a different patient, when from one of the rooms behind the closed door came a chorus of screams- it sounded like a football stadium uproar. at first i thought maybe it WAS cheers, it was so loud and simultaneous- maybe the patient awoke from a coma, or took an independent breath or something- but it quickly became obvious that it was grief. i think the very moment that the patient expired, all 10+ family members who had been in the room screamed in agony. they ended up out in the hallway, hyperventilating, wailing, clinging to each other. it was quite a scene. it's just still incredible to me that i get to be involved with birth and death, hope and sorrow. so much access to the human spirit.

so, this has been a great (and occasionally emotional) few days and i look forward to the rest of the rotation. i'll keep you posted.

Back to the Big Kids (gracias a Dios)

peds is done. took my exam and moving on. i really enjoyed the rotation over all. i learned a lot of useful medical terms in spanish, and a lot of peds concepts and exam techniques from the MD. i never found the courage to sing to the kids as i examined them as he does, but i became brave enough to persist in looking/listening for what i needed despite tears and protests from the wee patients.

but i really missed adult medicine. it's the bulk of what we learned in school. and adult patients can express to you what's ailing them and can describe in detail their symptoms. and you get to do more teaching...since usually adults are seeing a doc w/ a problem or a question. i translated for the internal medicine side of the clinic a few days ago and actually felt relief at being able to talk about hypertension and chest pain and thyroid conditions....and not just seedy yellow poop and how to most effectively suck nose boogies out.

kids are funny, though. i'll miss their bluntness. everyday during this rotation i laughed out loud at something one of them said or did. i wish i could remember more of the anecdotes. the other day the doc was asking a little girl about her vision and she said, "well, i can see that you don't have much hair." and i watched the doc doing a genital exam on a 7 year old boy one time and when he was done the mom said- "jimmy's been worried that his, umm....thing is too small. is it normal?" i thought the kid was going to run out of the room w/ his pants down, he was so embarrassed. (don't fear, sportsfans, it was normal). and i while i was taking her history, i had asked a 6 y/o girl if she'd ever had chicken pox and she said she had not. when i had her up on the table and was looking in her ears, i caught her staring at my face and she said, "but i can see that you have chicken pox right now" as she pointed at a healing zit on my cheek. :)

adorable. simply adorable.

so i loved the opportunity, and am so glad for my few weeks there, but i'm looking forward to my next few rotations. next week i start a quick 2 week elective in nephrology (renal-kidneys) and then 6 wks in internal medicine. after that ER....then psych and my preceptorship and i'm done. amazing how fast this has gone...but also how far we still have to go. i had breakfast today w/ some classmates and one was saying that she's ready to be done and doesn't want to feel like an indentured servant anymore. :) i haven't felt taken advantage of yet (crazy long hours, scut work piled on me, etc) like some of my peers- but it will be nice to eventually be paid for working full time, and actually stay at one job longer than a month and a half. it gets tiring learning new faces, new rules, new expectations every few weeks...so i guess in some ways it feels like there's still a lot left to this year.

Last On This, I Promise

in the last few days a few articles have jumped up at me about vaccines, and i wanted to share them, in case you're interested. they both kind of support my opinion that vaccines are more helpful than harmful and that a world without them would be a problem....and that scare tactics are used to dissuade people from using them (often without any adequate facts).

by the way....i think parents should be aware of everything their child is exposed to and receives- i think it's good parenting to do research and determine what measures are good for your kids. and i don't think parents should take everything on blind faith- always ask questions, always ask for data and proof. i'm providing the proof that i have. and the perspective of modern medicine. there's a whole lot more to discuss on the topic of immunizations, but i'm bored w/ it (as i'm sure you are), so this is the last i'm going to mention it.

and both articles are from the NY Times- so my big time apologies if to get to the links you have to sign up for a free NY Times account or something. i don't think you should have to, but maybe...

article one is from 2005 when a group of non-immunized Amish children in minnesota were somehow exposed to the polio virus...and how scary it was when it got loose in their community. Amish, Polio Scare.

article two is talking about the new ABC show, "Eli Stone" and how its first episode (out January 31st) depicts the show's hero defending a family whose child was exposed to thimerosal and developed autism...and how ultimately the big bad vaccine-making drug company was brought to its knees when shown as the villains that they actually are. "Eli Stone."

OSCAR CHALLENGE!!

i know this is off the topic of medicine, but another passion i have is for movies....so.....

the 80th annual academy awards are coming up (barring further writers' strike complications) on sunday, february 24th. as in the last few years, i plan to try to see every movie that is up for a "best picture" nomination before the awards. i like to see movies that are considered to be 'the best' the film industry has to offer in a given year. i think that often the movies that win and the messages contained within tell us a lot about our society at the time. and often there are movies nominated that i wouldn't otherwise see, so it's good exposure to good film. this year, the movies all look amazing and i haven't yet seen any of them, so i'm excited. as i see them, i will post my comments on them in the movie side bar. i challenge you to see them all, too, and then post your comments on what you like/don't like about them and which you think deserves to win and why. (responses do not need to be made in complete sentences or essay formats, there is no minimum word requirement, and purchase not necessary). :)

the nominees:

1. Atonement
2. Juno
3. Michael Clayton
4. No Country for Old Men
5. There Will Be Blood

Una Buena Pregunta....

in case you can't read spanglish very well- there was a comment posted recently that asked what i've learned about vaccines. it's a pretty controversial topic in some circles. in school we learned about current recommendations and some of the evidence for/against giving them and how/when we give them. independently, out of curiosity, i've spoken to many of the docs i have worked with on their thoughts on immunizing children. there's all kinds of good info on the CDC website (where i got my facts) and at your state's health dept web site, if you're interested in more info. but here's a little bit that i know (mostly) off the top of my head:

we vaccinate, starting at birth and going through at least age 11 against all of the following diseases: diptheria, tetanus, pertussis, polio, measles, mumps, rubella, hepatitis a and b, pneumococcal, varicella, haemophilus influenza type b, meningococcal, influenza, and human papilloma virus. most of the vaccines come in a series, they require several boosters to complete. most of them are not live vaccines. those that are, aren't given until the child has reached a year or more and their immune system is more developed and they are no longer utilizing the immunity imparted on them by the mom in utero or through breast milk.

we have almost entirely eradicated many of the above diseases....before we got rid of them, their damage ranged in severity and included birth defects, paralysis, brain damage, meningitis, pneumonia, respiratory failure, diarrhea and dehydration, liver disease, and genital warts and cervical cancer. we've had great success in preventing childhood illness and death. things that used to be assumed threats/inevitable causes of death are now a thing of the past. and we continue to invent new vaccines for devastating illnesses--even cancer!

polio, for example, caused severe disability and death in thousands of children who contracted it each year before the vaccine came out in the 50's. since then, we hardly see it/hear of it other than in the occasional older person limping by or in movies. rubella, if caught during pregnancy, causes grave birth defects and fetal mortality--it was a major cause of infant death prior to the discovery of the vaccine in the '70's- now it's all but unheard of. chicken pox (varicella) will very soon be a thing of the past. you might say- "what's the point of vaccinating against chicken pox? i had it, and i'm fine." but now that you have the uncontrolled virus in your system from your exposure in childhood, you are at risk for shingles as an elderly person. and with shingles can come nerve pain (postherpetic neuralgia) that may last years. also, chicken pox has always caused a small percentage of deaths in the children who contract it, especially those who are immunocomprimised- why not eliminate that risk now that we have a solution?

now the controversy- the threat of SIDS (sudden infant death syndrome) and autism are the most common reasons people give for not immunizing their kids. these risks have been well investigated and at this point are considered unfounded by the medical world. the mercury-containing preservative thimerosol was speculated to be responsible for the rising rates of autism in the US, but this has never been proven. again- without any concrete evidence to its potential harm- it was still, as a precaution, removed from all vaccines around the year 2000. and the rate of autism continues to climb today. the MMR vaccine was also eyed as a culprit for the increasing rate of diagnosed autism- called out in a study in the late 90's that reviewed a tiny number of patients (something like 12) and published conclusions linking the MMR vaccine and autism. several years later, after the conclusions of that study could not be repeated and were determined invalid, 10 out of 13 of the scientists who had published the study retracted their findings. since then, large scale studies in several countries around the world have shown no link in MMR and autism. speculation i've heard from MD's as to why this myth has held on for so long is that symptoms of autism show up around the same time the vaccination is given and so appears to have caused it...and that we're diagnosing more traits under the umbrella of "autism spectrum" than we ever have before, so naturally the rates are climbing. (by the way-autism is devastating and there's much work being done to find a solution. something in our genes or environment may very well be to blame for the spike in diagnoses- everything from IQ of parents of kids with autism to high fructose corn syrup is being studied to try to find the source).

with SIDS- again, in all the studies done over the years, no link has ever been made to any component of vaccines. most SIDS deaths occur between 2-4 months of age, the same time that babies are receiving many of their early vaccines. so it's easy to see why people might make the assumption that the two are connected. but i am more impressed with the fact that since the "back to sleep" campaign started (encouraging babies <1 years old to sleep on their backs), infant mortality from SIDS went down by over 50%. which strongly supports the theory that little baby neck muscles can't always hold up giant baby heads when on their tummies and so babies suffocate in their mattress/blankets when asleep on their fronts. that's pretty good evidence to me that respiratory failure from suffocation is a primary cause of SIDS. we've never seen such persuasive data on any risk from vaccines.

this is the longest post ever, so i'm going to wrap it up. but basically, everything i've read and heard has led me to trust that vaccines do a whole lot more known good than speculated harm. of all the MD's i talked to about it- they all vaccinate their kids. even one surgeon whose son developed autism around age 2-- he was devastated and looking for answers- but still the facts led him to conclude that there is still more risk in not vaccinating. i just hope that the communities of concerned parents who aren't vaccinating their kids don't permit these epidemics to return. it would be tragic if we started dying again of things we can prevent.

A Very Tall, Sad Little Boy

my husband separated his AC joint (shoulder- acromioclavicular joint) this weekend from a fall while playing indoor soccer and has had his dominant arm in a sling and has been looped up on vicodin since then. he's pretty bummed. and sore. and pathetic. been sitting on our couch watching a lot of "batman the animated series" over the last few days. and he's a little goofy. i just found a note scrawled in big, loopy nearly illegible letters that says "2pm tommorrow (sic)." so, in his disoriented and helpless state, i have been caring for (laughing at) him when i'm not at the clinic. he went to his MD today to put a game plan together and he is being sent to the orthopedic surgeon tomorrow (thus the reminder note for 2pm tomorrow- he says he misspelled it because he was concentrating so hard on writing properly w/ his left hand). :) a separation is a pretty serious thing- potentially difficult recovery (could be surgery, definitely PT and lots of rest from sports) and expensive and time consuming. but he's remaining pretty positive, and i'm (clearly) enjoying his incapacity and vulnerability. i like occasionally having an excuse to take care of him. i like to be needed. i just hope he feels better soon and doesn't need me for TOO long. and i am praying that he is ambidextrous when it comes to, uh, bathroom needs. i'll let you know.

addendum: they say your other senses heighten when you lose one. maybe it's the same for wounded limbs. he tells me he has been using his teeth to do everything but tie his shoes (that's my job). maybe he'll learn that he can type with his tongue or hold a paintbrush in his teeth and take up impressionism or something. or maybe it's more like phantom limbs- tonight we walked by a poster of a guy doing push-ups and he said, "i remember when i used to be able to do push-ups." sigh. like he did them all the time and they will really be missed......but i guess there was always the possibility of doing them until the injury, when that dream was dashed.

so anyway...

the clinic is still going well. i'm getting a little tired of vaccines all day long and trying to see in tiny ear canals full of ear wax while the kid screams. and i still am exhausted by the end of the day from translating. my spanish isn't getting a whole lot better faster, i'm afraid. i think i'm telling people to come back in a month for a second vaccine, but i'm probably actually reminding them to "feed their hippopotamus before the grass baby front mine was." or something equally helpful. they're pretty polite- they just nod and smile and hold their children a little closer to them.

And They're Funky, Too

there is a lot of stink that comes from babies and children. while the "baby smell" of fresh new skin gets all the press, there are all kinds of odors from in front, in back, on bottom and top that really can put a person off her lunch. and i think all little boys over the age of 5 should get odor eater foot treatments in their stockings each year for Christmas. perhaps i should write santa clause about it. or maybe amend the nativity story to include it ("and the three wise men brought the baby Jesus gold, frankincense, myrrh, and Arm and Hammer Baking Soda Odor Eaters Specially Formulated for the Active Little Savior.").

it's been a good week so far (despite the smells). i still am having a lot of fun re-learning spanish. and i've now seen a lot of derm issues i haven't previously seen on actual patients, but merely in pictures. things like flea bites, scabies, pityriasis rosea and alba, moluscum contagiosum, seborrheic dermatitis, etc. it's hard to tell them all apart, but the MD is a great teacher.

it's kind of slow at the clinic right now- we're only seeing maybe a dozen patients per day. so i have lots of time to get to know the staff. they are mostly black and hispanic and pretty much all have children. so we've been having some interesting conversations about how different cultures raise their kids. things like how long is "normal" to breast feed (all agreed that the 5 year old who came in still sucking at the teet the other day is WAY overdo) and what "spoiled" means.

i find myself feeling like a barren old maid sometimes. i often get a look of pity from people when i tell them i don't have kids (tienes 27 años!! y no bebes? ay, pobrecita abuelita!). and i feel like i need to emphasize the word "YET" and i quickly rush into a "but-we're-planning-on-it-as- soon-as i-finish-school-and-it-will-be-ok-and-my-kids-won't-be-THAT-much-mutated- because-i-waited-to-have them-until-i-was-GASP, SHOCK-in-my-30's." maybe i'm a bit defensive. what do you think? they were also telling stories today about how after having kids, their boobs shrunk, their feet got bigger, they're no longer totally continent, and they have new food allergies they never had before. i should have said, "oh, really? cuz i have a nice rack, delicate pixie feet, never whiz on myself, and can eat whatever the hell i like." yea. take that. hah! what's wrong with me? why don't i have babies already???? sob. :)

so anyway....one more thing.....i have a friend who is considering going to PA school to get his degree. so for him and anyone out there considering medicine- let this story entice you. this morning on my way to the clinic i got pulled over by a cop because i went speeding through a yellow light (ok, maybe more like orangeish-red). before he approached, i threw my white coat over the passenger seat next to me to be sure that he could see that i was an officer of health, and when he asked me where i was going in such a hurry, i said "the pediatric clinic" in a way that led him to believe that they were depending on me to go and save tiny little lives. a few minutes later, when he was back in the cop car w/ my license and registration and stuff, he called me on the intercom thingy from his car to walk back there. my first thought was, "oh, sweet shit. he's going to throw me in jail for impersonating a doctor" but when i got to the cop car, he just said, "well, since i'm not going to give you a ticket, i thought we could share the cold and each only have to walk in it once." i smiled a charming, dutiful citizen smile, jumped in my car and drove off to go save tiny little lives. (right). this is not the 1st time my medical-ness has gotten me out of trouble w/ the cops. i once was carrying a cooler of blood to the lab from a free clinic and got out of a conflict with the drug enforcement administration, too. (don't ask). think about it, folks. being in medicine with all the schooling, stress, and lawsuits kind of seems more tolerable in the light of the $50 i just dodged, doesn't it?

It's Official, Kids are Annoying in All Languages

...and kind of really great, too. and funny as hell-i'm sure i'll have lots of stories of their goofiness.

i'll admit that this is going much better than i thought. i like peds (at least at this clinic) more than i ever thought i would. i'm in an out-patient clinic and still don't love that about it (still think i prefer hospitals) - but this one is pretty awesome. totally unlike the one i just left.

it's a subsidized clinic where most of the patients are low enough income to be on medicaid or altogether uninsured. the population is chiefly hispanic, african american, and middle eastern. many recent arrivals to the US w/ little english and some without citizenships. the doctor speaks fair english and is fluent in arabic, but speaks only very little spanish...and since i have a minor in it from undergrad (but haven't used it in forever and am extremely TERRIBLE at it), he is using me as a translator. so i'm kind of useful, and that's really nice. it's an interesting, diverse population that the clinic serves. and the medicine they practice is very different than i've seen previously. it is limited to what will be covered by the state, so it's both more tricky and more of a simple chore to treat patients. a lot of advice is given on using vaseline for dry skin and washing out noses instead of prescribing meds for colds that don't do anything anyway or ordering xrays and consults at the drop of a hat.

the doctor is amazing w/ kids. he has a very calming presence and sings to them all the time. i will learn a lot from him in how to best manage and examine little niñitos.

i have already had several embarrassing moments as i translate for the doctor. one was while we examined a 15 year old boy w/ some "down under" complaints and the doc made me ask him if he is sexually active (at all? in any manner? umm....with girls or boys? with any body parts? eh...) and whether or not he masturbates (you know, uh, touch your own self? in your area? ummm....crap.). we ended up pulling another spanish-speaking staff member into the room to help, since i was struggling so much... so there were 3 adults standing on one end of the room from this poor guy all interrogating him about his self abuse. sigh. and you wonder why people avoid going to the doctor.

the other was when i had to tell a prepubescent girl that she needed to lose 15 pounds. i struggled for some of the words and then, since my vocabulary is so bad, i found it difficult to be as compassionate and delicate as i would have been in english. sigh again.

i assume it will get better. already words and phrases that i haven't used in years are returning to me. and i'm putting together a cheat sheet to have at my fingertips. i can tell you that by the end of the day yesterday, my brain hurt from not only getting grilled by the MD on medical questions, but also from thinking in spanish/english all day. i got home and asked my dog if she wanted dinner and couldn't figure out why she wasn't frolicking in glee until i realized i had asked her in spanish. i should have remembered that she only speaks english and russian.

i'll write more soon. this will surely be an interested rotation.