I shadowed the pediatrician on Wednesday. It was a little more exciting than usual because the water was not working. No sinks. No working toilets. Nothing in the entire building! The hospital next door also did not have water, but they could run off the reserve tanks. Nobody talks about urine as often as they do when emptying your bladder is no longer an option! The nurses joked about cathing each other and a few little patients needed urine specimen cups because they simply could not wait. It was the first time I ever left campus for lunch while shadowing because venture out into the world in search of working restrooms. I had to ration my beverage at lunch so that I wouldn't have a full bladder later in the day, which worked like a charm. Nice to know I can hold it when I have to, I've heard enough horror stories about med school and residency to know it is a skill I need to have.
Clinic itself was interesting, as always. A few new things I saw: a 5 year old who broke 100 pounds (I thought the nurse had written the temperature in the wrong spot on the chart!), molluscum contagiousum, and fingernail shedding from HFMD. I also got to use the otoscope to visualize an infected ear (KayTar was so jealous when I told her I used the otoscope). We saw a few kids with pneumonia, one poor guy with both flu A and strep, and a lot of cute 9 month old babies. It was 9 month old day, evidently. I learned that sometimes, no matter how many different ways you say it, parents/patient just don't understand that something cannot be cured with a prescription...be it eczema or a virus. These are the patients/parents who leave very unsatisfied when they don't leave with a magical cure-all prescription and feel like they've wasted their time in clinic. I also learned that sometimes you can spend 10 minutes explaining something to patients/parents in great detail as they nod in what you perceive to be understanding, and as soon as your hand touches the door knob to leave the room, they ask you the EXACT SAME question you just spent 10 minutes answering. It makes you wonder about people.
We ran behind and didn't finish up until nearly 6pm. I got home between 6:30 and 6:45pm. Josh and BubTar had been working on his science fair project. The house was messy, the kids hadn't had dinner, and they go down for reading time at 7:30pm and bed at 8. My feet were quite tired (I'm not used to standing and walking all day yet!), so I took a 5 minute break when I walked in the door (well, if holding a chatty 5 year old in your lap counts as a break), but then we had to get down to business. We cleaned up a bit, made BubTar a quick dinner, and then KayTar begged me to play a game with her, so I did. We played anarchist Cootie (Cootie without rules) and she decided to make a KayTar-Cootie and an Uncle Z-Cootie and marry them. I told her, "KayTar, you can't marry your uncle!" And she said, "This is NO RULES Cootie, we are going NUTS!" I couldn't argue with that logic, so I officiated the Cootie marriage. In the blink of an eye, it was reading time. Once the kids were in bed, I took my shower, ate a pudding cup for dinner, and fell into bed. I think I watched a little TV, too, before zonking out around 10pm...which is early for me. This was the first mid-weeknight I have shadowed and it was quite a different experience at home. On a Friday night, things are much less structured around here so it doesn't make much of an impact, but during the week it does...it felt more accurate. Makes me wonder what evenings are like for most doctors with young kids! By the time I'm an actual doctor, my kids will be considerably older...but I'm sure we will have plenty of wild evenings during training!
It seems as though I brought home a little souvenir from clinic, as my throat has been inflamed for a day or two now and sleeping last night was next to impossible between little apneic episodes and the general discomfort in my throat. It isn't painful, it just feels swollen. I feel fine otherwise, but my throat sure is irritating me. I really enjoy being in clinic, though, so a little viral pharyngitis is a small price to pay, right?
Monday, January 31, 2011
Saturday, January 22, 2011
So, I was right after all.
Last week I received a call from the genetics/metabolic clinic. The nurse told me that KayTar's recent test for VLCAD was negative and they were dismissing her from clinic. I was irate. I don't care that her test was negative, I mean, what is one more negative diagnostic test on top of the giant teetering stack of negative diagnostic test she already has in her file? I cared that she was being dismissed altogether. "I don't know." is an acceptable thing for a physician to say, but "I quit." is not acceptable, at least as far as I'm concerned. I understand not having any new leads or any idea what the next step might be, but if a kid has a metabolic issue, then metabolic clinic should continue to follow her case at the very least. Follow up once a year, maybe. However, I didn't say any of this, I just said, "Thanks. Goodbye." and choked back a few hot, angry tears.
Yesterday we had a follow up with endocrine which I feared would be a repeat of that last interaction with metabolic clinic. I was pleasantly surprised; the doctor and I actually spoke to one another, she reviewed her chart, labs results, and got updates about how things have gone for the past few months at home. At the end of all that, it turns out, I was RIGHT months ago, when I said it was ketotic hypoglycemia. It is a diagnosis of exclusion and since we've excluded EVERYTHING imaginable, we are officially calling it idiopathic ketotic hypoglycemia. I wish I could have been right without all these miserable tests, especially the inpatient fast, but I know they had to rule all those other conditions out. The diagnosis itself is just a catch-all and idiopathic is fancy medicalese for "who knows why!", but sometimes that is the best modern medical science can offer. It is better than nothing and being right is somewhat satisfying. Wonder if I can put this on my med school applications? ;) Basically, we will continue to do what we are doing; glucose checks, adding cornstarch to her feeds, frequent feeds, monitor her activity levels, test for ketones, overnight feeds when sick, go to the ER when we can't fix things at home, and follow up with endocrinology in 6 months. Hopefully, she will outgrow it at some point!
Yesterday we had a follow up with endocrine which I feared would be a repeat of that last interaction with metabolic clinic. I was pleasantly surprised; the doctor and I actually spoke to one another, she reviewed her chart, labs results, and got updates about how things have gone for the past few months at home. At the end of all that, it turns out, I was RIGHT months ago, when I said it was ketotic hypoglycemia. It is a diagnosis of exclusion and since we've excluded EVERYTHING imaginable, we are officially calling it idiopathic ketotic hypoglycemia. I wish I could have been right without all these miserable tests, especially the inpatient fast, but I know they had to rule all those other conditions out. The diagnosis itself is just a catch-all and idiopathic is fancy medicalese for "who knows why!", but sometimes that is the best modern medical science can offer. It is better than nothing and being right is somewhat satisfying. Wonder if I can put this on my med school applications? ;) Basically, we will continue to do what we are doing; glucose checks, adding cornstarch to her feeds, frequent feeds, monitor her activity levels, test for ketones, overnight feeds when sick, go to the ER when we can't fix things at home, and follow up with endocrinology in 6 months. Hopefully, she will outgrow it at some point!
Thursday, January 20, 2011
Even more books...
Graceling: If I was judging a book by its cover, this would be my favorite. I thought the cover art was really beautiful. The story itself was enjoyable, too. It is a fantasy novel, the main character is named Katsa and she is a Graceling, a person with two different colored eyes which marks them as having a Grace (which is a talent or gift for a certain skill or ability). It could be cooking or mind control or as it seems in Katsa's case, fighting. In this world, Gracelings belong to the King, who uses their skill however he sees fit. I don't want to give too much away, but it was a good read. It had a bit of mystery, battling, and a love story. It wasn't my favorite book ever, but I liked it enough to read the companion book as well.
Catching Fire and Mockingjay: I loved these. I read through one a day. I loved both Katniss and Peeta and I hated the world they were stuck in. Catching Fire took me by surprise many times, though in retrospect I guess I should have seen some of those things coming. The world in which these stories take place is not light or beautiful or smooth, but there is still such goodness in it, even in unexpected places. It seems each book gets darker, but there is always light to be found. As for Mockingjay, there were parts I didn't like, parts that made me exceedingly sad, but in the end, I was pleased with the outcome. It is tough to say much about these without giving things away, but READ THEM, if you haven't.
Fire: This is the companion book to Graceling. It takes place before Graceling in the same world, there is only one character in both novels and he is not the main character in either. Fire takes place in an adjacent kingdom, where Gracelings do not exist, but monsters do. Monsters are creatures that are equivalent to the animals (and even people) in our world, but they have vibrantly colored hair/feathers/fur and they also can influence the minds of creatures and people around them. Fire is the protagonist and she is a monster, the last human monster, in fact. The novel is largely the story of her self-discovery and how she learns to love herself and find her place in the world. There is also mystery, battling, and a love story like Graceling. I've read reviews that complain about the fact that menstruation is mentioned several times in the book, but it wasn't bothersome to me. It fit into the story because monsters crave the blood of other monsters, so Fire attracted attacks from other monsters during those times. It actually made me wonder why it wasn't addressed in the Twilight books...I mean, if Jasper freaked out over a paper cut on Bella's birthday, how did he ever survive high school with all those menstruating teenage girls in class with him? I digress. I liked Fire and I'll read the next companion book, Bitterblue, when it comes out.
All told, I read 10 books in my 2 weeks of child-free break. I think it was a lovely way to relax! I'm reading The Book Thief currently, but I imagine school will slow me down somewhat. ;)
Catching Fire and Mockingjay: I loved these. I read through one a day. I loved both Katniss and Peeta and I hated the world they were stuck in. Catching Fire took me by surprise many times, though in retrospect I guess I should have seen some of those things coming. The world in which these stories take place is not light or beautiful or smooth, but there is still such goodness in it, even in unexpected places. It seems each book gets darker, but there is always light to be found. As for Mockingjay, there were parts I didn't like, parts that made me exceedingly sad, but in the end, I was pleased with the outcome. It is tough to say much about these without giving things away, but READ THEM, if you haven't.
Fire: This is the companion book to Graceling. It takes place before Graceling in the same world, there is only one character in both novels and he is not the main character in either. Fire takes place in an adjacent kingdom, where Gracelings do not exist, but monsters do. Monsters are creatures that are equivalent to the animals (and even people) in our world, but they have vibrantly colored hair/feathers/fur and they also can influence the minds of creatures and people around them. Fire is the protagonist and she is a monster, the last human monster, in fact. The novel is largely the story of her self-discovery and how she learns to love herself and find her place in the world. There is also mystery, battling, and a love story like Graceling. I've read reviews that complain about the fact that menstruation is mentioned several times in the book, but it wasn't bothersome to me. It fit into the story because monsters crave the blood of other monsters, so Fire attracted attacks from other monsters during those times. It actually made me wonder why it wasn't addressed in the Twilight books...I mean, if Jasper freaked out over a paper cut on Bella's birthday, how did he ever survive high school with all those menstruating teenage girls in class with him? I digress. I liked Fire and I'll read the next companion book, Bitterblue, when it comes out.
All told, I read 10 books in my 2 weeks of child-free break. I think it was a lovely way to relax! I'm reading The Book Thief currently, but I imagine school will slow me down somewhat. ;)
Tuesday, January 18, 2011
First Day.
Spring term started today. I started my day with PreCal at 8:30am...the professor was late and we have our first homework problems already. Math takes pity on no (wo)man. The professor seems decent. Our grade will come from 3 exams, homework and quizzes, and the final. On the upside, the professor moved our start time back by 15 minutes and I remembered a good bit of the review work we covered today. Then I had an hour and 15 minutes of break, which I spent reading and enjoying a coffee from Starbucks.
Break time was followed by Government I, during which my stomach began to make such noises that I felt certain I had accidentally swallowed a baby whale along with my coffee. Thankfully, the professor was having issues with the sound system and the whole room was full of a mid-level buzz from the microphone feedback, so I think my digestive whale song was mostly covered. Again, the professor seems decent at first blush and I was pleased to discover our grade comes solely from textbook-based multiple choice exams, which he gives review for. We got out a bit early, so I went downstairs for a bit and discovered they were giving out free ice cream! Yum! I just missed out on the free burritos from FreeBirds, though. I read for a little while after finishing my scoop of ice cream.
My final class of the day was Storytelling, which was both interesting and terrifying. He kept referring to it as a performance-based class...and I hate to perform! I had to fight the urge to flee the class and drop it immediately. The bottom line is, I have to get my communications credit and the experience of the Storytelling course is going to be much better than a straight-up Speech course, I think. In any case, I am not looking forward to getting up in front of the class without notes or books 4 times this semester; 2 personal narratives, 1 children's bedtime story, 1 young adult/adult folktale. Our grade will come from those 4 assignments, plus 2 exams, one of which is a take home exam. After that class was done, I rushed to this side of town to pick up the kids and made it right on time. It was quite a full day and I didn't get a chance to have lunch until we were home and the kids were doing their homework. 1 day down, 31 to go!
Break time was followed by Government I, during which my stomach began to make such noises that I felt certain I had accidentally swallowed a baby whale along with my coffee. Thankfully, the professor was having issues with the sound system and the whole room was full of a mid-level buzz from the microphone feedback, so I think my digestive whale song was mostly covered. Again, the professor seems decent at first blush and I was pleased to discover our grade comes solely from textbook-based multiple choice exams, which he gives review for. We got out a bit early, so I went downstairs for a bit and discovered they were giving out free ice cream! Yum! I just missed out on the free burritos from FreeBirds, though. I read for a little while after finishing my scoop of ice cream.
My final class of the day was Storytelling, which was both interesting and terrifying. He kept referring to it as a performance-based class...and I hate to perform! I had to fight the urge to flee the class and drop it immediately. The bottom line is, I have to get my communications credit and the experience of the Storytelling course is going to be much better than a straight-up Speech course, I think. In any case, I am not looking forward to getting up in front of the class without notes or books 4 times this semester; 2 personal narratives, 1 children's bedtime story, 1 young adult/adult folktale. Our grade will come from those 4 assignments, plus 2 exams, one of which is a take home exam. After that class was done, I rushed to this side of town to pick up the kids and made it right on time. It was quite a full day and I didn't get a chance to have lunch until we were home and the kids were doing their homework. 1 day down, 31 to go!
Tuesday, January 11, 2011
Books, books, books!
When the kids went back to school last week, I started reading. Since then, I've read Twilight, New Moon, Eclipse, Breaking Dawn (yes, I finally caved and jumped on that bandwagon), The Host, and The Hunger Games. Today I'm expecting to get Graceling in the mail and tomorrow Catching Fire and Mockingjay are set to arrive. I can't remember the last time I've burned through novels this way, in fact, I can't even keep that "What I'm Reading" button on my sidebar up to date, but I can't seem to get enough! I'm sure it will come to a screeching halt when my term starts next week, though. Here's some thoughts on what I've read so far...
The Twilight Saga: Vampires, werewolves, unrequited teenage love...I was skeptical at first. Although I love Harry Potter, I started reading them BEFORE it turned into some sort of worldwide phenomenon and the Twilight hype made me resist reading these for a long time. However, I needed a good junk food novel and so I took the plunge. They were excellent reads. People say Stephanie Meyer isn't a technically great writer, but she is masterful with character development and if I can click with a character I'm pulled into a book, no matter the story. I read these in such quick succession, I'm a little unsure about when one book ended and the next began so I can't really review each individual novel (I think Eclipse must have been my favorite as I read it start to finish in under 12 hours), but even as one big storyline I enjoyed it very much. And, for the record, I was always on Team Edward and couldn't really understand how Team Jacob ever came to be. ;)
The Host: This one is also by Stephanie Meyer, but meant for adults rather than a young adult audience. I was unsure about it at first, it is a slow starter and the subject (alien takeover) is not really my thing. I pressed on through the initial slow chapters and once I hit chapter 9 or 10, I was really pulled in and it just got better and better. Again, it was the characters that kept me reading. At times, I worried this one wouldn't resolve in a way I could be happy with, but it ended perfectly. I've read that she plans to make this a trilogy and I would love that!
The Hunger Games: If I was a little skeptical about Twilight, I was EXTREMELY skeptical about this one. Everyone was raving about it, so I decided to give it a chance, but the plot was not appealing to me at all...kids fighting to the death as televised entertainment?? It seemed too dark, dreary, and violent. Somehow, though, the book rose above all that to deliver a really beautiful story. There were battles and death, sadness and fear, but the author found a way to make even the deaths (at least the ones you cared about) well done and meaningful. Again, the connection I felt to the characters overcame any dislike I had of the setting or plot, and I can't wait until Catching Fire arrives on my doorstep tomorrow!
So, that's where I've been lately...on the sofa with my nose in a book. ;) I'll be back in a few days to review my latest reads!
The Twilight Saga: Vampires, werewolves, unrequited teenage love...I was skeptical at first. Although I love Harry Potter, I started reading them BEFORE it turned into some sort of worldwide phenomenon and the Twilight hype made me resist reading these for a long time. However, I needed a good junk food novel and so I took the plunge. They were excellent reads. People say Stephanie Meyer isn't a technically great writer, but she is masterful with character development and if I can click with a character I'm pulled into a book, no matter the story. I read these in such quick succession, I'm a little unsure about when one book ended and the next began so I can't really review each individual novel (I think Eclipse must have been my favorite as I read it start to finish in under 12 hours), but even as one big storyline I enjoyed it very much. And, for the record, I was always on Team Edward and couldn't really understand how Team Jacob ever came to be. ;)
The Host: This one is also by Stephanie Meyer, but meant for adults rather than a young adult audience. I was unsure about it at first, it is a slow starter and the subject (alien takeover) is not really my thing. I pressed on through the initial slow chapters and once I hit chapter 9 or 10, I was really pulled in and it just got better and better. Again, it was the characters that kept me reading. At times, I worried this one wouldn't resolve in a way I could be happy with, but it ended perfectly. I've read that she plans to make this a trilogy and I would love that!
The Hunger Games: If I was a little skeptical about Twilight, I was EXTREMELY skeptical about this one. Everyone was raving about it, so I decided to give it a chance, but the plot was not appealing to me at all...kids fighting to the death as televised entertainment?? It seemed too dark, dreary, and violent. Somehow, though, the book rose above all that to deliver a really beautiful story. There were battles and death, sadness and fear, but the author found a way to make even the deaths (at least the ones you cared about) well done and meaningful. Again, the connection I felt to the characters overcame any dislike I had of the setting or plot, and I can't wait until Catching Fire arrives on my doorstep tomorrow!
So, that's where I've been lately...on the sofa with my nose in a book. ;) I'll be back in a few days to review my latest reads!
Thursday, January 06, 2011
The Big 10 of 2010
* KayTar made it to the one year mark of being episode-free.
* KayTar had not one, but TWO urgent g-button replacement surgeries.
* We ruled out adrenal insufficiency, growth hormone deficiency, and GSD 0...as well as a nut allergy!
* BubTar learned to ride a bike!
* Josh and I transferred to university.
* KayTar started MAINSTREAM Kindergarten!
* KayTar had an inpatient fast, which was horrific. Blech. We learned that she doesn't have a proper cortisol response when her glucose is low and that she has a large number of very long chain fatty acids in her blood when she is hypoglycemic which means her body isn't utilizing them properly.
* My mom discovered my blog. (Hey there, Mom!)
* Our home was burglarized. Boo.
* I passed organic chemistry, miraculously.
It was tough to choose, but I think I hit most of the major events of the year...as usual, they are mostly KayTar-related. ;)
* KayTar had not one, but TWO urgent g-button replacement surgeries.
* We ruled out adrenal insufficiency, growth hormone deficiency, and GSD 0...as well as a nut allergy!
* BubTar learned to ride a bike!
* Josh and I transferred to university.
* KayTar started MAINSTREAM Kindergarten!
* KayTar had an inpatient fast, which was horrific. Blech. We learned that she doesn't have a proper cortisol response when her glucose is low and that she has a large number of very long chain fatty acids in her blood when she is hypoglycemic which means her body isn't utilizing them properly.
* My mom discovered my blog. (Hey there, Mom!)
* Our home was burglarized. Boo.
* I passed organic chemistry, miraculously.
It was tough to choose, but I think I hit most of the major events of the year...as usual, they are mostly KayTar-related. ;)
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