A small town called home

I've been a bad blogger. That tends to happen around the weekends for me.
Below is a link to an article my dad sent me in an e-mail.
I want to forewarn you that it is a rather lengthy and sad article that still manages to capture the essence and heart of my hometown.

http://sports.espn.go.com/espn/eticket/story?page=willows&lpos=spotlight&lid=tab8pos1

a day as an outpatient peds doc

I spent my day yesterday from 9-5 in an outpatient clinic. I'm actually in outpatient clinic all week - 2 full days and 3 1/2 days. I still see newborns and inpatient's in the mornings. I enjoyed my day today and think that I'm meant for something outpatient. I know, I know - I'm supposed to keep an open mind and I am trying my best, but I feel good at the end of a day in an outpatient clinic, be it family or peds (my only 2 experiences yet). The rest of the year is yet to come and we shall see how it all pans out. Next week I'm on inpatient all week - so I will let you know how that goes.

But my day yesterday:

Your typical well child checks - 4 mo, 12 mo, 18 mo, etc. Those are just run of the mill - answer any questions parents might have. Make sure the kids are hitting all of their milestones - can they sit up, are they walking, talking, eating solid foods.
One specific cute 18mo old knew a little bit of sign language and made the best faces when I pushed on his belly and touched him with my cold hands. Another parent was worried about bubbles in their baby's poop. Dr. H calls them poop watchers, which most parents are. You only have to worry about it if it's red, watery, or black. Those are Dr. H's rules to poop. Personally, I think the baby is just making fart bubbles in her diaper.

Then we had a kid come in for a refill on his ADHD meds. Seemed like your normal quick visit for some amphetamines to help control the child. Some parental counseling about not letting this kid have a tv in his room, since mom is concerned because the child has a hard time falling asleep at night. Interesting part about this child is...as he is checking out he decides to turn around and vomit all over the floor. He seemed fine when I saw him. I asked...do I have to write that in his chart? Dr. H says pretend you didn't see it. Most likely viral illness. He'll be back in a few days if he's not feeling better.

Then a few 10 year olds came in for nausea, vomiting, and sore throat. Apparently in children usually 10 and under this is how Strep throat can present - with the nausea and vomiting. I saw one of the kids and Dr. C saw the other one. This boy had the best posterior palate petechiae I have ever seen! picture perfect - see below red dots on posterior palate!
this pic was taken from www.strepthroatinformation.com

So we did a throat swab. Rapid strep test came back negative. We thought this was rather unlikely seeing as his history and exam made it seem extremely likely. Dr. C did the next throat swab and definitely got a good sample - gagging and tears coming out of his eyes. We really wanted to treat him if this test was positive to quicken the course of the illness. Her swab came back negative too! The swabs are also sent out for culture which is more sensitive at picking it up. If it's positive then we'll treat. Otherwise for now it's most likely viral.

Followup Emergency Department visit for a child with a history of asthma and cough/cold. Kid also had epistaxis (bloody nose) 2x's yesterday am. This child's lungs sounded fine, he looked well - happy 15mo old interactive, alert, etc. Dr. H has seen this patient before and most likely a case of overly worried mom. So we talked to her some - the kid just has a cold.

That's all I remember for now. This is getting to be pretty long. So there you go - a typical day. May sound boring to you, but I enjoyed myself (minus the 4mo well child check where the baby didn't stop crying for the entire visit!).
Ok off to eat lunch and then back to clinic this afternoon!

Disneyland

My mom, Aunt Ed, and a friend of theirs are on their way to Disneyland! I wish I were going! They are going to see it decorated for Halloween and enjoy all the wonderful rides, etc.
As a kid, I have about a million memories of Disneyland - I went a number of times due to my A. Ed living near L.A. and my Dad going to some grocery conventions in the area. I remember playing with the little sample boxes he would get at the conventions.

And no matter how old I get - it is ingrained in me how "we do Disneyland." It's reflexive for me to approach any trip to Disneyland in this fashion. Someday I hope to take my kids and pass on this crazy neurotic tradition to them.

We have our system (really my mom & aunt's system) of how to make sure we get the most out of Disneyland. First, you must understand we are ride people. That's ultimately why we are there. You have to arrive as soon as the park opens - which means be at the gates when the park opens ready to go. Hit the big rides first - the ones with the longest lines (space mountain, Indiana Jones, etc). Then from there you can space out the other rides depending on where you are in the park and where your fast passes take you. In the afternoon when it gets hot, we take a trip back to the hotel for naptime (more so when I was young and needed the nap). After missing the heat of the day it's back to the park to ride more rides. The first day on any trip to Disneyland I was allowed to watch the Light Parade - now they have some other parade. The next day (we were usually there for more than one day) - there is no watching the parade - it is prime time to ride the rides while everyone else is watching the parade. And that's how we do Disneyland!



I'll never forget one trip when I was younger, my mom and I rode Splash Mountain late at night. As soon as we got off the ride soaking wet, we were freezing cold - we ran to the nearest souvineur shop and bought sweatshirts to keep us warm! It may not seem that exciting, but when you're a little kid running through Disneyland at night with your mom in search of a brand new sweatshirt is pretty exhilirating!


My one and only tea cup riding partner!

Ah...Disneyland the happiest place on earth ;)

moo mama moo

This article was posted on a cupboard in the newborn nursery. I thought it was interesting and wanted to share it with you!

http://www.time.com/time/health/article/0,8599,1844721,00.html

Breast milk ice cream? It's cruel to milk cows, but not people? Not to mention all the other issues associated with such an absurd idea.

When normal becomes abnormal

I've noticed over the past few months in both my family practice rotations and this pediatrics rotations that I am excited and surprised when I walk into a patient's room to see both a mom and a dad sitting there with their child. This is a rarity. It's a rarity to find a married couple excited and curious to learn about their new little one. You would be surprised the family dynamics that can be observed in a 15 minute visit. My insides smile when I see parents who you can tell care about each other and show love and concern for their little one.
It is far too often that I see teenage and single mothers with these babies that yes they love, but just want them to be better so they will stop fussing. I am not saying that a teenager or a single mother cannot be a good parent, I'm just commenting on what I have been observing far too often. It is amazing the developmental differences between these types of kids - the ones who are nurtured and truly cared for compared to those who are left in front of video games or the tv all day.
It's a tough job for both the physician who has a limited amount of time with their patients - often referring to social services when needed. I have lots to learn about social services and what they can do for my patients. Don't worry I have the perfect resource - social worker in training - Ashley Melson.

One more example of when normal becomes abnormal. Melanie was in outpatient clinic the other day and this mother came in worried that her children were not gaining enough weight. She said she felt they were too thin and wanted to know if it was a problem. The doctor said nope - the children are fine and are at a very good weight for their age and height. The reason that your kids look so thin is because many of the other kids are overweight!

Cherry triangles, gnocchi, and jelly

So I was thinking about what to write today. I realized that even though I brought my camera with me to York that I forgot the cord to my computer. So you have to wait 1 more week to be able to see pictures of my lovely dorm room. This will give you the full effect when I have had more time to settle in (aka spread all of my crap everywhere in a chaotic mess).

In thinking of this I remembered what I get to look forward to this weekend. My Grandma sent me pomegrantes! Yes! I love pomegrantes - just eating them plain or adding them to a salad. The worst part is peeling them and trying not to stain whatever clothing I have on. Grandma's pomegrante jelly is the best. Lucky for me that stays good all year long!



Looking through some pics I found a few of Gma teaching the kids and grandkids some things. The types of dishes where recipies are a suggestion rather than a rule. The cooking is based more off of a feel and experience that exact measurements. The fine art of baking that cannot really be taught, but only learned through obesrvation and practice.



Throughout the post are pics of the fam learning to make yummy cherry triangles and gnocchi. I don't have any pics of us learning to make fillozes (portuguese donuts). Those are my absolute favorite.

texting

Many of you probably heard about or read about the train wreck caused by a person text message. Well - according to a magazine I get from AMSA (american medical student assoc) text messaging while walking has led to enough emergency room visits (stepping off curbs, falling down, walking into poles, etc) that the American College of Emergency Physicians has issued an alert about how dangerous it is.
There have even been injuries reported while bicycling, riding a horse adn cooking noodles. 2 texters lost their lives after being hit by cars while texting.

It seems like common sense, but I know there are a lot of us out there who text when we should be paying attention to other things. Just something to keep in mind.