Gotta Be Somebody

Some how this song came up in my thoughts:

http://www.youtube.com/watch?v=75cnteFDv3o&sns=em

Best Time To Buy Plane Tickets

Article with tips on buying the Cheapest Plane Tickets

And some medical fun: Abbreviations Kill

My Sacrificial Claim

Scrubs, my new past-time that I've started in 3rd year to make me not feel too guilty (b/c I'm "learning" at the same time), actually has some pretty profound messages.  Like this past episode I watched: season 1, episode 21 "My Sacrificial Claim":

Everyone has to make sacrifices and make priorities:

• You might have to give up something you want now for something you've wanted all your life.  In Elliot's case, it was giving up a relationship with a seemingly "perfect" guy for her.  I'm assuming she's giving it up to be the best doctor she can be.  That seems like a perfect definition of a work-a-holic in her case.  Anyhow, I feel bad for Elliot...and even worse for her boyfriend.
• You might have to give up a bit of safety.  In DJ's case, it was being willing to be around sick people.  I'm surprised he made it through 4 years of medical school and intern year before realizing this fact.  But it's true.  I suppose especially true in pediatrics, when it seems like every fall/winter/spring, the pediatricians get sick.  
• You give up time for yourself to spend more time with the people you love.  I think this was probably the most important lesson to remember. Going to medical school, I've found that it's so easy to think about myself so much- my education, my exams, my studying, my grades, my rotations, my patients, my career...that I've sometimes lapsed in caring about the people who love me.  

Peds Surgery Encounters

It's good to be in the Children's Hospital! Interesting cases:

• VATS (a look inside the chest cavity) for unusual lung mass in child with possible ROHHAD - pretty much a syndrome where you get fat really quickly (and hypoventilation, hypothalamic issues)
• Gnathodiaphyseal dysplasia syndrome: Baby who came in with cartilaginous tumors of the jaw that made him look like he had 4 giant plums in his mouth.  He was born with normal jaw, but in 6 months, developed these tumors.  Other than being born with a femur fracture (bone fragility), nothing else really wrong.  Apparently nobody really knows much about this syndrome, and once-in-a-life-time-case!  Crazy stuff!  Kind of looks like this, but even bigger!
•  After taking out the tumors, baby looked a lot more normal, but sadly, it's likely to recur.  
• Bilious emesis (vomiting green stuff): volvulus
• Biliary atresia s/p (status post, aka after) liver transplant and failed Kasai procedure where they connect bile ducts with small intestine.
• Pyloric stenosis: I got to feel the "olive"! - nonbilious vomiting, hungry, s/p open pyloromyotomy
• Medulloblastoma, needed a portacath and gastrostomy for chemo
• MEN2A: Baby with constipation, go biopsy for Hirschprung's disease to look for aganglionic colon, but turns out there were hypertrophic ganglions. Pathologist recalled that being part of MEN2A syndrome, so endocrine surgeon did a thyroidectomy (supposed to be prophylactic against medullary carcinoma because rate of getting medullary cancer in MEN2A was 100%), and the baby already had cancer in their thyroid.  
• VATS for a kid with lung nodules s/p chemoradiation for metastatic nasopharyngeal rhabdomyosarcoma (muscle cancer). Yikes!
• Enormous Wilm's tumor (10cm) + nephrectomy (taking out the kidney)
• Enormous bilateral ovarian serous cystadenoma
• Kid with heterotaxy polyspenia!  (Article about it for those with access.)  It's some insane congenital condition where there's malformation asymmetric organs: malrotation of the bowel, heart malformations, multiple small spleens, bilobed lungs, transverse liver, azygous continuation of the IVC...etc.  
• Cleft palate fistula
• Gastroschisis (baby's bowel is coming out of a hole on the side of the umbilicus) + silo (to house the bowel to wait more room in belly to push bowel back in) + TPN 1mo
• LaForte I and III from ATV crash (wear helmets everyone!).  Surgery to plate the fractures was insane!  It was the first time I've seen someone get degloved (aka, scalped)!  It was pretty much like you peel off everything from the skull.  Picture examples for the non-queezy: degloving the face; degloving scalp.
• Nissen fundoplication (wrap part of stomach around esophagus to prevent reflux)
• Right lower lobectomy (via thoracotomy) for CCAM (congenital cystic adenomatoid mass)
• Handle bar injury: jejunal perforation
• Pectus Excavatum + Ravitch procedure (break cartilage, add metal bar) - Haller index 6.8
• I missed the duodenal atresia!!! So disappointed!!  b/c of oral exam...darn. Apparently also had malro!
• Interesting conditions: Diamond Blackfan anemia 
• Fontan (extracardiac) procedure for left hypoplastic heart syndrome (no left heart): IVC connected to pulmonary artery.  Kid also had previous Norwood (RA to neo-aorta) and Glenn (SVC to PA).





Hypoplastic Left Heart Syndrome

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• Sad cases: asphyxiation due to car window, drowning in home pool, 3yo ejected from car and massive head injuries, pronounced brain dead.  

Teratomas

Hahaha! Friend of mine said studying ovarian teratoms (often find hair, teeth, strange tissue in them), reminded her of this clip:
Now You Are Family - Oh, how I love "My Big Fat Greek Wedding"
Thanks MNZ!

Chinese Accents by a White Dude

Haha, this was pretty darn impressive.  Especially the Chinese Northerner and Taiwanese dudes.

Guy Playing 12 Guys: Chinese, French, Russian, Afri-American, White-American speaking English and Chinese

Worship Signals

" Whether you want to or not - you're probably going to laugh at this..." (UK Gospel.com)

Sighs, I'm a rookie.

Pediatrics Ortho

Fun cases:

• DDH (developmental dysplasia of hip) : bilateral Pembertons (iliac osteotomy and bone graft wedge)
• SCFE (slipped capital femoral epiphysis): femur osteotomy and derotation 
• Club foot anterior tibial tendon transfer onto cuneiform (no heel cord lengthening)
• Myelomeningocele kid: Right femur and left tibia derotation
• Neurofibromatosis 1 + flat foot: midfoot osteotomy, CC joint fusion, calcaneal neck lengthening (no peroneal tendon lengthening)
• Unicameral bone cyst: iliac crest bone marrow aspiration + injection with ETEX (demineralized bone matrix) into cyst
• Cavovarus reconstruction: midfoot osteotomy (m/l cuneiform, cuboid osteotomy), plantar fascia/scar tissue dissection
• Open both bone fracture of forearm. Rx: OR washout, ORIF + Nancy nails. Got to help reduce and hammer one in!
• Septic elbow - I&D
• Of course, a lot of spika casts for babies with DDH, supracondylar humerus (elbow) fractures that require reduction via flexion and pinning + casting and ankle fractures (SH-4, bimaleolar) requiring reduction and screws.  Yay for getting to reduce an elbow fracture!

Grandmother Talk

Oh man, I thought having my mom getting on my case about not having a boyfriend was bad - my grandmother just gave me a whole speech about how all she's expecting is a nice boy and some mutual love - at least I think that's what she said.  Then she made me promise something, but between my poor understanding of Chinese and the bad connection, I'm not really sure what I promised.  I'm guessing something about having a nice prosperous family in the future.  *Sighs* No point explaining that finding nice boys is not so easy when I will be living in the hospital, so all I could do was smile and nod.

Hepatic Encephalopathy

Funny email chain going around among friends:
AL: Does anybody else think this slide pretty accurately describes exam week for us also?

YW: YES!!!!! *sigh*

AS: You are astute and hilarious.

TL: Especially stage 1...
CL: I just love how peaceful this image looks. It looks like a guy enjoying an awesome slide, and then falling asleep at the bottom. 
GA: yeah...gosh i wish i were comatose
HK: How does falling on ur butt correlate to drowsiness? Also, I think this guy has some problems with his arms. Who goes into a coma with his arms raised?
ED: BAHAHAHAHAH yeah this guy looks like he's doing modern dance while rolling down a hill.

Brasserie by Niche

Yum! Brasserie by Niche supposedly has one of the more authentic French dishes. This is what I had:
Bouillabaise: pollack, clams, mussels, prawns, potato, tomato - slightly salty, but very strong seafood flavor and tender shellfish.
French onion soup: very good with crusty cheese on top, crunchy bread underneath, and thick onion soup.
Cherry clafoutis with burgundy ice cream: deliciously sweet and tart.  Probably my best choice. I'll try to make it some day.
I also tried friend's boef bourguignon (very tender beef) and roasted chicken, both of which were very good - I might even say better than my main dish, bouillabaise.  If I were to go again, I'd probably get the boef bourguignon.

On that note, why not consider the other 40 Best Restaurants in St. Louis.

*Note, I didn't take the photos, but my food looked exactly like these.

Redeem Yourself as a Doctor by Reducing a Shoulder Dislocation

I remember when we were playing frisbee and a guy dislocated his shoulder, and we all looked at the 4th years, but they refused to do anything b/c of fear of damaging nerves.  Well, in reality, that's unlikely (per ortho attending).  So, even though I'm going into peds and not ortho, hopefully someday, I can redeem myself for not knowing what to do that day and show that those thousands of dollars in debt for medical school wasn't put to waste: Reducing an Anteriorly Dislocated Shoulder.
primary-surgery.org
And while we're at it, why not also reduce a posteriorly dislocated hip? (Anesthesia please)
helig.digicollection.org

Public Announcement for All Sports Players

After 2 weeks in sports medicine, I find it ridiculous that pretty much everyone who comes in has weak hip, back, and shoulder cuff muscles.  That sums up 90% of the injuries!  Before you waltz off thinking, "Well, I've been playing sports since age 1, so I have strong muscles," the truth is, no sport actually strengthens those muscles.  According to my attending, if sports did strengthen those muscles, then he'd be out of business. (Hm...maybe that's why there hasn't been any education about strengthening those muscles).  Even if people DO do weights, mostly likely they never strengthen those particular muscles.  The only way to strengthen those muscles is through resistance training (against gravity or with light weights).  Unfortunately, people tend to only work on muscles they see in the mirror (biceps, abs), but miss the important ones like hip muscles (abductors, extensors), back muscles (core means back muscles too!), and rotator cuff muscles (which are the more fine muscles of the shoulder, not the huge bulky deltoid).

Without further ado, these are exercises to strengthen each group:

• Hips: most notorious is the "clam" or the one where you sit in the gym and move your knee apart or closer to each other.  Yup...sounds embarrassing right? That's one reason why everyone's weak there.  
• http://physicaltherapy.about.com/od/strengtheningexercises/p/HipEx.htm
• "Clam" video
• Hip exercise 2 video
• Hip exercise 3 video
• Hip exercise 4 video
• Interestingly enough, if you have "IT band" pain (pain on outside of hip or outside of knee), you probably have weak hip muscles too.  Of course, exercises for the IT band also helps. 
• Back: A simple one is to be on your stomach on a table/chair, have your upper body hang off the side, and raise your back straight.  Video. Here are some videos:
• Lower back home exercise video (0.35)
• Rotator cuff: many people who do overhead sports end up with "impingement syndrome" - which is a result of weak supraspinatous muscles.  
• Supraspinatous muscle strengthening video
• Other rotator cuff muscle exercises (2:15)
• Note: Use less than 3lb or else you'll start using other muscles (deltoids).

Remember to RICE! Rest, Ice, Compress, and Elevate! (okay, compress and elevate don't really make sense in these 3 cases).  Keep these muscles strong, so that you won't get worse injuries in the future!

Pondering Pediatrics

Someone blogged about their reasons about not going into Peds.  Well, here is my take on it:
1) I spent my whole damn rotation sick with URIs and GI bugs.
Surprisingly, I didn't get sick at all during the peds rotation.  But I usually get sick at least twice a year anyways.
2) Really sick kids make me desperately sad, to the point where even doing a practice question about a child with cancer ruined my whole day.
Interestingly enough, I did heme/onc clinic, and I was worried I would get really sad, but I didn't.  Maybe it's because it was an outpatient clinic, so the kids were still well enough to not have to stay in the hospital.  But in general, even the sickest kids have some spunk about them.
3) I am really, really bad at looking in screaming baby ears. And that's like half of what pediatricians do.
Hm...I guess I didn't really do too much of that.  I suppose when it has to be done, it has to be done.  I think after taking care of my baby brother, I've learned how to be tough with kids when necessary.
4) I found medicine involving non-sick kids to be really boring. Strep throat? Boring. Rashes? Boring. Otitis media? Boring.
I just enjoy seeing the kids.  Even if they just have a cold, they're just a joy to be around.
5) Parents = mega aggravating. (Of course, now I deal with adult children, which are also mega aggravating.)
True...unfortunately.  But I figure if you can get along with the kids, that's half the battle.
6) When I saw a cute baby, I mostly just wanted to play with the baby, kiss him all over his cute little pudgy face, and then go home and make lots of babies. And when I couldn't do those things, I got frustrated.
That's also very true, minus the make lots of babies part.  I suppose if I really need to play with someone, I can always find my little bro.
7) Whenever we'd have guests at peds club, they always complained about their salary. (I saved the most shallow reason for last.)

Ah, the money issue.  I'm just hoping God will provide.  Also helps that I've always been a minimalist.


Although my clerkship evals weren't as stellar as I had hoped (should've scheduled it later in the year), peds turned out to be one of my higher shelf scores. 


After doing orthopedics where the resident talked daily about how awesome it is that you can just find a problem and fix it, I actually started thinking about surgery since the general stereotype of surgeons are "jocks" and I figured I was fairly athletic.  Although I do like how there's a definite fix and I love the mechanical/hands-on part of surgery (considered doing mech-e as an undergrad), there were definitely aspects of general peds that were more appealing.  My calm, detail-oriented personality seems to be more fitting for general pediatrics.  I like having the chance to talk to patients and really getting to know them - especially those cute little kiddos!  I also like having the opportunity to follow patients for a long time, given that I tend to be someone who remains friends with elementary school friends. I like coming up with a differential and going through all the evidence of ruling out things.  One of my favorite parts of medicine was going to resident rounds and see them go through the thought process of coming up with a diagnosis.  Ah...too bad there isn't really one thing that encompasses everything, except for maybe family medicine and possibly ob/gyn.  But trying to do everything makes it seem like it would be too difficult to be good at anything in particular (family medicine), and ob/gyn seems to be relatively simple internal medicine stuff, and when it gets more complicated, they get consults anyways.  I suppose it's true with general peds too that the more complicated stuff gets consulted on.  Ah, that's the dilemma of medicine: do you want to know very little, but know that little stuff very well or know a lot, but not anything in particular that well?  

#Whatshouldwecallmedschool#

Wow, whoever started this was brilliant:  #Whatshouldwecallmedschool#  I've been laughing my socks off...oh, the truthfullness of it all is hilarious. Some of my favorites:

• Trying to do a physical exam on peds
• When sleep deprivation catches up with me post-blam
• When M3s on rotations give M1s advice about school
• When there is someone in lecture I've never seen before
• Arriving to your surgery rotation
• How I feel whenever people around me complain about being stressed (not looking forward to intern yr)
• The first time you correctly diagnose something in clinic, you're just like...
• My understanding of the musculoskeletal exam
• When I saw my first natural birth (not true, but the face is priceless)
• Can't wait: When you're a post-match MS4
• When socially inept MS3 tries to correct attending on rounds - lol!
• When you try to place your first foley - rofl!!
• Putting an IV in for the first time - oh, good times!
• First Day on Psych - she's hilarious :D
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Notables:

• Unfortunately, my communication with non-med people has significantly deteriorated.
• This baby is too cute: During the 4th lecture of the morning
• ...and this one: Derm lesions
• Oh...the Trendelenburg gait.
• The first time I heard a murmur in clinic - yup, it's that rare.
• But...I don't drink coffee: No coffee?
• Hahaha...Can't find a nerve?  For me, it's more like, "Oops, that was a nerve."
• Sighs, sadly, this is true: M3's starting rotations
• Morning post call, when I see the sunlight - so true!
• Anytime a lecturer promises to end early - heart throb
• My first day on 3rd yr rotations - sadly, it's true
• When I'm typing up a pass/fail case report
• This pic is just pretty awesome: When I start taking an exam I thought I was prepared for
• The extent of the derm physical exam - oh, I love Jim Carrey
• Sadly, so true: When my friends with jobs have houses and cars that are equivalent in value to my level of debt half way through medical school (more like 1/4 way)
• When you get pimped by your attending - 3rd guy is way awesome
• After I press submit on the final section of the usmle - cuteness overload!
• When you see a disease in clinic right after learning about it in lecture - I'm gonna look back on this with embarrassment
• When you pass the under-preserved body in anatomy - yup, our body
• When someone tells me they don't like first aid - cuteness overload!
• Oh...the ophthalmoscope: can't say, can't see.
• What you hope doesn't happen on your first delivery!
• I should've used this to my advantage: black box
• This one's pretty cool: Who wants to write discharge summaries?
• Oh...anatomy book
• Hahaha...so true: When med student, fellows, residents, attending are all in the same room
• How I feel when I gown and glove in the OR....well, it's more like: I can't move or I'll explode.
• Free food, free food, free food!
• Cuteness: When a patient is on tones of medications..., How I feel trying to exercise after two years of med school and stress eating
• How I feel after pulling an all nighter before an exam - this is pure evil.
• Most adorable seal ever: when I let my classmates practice the abdominal exam on me
• Wow, this dude is incredible: After a fun long day of surgery
• Oh...medical school.
• So cute and so true: Radiology