Textbook Classic

Sometimes a patient walks in and is the exact textbook version of whatever their diagnosis is.  In the middle of January, I saw a patient walking out of the clinic wearing a sundress, flip flops, and no jacket (and for those of you who forget I'm from NJ, reminder: I do not live in Florida).  And in my head, I was like, "Wow, crazy person."  But then later the other med student in the office was like, "We had such a stereotypical hyperthyroidism patient today."  And I was like, "I SAW HER!"  (because amongst other things, hyperthyroidism raises your body temp.)

a clear-cut case of hyperthyroidism

But sometimes things are really not so textbook.  For example, to remember who is most at risk for gallstones, everyone thinks of the Four F's: Female, Fat, Forty, and Fertile.  One day in college I get a call that my lanky 20-year old brother was in the emergency room with terrible abdominal pain.  It turned out to be gallstones, and a LOT of them.  My brother is not female, certainly not fat (especially three years ago), not forty, and not fertile (at least not in the estrogen-heavy-between-menarche-and-menopause sense of the word). 

However, he had very recently gotten over a really intense infection and was on like 7 billion different antibiotics (I took some creative liberties there and exaggerated just a touch), and the gallstones were most likely caused by one of those.  Once he stopped taking all the medications, the gallstones disappeared.

wise like Yoda I am

All I'm saying is .... sometimes things happen exactly as you expect them to, and sometimes they don't.  (Yes, I know, I'm very wise.)

Addendum to Theory of Relativity

Last night (Friday), I went out to dinner with some friends, and one of my friends is on his surgery rotation and was on call Saturday (today).  For those who have not gone through third year of medical school: when you are on call on the weekend, it means you show up in the morning for rounds and stay overnight through rounds the next morning. 

We were debating how much sake we wanted to order and my friend who was on call the next morning said, "I can drink as much as I want, I don't have to be in until SEVEN tomorrow!"  As if that was an awesome time to have to be somewhere on a Saturday morning.


And so I absolutely stand by my post that everything is relative, and seven can be awful or amazing depending on what time you woke up the mornings leading up to it.



....says the girl who wakes up at 8 am on Saturdays to update her blog.

Favorite Body Part

As I'm sure you all assumed, my favorite cells in the body are the juxtaglomerular cells in the kidney!

Why?  Because they are next to the glomerulus, of course!

"But Elena," you say questioningly.  "Who cares?  Why would that make them your favorite?"

Well, let me tell you.  'To juxtapose' (loosely) means "to place side by side" - so then what does juxta-glomerular mean?  It's an adjective meaning next to the glomerulus!  And wait, someone remind me where the juxtaglomerular cells are... THAT'S RIGHT, just next to the glomerulus.  Love it!


[If we wanted to take this one step further (which we do), they should really be called the renin-secreting juxtaglomerular cells - because then I could also remember what they actually do, not just where they are.  But hey, I'll take what I can get.]

Theory of Relativity

It's funny how quickly we get used to things.  I was soooo looking forward to this half of the year; after getting to the hospital at 5 for my surgical rotations, I figured 7 would seem like a godsend - I mean, the sun is already up by then!!  And family medicine - working outpatient hours?  Like a normal human being?  Unbelievable.

Well, turns out 7 is still pretty early to be somewhere.  It's not like my alarm goes off at 5:50 and I jump out of bed whistling a merry tune and thinking, "Gee golly am I happy it's not 4 am" - my first thought is usually still just, "Uchhhh." 

I'll be honest, there were some mornings on surgery when I cried actual tears when my alarm went off (not even kidding) - soooo obviously that was much worse, and maybe if there was a day on surgery when the residents were like, "no, please, don't come in until 7 am tomorrow," then 7 would seem AMAZING.  But when they're not right next to each other, 7 is so not amazing.


And I'll admit, my family medicine hours are amazing - the practice doesn't open till 10!  Yet somehow, I am still EXHAUSTED at the end of every day, and more often than not, no studying AND no socializing get done in the evening (oh, I had such high hopes for both during this rotation).  I know, I know, woe is me, I'm tired, wahh.  But I'm tired!  Wahh!

Naming Origins

The antibiotic vancomycin is named for the person who....

Just kidding.  It's named after no one.  It comes from the word "vanquish."  So naturally, from here on out, I will only be spelling it vanquomycin to be more correct.


It was actually originally called Mississippi Mud because (I kid you not) the preparation was brown and full of impurities.  I guess if I had to choose, I'd rather my antibiotics be named after a word meaning to conquer than after murky river dirt.

But I mean... yumm: Mississippi Mud Cake.

..I'm not lying! Source

Technical Terms

Me: Have you ever had a mammography?
Patient: Which one is that?
Me: It's a breast -
Patient: Oh yeah yeah yeah, the titty press.
Me: Yes, that one.

Greedy

I am sorry, but does Dr. Guido Fanconi need two major (and completely separate and unrelated) diseases named after him?  No, no he does not.  That is greedy.  I don't care if he was a brilliant clinician as well as hospital administrator and discovered like eleven separate syndromes - one eponym should be more than satisfactory.

so smug

And noOooo this post is not out of bitterness because an attending told me to read about Fanconi Anemia and I accidentally read about Fanconi Syndrome, and then knew close to nothing about Fanconi Anemia the next day.

....Ok, so maybe it's a teeny tiny bit out of bitterness.  Geeeeze.  Shut up.

Logic Games

I love logic games as much as the next person.  You know the kinds I'm talking about:  "You're planning a dinner party, and Bob wants to sit next to Mary and Mary can't sit next to anyone over 6 feet tall, and Joe is a gorilla.  So what color shirt is Cassandra wearing?"

That is what it felt like to memorize the catch-up immunization schedule (aka, a 15-month old comes into your office and mom says he hasn't been to a doctor since he was 6 months old - what immunizations are you going to give him today, and when should his next appointment be?).


Well if you are over 6 months old, then you can't get the rotavirus vaccine at all (you snooze, you lose).  But you have to be at least 6 weeks old to start getting any doses of Rota, DTaP, Hib, PCV, IPV, or MCV.  And you have to be at least 1 whole year before getting MMR, varicella, and hep A.  But that's just the first dose!

Let's take Hib (Haemophilus influenza type B) as an example [the vaccine which has, by the way, drastically reduced the number of cases of meningitis, life-threatening epiglottitis (seriously, you don't even see that anymore), septic arthritis, osteomyelitis, and occult bacteremia in kids].  Ok, put your logic cap on, because this is where it gets tricky:

this is my logic cap. find your own.

If Billy received his first dose of Hib at younger than 12 months, then you have to wait at least 4 weeks before giving him the second dose.  If the first dose was received between 12 and 14 months, then you have to wait at least 8 weeks to give the second dose!  But if the first dose was given at older than 15 months, then he doesn't even need a second dose.

But don't worry, you're not even done with Hib yet.  For the third dose, it's similar.  A 4 week waiting period if current age (NOT previous dose) is less than 12 months, an 8 week waiting period if current age is greater than 12 months AND first dose was administered before 12 month and second dose before 15 months.  And again, no third dose needed if second dose was given at older than 15 months.

And lastly, a fourth dose is only needed if all three previous doses were given before the age of 12 months.



That's just one of the vaccines (ok fine you got me, it's definitely one of the more complicated ones - some of them are only two doses with no caveats).  And since we didn't know what aged child we would encounter on the exam, you had to* memorize the catch-up schedule for all possible ages.


I was half-expecting to see the question on the exam to say "So how many kids did Billy ride the school bus with on Wednesday?"


*were supposed to