Sunday, June 24, 2007

Go Angels

3 entries in one day! Vacation ends tomorrow, and I did not want to miss the opportunity to show you the finished version of my dad's birthday slippers. He was kind enough to take some photos of the L.A. Angel's themed slippers on his feet, and here they are for your viewing pleasure:

Second Sock Syndrome

Casting on and finishing the first sock of a pair is always exciting - it is fun to see both the pattern progress and how the yarn will knit up as the first sock comes into being. However, with sock #2, all that is old news. So, second sock syndrome refers to the waning enthusiasm I feel when it comes time to knit up sock #2. I thought I might avoid the second sock blahs by knitting three different socks at once - well, not at once, really - but knitting sock #1 for three pairs in succession. This way, sufficient time will pass between the knitting of socks #1 and #2 for any given pair providing me with an opportunity to muster the enthusiasm and energy necessary to knit the same pattern again. Clear as mud?

Anyways - sock pair #1 was the Monkey sock mentioned in a previous entry.

Sock pair #2 is Breeze from the latest edition of Knitty.

Sock pair #3 is a Jaywalker from Grumperina.

The first sock of the pair is done for the Monkey socks and for Breeze. The first Jaywalker is about halfway done.

Am I insane? Yes, that is a definite possibility.

El Lago del Diablo

We're back! Wisconsin is beautiful, and we had a great time. Here are some pictures:

Raul getting ready to make spaghetti carbonara with our new camping stove (thank you HiK!) Excellente!

We went hiking with the dog on Saturday. Here's a trail map display.

If I could figure out how to mark our route on the picture, I would. But, alas, I have no gift for the manipulation of sophisticated computer software. So, I will simply tell you that we hiked a long, long ways. So long, in fact, that we all stopped and took a nap (nap spot locatable on above map as ice cream cone near boardwalk, and yes - I did have some ice cream before napping.) The trails were awesome, and the weather and scenery were gorgeous. And the dog was a brutal trail leader - he was relentless in his pace (hence the need for my aforementioned nap.)

Photo by the lake:

Me getting my knit on with head lamp by campfire. How luxurious!

Photo for Grandma - Evidence of my cribbage triumph. For Raul's benefit, I will not neglect to mention that he nearly skunked me a few days earlier.

We had a great trip - though we did learn one valuable lesson. Two medium to large humans + air mattress + one 70 lbs Labrador that likes to snuggle in a 2 person backpacking tent = way cramped quarters. Next time, we will get a bigger tent.

Monday, June 18, 2007

Currant Jelly

Be forewarned - post is full of gross and graphic details. It is not for the squeamish, but I had always hoped that I would one day get to use the word 'hematochezia' in a post.

Two posts in two is good. Though today we did have some of the bad kind of excitement. Necessary background information - as mentioned previously, Raul and I traveled out of town to take Step 2 CS. And a friend was gracious enough to watch Flynn while we were away. While staying at our friend's house, Flynn ate half of his dog bed. We think he did this because there was a big storm passing through and he was frightened. And he seriously ate half the bed - the cloth cover, the protective lining and the filler cedar chips. It caused significant vomiting for a day or two, and then he was fine. Until yesterday - when he threw up more cedar chips and some other dog bed remnants. Worrisome, yes, and gross, but he was acting normal, so we decided not to be too concerned. While walking him this morning, I stood to watch him have a bowel movement as I normally do (evidence to support previous claims that I lead a very exciting life), and I was quite dismayed to see Flynn produce blood and cedar chips per rectum. And me without my cell phone. I had a small panic attack. And then being the diligent dog parent and medical student that I am, I sprang into action. I formulated a differential diagnosis whilst retrieving a sample of his stool. And then we ran home carrying the bag of aforementioned hematochezia. I eliminated the more serious diagnoses from my list when I had to stop to rest before the dog tired. Anyways, long story, we took Flynn to the vet - the x-ray looks normal, so we think he has a serious case of colitis (inflammation of the large intestine). He has some antibiotics and some special food, so all should be well soon. He does not seem to be in any discomfort - he is such a happy easy going guy. Our camping trip may be delayed by a day, but it is looking like we will all three still be making the trip.

And as promised - knitting!
First up, a Monkey sock in Cherry Tree Hill supersock. Sock #1 is down, and #2 is waiting to be cast on.

Slippers for a friend that just finished law school is studying for the bar (grumpy cat for scale):

Cute dog in my sun hat:

Sunday, June 17, 2007

M3 no more

Say hello to a newly senior medical student. Hallelujah. And as a an added bonus, we have the next week off. Vacation! How luxurious. Sleeping in until 7am, forgetting my present station in life and generally being very lazy - this is how my weekend was spent, and really, it was bliss. And it doesn't end tomorrow! We have 7 more days of heaven! Later this week, we are off to Wisconsin for some camping and perhaps some scuba diving. Oh - and there has been knitting! Pictures to come tomorrow. Yes - you did not misread, the promise of two posts in one week. This is an exciting week in my life, friends.

Happy weekend to all!

Sunday, June 10, 2007

8 interesting things about me

HiK tagged me with this meme. After some serious brainstorming, I realized that coming up with 8 interesting things about yourself is really quite hard. Or maybe I am really quite boring. Anyways, here goes:

1. I have red hair. Supposedly, before having kids, my mom thought red hair made for an unattractive child. When I was born, my grandma pointed out that I was a redhead. My mom said no - my hair was orange. No worries, though, the red-orange hair grew on her - so much so, that there was some serious devastation that occurred after I shaped my shoulder-length hair into a mullet that any 80s rocker would have been proud of when I was about 3 years old. Good thing I still had my charming personality.

2. I am a chronic allergy sufferer, and somewhere along the way, I learned how to scratch my nose without touching it. It involves a maneuver that makes me look very much like a rabbit. This was Raul's idea to say this was an interesting thing about myself - as stated earlier, I am quite boring and was really grasping for straws.

3. I smear aquaphillic lotion all over my face after every shower. It is a super thick lotion that we recommend for diabetic feet. For anyone who has ever seen some diabetic feet, you know that any substance that can keep those dogs moisturized and free of cracks and fissures is a serious miracle in a tub. I decided that if it was good enough for diabetic feet, then I should surely put it on my face. I heard Cybill Shepard smears vaseline all over her face every night - it's a similar idea and she is well preserved, so maybe it will work out for me in the end. We could do an epi intervention trial - any volunteers for the placebo group? We could take pictures of our faces now and then 50 years later and do 'now and then' comparisons of our respective number of wrinkles.

4. I have become addicted to the Simpsons since I met Raul. The hour that falls between 5pm-6pm Monday through Friday is a fine hour, indeed.

5. On Friday I took Step 2 Clinical Skills of the US Medical Licensing Exam. It involved me interviewing 12 different patient actors in staged clinical settings over 8 hours. It was kind of fun - some of the simulated patients are very interesting. The best part of the trip was getting to catch up with a college roommate. We reminisced about crawling across dormitory rooftops in the rain (mom, dad, grandma, and all other parental figures - no worries, I no longer engage in such activities.) She is now a famous blogger (anonymous, though, so no names can be named) and hugely inspirational figure. I heart her.

6. I am a certified scuba diver. I was certified here in the Midwest. My first certification dive was in a muddy quarry that was created by the local transportation department - they needed sand to build a highway, and someone later put a dive platform in the bottom of the hole and filled with with water. Sheer genius, and awesome dive conditions as you can imagine. My third dive was in Hawaii, and things were much better. My fourth dive was a night dive, and it was terrifying. I had lots of trouble controlling my buoyancy, and I accidentally kicked a fellow diver with an expensive camera off the lead rope while we were ascending. He was not pleased. Oops.

7. I used to play a lot of soccer, but I stopped in college because my knees started dislocating. Not a fun time. Each knee has dislocated twice - 3 of the 4 events were while playing soccer. The fourth occurred while I was inside a giant sumo wrestler suit, engaged in combat with my college roomie turned famous anonymous blogger. So, now I avoid soccer and giant sumo suits.

8. This is my shame - I am addicted to celeb gossip. Please do not hold it against me. But I can tell you all about Britney's latest shenanigans and about Shiloh's 1st birthday and about those scandalous pictures of Vanessa Minillo and Lindsay Lohan. Poor Nick Lachey. It's a sickness, really. If you find the cure for this addiction, please let me know.

Okay - I tag my friend JPo (have you done one of these recently? And seriously, friend, hand over those camping recipes!) and my cousin Amanda and my hilarious brother Raymond that is so desperately missed from the blogging world. Start thinking about 8 interesting things about yourself that you want to share with the rest of us (at your convenience, of course.)

Saturday, June 2, 2007

Code status

Yesterday, I finished up my 2 weeks on the stroke service as part of my neurology rotation. On this team, we admitted and managed all patients presenting to the hospital with acute strokes. This last week has been one of the most emotionally difficult times I have experienced in medical school. The situations of some of our patients are profoundly sad and tragic. Imagine that you are partnered to a vibrant and beautiful 30 year old person, a caring partner and parent. Now, you hear them complaining of neck pain and a headache, so you offer your partner some sympathy and suggest ibuprofen or rest. Unbeknownst to you, your partner, or anyone - the blood flow through a major artery to the brain has slowed to a trickle and your partner's brain is dying. Some time later, you notice that they are slurring their speech or they seem to have weakness on their left side or their personality is now a little different from baseline - you take them to the hospital and are told that they are having a stroke. If you are lucky - your hospital will have a stroke service to admit and manage your partner; if not, hopefully they will be airlifted out to a hospital that does have a stroke team. If the stroke is identified early, a few very effective interventions are available. If stroke is severe or identified too late, not even the most heroic of measures can improve the final outcome.

I suppose I always knew strokes were bad news, but I wrongly assumed that the stroke population largely consisted of elderly men and women with serious risk factors (ie poorly controlled diabetes, history of blood clots, a bleeding disorder.) I learned this week that anyone can stroke. Granted strokes are tragic at any age - you are no more prepared to lose a partner at age 70 than you are at age 30. But really - 30 year olds with spouses and children and lives full of promise should not have strokes that result in clinical brain death, but they do.

So, in the past two weeks, I have seen patients and their families devastated by an event that often occurred without warning. In med school it is sometimes easy to lose perspective - you see the very sickest of patients and begin to think that that is the norm. I must remind myself that not every headache or neck-ache is a stroke. And there are things that you can do to make this situation more bearable should it ever occur - first, recognize it early. Should anyone you know ever experience slurred speech (sudden onset, not due to intoxication), or a one-sided weakness of face or body, or loss of sensation on one side of the face or body, or personality changes, take them to the ER for evaluation. Time is brain. And second, clarify your code status with someone that you would want to act as a surrogate decision-maker should you ever become incapacitated. It is not a fun discussion to have, but you need to talk about what kind of life saving measures you want undertaken if your chance of survival is low. Let your partner know how you feel about living with severe disability. The families of patients with severe strokes are the ones called upon for medical decision making - it is a terrible position to be in, to be faced with such important decisions while overcome with grief. It seems to provide some comfort of family members are able to act in accordance with the patient's wishes.

So, long post. And likely not an uplifting one. I am sorry - this has been a tough couple weeks, and I felt I needed to say this. I am also presenting a very simplified version of stroke neurology - strokes have varying etiologies and mechanisms and can affect various parts of brain and produce different signs and symptoms, but I will spare both you and I a painful neuroanatomy lecture. Also DNR/code status issues are much more complicated than the questions asked above. If you have more specific questions, please ask, I would be happy to discuss any and all topics in more detail.
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