Trach butter

So, today I started a new rotation - Otolaryngology (also known as ears, nose and throat.) It's a two week rotation, and I'm back at the VA. Good old VA. And I am off to a great start. This afternoon in clinic, I had a patient that had a tracheotomy several years ago, and he'd come into today for a follow up visit. He was having some pain around his trach site and for the past week or so had some increased cough and secretions from the trach. I learned that you should never stand in front of someone with a tracheotomy while they're coughing - pieces of phlegm can fly projectile style out of the trach site propelled by the force of a cough. That's what happened to my clinic patient and it landed right on my pants. Sweet. All you can do is grab a Kleenex, wipe it off and tell your patient not to worry about the phlegm he just spit on you. My senior resident informed me that such secretions are called trach butter.

And now, I have to rant. In med school, you have no control over your time. You are constantly being told the when and where of all the minutes of your days, and you never get to go home until your senior resident tells you it's time to leave. It gets really frustrating - especially when your residents have no qualms about wasting your time. Like today - we had clinic in the afternoon. The other med student on the rotation and I saw patients and wrote the residents' notes, and we finished clinic early. I was told that I could leave after we went and saw the two patients on our service in the ICU. My resident then proceeded to spend the next 2 hours working on old notes, checking her email and on the phone making plans to watch The Bachelor later. Finally, we went down to see the two patients, and they really were not doing so well. One patient's neck was disintegrating. The poor guy was in really bad shape. I'm not entirely sure what happened, but a disintegrating neck is never a good sign.

My apologies for the cranky post. Oto blows. Too many ears, noses and throats. I have to go make my lunch for tomorrow and then go to bed - I get to see one of the two ICU patients and have a daily progress note written on him by 6:20am. Good times.

It smells like updog in here

So, a friend's 4 year old daughter told me this joke -

Maria: It smells like updog in here.

Shannon: What's updog?

Maria: Not much, what's up with you?

It smells like updog in my house. I had forgotten that dogs totally smell. Flynn's a good boy too and doesn't generally roll in dirty or smelly stuff, but he still smells. And sheds like crazy - the couches are covered in short little black hairs. He's been confined to the living room and Greta's had roam of the rest of the house. And it probably didn't help that this is what we did for the latter part of last week:

I had to study - too busy to vacuum all the black hair off the couch or to wash the dog or to pick up the thousand pieces of cat food that were scattered all over the basement stairs when Greta knocked over her food dish running away from the dog. Enter wonderful husband to the rescue. Raul is doing a rotation in Council Bluffs, IA right now in Family Medicine, and he was able to come home for the weekend last Thursday night because his preceptor had to travel to Vegas to give a lecture for a pharm company. So, Thursday night, he helped me study for my test the next am. On Friday, I took my exam (hard!) and then at Raul's suggestion, I went and got a pedicure with a friend. While I was out, he totally cleaned and vacuumed the house. He's a keeper.

In knitting news, Glee is near the point where the sleeves separate and I start knitting the body. I've been dying to knit socks lately, for some reason. I'm going to start a pair tonight. Pictures to come!

PS - Grandmas are the best. Recent contributions to the yarn stash from the grandmas.

Thank you

Thanks for all the compliments and encouragement re: Flynn that you all have sent my way recently. It has been quite an experience to be a dog owner - full of pleasant surprises and interesting lessons. This afternoon, for example, I learned that carrying an empty and appropriately sized bag on walks is absolutely necessary. Without the aforementioned item, cleaning up after your dog when he goes to the bathroom becomes a gross, messy and somewhat traumatic experience. No worries though - only minimal psychological trauma was sustained and an important lesson was learned! Raul and the dog have really bonded - they are quite the cute pair. Unfortunately, I am single parent for the next couple months while Raul is completing out of town rotations. Both Flynn and I are very sad. Wish me luck!

Otherwise, life is going well. The VA continues to provide very interesting and odd experiences. I admitted a patient yesterday with a diabetic foot ulcer. Have any of you seen a diabetic foot ulcer? They are not pretty. With poorly controlled diabetes (especially type II, or adult onset, diabetes mellitus), you have consistently elevated blood sugar levels. All that extra sugar in your blood sticks to everything, and you wind up with damage to your blood vessels and your nerves - especially in your feet. So, you can see how if you can't really feel your feet, you could easily get a sore from wearing uncomfortable shoes or stepping on something. And if your blood vessels in your feet are damaged, then the sore will not heal as well or as quickly as it might in a non-diabetic person. These sores often get infected, and if the infection cannot be controlled, part or all of the foot often has to be removed. My patient had had that sore on the bottom of his foot for over six months, and it got infected - it was pretty bad, and it really smelled. Infections with anaerobic bacteria really smell. He was also having fever and chills indicating that the infection may have spread to his blood stream. These ulcers are big deals - if you have DM, controlling your sugars is really important. It is not an easy task, but trying for tight glucose control is one of the biggest favors you can do for yourself now and later in life. And take good care of your feet. Wear good shoes, check your feet nightly for sores and see a podiatrist regularly. Okay, stepping down from soapbox, sorry for the lecture.

Hope all is well with everyone!

Flynn, the newest addition to the E-C family

Meet Flynn -

We're proud parents.

As first-time dog owners, we decided this whole endeavor would be much less stressful if we had all the right accessories. We made our third trip to the local pet shop, Leash on Life, today - now we've got a kennel (see above) snacks, food, toys and helpful handouts for new dog owners galore! Yay us!

Homeinkabul - valid concerns re: Greta. Flynn's been kenneled inside the house and thus far she has been observing him from a distance. We're hopeful.

I am lost in the alternate universe that is the Veterans' Hospital Administration

Seriously. I had heard that the patient population was very different as was the nursing staff and the facility itself, but I really had not expected it to be this different. And so busy! My team has had the maximum number of patients we can carry since my first day, and they are all so sick. And have very interesting and complex personalities. Some of our patients are quite endearing - they remind me of obese, cantankerous versions of my grandpa. Others are slightly less endearing and make decisions that ensure their health will never improve. Here's a for example - one patient, let's call him "Mr. S", was admitted for an exacerbation of heart failure and a GI bleed. When you have heart failure, your heart is an inefficient pump and fluid starts to back up and accumulate everywhere - your lower legs, your belly, your lungs (making it difficult to breathe.) Edema is a vicious cycle, and the best way to eliminate it is with diuretics. So, we started diuresing Mr. S and had him scheduled for an endoscopy and a colonoscopy to determine the source of the blood in his stools. On hospital day 2, Mr. S decided that he had had enough of the hospital and was going to leave AMA (against medical advice.) His family did not support him leaving and refused to pick him up, so he stood on the side of the highway with a cardboard sign requesting a ride to his hometown. The cops picked him up and brought him back to the hospital, and his family talked him into staying and doing the scheduled tests. Before you have a colonoscopy, you have to do a bowel prep. The bowel prep involves you drinking a gallon of this stuff called GoLYTELY - which basically hyperstimulates your bowels, makes you have diarrhea and completely cleans out your colon. So, Mr. S agreed to have the endoscopy and colonoscopy, drank the gallon of GoLYTELY and cleaned out his colon only to refuse the scope while he was up in the GI suite minutes before it was going to happen. So, Mr. S was discharged home several pounds lighter but he still has a GI bleed from an unknown source. Don't get me wrong - colonoscopies are no fun and no patient should be forced into a procedure they do not want, but the prep is the worst part - seems like impaired decision making to drink all that GoLYTELY and have all that diarrhea and then refuse to be scoped. Gentle readers, if you are going to refuse your colonoscopy (probably not the best decision if you have a GI bleed), be sure to do it before the prep.

Only two weeks left on this rotation. I can make it!

In more exciting news - Raul and I are getting a dog! We have been making occasional trips to the local animal shelter to see if we might find a dog that would be a good fit for our family. Yesterday, we met a super nice black lab named Flynn and decided that he's the one. We filled out an application for adoption yesterday, and the animal shelter has a 24-hr waiting period for animal adoptions, so hopefully, we will be bringing him home sometime this afternoon. I will post pictures soon!