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!

Glee

I am knitting a sweater. Here is my progress thus far:



And here is what it is supposed to look like:



This is a sweater that you knit from the top down. The pattern is Glee from Zephyr Style; I have heard it is simple and easy to follow which is good because this is my first sweater. The yarn is Knit Picks Shine Sport (color: grass) knit using size 2's for the ribbing and size 3 needles for the body of the sweater. The only modification I have planned is to make the sleeves longer, so they'll end just before the elbows. I am anticipating that Glee will take me a while - right now my knitting time consists of the 45 minutes I get everyday at the Internal Medicine residents' noon conferences. Aah med school, I love how you suck away all my time.

As a side note, I am home alone this weekend. Sad, yes. Husband E-C has traveled to Ann Arbor, MI to do some research. I plan to catch up on some work, tidy up the large pile of clothes on my floor (though I maintain that large clothes piles are a time saving strategy - you waste no time hanging up your clothes, and they are quickly accessible on the floor when you awake early the morning), lay on the couch for significant periods of time and sleep. Should any of you decide to call me this weekend, I will likely be available. Good times for me.

Happy weekend to all!

Growth

I have seedlings!

Operation seedling might be a success! Over half the seedlings have sprouted. For those of you with some experience - do you know when I should thin them? I dropped multiple seeds into the cells, so now I have multiple seedlings in each cell. Should I wait for them to get a little bigger before thinning? Very exciting. It seems that the weather has finally decided that it is springtime - a welcome change after the couple inches of snow we received earlier this week. I am ready for some warmer days.

More good news - I have both Saturday and Sunday off this weekend! Three weeks down, and three weeks to go on this Internal Medicine rotation. Here, Internal Medicine is a 6 week rotation, and you spend 3 weeks at the university hospital and 3 weeks at the Veterans Administration hospital. So, on Friday, I finished my 3 weeks at the U and my senior resident was kind enough to give me the weekend off. On Monday, I start 3 weeks at the VA. I have heard that the patient population is drastically different between the two hospitals. I foresee lots of older men with interesting histories and cardiopulmonary disease in my future.

I have learned so much during the past three weeks. And I also feel this experience has really aged me - these three weeks feel like years. I have to remind myself that I am lucky - I am tired, and I have to work long hours and oftentimes life is stressful, but I am very lucky to be having these experiences. Medicine is fascinating, and the staff physician on my team at the university hospital is an exceptional teacher. It is inspiring to work with someone with such brilliance and such passion for teaching. And so kind to patients. And to his colleagues and residents and students. Physicians/residents are not always kind to patients or to each other. I have observed and been on the receiving end of unkind actions from people in positions superior to mine, and I suppose that these are good learning experiences as well. A classmate remarked that you can see the quality of a person in how they treat those that they are able to abuse.

For those of you wanting clinical details re: my patient care experiences, your wait is over. I participated in the management of a patient with diabetic ketoacidosis - these patients are typically severely volume depleted and require 4-5 liters of fluid IV as well as insulin and other electrolytes. I had the opportunity to care for another patient with a metabolic alkalosis due to spells of intractable vomiting associated with binge drinking - these patients are also very volume depleted and require a significant amount of IV fluids. It is a funny perspective to see a patient as a learning experience rather than a person. But I must say that in treating these patients (and a few others), kidney physiology has finally become my friend. I also saw a very interesting case of gallstone pancreatitis (where a stone from your gallbladder moves down through your bile duct and occludes the opening of your pancreatic duct. Ouch!) I still have so far to go and so much yet to learn, but it is exciting to have some understanding of the pathophysiology and management of complicated disease states.

And how could I almost forget! I did my first procedure last week. Albeit only an arterial blood gas (and given the low reported oxygenation level, I likely pulled the sample from a vein rather than the artery) it was my first procedure nonetheless. Here is a graphic photo:

And here's what I did: