Merry Sick-Mas

Hope everyone has had a wonderful Christmas (or Hanukkah or St. Nicholas Day or hidefromyourcrazyfamily day or whatever holiday you celebrate)! We’ve had a nice break, but everyone on our end has been sick with the same upper respiratory infection/cold (coughing, sore throat, mucus nastiness) for the past week. We are gradually feeling better, but taking it easy for now. I’ll be back from my Holiday Hiatus later this week with a post about all the marvelous things we were gifted with last week. We are spoiled, to say the least. 

It’s Because I’m Green, Isn’t It?

If I had a dollar for each time someone has called me cuddly-as-a-cactus since my previous post I’d have a million dollars. Okay, that’s a total lie – I wouldn’t have any dollars (which is not so different from the amount of dollars my bank account has, so I’m in good company), but I did feel very judged after admitting my aversion to Frosty the Snowman. 

So, in attempt to reconcile with my audience the four of you who read this and with my family (Christmas is here, there are gifts that will require my acceptance) I will explain myself further.

“How do you hate Christmas music? I LOVE this time of year.”
Whoa, whoa, whoa. Hold yir horses there cowboy. I didn’t say I hate Christmas or this time of year. Au contraire grasshopper, I love almost all (non-musical) things Christmas and I greatly enjoy this time of year. In fact, making, sending and receiving Christmas cards has to be one of my favorite things ever. This year we actually had a wonderful photographer, who also happens to be a wonderful friend, take some “family portraits” for us.
If you follow me on Twitter you know I am ridiculously happily married to my (intensely handsome and exceedingly geeky) college sweetheart and we have three children crazy dogs. We have been a “family” for almost 3 years now and despite having an absurd amount of pictures of our dogs, we have no pictures of all 5 of us. So, I decided Christmas cards would be a divine excuse to obtain such a picture. I mean, if we’re going to force our friends and family to look at pictures of us and our hairy children, they might as well be good pictures, right?
So, in my giddiness to create Christmas cards I contacted my friend and we had a little photo shoot. I peed my pants the day our cards came in the mail. Unfortunately, it seems not everyone gets this delighted to send and receive Christmas cards. My cognizance of the Christmas Card Haters was born following a riveting conversation I had at a local drug store:

Me: “Are there 20 stamps in each booklet? I think I need two sets.”

Checker: “Yeah. What do you need so many stamps for anyway?”

Me: (Alright meddling woman, I’ve been looking for stamps for an hour….freaking sell them to me so I can get on with my life.) “To mail our Christmas cards.”

Checker: “WHAT!? This is a LOT of money to spend on Christmas cards. You should just send a text. My Christmas card is a mass text to my friends.

Me: (WHAT is wrong with your my generation!? Snail mail is dead and part of my heart has died with it. You kids and your new-fangled mePhones and weemail….pick up an ink pen dagnabit) “Thanks, Merry Christmas. I’ll text you.”  

Merry Christmas, Friends – With Love From The Joneses
Danielle, Donnie, Wrigley, Sage & Mae
More photos and hilarious blooper shots on our post at Linda Schillberg’s blog

So, rest assured hollyjollychristmasers, that I know how you feel when you tell me it makes your peanut brittle to hear that I hate Christmas music. I felt like I’d be given a stocking full of coal when I discovered there was a breed of folks out there who hate Christmas cards. The only thing I love more than designing and sending our Christmas cards is receiving cards from our friends and family.

Some of the cards we’ve received from friends & family this year.
Tell me, readers, what do you think of Christmas cards? And please tell me you aren’t mass texting your friends and family as their holiday greeting….I need my faith in our generation restored. 

La La La I Can’t Fa La La Hear You

I have a confession to make.

Every, single year it happens in November, typically on the day after Thanksgiving, but occasionally before the wonderful day of food giving thanks. It usually begins on a lonely, silent night when ye merry gentlemen are just settling down for some rest. Without fail it will catch me off guard like a bell jingling during a dream about how December 25th might turn out to be white this year or while I’m busy offering a cup of cheer to my neighbor. Yes, I have to ask, do you hear what I hear?

Original Photo Courtesy of Striatic on Flickr.

Hark! I hate Christmas music.

It’s true. I despise the songs of the holidays. I abhor them even more than I hate those little pieces of fuzz that end up all over my dryer every time I clean the filter thing out. More than I hate grocery baskets being left in parking lots so they can bang into my car. I almost hate them as much as being asked if I’m wearing my husband’s jacket, but that’s pushing it a little.

Every time someone joys to the world at the grocery store or holly-jolly-christmases on my radio red and green goo starts seeping out of my ears. Then I change the station to no avail. It’s everywhere. It’s like the FM carolers are sitting in my passenger seat overflowing with Let It Snows to propel in my direction. 

I don’t know what it is. Maybe it’s because the music is so effing jolly. Or maybe it’s because I can’t get away from it. Or maybe it’s because I really prefer to listen to music in my car that doesn’t get burned into my brain for 6 hours after I’ve killed the engine. Whatever it is, it makes me shudder. You know that feeling you get when you ask a not-pregnant lady when her baby is due? You know, like you need to run really fast in the opposite direction and not stop until her wails of cursing can’t be heard anymore? No? Well, whatever makes you want to run really fast with your fingers in your ears screaming “LA LA LA I CAN’T FA LA LA HEAR YOU” – that’s how Christmas music makes me feel. 

I know I’ll probably lose some friends over this one. So, I guess if you can’t relate by telling me how much you hate Christmas music you can list your favorite Christmas songs in the comments so I can tape them to gift boxes and throw darts at them….or maybe I’ll make tiny little straight-pin flags to torture my Voo Doo Santa with.

Then I Broke An Old Lady’s Zygomatic Process

….okay not really, but if I wasn’t anti-oldladypunching I would have. It’s probably a good thing I hold this stance on using my fists to show 70 year old women what I think, otherwise there’s a good chance I would have earned myself a nice new set of silver bracelets yesterday afternoon (and this blog post probably would’ve been titled very differently – ex. “How I Got Kicked Out Of Medical School”).

Anyway, let’s start at the beginning. During my 12 minute drive (that is a long drive for this town) to school yesterday I had some time to think. Naturally I was thinking, “How can I bore these gullible people who read my blog just a wee bit more today.” I decided I would write about how, when people ask what I’m doing with my life and I tell them I’m in medical school, the most common response I hear is “Oh, to be a nurse?

Now, let’s get this straight right now, I have nothing against nurses. In fact, my mom is a nurse and she’s pretty dang awesome. And my sister-in-law is a nurse and she is almost as awesome as my mom. I just think it’s….strange….that I get asked this so often. I did some very formal research asking around at school and have conclusively discovered that my male counterparts have never had this response, but many of the other females in our class hear the same question often. I guess all I really mean is that a stereotype still exists that girls are nurses and boys are doctors. I won’t get into how absolutely eff-ing ridiculous this is based on the amount of male nurses and female doctors I’ve worked with, but it’s obviously something people still believe, whether they hold that belief on a conscious or unconscious level I have no idea.

So, really this post was supposed to be to brag on how cool I thought it was that the last three people who asked what I’m in school for have responded with “Oh, to be a doctor?” before wondering about any other medical profession.

But, then I put on my new jacket I purchased from the Ob/Gyn club’s fundraiser and went to the home improvement store (don’t get me started on the irony of that) to make a return.

New Jacket                    
The lady doing my return looked straight at the logo on my snazzy new jacket (which has the name of my school on it) and said “Oh what’s your major?” but, before I even had time to explain she blurted out “Or does that jacket belong to your husband?”
Excuse me? Does it…….what?

-glance around for store security

consider jumping across counter and using caulking tube as weapon-

“Uhh….ummm….no….NO actually it’s mine” was all I could get out.

So, normally I can pass the “Oh, to be a nurse?” off as maybe they don’t know that ‘Medical School’ is not actually some all-inclusive term for learning about anything remotely related to health care. I can understand that, everyone doesn’t know someone in nursing school or PT school or medical school and they might not understand that they are different.

But, this one….there was no mistaking her subconscious stereotyping.

She was either saying “You look like you wear men’s clothing.” or “There’s no possible way you are actually in medical school, that MUST belong to your (apparently very tiny) husband.”

I’m Now A Pro At IVs, Foleys, & NG Tubes….

assuming my patients meet a few criterion:

  1. Patient is made of plastic.
  2. Patient consists of only the body part I need.
  3. Patient is unable to move. 
  4. Patient is not breathing.

Today we had a workshop, hosted by the Emergency Medicine club, to learn how to place IVs, insert Foley catheters and introduce NG tubes.* Several of the nurses from our ER volunteered to meet us down at the brand-spanking new (very expensive!) SimLife Center and teach us these skills. We would be nothing without nurses who were willing to help us, it’s amazing how little clinically-relevant/procedural skills we learn in the first two years of medical school.

These mannequins are really cool, y’all. Some of them have pupillary reflexes, cry, have blood in their veins, mimic heart murmurs, respond to medications, all kinds of stuff. One of them even gives birth! To a mannequin baby!! 

Ashley – Inserting IV into Severed Arm Man
Me – Inserting Foley Catheter into Truncal Woman

Eva and MS1 I Don’t Know –
Learning to Insert NG Tube

So here are a few tricks of the trade they I learned today:

  1. Feel for veins with the pads of your fingers, not your thumb.
  2. Never pull the catheter out without deflating the balloon or

    your patient will kick you and you will deserve it. 

  3. Get a good grip on the – ahem – apparatus when inserting

    a Foley catheter into a male patient.

  4. Lube….use it….liberally….to prevent angry patients.
  5. Tell your patients what you’re doing….even if they are

    unconscious (or pretending to be uncouscious).

So these aren’t very difficult procedures, but I’m happy we had nice nurses willing to teach us in a non-stressful situation where we couldn’t hurt anyone. 

Plus if you stick around long enough, you might even
stumble upon a little blue box full of nice, plastic vaginas.

*For the non-medical geeks people out there: IVs = Thing they stick in your arm at the hospital to make administration of drugs easier, Foley Catheter = Thing that drains your pee, NG tube = Tube through your nose and into your stomach to pump things out or put things in.

Just One More – Eating Disorders in the US

Thanks to all the people who answered yesterday (apparently only in their brains, not on the comment section – 
it’s okay you wussies, I just know you would have been wrong anyway, so there). The answer to yesterday’s question is E) Secondary Amenorrhea – cessation of a woman’s menstrual period as a result of an underlying disease or condition. The causes can range from pregnancy, breast feeding and menopause to eating disorders, Polycystic Ovarian Syndrome and hypothyroidism. Based on our patients symptoms the likely cause is Anorexia Nervosa. Why the other answers are wrong is discussed at the end of this post.

Photo, with permissions, courtesy of xJasonRogersx on Flickr.

I chose this question because of an article to be published next month by the American Academy of Pediatrics discussing the rise in incidence of eating disorders among children younger than 12. You can see the PsychCentral article discussing the paper here. Did you get that? Kids younger than 12 years old….and not just girls. 

The article states that eating disorders now account for up to 4% of hospitalizations for US pediatric patients. That statistic floored me and what followed in the article deserves major attention by doctors and students of medicine, as well as the national media.

Pediatricians and Family Practice doctors need to be more informed about these diseases. They need to be aware that eating disorders aren’t just affecting females. And that being a normal (or even higher than normal) weight absolutely does not rule out the possibility of a patient having an eating disorder. These doctors need to learn to screen for these diseases. They need to understand that males now comprise almost 10% of all eating disorder diagnoses. So, why don’t they know these things?

We have literally barely touched on eating disorders in my 1.5 years of medical school. I don’t even know if most of my classmates could tell you the difference between Anorexia Nervosa and Bulimia. I’m pretty sure most of them wouldn’t be able to tell you there are other types of eating disorders, like EDNOS (Eating Disorder Not Otherwise Specified) and Binge Eating Disorder and Pervasive Refusal Syndrome (similar to Anorexia, but occurring before puberty) and Night Eating Syndrome – all real eating disorders as defined by the DSM-IV (a Psychiatrist’s Bible) or it’s appendix. This doesn’t even touch on things like Pica (cravings for non-food items like chalk, coffee ground or ashes) and rumination which are currently defined as “feeding disorders,” generally of infancy and childhood, but definitely not exclusive to such a time period.

Why does it matter if they know that since they aren’t going into Psychiatry?

Well, frankly, because Psychiatrists are rarely the people who are having to screen for these disorders – they are the ones who treat them. Eating Disorders need to be caught at yearly physical exams or sick exams to prevent them from getting to a deadly stage. If doctors were supplied with a more appropriate skill set to identify possible cases of these disorders, there would be a much higher potential for these patients to be referred for counseling before their disease got even worse. If doctors were screening for Eating Disorders like they screen for – oh I don’t know – Scoliosis, how many lives could be saved? I’m not just talking decreasing the lethality of these disorders, I’m talking about changing lives. Preventing downward spirals. Ending bad habits before they become worse. Allowing a child who doesn’t know how to ask for help the opportunity to access it before they are so sick a bystander can tell they have an eating disorder.

There are often many, many more aspects to an Eating Disorder than weight alone. Almost invariably the patient is suffering from low self-esteem along with some kind of control issues. Physical, verbal or emotional abuse is a common co-morbidity, whether it be from a sibling, parent, classmate or significant other. The physical manifestations of a long-term struggle with these diseases can be debilitating and even deadly. In 1995 a study indicated that, for females age fifteen to twenty-four years old suffering from Anorexia Nervosa, the mortality rate associated with the illness was twelve times higher than the death rate of ALL other causes of death. I realize this is an outdated study, but with the incidence of eating disorders on the rise I can only infer that the mortality rate from these diseases is still very high.

If an adolescent suffers from a long-term eating disorder yet escapes lethality as a consequence, the aftermath can still be extremely caustic. From brain atrophy, scurvy and tooth decay to osteoporosis and extreme loss of bone density before age 30, not to mention the social and occupational effects that are so common. If we caught these things earlier, we could change some of these outcomes.

So, what do you think, friends inside the internet? Would you like to see more screening for Eating Disorders by Pediatricians and Family Practice doctors who are seeing children? Do these doctors owe it to their patients to be more educated about this? Should it be a required screening program?

How can we help keep these kids from being Just One More?

Incorrect Answers:
A) Calluses on hand/fingers (Also known as Russel’s Sign – an indicator of induced vomiting) and B) Dental Erosions could both be symptoms of Bulimia or other eating disorders, even Anorexia, but these answers are not “as good” as Secondary Amenorrhea. Although someone with Bulimia might also experience secondary amenorrhea, it is much more common in those who have Anorexia, since bulimics are more often of normal (or higher) weight. Unfortunately, this makes Bulimia a very difficult disorder for physicians to detect and it is most often discovered by a family member or house mate.

C) Hirsutism is a condition of excessive hairiness. It has many causes, but eating disorders are not one of them. Lanugo, a fine hair that grows on fetuses, can also present on those who are malnourished due to Eating Disorders or other causes, but it does not fall into the category of hirsutism.

D) Primary Amenorrhea is absence of menarche by the age of 16. Our patient does not have this.