Seeing patients is the best!

I really love my clerkship experience because, as I've pointed out, it puts what I'm learning in the classroom into practice. For example: Group B Strep and pregnancy.

Last week I saw a patient with Bell's Palsy affecting the left side of her face. As it turns out, this facial paralysis is thought to be the result of latent herpes viruses reactivating in the immunosuppressed mom. Pregnancy causes a reduced cellular immunity system (so the mom's body won't reject the baby) and latent viruses, such as Herpes Simplex 1, take this opportunity to do their thing. The virus in this case causes inflammation of the facial nerve leading to the symptoms.

Patient's with Bell's Palsy complain of weakness or complete paralysis of the muscles on one, or both, sides of their face. They can't blink their eye or smile on that side. The corner of their mouth droops a little. Eye irritation from a constantly opened eyelid tends to result. Interestingly, facial sensation is preserved. I touched both sides of the patient's face and asked if she felt the sensation equally. She said yes.

Bell's Palsy can occur in anyone at any time, but is seen more in patients who's immune system is not as strong and therefore allows the facial nerve to inflame. It resolves on it's own in 3 weeks to 3 months, but drugs to reduce inflammation of the nerve or antiviral drugs against the herpes virus should be used.

On a completely different note, I wanted to share a quick story about a couple who brought up adding something to their family medical history. The mom-to-be's brother was just diagnosed with leukemia last week. Dr. R. very kindly offered sympathy for the brother and said that the diagnosis of leukemia wasn't something that would impact the pregnancy, but would be something that might come into play in thirty years or so when the child is grown. A family history is always very important. But then the couple offered the real reason they were asking, "We've rethought our decision and we want to bank the umbilical cord-blood."

I'm not sure if they were considering the possibility of helping the woman's brother, or the baby's future medical needs, but I'm interested to learn more about the advantages and reasons to bank your newborn's cord-blood. Seeing patients is really great!

1st Day in Ob-Gyn

14 patients in 4 hours! Wow. But time flies when you're learning more than you can possibly absorb, understand, or make connections to your classwork! It was a whirlwind of an afternoon with Dr. R, my preceptor for my outpatient rotation. He is a fast walking and fast talking short man who mixes up his 'v' and 'b' sounds because his first language is Spanish. (Which actually reminds me of my Pap-pap, so that's kind of nice!)

We saw women for their yearly exam and Pap smear, women who were 16 weeks or 24 weeks or 36 weeks pregnant, a woman who gave birth 6 weeks ago and was in for her postpartum exam, a 74 year old woman with lower right abdominal pain, and two women in their early 30s who each had constant heavy bleeding and were there to ask Dr. R for a hysterectomy. I need to take a notepad with me this week to take notes on things I need to look up, questions to ask Dr. R after the patient leaves, and tidbits I learn along the way.

Tidbits from last week:

- Starting in the second trimester, fundal height, the distance from the pubic bone to the top of the uterus, in centimeters generally equals the number of weeks along in the pregnancy... 32 weeks along means a 32 cm belly!

- 10% to 30% of pregnant women are colonized (but not sick) with group B strep in the genital tract - not really a problem for healthy adults. But this does put the baby at risk for sepsis (infection of the bloodstream) and meningitis (infection of the lining and fluid surrounding the brain) and a common cause of pneumonia if this bacteria is passed on during the birthing process. Dr. R, and most other doctors in the US, test all pregnant women for group B strep at some point in their pregnancy and treat both the mom and the baby with antibiotics at the time of delivery if the culture is positive.

... and it just so happens we learned about this very thing in Infectious Disease class today! Med school does work :)

Unplug

Matt just sent me this article: What happens when mom unplugs teens for 6 months?

So, I obviously received the article through email, read the article online, and am reflecting on it on a blog. There are also conveniently placed buttons to "f share" (which I guess means on Facebook), retweet, and email the article both at the beginning and at the end of the page. Makes me laugh.

Last night Matt and I looked at each other around 7:30 and asked, "So what do you want to do?" We actually don't have TV. Not even the basic channels 2, 4 and 6. (And we were already up to date on our hulu shows... but that's another story!) Basically, I love not having TV! I read for pleasure probably 2-3 nights per week (Atul Gawande's books Better and Complications are MUCH more interesting now that I've started school), getting a RedBox movie is a treat on the weekends, and last night we spent an hour talking about our favorite restaurants around Baltimore.

I'm not by any means unplugged... but that little break from what I guess is "reality" is really valued and highly suggested.

Just another Manic Monday

It's just another manic Monday
(oh-woe)
I wish it were Sunday
(oh-woe)
So I could wake up before 11am
(oh-woe)
And do the studying I had planned
(oh)
It's just another manic Monday

And because this got stuck in my head during the time I was supposed to be reading about how the immune system deals with intracellular viruses... I will now go do that. I tried really hard to change all the lyrics... then I gave up.

(Then I asked Matt for help, just to procrastinate more. His response:)

You picked a tough lyric to try to replace there.

I think you know the original is:
Cause that's my fun day
My I-don't-have-to-run day

SO... my best thought after a couple minutes is something like:
Cause that's my studies day
My books-are-my-buddies day

That's all I've got

I love him :)

Six o'clock already
I was just in the middle of a dream
I was kissin' Valentino
By a crystal blue Italian stream
But I can't be late
'Cause then I guess I just won't get paid
These are the days
When you wish your bed was already made

It's just another manic Monday
I wish it was Sunday
'Cause that's my funday
My I don't have to runday
It's just another manic Monday

Have to catch an early train
Got to be to work by nine
And if I had an air-o-plane
I still couldn't make it on time
'Cause it takes me so long
Just to figure out what I'm gonna wear
Blame it on the train
But the boss is already there

All of the nights
Why did my lover have to pick last night
To get down
Doesn't it matter
That I have to feed the both of us
Employment's down
He tells me in his bedroom voice
C'mon honey, let's go make some noise
Time it goes so fast
When you're having fun

I'd like to thank my wonderful husband, Matt, for making every common life situation into a song... and inspiring me to do the same.

Food Allergy on MedlinePlus

There is a friendly family debate in our house that goes something like this:

Matt: Choosy moms choose Jif.

Melissa: Um, no thank you, I'd rather have my Smucker's All Natural Reduced Fat Peanut Butter.

(Ignore the weird stripped peanut butter and jelly concoction. That just looks gross.)



We are in the Immunology Block right now and today we touched on allergies. Here are some pictures:The first picture shows a reaction to peanut butter. The young man went to Little Italy and actually ordered spaghetti, but as it turns out, the chef's secret sauce recipe (according to our lecturer today) included a spoon of peanut butter.

The second picture shows on unfortunate little boy who has an allergy to milk. He was in the school cafeteria, not drinking milk, but then his buddy across the table decided to use his straw from the milk carton to blow air across the table. (Again, according to our lecturer) A drop of milk touched the little boy's skin on his face and the allergic reaction kicked in.

To kill two birds with one stone, I decided to check out MedlinePlus by searching for "peanut allergy." If you click on this site you can see a crazy amount of good information on all food allergies. Latest news, diagnosis and symptoms, pages on specific conditions, links to clinical trials for the disease, organizations, law and policy, children or teenagers or women specific information, and patient handouts about diets and reading labels are all right there.

One link on the MedlinePlus - Food Allergy site is a video "If I had an allergic reaction." Interesting and super useful for new moms! (*Bridge)

Useful Websites

I have not spent any time on any of these sites, but here is a quick rundown of the 3 resources we were given in class today. They are trustworthy, reliable and useful. I would make these websites your first stop when trying to find health information online.

I plan to explore these sites and then I'll comment more specifically on what each has to offer. Feel free to share your thoughts or tips for using these resources as well!

MedlinePlus - (from their "About" section) MedlinePlus is the National Institutes of Health's Web site for patients and their families and friends. Produced by the National Library of Medicine, it brings you information about diseases, conditions, and wellness issues in language you can understand. MedlinePlus offers reliable, up-to-date health information, anytime, anywhere, for free.

You can use MedlinePlus to learn about the latest treatments, look up information on a drug or supplement, find out the meanings of words, or view medical videos or illustrations. You can also get links to the latest medical research on your topic or find out about clinical trials on a disease or condition.

HONcode - The Health On the Net Foundation (HON) promotes and guides the deployment of useful and reliable online health information, and its appropriate and efficient use. Created in 1995, HON is a non-profit, non-governmental organization, accredited to the Economic and Social Council of the United Nations. For twelve years, HON has focused on the essential question of the provision of health information to citizens, information that respects ethical standards. To cope with the unprecedented volume of healthcare information available on the Net, the HONcode of conduct offers a multi-stakeholder consensus on standards to protect citizens from misleading health information. (from their website)

National Guideline Clearinghouse - NGC is a public resource for evidence-based clinical practice guidelines

First Clerkship

Our orientation to the Longitudinal (Outpatient) Clerkship today really got me excited about the next step in training. Most of our clerkships will be 8 week rotations through the hospital in areas such as pediatrics, (adult) medicine, emergency medicine, neurology and psychiatry, and ob/gyn during years 3 and 4. But we are actually given a wonderful opportunity to start our clinical training early by being paired with a physician and spending 5 hours a week at that practice seeing patients!

The goal is to practice the interviewing skills and physical exam skills that we began to learn last semester. Additionally, we will have the opportunity to see how a practice is run, how referrals, scheduling, follow-ups, and administrative tasks are handled, learn how insurance works (or doesn't work) and how patients experience their interaction with the health care system.

I was paired with an OB/GYN in a community practice in Howard County, Maryland. Although I'm a little nervous to begin interacting with patients outside of the Simulation Center where we practiced on Standardized Patient Actors and Physical Exam Teaching Assistants, I'm mostly excited to get out of the classroom and into the real world setting of my future career!

Winter Break Highlights and First Day Back

Annual Baltimore Christmas Party(bonus: with family) - Hutchinson Christmas Celebration and making Luminaries - Babysitting Juliana all day - Skiing with Matt at Holiday Valley and getting down the diamond - Family frosting Christmas Cookies - Catching up with the Olean Girls - Babysitting the puppy - "Back-to-School Shopping" with Mom, Bridge and Mals - Christmas Eve and Day with the Family and awesome home cooked meals - Competing for top Wii scores in skateboarding, table tilt and obstacle course - Reading by the fire - 5' x 5' painting purchase in Ellicotville that we can't fit in a car to get back to Baltimore - Staying in with my husband for New Years Eve - Friends and Catch Phrase + Sleepover @ Erin and Rubin's - Rereading the Jan. 2nd email from my future husband - Organizing all first semester notes!

A two week break from school is just what the doctor ordered! I was rested and ready to start learning Immunology at 8am! Then the new terminology started and I felt like I had fallen back into the alphabet soup of metabolism. But I refuse to get the least bit worked up or frustrated. So I spend the afternoon reading the lecture notes for 1 of 3 lectures from today and pre-reading both of tomorrows lectures. Do I understand how antibodies work? Not yet. Do I know that another word for antibody is immunoglobulin (abbreviated Ig) and that there are 5 classes: IgM, IgG, IgA, IgD, IgE? YES!!!

And I can also tell you that antigens are foreign things (like viruses, bacteria, pollen) that are recognized by antibodies causing a immune response to save the body from whatever problems the antigen might cause.

But the BEST thing I learned today was the CBC: Complete Blood Count. As in a line from every episode of House like: "We did a CT, MRI, CBC, Chem-7 and chest x-ray. All the tests came back normal. There’s nothing to explain his symptoms." On Christmas Eve my uncle was giving me a hard time about what I had (or had not) learned in my first semester... and I came up blank when he asked what a CBC was. (My standard answer to random health/medicine questions over this break was, "Oh, we're learning that next semester.") Then he rattled off a line just like the one above and said something like, "You should watch House, see, they teach you more on that show!" So I texted him while in class "First day back and we're learning the CBC." I guess I was right about the next semester thing :)