Christmas in Carolina

Shortly after Corey and I arrived in SC on Christmas Eve our newest niece arrived home from the hospital. The girls were very excited to meet their little sister:


After unpacking the car and placing the presents under the tree it was off to bed for a short while. Lacey was too excited to play with the girls and my sister's dog Brownie that she did not let us get much sleep that 1st night. Come Christmas morning the living room was stuffed with presents and we all had lots of fun opening the various gifts. I don't think I've ever seen 2 girls get as many presents as Emily and Lizzy did!


After opening all their presents the girls got to hold their baby sister for the first time.










The rest of the day was a pretty lazy day for us and such has been most of my time down here. We went bowling yesterday with the exception of the new parents and the baby and Corey and I performed horribly, but enjoyed it nonetheless. Today Corey left to go back to VA for a couple days of work but will be back shortly for our trip down to Hilton Head.

Here is Miss Juliette Joy on her 1st Christmas (and 3rd day of life):

Merry Christmas Y'all!

It will indeed be a very Merry Christmas for my family. Later today Corey, Lacey and I will be in the car packed with suitcases and gifts on our way to South Carolina to spend Christmas with my sister, brother-in-law, parents, and my 3 nieces - yep I said 3! My sister gave birth to her 3rd daughter last night around 8pm. Juliette Joy was born 7lb 5oz and 19 inches. Mom and baby are doing well and we are all hoping they are able to leave the hospital today and will be home for Christmas morning. I'm really excited to spend this Christmas with my family because it seems like forever since I've been with them for a holiday.

I hope everyone has a wonderful Christmas and a very blessed New Year!

Snowpocalypse 2009

Starting on Wednesday our local weathermen were calling for lots of snow - between 3 and 6 inches of accumulation - between Friday night and Sunday morning. Then Friday morning the forecast changed - now anywhere between 12 and 24 inches of accumulation! Wow - bit of a difference, eh? Needless to say that threw things into a frenzy around here sending people out in droves to do some Christmas shopping, to stock up on groceries and fill their car gas tanks. I waited patiently for the snow to start falling Friday night and started getting pretty worried once 8pm rolled around and it hadn't started yet. Well by the time we went to bed there was snow falling and accumulating on cars and grass. I had a hard time sleeping overnight because some people started shoveling snow right outside our bedroom window at 2am. I went out to the couch close to 3am and watched the snow fall through our sliding glass door for a few hours before falling back asleep. I woke up later in the morning to find what I thought was lots of snow covering the ground.


Throughout the day the snow continued to fall steadily, becoming pretty heavy at times. We enjoyed watching it fall throughout the day. We tried to go out and let Lacey play in it but there was a lot of wind whipping the snow around which was hard on our eyes. Also, some of the drifts were pretty deep and scared Lacey. We spent the rest of the day inside. I decided to bake some cookies and tried a new recipe for mint chocolate chip cookies - yummy! They were pretty much the usual choco chip cookie recipe but with peppermint extract instead of vanilla. While looking for the cookie recipe I happened upon a recipe for chocolate chip pancakes. I was intrigued so I decided to make them for dinner - they were super delicious as well! We even had the leftover pancakes for breakfast this morning.



I think the snow finally stopped around 10pm last night leaving a total of about 22-23 inches of the powdery white stuff behind. We went out this morning to find quite a sight - cars absolutely enveloped in snow (including mine!), piles and piles of snow thanks to snow plows, mountains of snow drifts, and beautiful icicles. There was white as far as the eye could see. After taking Lacey out, we decided to dig Corey's car out because it was relatively spared. We had gotten a bit of cabin fever staying inside all day Saturday so we decided to brave the roads and do a little shopping. Some roads were still covered in snow, some were slushy and others were completely clear.

My poor car is somewhere under that snow:

Some pictures from our drive around town:

There is still a ton of snow piled everywhere and lots of roads were still not completely cleared as of 7pm tonight, but things look much better than last evening. Hopefully I can dig my car out tomorrow because it needs to go to the shop before we head out of town on Thursday!

My favorite picture - this is what we saw in a store parking lot today:

Quality time in the kitchen

Today I had a day off - yesterday was my last day of OB/Gyn and tomorrow is my end of rotation exam. So what did I do today? Instead of studying like I should have, I ran some errands early this morning, addressed and mailed off our Christmas cards, then spent the rest of my morning and early afternoon whipping up some treats to share with my classmates. I had some fresh cranberries I bought initially to use as decorations, but then I decided it might be fun to actually cook with them. I found a cranberry muffin recipe that looked pretty appealing. I also had bought some raspberries and wanted to make some muffins with those. I ended up making 2 batches of the cranberry muffins because they were super easy and pretty tasty and one batch of raspberry-cream cheese muffins. I tried one of each because there was no way I was sharing them with my class if they didn't take any good! I'm happy to report they were both a success! Very yummy - a little sweet, a little buttery, a bit crumbly, and a bit tart. Yum!

Then to top of my day in the kitchen I decided to spend some time on a good, hearty dinner for Corey and I ---so I made the Beef & Barley soup that we've fallen in love with. It takes a little prep time and has to simmer for a while, so its only practical for me to make on a day off. It also turned out well (despite me accidentally using 2x the amount of broth called for in the recipe - oops!)

Now that I've done my errands, spent the day cooking, cleaned the kitchen and done some laundry, perhaps I should crack a book or read some notes :)

It's Beginning to Look a lot Like Christmas

The tree and other Christmas decorations have been up since the weekend after Thanksgiving, my Christmas shopping is done, the presents are wrapped under the tree and the presents for far away family are in the mail. We had our first snowfall, the weather is cold and blustery, Starbucks has peppermint hot cocoa and the school semester is super close to the end. Yep, I'd say its almost Christmas!! (Now all I need to do is send out our Christmas cards and I'm set!)

This year we'll be spending Christmas with my sister, her family and my parents down in South Carolina. She will be VERY pregnant at the time of Christmas (due date is Jan 4th) so I am hoping she delivers a little early. We are bummed that we cannot be in TX during the holidays, but there's not enough time or money for that this year, plus we were there last year. But I am super excited to spend time with my family in SC. Plus, we can drive down there which means Lacey gets to come with (she is very excited)! Unfortunately we won't be leaving until Corey gets off work on Christmas Eve - which means we'll be getting in pretty late! No Christmas Eve service for us this year :( I guess I'll have to download a good version of Silent Night (in English and German) and listen to it in the car to make me feel like I'm back in my childhood church on Christmas Eve!

So maybe OB/Gyn isn't all that bad...

Yesterday, my first day on day float, I messed up before the shift even started. I was terrified that this week was going to be horrible from that point on. Despite my worst fears, these past two days have been awesome! Yesterday I scrubbed in on a C-section then watched a vaginal delivery. After the baby was delivered I got to deliver the placenta - kinda gross and kinda cool all at the same time! Then today I came in crazy early because I had to round on my two postpartum patients. After sign-out we had a couple patients to see and one to prep for a scheduled c-section. I was lucky enough to scrub into the c-section again and do a bit of suture cutting (nothing too exciting, but watching is lots of fun). Then immediately after we finished closing the c-section patient, we headed to our next laboring patient's room because she was feeling the need to push. I'm not really sure how it came about but it was decided that I was going to get to deliver the baby. So I quickly got my sterile booties, gown and gloves on and sat in the stool between the patient's legs. The chief resident stood over my shoulder and quietly gave me a rundown of what I needed to do and when. Less than 2 minutes after I sat down the baby crowned, the head was delivered then I got to do my part. I grasped the head between my two hands and exerted downward pressure in an attempt to deliver the anterior shoulder. We discovered the baby had what's called a nuchal cord (when the umbilical cord is wrapped around the baby's neck). Once that was fixed and we finished delivering the anterior shoulder I pulled up on the baby's head to deliver the posterior shoulder. Once both shoulders were out, all he needed was a quick tug, I grabbed his head and leg and held on for dear life. We clamped and cut the umbilical cord then I got to deliver the placenta (which just entails massaging the uterus, applying suprapubic pressure then tugging gently on the remaining umbilical cord which is still attached to the placenta).

I cannot explain the rush that came along with the delivery! I was jittery for a good 30 minutes after we had finished everything. Does this mean OB is for me? Definitely not! But I had an experience I will never forget!

The weather outside is frightful

Yesterday started off cold, rainy and miserable with the promise of snow later in the day. The forecast called for 1-4" of accumulation, but I was pretty doubtful, after all we had temps in the 50s and up to the 60s for the week prior. I went up to campus (in DC) to help out with interviews for the morning. It was snowing there but nothing was really sticking. But as I was driving home, I quickly realized the landscape looked rather different the farther away I got from the city. By the time I got home there was close to 1-2" of snow on the ground and still tons falling. So I guilted Corey into going out into the snow with Lacey and I to have some fun and take pictures.


We ended up taking lots of pictures, running around in the snow and throwing snowballs which Lacey loved chasing.


We were frozen when we got back inside, but Lacey wanted to head right back out immediately. I ended up taking her out again later - she is definitely a snow bunny! Luckily there was still lots of powdery fluffy snow out this morning that she got to play in again.


Pretty impressive snowfall for the first of the season! We are eagerly awaiting the next!


On a completely different subject, I'm on my OB rotation right now and cannot wait for it to be over. Last week was spent on "clinic" duty which ended up with me having multiple half days, one afternoon watching OB sonograms and one day completely off. I actually only spent two mornings and one afternoon actually seeing patients in the clinic. It's pretty frustrating for me because as much as I like having an easy schedule, I'm also here to learn, and that's obviously not happening if I'm having all this time off. On the other hand, I'm not at all interested in OB so I keep telling myself to enjoy my schedule, after all its better than me having to work 80 hour weeks in something I don't like. I only have 7 working days left in the rotation and 4 of those are >12 hour shifts doing either Labor and Delivery or Gynecology float (seeing ER consults, rounding on post-op patients, etc). I also have one day on call, then 2 days in the clinic. I'm just trying to make it through the rest of this rotation and on to Christmas vacation. Perhaps being busy and seeing some deliveries will help make it go by faster!

Black Friday Fun

Today, Kelli and I decided neither of us wanted to sit around the house, so we headed to the mall with fingers crossed. We got to the closest mall (not the biggest - we weren't feeling that adventurous!) around 10am and easily found a parking spot - good start! Then when we got into the mall, it wasn't too crowded. Whew! We spent a couple hours trolling the stores, where I bought some Christmas gifts (and some gifts for myself). I was able to take care of 3 family members' gifts and purchased a couple pants for work. I also learned I look kinda cute in some felt hats - thanks to Kelli :) I couldn't pass up the deal on the pants - they were from Ann Taylor - originally $110, on clearance for $40. Plus they were having a promo where you got 40% your entire purchase before noon, so when I checked out at 5 minutes til noon, I got my $110 pants for $23.93 for a grand total of 80% savings! Quite possibly the best deal I've ever gotten on clothing, especially clothes of that quality. I also bought myself a potato masher (see previous post) to help with future mashed potato ventures. We finished off our shopping trip with lunch at Panera and good conversation. All in all, it was a great way to spend my day!

My first turkey!

So yesterday I made my 2nd entire Thanksgiving (last year was my first for Corey and I down in Hilton Head). This year was different though, because I made my first turkey! Although there was only going to be 4 of us at dinner, I figured I'd try a whole bird instead of buying just a turkey breast or a roasting chicken (like I did last year). I was a little worried, but felt okay because I had a recipe and it seemed pretty easy to follow. Well, as I was readying the turkey for oven, I decided I wasn't too sure about the recipe (it called for paprika and I wasn't sure about that) and there were small logistics I wasn't sure about. So what did I do? Did what any girl would do - I called my mom! She very patiently answered my questions and helped me get the turkey in the oven.

Later in the day, Kelli came over to help make the rest of dinner, including mashed potatoes, stuffing, brussel sprouts, corn, and bread. I tried to make the mashed potatoes in my food processor thinking it would cut down on mashing time ---bad idea! We ended up with what Kelli and I dubbed "potato paste." So we boiled a couple extra potatoes, hand mashed them and mixed them in with the paste in order to salvage the mashed potatoes. The turkey was nicely browned and the correct temp when I took it out of the oven. It had to sit a little longer than I'd planned, so it probably was a little cooler than I would have liked, but it tasted okay. I still have some practice to do before being able to replicate the turkey my mom makes. Everything else turned out well! My favorite part of the meal? The pumpkin pie! I used a Paula Deen recipe which used cream cheese and half-and-half --needless to say it was rich, but rather fluffy. I liked it much better than the traditional pumpkin pie.

Kelli and her dad joined Corey and I for dinner and we had a great time. We swapped stories and had great conversation, including Kelli's dad's jokes. Despite not being with family on Thanksgiving, I had a wonderful day!

Now its on to prepping for Christmas - we're putting up the tree and other decorations tomorrow and I've already started some Christmas shopping. Whew - hard to believe its less than a month away!

What's with these cancer screening recommendations?

So this week was a busy week for women and cancer recommendations - and they came from very different sources. First was the mammogram controversy: a US government task force recommended against routine yearly mammograms for women under the age of 50, citing the facts that "only" 15% of women are diagnosed with breast cancer between the ages of 40 and 49, and that many others experience false positive mammograms which result in stress and extra tests (ie biopsies of lesions). The other part of this recommendation was that women get mammograms every 2 years rather than yearly. The biggest concern with these new recommendations is that private insurance will no longer fund routine mammograms for women in their 40's. The other concern is who made up this task force - according to CNN not a single physician on the board was an oncologist .....wait a sec..these people are making recommendations regarding CANCER and there is no oncologist's input??? How does that make any sense?

This frustrated me greatly - first what about those 15% of women who are diagnosed with breast cancer in their 40's? Because they fall outside of the "common" age of women with breast cancer, they are not included in these recommendations? I'm not sure I feel comfortable about that. Also, now that my mother was diagnosed with breast cancer (at the age of 56) her oncologist recommended that my sister and I begin routine mammograms at 40. Now it is very possible that I will have to pay for every single mammogram out of pocket until I reach 50. The other thing is breast cancer can be very aggressive - the difference between a normal mammogram one year and an abnormal mammogram 2 years later can be astounding. All this made me wonder what other countries recommend for mammograms, so I looked it up on Canada and England's national health websites.

Canada recommends mammograms every 2 years for women between 50 and 75. (They do recommend you get a second mammogram one year after an abnormal mammogram with other normal testing like a normal biopsy). In England they have what is called the NHS Breast Screening Programme which women over 50 must be invited to participate in. You get your first invitation after you turn 50, but they don't guarantee that you will be invited at that time - however you are assured an invitation by your 53rd birthday at the latest. They give free screenings every 3 years under this program until you reach the age of 70. By 2012 they plan on expanding the age limits to 47-73. According to their website they set their age limits based of ease of mammogram readability and the lower incidence of breast cancer in women younger than 50. In pre-menopausal women, breast tissue is much more dense and mammograms are not as reliable. Since the average age of menopause in England is 50, they set their recommendation at that age. They do, however, point out that with the advent of digital mammography, mammograms can be better performed and interpreted on those women with denser breasts.

So how do these practices correlate to death & survival rates? These numbers must be taken with a grain of salt because they represent different years and lengths of time but it's the best I could find. Here are the 5-year survival rates for breast cancer based on country:

US (cancers diagnosed between 1999-05) 89.1%
Canada (cancers diagnosed between 1996-98) 86%
England (cancers diagnosed between 2001-03) 80%


Makes you wonder why our country is leaning toward what these other countries are doing?

If you ask me (which no one is, but I'll give my 2 cents anyway) I think we should be doing more to expand access to breast cancer screening like clinical breast exams and mammograms to the US people rather than creating more restrictions. It is shown that survival rates vary among SES and race in the US, so the best way to increase survival is to increase access to those who women don't have it, rather than restricting those who do have access. Okay, I'll get off my soapbox for now.

I'll address the cervical cancer recommendations in another post at another time...too many stats for me for one day!

Adventures in the kitchen

I've come to realize something about myself recently...I'm a bit of a kitchen-gadget addict. I have a kitchen full of fun stuff including (but not limited to) my Kitchenaid mixer, a full-sized food processor, a mini food processor, an ice-cream maker, a George Foreman grill, a waffle-maker and even a fondue pot. And I enjoy them very much - even if I don't use all of them all the time. I also have a ton of cooking pans, pots and dishes. The sad part about all this - I look longingly at all the gadgets I find in various kitchen supply catalogs. I think I might have a problem :) I need a bigger kitchen just to store all my stuff!

On a similar note, I like reading cookbooks + cooking magazines and browsing cooking/recipe websites. A couple years ago I found out that my grandmother was similar - she would buy cookbooks and spend all this time reading through them without ever making a single recipe from them. After she passed away, I was lucky enough to get a lot of her cookbooks, which I cherish greatly. Lately, I've decided to expand my recipe repertoire and actually start trying some new recipes. Some come from my cookbooks, but most come from cooking magazines and the internet. Some I try aren't exactly big hits, but for the most part I've been successful. Last week I made a super easy, super delicious and healthy dinner - Beef, Barley and Veggie soup. It earned such good reviews from Corey that I made a variation on it last night - Chicken, Barley and Veggie soup. And the best part about the soup- it gets Corey to eat vegetables!! I really like experimenting in the kitchen and hope one day I'll have the time and the skill to come up with my own dishes. Until then, I'll continue my cookbook, magazine and recipe collecting ways :)

Are there babies in my future?

I think so! Not my own baby, but perhaps working with kiddos. After 3 weeks in the peds office I came to a conclusion that I want to work with kids. Not sure if I'd enjoy private practice pediatrics because well-child visits get old pretty quickly, but I'm almost positive I want to work with primarily peds - perhaps in an inpatient setting or even in a pediatric specialty. I've known for a long time that I have an affinity for kids - I really enjoyed babysitting for several years in college and genuinely miss the little girl. Also, whenever I see a baby I get this urge to hold them and love on them. I even went through a phase shortly after moving out here where I honestly wanted to have a baby of my own. Of course that freaked Corey out and luckily I had enough sense to realize despite my strong desire to have a kid at that time, we were (and still are) in no position to be bringing a life into the world. Anyhow, that's all to say that despite my love for being around kids, I never thought I'd actually like having kids as patients. I always thought about all the poorly behaved kids and their over-bearing parents that we saw in the ER. But I've seen that was definitely not a correct characterization of pediatrics as a whole. There's just something about making a child smile when they are sick or calming them down when they are freaked out about the visit to the doctor that makes me smile.

So, now my list of "likes" is expanding. I've enjoyed every rotation I've been on and can see myself in each area (with the exception of psych - too much sadness/anger). And I haven't even done the big rotations (surgery, inpatient and outpatient). Oi - I'm in trouble! But, looking on the bright side, I can apply for all kinds of jobs and be happy with what I get, rather than being restricted to a couple areas because that's all that interested me, right?

Great Day!!

So my Monday morning started off knowing that TCU is ranked #4 in the BCS AND that ESPN's College GameDay will be broadcasting from my alma mater's campus on Saturday. Good start to the week, eh? Then traffic was light on the way in and I had time to get some hot tea from Starbucks before getting to work.

The morning was nothing exciting, but nothing terrible either. After lunch though was when it got really good. I did a well-child visit on a very chatty 6 year old boy with his rather humorous father in the room. It took some time because this little guy wanted to tell me story after story, and any question I asked him resulted in another story being told. Needless to say the history and physical took a bit longer than one usually does. One of the great things about being a student is I can take that time because they aren't expecting me to be super fast when it comes to seeing patients. After making it through all that and presenting to my preceptor she asked me to get some information for the father. As I went back in the room to give it to him he asked me if I was planning on going into pediatrics. I told him I was keeping my options open and wasn't really sure what I wanted to do. He told me if I did decide to work with kids he was sure I would be great at it - he could tell by the way I interacted with his son. Ooo-wee! I almost asked him to tell my preceptor the same thing but thought that my be kinda tacky (and who knows he may have mentioned it!)

So, I'm on cloud 9 right? Then, as my last patient of the day, I see a patient who probably has Kawasaki's Disease. It's funny because I remember learning about it in class and thinking I would never see a patient with it - Boy was I wrong! Kawasaki disease is interesting because scientists don't yet know what causes it. Pretty much it presents as a high fever lasting >5 days, red/swollen lips, rash including the hands and feet, conjunctivitis (irritation of the eyes), and enlarged lymph nodes in the neck. The most serious complication is development of vascular damage in the arteries supplying heart muscle which causes coronary aneurysms. It is the most common cause of acquired heart disease in kids younger than 5 (surpassing rheumatic heart disease - a complication from strep throat). So to diagnose this patient we ordered some labs that look at white and red blood cell count and markers of inflammation. Then we sent them to a cardiologist to get an echocardiogram done to look at the coronary arteries to determine if there is any inflammation or damage to them. If the diagnosis is made, the patient is started of IVIG (immunoglobulin) and high-dose aspirin to prevent damage to the coronary arteries. So cool! I'm pretty curious to find out if that is indeed the diagnosis.

And on another note - some more good news. My mom had her first chemo treatment last week and things are going well so far. She did have a bad reaction causing some problems with her hands and feet, but was able to take some meds which helped with that. She said she was feeling tired yesterday, and is having some metallic taste in her mouth, but all things considered seemed to be doing pretty well. Keep her and my dad in your thoughts and prayers please.

Would you like some cheese (and perspective) with that whine?

Talk about God's timing...just about 5 minutes after whining on Facebook about our inability to be in Ft. Worth for College GameDay's broadcast from TCU this weekend the NBC Nightly News comes on. And what's the first story? An update on the Ft Hood shootings in which the anchor talked about the deceased, wounded and their families as well as what the community is doing to lend a hand to all those affected by the senseless brutal acts of one man. Then there's a story about the 20th anniversary of the fall of the Berlin Wall and how restrictive and controlling the East German government was during the Cold War.

Talk about putting my life into perspective! I'm sitting around in my warm, comfortable apartment with my wonderful husband and crazy pup bemoaning my lack of time and funds to fly last minute to a college football game when there are parents, spouses, siblings and children mourning the loss of a loved one while survivors are wondering what happened and why they are the lucky ones to survive. And people in Germany are remembering the day that they were finally allowed to travel from one side of a city to the other without being stopped by guards or threatened with violence.

Thanks God for pointing out my silly and selfish ways. Sometimes I need to stop whining and start appreciating all that I've been blessed with!

Peds - not as easy as you'd think

So, I've been working in a private practice Peds office for the past two weeks, and - I've actually enjoyed myself! I was a little worried initially, thinking I would hate dealing with snotty-nosed kids and their parents. On the other hand, I absolutely LOVE working with little kiddos, so I thought maybe it wouldn't be too bad. Well, despite the snotty-noses and coughing all over me, the kids are adorable! Some are screamers, but surprisingly most are extremely well-behaved, especially considering most are sick and feel like poo. And then some are just downright cute :) However, I feel like the medicine is either boring or hard - not much in between. Often its just the run-of-the-mill flu, upper respiratory infection or well-child visits. But there's things you have to remember like congenital abnormalities and other illnesses that are unique to children. I always kind of thought as kids as miniature adults - not so! Luckily I don't give vaccinations to the kids, so at least I don't have to deal with pissed off kids after they get stuck with a couple needles :)

The biggest downside so far - I got sick. After only one week in the office I came down with a cold. Not a terrible one, but when commuting an average of one hour each way and not so short days, I was pretty exhausted all the time. Plus I felt bad sniffling while examining a patient. I did tell my preceptor that I wasn't going to see any of the kids under 2 months old because the risk of giving them my cold was just too high for my comfort. (I'm pretty sure she appreciated that) I finally kicked the cold after almost a week and having to take a day off. Still better than the flu, though! After seeing so many kids with presumed H1N1, I'm very glad I got my vaccine! Plus I've managed to stay away from pink eye so I'm pretty happy about that.

In other news, this week we found out that my sister-in-law (Tess) is most-likely having another girl for her 2nd child. The sono tech told them she was 75% sure it was a girl, but apparently the baby wouldn't spread her legs for the sono, so they are having another at the end of Nov to get confirmation. That means, come spring, I'll have 6 nieces (5 on my side and one from Corey's side)! That's a whole lot of estrogen! Now the question is, will Corey and I buck the trend and have all boys, or will we continue it with having a girl? That question won't be answered any time soon though - still lots for us to do before having babies!

Making Strides for Breast Cancer

This morning Corey, Kelli (a friend from school) and I walked in Making Strides for Breast Cancer Walk put on by the American Cancer Society. Thanks to extremely generous family and friends our team (Betty Benson's Fan Club) was able to raise $610 in only 2 1/2 weeks! Wow! I am amazed by people's willingness to give for such a wonderful cause.

At the walk there were several speakers - one of which was one of the lead researchers who brought Tamoxifen to the market for the treatment of breast cancer. He told the story of how it was initially developed as a birth control pill - but, although it prevented pregnancy in rats, it didn't work in the least for humans. The drug works to block estrogen at it's receptors. So this scientist thought - This drug blocks estrogen receptors and there are breast cancers which are fed by estrogen - perhaps this can work to treat those cancers. And this mistake was turned into a "miracle drug" which has saved thousands of women's lives. What an amazing story!

It was great to see all the people who were walking and the effort they put into the walk. Several were wearing costumes (it was Halloween after all). Others made team t-shirts which said who they were walking for. Some were decked out completely in pink - from a pink shirt, skirt, and tights to neon pink wigs with big pink sunglasses.

• A line of walkers
  

• Betty Benson's Fan Club:

• My wonderful husband who supports me in all I do:

• Walking for my mom!

Our Little Horned Frog Fan!

These are a few of my favorite things...

Raindrops on roses and whiskers on kittens.... :)

Seriously though, I was thinking this afternoon about stuff that I love so I decided to share the list (in no particular order):

• Coming home to a dog that is super excited to see me
• Seeing the leaves change brilliant shades of red, orange and yellow during fall
• Snow!
  
• Getting the Pottery Barn/Crate and Barrel/Williams-Sonoma catalog in the mail
• Getting my Cooking Light magazine in the mail
• Taking vacations
• Going home (CA or TX) to see family and friends
• Beautiful afternoons full of sun and warmth
• The feeling after finishing an exam
• Cookies, cakes, brownies, breads...anything baked and sweet!
• Baking sweet things ;)
• Playing with babies or kiddos
• Spending time with my hubby
• Going to the movies
• Reading a good book (been a while since I've been able to finish a book that's not school related)
• Exploring new places
• Hot chocolate from Starbucks
• The feeling of satisfaction after cleaning the apartment
• Grocery shopping (especially at Wegmans!)
• Road trips
• Watching Lacey do crazy stuff like attack the rug or run around like crazy
• Watching it rain/watching a storm roll in
• Seeing patients with cool illnesses
• Correctly diagnosing said patient with the cool illness
• Shopping - online and in store!
• The beach
• A good margarita or mojito
• Mexican food
• My hubby
• My 3 beautiful nieces (with two more on the way!)
  
• My wonderful family (including the in-laws!)
• Christmastime
  
• Listening to music
• .....
  

And the list could go on and on, but we'll stop there for now. Hope this brought a smile to your face! What are some of your favorite things?

Help me raise money for Breast Cancer

Tonight, I decided to join the Making Strides for Breast Cancer Walk in honor of my mom, which will be occurring in DC on October 31. Here's my website where you can go to join my team or donate money to my fundraising efforts. Thanks in advance for your support!

http://main.acsevents.org/site/TR/MakingStridesAgainstBreastCancer/MSABCFY10SouthAtlantic?px=13426084&pg=personal&fr_id=19952v

My ER rotation is close to being over :( I only have 5 shifts left before I move on to Peds at a private pediatric practice about an hour away. So far I've seen TONS of cool things in the ER. It's not a large trauma center, so the only trauma we see are patients involved in small car wrecks or injured joints after football/softball/field hockey (pick your sport) games. We have seen a lot of sick patients, though. I've seen a couple people in diabetic ketoacidosis which can be very dangerous for diabetic patients dependent on insulin. It's a very complicated, but fascinating disease process. I've also seen a couple of patients with infected gallbladders (cholecystitis) - one of which I diagnosed just after interviewing her and doing her physical (for which I got a nice compliment from my preceptor). I did get to place a couple sutures in a guy's finger which was cool. Unfortunately though, I haven't had the chance to do any other procedures. Hopefully that will change in the next week! Of course there's been tons of people (kids mostly) with "flu-like illness" which we are assuming is H1N1. Luckily (knock on wood) I have not come down with any of it as of yet! And, as of today, I've been vaccinated against seasonal flu and H1N1. I've never once gotten the flu vaccine, but I decided this year, with the daily close contact with sick patients, my chances of getting it and/or passing it along were just too high. Plus, working in the ER then peds at the beginning flu season means my risk is just that much higher!

I realized the other day just how lucky I've been so far in my training. I met a girl from another PA program who is only 2 months into the program and is extremely frustrated with what's going on within her program. She also told me she was told by a patient that they did not want to see her because she was a student. I have been fortunate thus far in that I haven't been turned away by any patients. I've also had the chance to educate several patients on what PAs are and what we do - hooray!

Finally, this article was published earlier this week ranking Physician Assistants as the #2 Best Job in America! Wahoo! I cannot wait to fully join the profession upon graduation :)

Sometimes I drive myself crazy...

• Like when there's kitchen full of food but I can't find anything to eat

• Or when my feet are freezing, but they get too hot when covered up
  

• When the house is dirty, but I can't motivate myself to clean it

• When I watch horrible daytime TV instead of studying/working on school stuff
  

• When I'm bored speechless, and I've got a zillion things to do at home or outside, but nothing seems enticing

• But mostly, when something's bothering me, but I don't have the guts to say something

Guess, I've got some things to work on :)

Back to work

Tomorrow I start back to work treating and caring for patients to whom I'm not related :) Over the last week I was fortunate enough to go home and be with my parents while my mom had surgery. The surgery went well and she is currently recovering at home with help from my aunt and dad. Once she's healed (another 3 weeks or so), she'll find out more about radiation and things of that sort. Now that it is October we are in Breast Cancer Awareness Month and it means even more to me than it ever has before. My mom was fortunate because she had regular screenings and the cancer was caught early. She also was lucky to live near a hospital with a specialized Breast Care Center and a renowned breast surgeon. I thank God for the ways things have turned out for her thus far.

I came back to the east coast Friday and have been able to unpack, clean, relax, recover from jet lag and spend some quality time with Corey before diving into the unpredictable shift work that comes with an ER rotation. Today we spent the morning driving west to an orchard to pick our own pumpkins. The drive was pleasant through some fall colors and the weather was great! We picked out 2 large pumpkins to carve and 2 "baby" pumpkins for decoration around the apartment.

• A view of the pumpkin patch full of great pumpkins!

• Our pumpkin "family" - the 2 big guys will be carved sometime this week
  

On the way home, we stopped off at a Farmer's Market and got some treats like apple butter, blackberry jam, produce and homemade dinner rolls. After all this, we made it home in time to watch Sunday afternoon football - which made Corey very happy. If only the Cowboys were able to pull off a win....oh well - still a great week overall. Looking forward to a great week full of exciting adventures in the ER!

Driving in DC

So, lately, I've had lots of thoughts regarding driving in and around our nation's capitol and I thought I would pass them along.

Driving into the city is one of the most amazing things to me, even after living here for over a year. It still makes me smile when I drive over the bridge from Arlington, VA into DC. First I pass the Iwo Jima Memorial, then I drive over the Potomac where I often see Georgetown's Crew team practicing. Then to my right is the Washington Memorial (see below) and to my left is the Kennedy Center and Georgetown's Waterfront. It's a great way to start the day, let me tell you!


This past month, I've been driving to the local children's hospital which requires that I drive through the city (as compared to driving to campus which is just on the other side of the river). When driving through it's pretty cool because it's like the city is just waking up, without all the crazy traffic and masses of pedestrians. Most restaurants and shops are closed, a few cabs are driving around, the garbage trucks are making their rounds and some early bird pedestrians are milling about.

Unfortunately, the afternoon/early evening is HORRIBLE! There is traffic and congestion on practically every road I have to take. And if there is ever an "incident" traffic backs up and things don't move. For example, the other day, a motorcade came down the street I was driving along. All these cars had to figure out how to get out of the way when there were a huge line of cars in front of them - not exactly an easy feat. Or, the big-rigs or delivery trucks that think nothing of taking up an entire lane during rush hour traffic on an already busy street. Or, how about the fact that it can take anywhere from 45 minutes to 2 hours to get home on any given day - oy! Those things can get super frustrating.

I always thought I would be afraid of driving in a city like this, but some sick part of me enjoys it. There's something about driving around, being able to navigate the one-way streets and dodging cabs and pedestrians that makes me smile. Plus, if I have to be stuck in traffic, DC has some pretty cool architecture, tree-lined streets and all those government buildings and monuments to look at. You can call me crazy, I'll understand :)

Oh Lacey

Our poor dog is absolutely crazy. Sometimes when we have the windows open in the bedroom and the sliding glass door to the balcony open wind blows through the apartment. And, if we don't make sure the bedroom door is held open with something it will sometimes slam shut. Well, this exact scenario happened this morning. Lacey barely escaped the door slamming shut on her and since then has been panicking. She's been pacing around the apartment going between Corey and I, for comfort, then will leave and just walk around in circles. She's walking around with her head and tail down and she won't sit down for longer than a few seconds at a time. I'm pretty sure she's gone bonkers...but we love her. Hopefully she gets over this scare pretty soon, because she's starting to make me anxious!

Manic Monday...and Tuesday...and Wednesday...and...and..

Who would have thought psych would be keeping me so busy? Well it has - my days start at 5:15 am when the alarm goes off and I've been making it home between 6:30 and 7 almost every night! The ridiculously long commute of 1.5-2 hours home doesn't exactly help make the days any shorter. But I am enjoying myself - for the most part.

I had somewhat of an emotional breakdown at work in front of the resident which, might I say was super embarassing, but things happen, right? It pretty much started with a patient who was so unbelievably rude to me for the entire time I was trying to interview her that it made me really angry. I told the fellow about it and how I felt I would have negative counter-transference toward the patient. The next morning in rounds, the resident made a comment to the effect of "Jodi doesn't really like X." To which I got defensive and blurted out that it wasn't that I didn't like her, just that she was so rude and disrespectful. He immediately told me he wasn't being critical just stating an observation. I hated that this patient could make me so upset and defensive about things. Later, I pulled the resident aside for advice on how to handle the patient in regards to setting boundaries, showing my anger/frustration, etc. While asking about this I got upset and he asked me what I was feeling. I tried to tell him I was frustrated and in the middle of it, burst into tears. The first thing out of his mouth was "This is powerful." Are you kidding?!? I just embarassed myself in front of you and that's what you say? He went on to explain that this was what's called projective identification - pretty much where a patient makes you feel how they feel by treating you a certain way. So, in other words, this patient was projecting feelings of frustration, anger and sadness on me, making me feel this way, despite the fact that she never said that was how she was feeling. Crazy stuff, I tell you! Of course after all this, the patient was being needy and asked to talk to me multiple times. Oy!

Backtracking - last weekend was great! On Thursday, Corey, Dianna and I met up with Amy, her mom and her aunt+uncle for dinner. We had a great dinner and had lots of laughs thanks to stories like Amy almost being trampled by a moose :) Then Friday after work, I had a birthday dinner with Corey, Dianna and Kirsten at a great Mexican restaurant nearby. We ended the night playing Yahtzee and watching Mamma Mia...kinda dorky, but lots of fun. On Saturday we packed up the car, drove down to Charlottesville, did a little tailgating, then watched TCU beat UVA in the first football game of the season. It was loads of fun, except the fact that we were surrounded by UVA fans - nonetheless we had GREAT seats thanks to Corey's bargaining power! Sunday I spent a birthday gift card to buy some work clothes - amazing how quickly you can spend money when buying nicer clothes.

Now I've got one week left in psych. Then I'm heading home for almost an entire week because my mom is having surgery. I'm really happy I'm able to make it home - thanks to my preceptor for the next rotation (ER) being unbelievably kind and flexible. Also, we were able to find a reasonably priced flight and the in-laws generously contributed a little financial aid. I'm really looking forward to the trip home, despite the circumstances. Please keep my family, my mom and her surgeons in your prayers.

Prozac makes the world go 'round...

Well, much to update on since the last post!

I've started my psychiatry rotation at an inpatient adolescent unit - needless to say I see lots of interesting stuff ranging from the first onset of schizophrenia to depression. I've also seen suicidality, anxiety, eating disorders and psychosis. Some of it breaks my heart to see, other stuff is just plain interesting. Being that adolescent inpatient psychiatry is a relatively small area, I will refrain from telling specific stories in the interest of patient privacy, but I'll definitely share my insights and experience as much as I can. The fellow on the unit is absolutely wonderful and the resident is great. My resident is the most passionate person I've met in a long time - he is fascinated by every single patient we see and absolutely loves teaching. Sometimes he's a bit over the top, but it makes work that much more enjoyable for all of us. In an "It's a Small World" incident we realized he went to college with my cousin at Brown and actually knows her. Crazy stuff! So far, the most important thing I've learned with this rotation is how normal my life has been up to this point. I have so much to be grateful for, but most of all I'm so lucky to have such wonderful parents who raised me in a caring, loving, and supportive environment.

For Labor Day weekend, Corey, Lacey and I drove down to SC to visit Crystal (my sister) and her family. She has a new dog so Lacey had a playmate for the weekend. Unfortunately they fought a decent amount of the time, but when they were playing they seemed to be having fun. Strange how animals can be. Lacey exhausted herself though because she slept the entire car trip home and has been asleep since we got home. Corey and I just spent time with my sister, her husband and their two kids. They have one more on the way, due in early January, so we spent some time at Target buying baby stuff - lots of fun! It's nice having family close enough for us to drive down for a weekend. While we were down there we visited Corey's cousin Adam who lives nearby. It turned out that his other cousin was down there visiting as well as Adam's girlfriend. We had a nice brunch with them on Sunday. It was great to get out of town for the weekend and visit with family, but it definitely made us miss Texas even more!

This next week is going to be extremely busy. Dianna (my college roomate) and Amy (my college friend) are coming into town on Thursday to go to the TCU football game! Friday is my birthday and Saturday is the game. Should be lots of fun!

On a more somber note, my family could use some prayer and positive thoughts. Without going into details, there are some health issues affecting one of my family members which will result in surgery at the end of the month. I would really appreciate it if you could keep my whole family in your thoughts and prayers.

Happy Birthday Alexis Belle

Today Miss Lexie is turning one! I'd say she is quite the miracle baby - born 1 lb 6 1/2 oz and 12 inches at less than 26 weeks gestation. She is now thriving beautifully :)


Shortly after her birth:

On our visit in July:

Happy Birthday Lacey!

Well today is not really her birthday - it was 2 days ago, but being a neglectful dog mom, I forgot. Here's the first picture of her we have:


When we picked her up from Oklahoma City she weighed barely 5 pounds and was shaking like a leaf. I remember the first night I had friends over for dinner, so I put her in her kennel in my bathroom to prevent her from going potty all over the apartment. She whined and wimpered the entire time.

Here are a couple pictures from her first day with her new family:


Over the time we've had her, she's been a source of lots of fun and joy and occasionally frustration. She is the smartest, most annoying and neurotic dog I've ever known. She loves playing with people and other dogs (still not realizing she's not one of the "big" dogs). I still say she is the best Christmas gift I've ever received.

And because she's so cute (not that I'm biased or anything) - here's some more pictures:

• With Corey's cousin's daughter (Christmas 2007):

• Her favorite place/position - asleep on the couch:
  

• Spending time with her buddy Jake in Hilton Head:

• Snow! In VA - March 2009

And, I took this just a few nights ago. I went into the bedroom looking for her to take her outside before bed and I find her like this:
She was just hanging out in her kennel - mind you we have not put her in her kennel in several months - usually we just close her in the bedroom. It was too cute not to take a picture.

On a different note: I finished my neurosurgery rotation alive and with my sanity! And, strangely enough, I really started enjoying it toward the end. Enough that I might even consider it as an area to eventually work in. Crazy, I know, but its pretty interesting and a great mix of OR, floor and ICU time. We shall see how things turn out... Monday I start my Behavioral Medicine (aka psych) rotation at Children's National Medical Center. I'll most likely be working on the inpatient adolescent unit so it should be interesting!

This is what greeted me when I got home today - an amazing storm rolling in...I'd say this makes for a great night! Today was one of the best days of my rotation so far. Not that I did anything that exciting, but some great stuff happened. First, I got to scrub in on a great case - it was a cranioplasty with a custom made synthetic bone flap. This company used the patient's CT scan to reconstruct a 3D model of their skull, then made a synthetic bone fragment to fit perfectly over the defect. It was so cool! And the new fragment was see-through so after screwing it on you could still see the brain underneath - kinda like a window! Then this afternoon the chief resident complimented me, tried to convince me to be a neurosurgery PA, and told me to call him when I got closer to graduating to talk about job opportunities...all this in front of 2 med students and another resident. And to top it off we got to leave at 4:30. All in all an excellent day!

I only have 3 shifts left, and am having quite mixed emotions. I'm excited to have more normal hours and to not wake up at 3am everyday. But I also feel like I'm just now getting to know the whole team and getting the hang of things. I'm really starting to have fun and am learning alot! I have a feeling this will be the storyline of the year - get used to and start really enjoying what I'm doing only to finish a week later. I guess I'll get used to it :)

Well, I didn't get to scrub in on the temporal lobectomy the other day because 2 other students already wanted to. Instead, I scrubbed in with a different MD doing a total corpectomy with cage insertion, which is where they remove an entire vertebral body and replace it with a titanium insert. This was done because the patient had pretty shattered one of their vertebrae. I was the only person assisting so I got to help a decent amount. He even let me put in one of the screws :)

This week has been pretty crazy because we are short a resident and they've had meetings/lectures this week. Also, yesterday it seemed like things just exploded around us. We were in the OR all day with the exception of a 30 minute lunch break. One of my residents was in the OR yesterday from 9pm til 5 this morning. Then she stayed to round with us and get stuff done on the floor. And I thought my hours sucked!

11 days down, 7 to go...

Not that I'm counting or anything :) Today wasn't too bad, but wasn't great either. The best part of the day was leaving just after 4pm - which is completely unheard of around here! My weekend was wonderful - in case you were curious. Saturday treated me with over 14 hours of sleep between going to bed at 8pm on Friday and getting a 4 hour nap Saturday afternoon. It felt great to catch up on some lost sleep. But, of course, I'm already feeling sleep deprived and it's only Monday night. There's a visiting lecturer from Italy here this week giving lectures about stuff I don't understand with a thick accent...it makes it really hard to stay awake. But at the same time I know I'm in the presence of a ridiculously smart man, so I'm trying my best to be respectful and attentive. Maybe tomorrow I'll understand a little more of his lecture topic.

Tomorrow should be interesting - I get to be a part of a temporal lobectomy with the head honcho of the neurosurgery dept. There won't be any residents around (at least for the first several hours) so maybe us lowly students will get our hands in the action...we shall see.

Now it's off to bed...

TGIF!

Oh goodness - it was a long week, but a good week. Despite a couple rough moments, the last couple days have been pretty good. I got to see an encephalocele repair yesterday. It wasn't that cool to watch because it was all endoscopic (through the nose with a little camera) but it is an interesting condition. Basically it is when a piece of brain herniates through a broken or dessicated bone in the skull. The herniated part becomes necrotic (dies) and sometimes the layers surrounding the brain can have a tear and leak cerebrospinal fluid into the nose or mouth. This patient had a tear in one of her sinuses, so she was have symptoms of chronic sinusitis for months until an ENT thought to check the type of fluid coming from her nose.

Today I watched a cranioplasty, which is when they place a bone flap or mesh matrix to cover the brain where a piece of the skull has been removed. When patients have brain bleeds pressure builds up quickly within the skull compressing the brain which can lead to permanent neurological damage and even death. To treat it the neurosurgeons will often remove a flap of bone in a procedure called a craniectomy. If the bleeding is not localized to one area where it can be easily removed, the flap is left off and the scalp is closed. They do this to allow the pressure to remain low. Eventually (months to years later) they will replace the bone flap, which has been stored in a sterile freezer for the patient. So this patient had a craniectomy decades ago and had a defect in her skull where the bone flap was never replaced. Since she had no protection over a portion of her brain, she was at a high risk for traumatic brain injury from even the slightest head injury. The surgeon cut down to the brain, exposing the edges of the bone that was still present, placed the mesh and screwed it into the skull, then closed her head up. One of the coolest things about this case was that you could see her scalp pulsating where the bone was missing.

This week was better than last because I actually feel like I know a little more about what's going on and what is expected of me. Also I've been getting to know the residents a little more and they seem to be warming up to us. Two of the med students I've been working with are moving on to a 2 week neurology rotation and me and a 3rd year are continuing. I've been pretty lucky to work with some great med students. The four of us got along really well which made the long days more bearable. We should be getting a new med student Monday which will be cool.

And to top everything off, I got off before 5 today and made it home at a reasonable hour :) Now I'm going to spend some time with my favorite person in the world this weekend and try to get some things done around the house. Perhaps I'll finally make this banana bread I've been planning to make for a couple weeks...

Rough day

Today seemed to be all about God reminding of the not so pretty side of medicine. Our team had to tell a man that his wife of over 50 years was essentially brain dead and surgery would be futile. He never questioned a single thing the resident said, and at the end of the discussion told us that he trusted our opinion. A few hours later his wife was taken off the vent and she passed away.

Then we diagnosed an extremely fit man in his low fifties with a serious brain tumor that usually carries a prognosis of 1 year or less. But he doesn't know his prognosis yet because the official pathology report isn't back, so no one wants to give him the news. It's amazing that this man was feeling just fine a week ago until he started having a few relatively minor symptoms which have since resolved. Now he will be receiving the news that he has one year to live.

Then a man who we'd just released one week after surgery came back to the ER for worsening symptoms and his poor family was just exasperated and exhausted.

I guess all this is just a reminder that medicine can cure a lot of ailments, but we can't fix it all. It's easy to celebrate the victories, but it's not so easy to accept the losses. Perhaps it's all part of the education process. As much as I hope to be able to take the negative aspects in stride, I pray that I never become immune to the feelings involved. If it ever becomes easy for me to tell a man his wife is dead or another man that he has less than one year to live, then it's time for me to leave medicine. I won't practice medicine if I can't do it with care and compassion.

Neurosurgery for Dummies

Right now I'm on my elective rotation and for some unknown reason I "elected" to do neurosugery. Last week was my first of 4 weeks there. My days consist of waking up at 3am to leave the house by 3:45. I see my patients before rounding with the residents at 5:30. Then the team of 10 rounds with the attending before heading off to see pre-op patients. The rest of the morning is usually spent in the OR watching various kinds of surgeries. So far I've seen an aneurysm repair, 2 brain tumor resections, 2 herniated disc excisions, a cervical spine fusion, and the insertion of an intrathecal (inside the sac surrounding the spinal cord) pump for medications. The afternoons are either spent in the OR or on the floor tending to patients and preparing them for discharge if possible. We then round one more time, finish up what's left to be ordered/done for patients and then go home around 6pm. Needless to say, the days are long and extremely tiring. My feet, knees, and back usually ache and my mind is numb. I get a couple hours to have dinner and spend time with Corey and Lacey before its off to bed (hopefully by 9 or 9:30).

Things I've learned so far: it's FREEZING in the OR (especially on the microscopic surgeries where the overhead lights are off), I can function before the sun comes up with enough caffiene, my 10 hour shifts as a scribe were a piece of cake, brain surgery is kinda violent, I'll never get used to the smell of burning flesh, the brain bleeds a lot when being cut into, and I know nothing about neuroanatomy. I've also learned how to remove central lines, staples, and JP drains (so now I can properly do the scut work for the residents).

It's exhausting and frustrating at times, but I'm already 1/4th of the way through and I'm determined to make the most of it. Now I must go finish reading the 70 page manual they gave us chock-full on everything a student needs to know about neurosurgery...

Welcome

While at the hospital earlier this week, I thought it would be fun to blog about my experiences on rotations. Since we are so busy and will continue to be busy, I thought it would be a great way to allow our friends and family to keep up with our life (if they care to do so). So, here it is - I hope you enjoy!