Catching Up

So , I haven't blogged in.. a long time. Apparently, since August when I discussed the Mosque Debate that was going on at the time in New York.

I'll go ahead and summarize what's been happening in my life, of course with as many pictures as possible and extra length for things that take up extra brain space for me.

Infectious Disease (September)
Originally I was attempting to get an away rotation/elective in Infectious Diseases in New York but vaccines, yes vaccines got in the way. That's right, Jenny McCarthy was right, vaccines not only cause Autism but ruin lives in general. NO, that's totally wrong. Jenny McCarthy has her attention misplaced much to the detriment of Autistic and Unimmunized children in America, I'll expand on that later..

Back to my vaccines. I never got chicken pox as a child. Blame my nurse mother or my introverted, outcasted schoolage version of Robert, Robert -2.0.


Therefore I had to get a varicella titer. Turns out my titer was 0. Zero. Nil. No more anti-varicella antibodies in me. So I needed a booster, which I got a bit too late. It'd take weeks to months to change my titers and I gave up. Plus I found out my insurance wouldn't cover labs, later I found out said insurance wouldn't cover me, being 25 and somehow stuck in a noncoverage gap.

Oh Frustration.

Immune status, FAIL.

So instead of spending time in my favorite city, I teamed up with our ID Doc @ my home hospital. This was fun because I was able to function at several levels. Initially I backed up the intern on ID and we split patients. Then our intern switched to another doc and I became a sort of resident intern working with a visiting student. The ID team is like the super internal medicine team. We're consulted when the main teams , be it ortho, surgery, internal med can't figure out what drug to use or what's causing the fever, etc. Ask a couple questions, draw on some people's legs. ( I love outlining cellulitis legs because you get to draw on people) , and then round with the attending in the afternoon or night.

I had lots of fun on ID. I liked thinking at a different level and doing a careful review of the patient as a whole to try and pinpoint the reason why we were consulted. At one point , I considered this as a career option, but not so much anymore.

Pediatric Cardiology (October- 4 weeks and December (@ home) - 2 weeks)

This rotation probably was the hardest I will work all of 4th year. This was my favoritest rotation.

First, I started off kinda rough. I didn't really have a schedule to begin with, so I kinda floated around for the first week. At first, it seemed intimidating being the only student in a congenital heart clinic. My attendings were as follows (all Peds cardio):

Maternal/Fetal Echo Mainly
Electrophysiology/Syncope/Chest Pain
Interventional
Echos/ Regular
Peds Cardiac Intensivists


Second, I'm used to guessing my way to an answer or making assumptions and whittling my way to an answer and my attending wasn't having any of that. So I realized I'd have to quickly learn my way around murmurs, a good physical exam, EKGs, etc. And I did. By week 3, I could skim an EKG, diagnose a murmur and even guess a diagnosis, work up chest pain/syncope and counsel like nobody's business.

The attendings eventually were won over by me. I find that if I prepare with reading and come in with a smile, I can win most anyone ever. I loved my peds cardio patients loads. A sampling of the things I saw:

Kabuki Syndrome: In essence it's a congenital condition that can involve cardiac conditions, hearing defects, mental retardation, growth retardation, etc. The syndrome is named as the children take on the appearance of a "kabuki" doll. My little guy was super cool, playful (interestingly, 50% are described as unusually playful). We played with toys as the cardiologist counseled the parents.


HLHS: B-T (Or Sano) , Norwood, Atrial Septostomy followed by Glenn followed by Fontan. This is one of the more amazing patients to follow on peds cardio. The Hypoplastic left heart kids and friends (friends being the various kids who have shunts for reasons like atresias, etc) In short, with the use of gortex, some fancy stitching , connect the aorta to the right/single ventricle. You shunt blood into the pulmonary arteries , patch it here and there as the kiddo grows, hopefully you outpace the inevitable cirrhosis.




The Tet Kids. Patch this, band that, call it a day and wait it out. I do have a story that warms my heart a wee bit. Please indulge me. So I was working with the E-P doc and NP doing stress tests. A cute little blonde teenage girl with ToF comes in for a stress test to determine the nature of her dyspnea and sats. So there goes the stress test, it finishes and the girl sits down.

A few minutes in , she starts crying. We ask her what happened? She says " I want to go to college." We realize that for whatever reason, she thought she was going to get bad news, that she wouldn't live to college years.

The EP Doc in a very classic Dr. N way (Dr. N has these phrases he uses to relate to adolescents and he uses them consistently and somewhat awkwardly) goes, well the only thing that'd keep you from college would be your SATs and grades...

Then he follows up with his old adage. As far as your heart goes, it's fine.. but I can't say a boy won't break it.....

Syncope/ Chest Pain

So I know what you're thinking. First, what does Gatorade have to do with Syncope. Second, what kind of innuendo is gatorade aiming for here. Young female athlete perspiring selectively in her "thorax" area.

Vasovagal syncope, the body's inability to restore homestasis in the setting of orthostatic changes and stress. (At least that's my definition) For my teenagers, basically your tank ain't full and your pumper aint pumping appropriately so your brain says woah and your body says get low.. and ya faint or feel faint rather. So to fix this, you keep your tank full with some gatorade, before , during and after sports and in hot weather , even without sports. With further dysfunction such as the autonomic dysfunction of Pott's syndrome, you might throw in some mineralocorticoids such as Florinef (fludricortisone) and vasoconstrictors to clamp the vessels a little.

And lastly, a review on Marfan's. Many of us have read up on the Marfanoid appearance. The pectus chest, the long limbs, the lens dislocation, the MVP, the joint laxity, hyperextension, scoliosis, elastic vessel changes.


So we saw a young man who looks Marfenoid but the genetic tests were all negative but we were keeping an eye on him for his aortic root dilatation.

Cool kid, basically got to d/c his beta blocker and say: Sports, have it chap!



























And lastly, lastly. Autism and Vaccines

I could rant about this for hours and hours. But here's my line. Vaccines do not cause autism. There is the possibility that they might trigger an underlying disorder but that's like blaming someone who steps on a remote mine for the explosion, sure they set it off, but they didn't put it there.

I read a really great book about the whole "link" and the publicity and Jenny McCarthy's campaign.

Take home message: We will see a resurgence of diseases such as Measles, Mumps, Rubella, Rotavirus, Influenza, etc.


Sure, there have been circumstances where Rotavirus vaccines had been pulled off the market for an increased rate of intussusception and then there's the Guillain-Barré syndrome warnings.

From the CDC:

What happened in 1976 with GBS and the swine flu vaccine?

Scientists first reported a suspected link between GBS and vaccinations in 1976, during a national campaign to vaccinate people against a swine flu virus. The investigation found that vaccine recipients had a higher risk for GBS than those who were not vaccinated (about 1 additional case occurred per 100,000 people vaccinated). Given this association, and the fact that the swine flu disease was limited, the vaccination program was stopped.
Since then, numerous studies have been done to evaluate if other flu vaccines were associated with GBS. In most studies, no association was found, but two studies suggested that approximately 1 additional person out of 1 million vaccinated people may be at risk for GBS associated with the seasonal influenza vaccine.

Well that's that. You've been updated. To follow: Med-Peds, the journey... where I talk about Med-Peds and the interview trail and why I chose this path for residency.