Differential

So....here's a list of some things that are plaguing me:

Pink, shiny papule right below my left clavicle....probably a basal cell.
Rough, scaly skin just distal to afore mentioned papule....potentially actinic keratosis, or squamous cell.
When I lay down to sleep at night, I can feel my abdominal aorta pulsating strongly - probably an AAA.
Random chest pain - most likely prinzmetal angina.
Occasional pain in the region of my right scapula....gall bladder must be acting up.
My left leg has been aching lately. Feels like bone pain. I don't think I'm growing anymore, so that leaves me with bone cancer.
I clear my throat a lot, as do my mom and grandma. I think we've all got silent GERD. Probably erosive esophagitis too.
I'm pretty sure my panic disorder is resolving - I can drive on the highway again, thank you very much - but I think I may have developed a little OCD. I check to make sure that things are unplugged or off SEVERAL times before I leave the house because I don't want my house to burn down, incinerating my animals. Completely rational, right? Thought so.
I could probably make a case for IBS, IBD, Crohn's or UC, but I'll leave those details to your imagination.

That's if for now. I would hate me if I were my patient.

I know I shouldn't

Sometimes when I get bored with studying, I check out petfinder.com. I realize that this is probably not the smartest thing to do because, well, I seem to have a knack for accumulating animals. And I live in a tiny little house that requires daily vacuuming to combat the hairballs that flow freely across the floor. So...I know, I know, I know, but is this not the cutest little peanut you've ever seen?

http://www.petfinder.com/petnote/displaypet.cgi?petid=11793234

This is Gus and he's available for adoption here in KC. Just look at that widdle face! I told Danny that we should probably go and visit him....you know, just to say hi and give him some love. He then reminded me what happened the last time we went to "visit" an animal rescue: this guy came home with us.....

....and our lives were complete :)

The most awesome thing I've heard in a while

"I'm having trouble with testicles today."
-Anonymous Pediatric Attending

HI

I haven't blogged in a few weeks, so I thought I should, even though I don't really have anything important to say.

Hmmmm....So I've been working at a family medicine clinic for the past 5 weeks. I went into FM thinking that I'd get bored with the sore throats and the diabetes and the hypertension, but I've actually really enjoyed this rotation. I've been there for the birth of two babies, one c-section and one vaginal (drugs please!), and I've seen a ton of different things from warts to minimal change disease, catatonic sleep disorders, autism, and someone my age recovering from a stroke.

I'm really kind of surprised at the number of patients that I see who are on anti-depressants. If I had to guess, I would say that upwards of 60% are on them. And while some are on them for generalized anxiety, panic disorders and chronic pain, a good number are on them for, well duh, depression. Don't get me wrong, I'm definitely a fan of any medication that can make you feel better and function like a normal human being, but I wonder if some emotional stresses in life are necessary, or even good. We had a patient recently who was on an SSRI over the summer because she was going on vacation with her in-laws. Um, yeah. Really? Really? This just seems a little ridiculous. We were created with emotions for a reason. Some things should make you sad, some situations should make you anxious. It is unsettling to me that there are so many people out there facing life with a drug-induced faux-happiness because they decided they didn't want to deal with a normal life situation. Again....I totally support those who take any sort of drug for actual problems: depression/anxiety/OCD or otherwise. In-laws don't count.

Something else I find slightly upsetting. Kids are now getting a vaccine for chicken pox. Okay, so medically speaking this makes sense, but chicken pox is a right 0f passage for Pete's sake! It was such a big deal when I was a kid. I remember my mom trying to get me exposed over the summer so I wouldn't miss any school. She made me share some pumpkin ice cream at Maggie Moo's with Megan Amos when I was about 6 because Megan was infected and my mom thought that it would be a good time for me to get sick. That strategy failed and I didn't get the chicken pox until third grade. But it was exciting! The pursuit of chicken pox.....finally seeing that first pock mark....watching as they spread....trying desperately not to scratch them.....counting my pocks in an attempt to one-up my friends. Then sharing my tales of battle, "I had 'em bad in my throat! Had to eat popsicles all day." "Oh yeah, well my mom counted 5,000 on my back alone!" I would imagine that I am not alone in my fear that we are somehow disservicing today's youth by sheltering them the experience of chicken pox. It's like a first kiss or learning to drive a car....not necessarily the best experience of your life, maybe even a little painful, embarrassing or dangerous, but necessary and memorable. Okay....now I've worked myself up into a tizzy. Where is my Xanax? (This is the funny thing....I actually have some in my kitchen. But I haven't taken any. Thanks Rach.)

Team Aniston

Do you have one of those people who you would consider your arch nemesis? The bain of your existence? The Mizzou to your Jayhawk, the Joker to your Batman, the Jolie to your Aniston? I had one. Up until a week ago, that is.

You see, there's this girl....we'll call her "Angelina." She had a leading role in something that happened about 4 years ago that essentially crushed my soul. Seriously....not exaggerating. On a scale from 1-10, this was a 10 on the crap-o-meter of life. So anyway....I've been wrestling with anger and hurt and resentment toward this person (and the situation in general) for a long time. In the past year or so, I felt like I'd come to a place of forgiveness. This was an internal thing and I thought that it would just have to stay that way because the receiver of the forgiveness lived in New York and, shoot, I would probably never see her again. And I wasn't about to call her up or offer her my forgiveness and well wishes over facebook. She would just have to feel the vibes coming from my direction.

A week ago Danny and I were walking around on the Plaza and decided to go to Scooters for a drink. I got mine first and was meandering around the store waiting for Danny to get his drink. I saw a girl with a USMLE First Aid book and was contemplating introducing myself to her when I heard a voice from the other side of the store say hi to Danny. I was interested to see who it was because I always enjoy running into friends. So with a preemptive smile on my face I looked around a sign that was between me and the voice, (Insert sound of screeching record here.......then crickets chirping) It was her....ANGE-frickin-LINA! UGH! Even though I'd forgiven her in my soul (that was once crushed by her - let me remind you :) I was not ready for this moment. I mean for real! The girl lived in New York, I shouldn't have to worry about running into her on the cotton-picking PLAZA! So my sympathetic nervous system kicked in big time and I literally had a fight or flight moment. Seriously, I'd be lying to you if I said I didn't consider jumping over the table and strangling her skinny little neck. But I didn't....I turned around and hauled my arss right out of there, thank you very much! Then I thought about finding a bathroom so I could wretch a few times.

As I was scampering away, I heard a voice behind me calling my name.
Dang woman! Why can't you just leave me be?
At first I pretended that I didn't hear her, but reluctantly conceded to her beckoning and stood there in the middle of the sidewalk as she opened her heart and apologized. She had attempted this feat in the past, but this time was different. I could tell that this time she was sincere. She'd grown up a bit, she'd gotten married and she now realized how hurtful her actions had been all those years ago. And there, face to face, I was able to tell her that I had forgiven her.

Not exactly the leisurely, carefree day that I had planned on, but that's okay. This was something that needed to happen and when it did, a huge weight was lifted and I was a little bit more okay than I'd been in a while.

Plaster and Pig Feet

I finally learned to put stitches in last week. Very exciting....especially for an A personality freak like me. Making the stitches line up at perfectly congruent angles is a thing of beauty. Even if it's only on a pig's foot.

After stitching up the little piggies, we learned how to cast. Also very exciting. Kind of reminded me of pottery class. Here's a picture of my friend Kelli and the beautiful cast I made her.

Third Year

Today I finished the fifth week of my third year. I can't believe how fast the time is going! Third year is so different from and so much better than the first two years. The first two years are kind of starting to feel like a distant memory to me (I think the therapy is helping).

Anyway, here are a few observations/thoughts/ramblings about my first 5 weeks:

Nursing home - Everyone....EVERYONE is on antidepressants. Living in a nursing home + hypertension + diabetes + stroke + parkinsons + memory loss + incontinence = sad people. Why not hand out a few happy pills? Oh, and the nurses seem to be less than thrilled to help med students with.....anything.

VA wound clinic - Lots of wounds. Venous stasis wounds, diabetic foot ulcers, gun shot wounds (I'm so street). There are a lot of people here who just don't take great care of themselves. If your sugars are out of control, you're not taking your lasix, you're not trying to lose weight, well, your wound just might hang around for a while. Interesting fact: nicely healing venous stasis ulcers look a lot like ahi tuna. Yum!

Hospice House - It's amazing how the body can tell you when death is knocking.

Pulmonary clinic - "Pickwickian Syndrome" essentially a fancy way to say, "Hey buddy, you're too fat to breathe!" If your BMI is, oh say, 106, then you might fall into this category.
Favorite moment from pulm: GI/hepatology attending walks up to fellow med student, asks if he's a med student, then preceedes to steal his stethoscope. I wish he had asked me for mine....it's pink :)

Rheumatology - They are trying to KILL me. Most clinics have regular hours, even get done early some days. Not so in rheumatology. The last patient is usually scheduled at 3:30 or 4:00. We're lucky if we get to them by 6:00. That's right! We're horrible people who love to make you sit in a little room and WAIT! Haaaaaaa! Suckers!!!!! Totally kidding. If we don't see you untill 6:00, we don't get to go home until 6:45.

Also slightly frustrating because the attending expects me to know everything he knows about his patients who he's been following for 15 years. Seriously???? I've got 20 minutes to see a patient and read through the novel (sometimes 2 volumes) that is the patient's chart. Difficult. Maddening. I don't like novels, or books in general for that matter. I don't like to read. Here's a fun fact - the smarties that assess USMLE practice tests thought that I might have an undiagnosed reading issue. Does anyone have the phone number for one of those Sylvan learning centers?

General Med - You see a lot of everything here. I saw some nasty feet today. For a split second I kind of thought I might throw up. The toenails were a lovely shade of yellow and appeared to be growing in thickness instead of in length. There was some funky stuff all up under the nails too. Then there was a nice, thick layer of dead, calloused skin covering both heels which the patient claimed underwent shaving on occasion. Oh, and they smelled rather badly. I went to put the patients socks back on, and the afore mentioned toenails snagged on the socks like fingernails on a chalk board . Man....I sure am concerned about those diabetic foot ulcers. Look how much I CARE!!!!

Okay, I'm going to go wash my hands now, again, for the 500th time since the foot incident.

I'm back.

One more observation: There are sneaky little 4th years, posing as third years whose only purpose in life is to make me look dumb. These 4th years, for whatever reason, have a third year clinical rotation that they have yet to complete. This may be because they've taken time off, decided to push their boards back, or they may have failed a rotation....or boards. Unfortunately the attendings assume that we're all at the same point in our education, but in reality these 4th years have a whole year of clinical experience on us. So they know the tricks....they know how to give a good presentation. They flaunt their skillz but keep mum about their fourth year status. I may have to blow their cover.