Great Weekend

One of my best friends from high school came to visit me in SF last weekend, and we drove to check out Stanford Business School for him before going to an 80s cover band concert on Friday night. The next morning, we biked around the perimeter of Angel Island, which was reachable by ferry and surprisingly lovely. The bike ride took about 1.5 hours, and the best part was how you could get a 360 degree view of San Francisco bay and how each part of the path gave you a slightly different by no less breathtaking view of the colorful houses, blue water, and white sailboats. I liked how the scenic view changed as you labored around the island, the changing nature was perhaps one of my favorite parts. It's weird, I told Leo, how after we visited Alcatraz 2 years ago, that I would not visit Alcatraz more than once, but I would definitely visit Angel Island again.

On Sunday, we visited Napa and tasted wine at Freemark Abbey, Louis Martini (hands down the best cabs in terms of taste & value, all 5 wines were amazing and I couldn't dump a single drop), V Sattui, Mondavi, and Opus One (ridiculous and excellent $30 tasting of one extremely hyped- up wine). We also saw the view from Artesa.

Today in medicine, it made me happy to think that only yesterday I was in Napa. :-)

Gone Baby Gone II

Learned from a fellow medical student that the baby from my first delivery ever died a few weeks ago. It was a huge jolt, because I never expected the baby to die, even though his Apgars (assigned by me after some review with the peds team) were 3, 4, and 6. I assumed that he was going to make it after watching him for almost 10 hours after he was born, and now he has become my first peds patient to pass away.

Peds vs. Surgery

Notable quotes

...from peds: a boy in clinic with penis pain says that his "peanuts" hurts...Awww!

...from a friend in surgery: a resident who barks, "THERE'S NO TIME FOR TEACHING, ONLY LEARNING."

Pausch's Last Lecture

Four days of fever, 1 day of sore throat, and 1 day of recovery (6 days total) and I'm back to baseline....wow, that took way longer than expected. :( I'm a little bummed that my 2-week summer vacation was cut in half by a pediatric viral illness, but I'm glad that it happened at a "convenient" time (so to speak) when there was not much going on and no patients to see.

Talking to my roommate made me realize that there are different senses of the word "sick," there's the conversational "sick" when you have sniffles or a mild URI. Then there's the second-level "sick," when you can't get out of bed and feel truly miserable and incapacitated for a short while and remember how much it sucks to not be healthy. There's also "sick" in the sense of mental illness, which is chronic and difficult to describe and quantify, and there's also the profound sense of "sick," usually earning you that "coveted" admission to the hospital because one of your organs is failing, or you need surgery with dorky UC med students watching, or sometimes because you are dying.

Most people on the web have heard of Randy Pausch, PhD, the professor at Carnegie Mellon University dying from pancreatic cancer who gave a stirring "Last Lecture" about life lessons. A few months ago, I learned about him from an interview in Time magazine, but didn't bother to Google his lecture until a friend in pharmacy school told me about it in the laundry room today. You can watch it on Google videos, it's a bit long (76 minutes), but worth the investment.

Naturally, I was interested because Randy is a pancreatic cancer patient, and if you don't read my blog that often, I am interested in pancreatic cancer research. Different cancers have different mortality rates, but pancreatic cancer remains a fearsome predator among cancers with a median survival of 6 months depending on how far the tumor spreads.

Oncology keeps drawing me closer, but still no idea. I told my friend in the laundry room that I'm interested in oncology because it's work that continually reminds me by its very nature why I am working and what really matters in this life. Somehow, by working with pancreatic cancer patients who continually face this duel with death, I feel like oncology motivates me to work even harder and with more purpose. Paradoxically and more importantly, oncology also simultaneously inspires me to appreciate everything non-work related in life -- family, friends, food, food, creature comforts, beautiful moments, holidays, and the ease of health. How can anything else teach me so elegantly to value both work and everything non-work?

Dr. Pausch's video: http://video.google.com/videoplay?docid=-5700431505846055184
Dr. Pausch's homepage: http://download.srv.cs.cmu.edu/~pausch/

Happy Graduation, Matthew!

My little brother Matthew is graduating from Arcadia High School today!

Congratulations, Matthew!

Pictured with his prom date, but don't worry ladies, he's single! (as far as we know)

Coxsuckie

Did you know...?

From Wiki: "The Coxsackie viruses were discovered in 1948-49 by Gilbert Dalldorf, a scientist working at the New York State Department of Health in Albany, New York. Dr. Dalldorf, in collaboration with Grace Sickles, had been searching for a cure for the dreaded disease polio. Earlier work Dalldorf had done in monkeys suggested that fluid collected from a non-polio virus preparation could protect against the crippling effects of polio. Using newborn mice as a vehicle, Dalldorf attempted to isolate such protective viruses from the feces of polio patients. In carrying out these experiments, he discovered viruses that often mimicked mild or nonparalytic polio. The virus family he discovered was eventually given the name Coxsackie, for the town of Coxsackie, New York, a small town on the Hudson River where Dalldorf had obtained the first fecal specimens."

There's also a good Wiki clinical description:
"The most well known Coxsackie A disease is hand, foot and mouth disease (unrelated to foot and mouth disease), a common childhood illness which affect mostly children aged 10 or under[1], often produced by Coxsackie A16. In most cases infection is asymptomatic or causes only mild symptoms. In others, infection produces short-lived (7-10 days) fever and painful blisters in the mouth (a condition known as herpangina), on the palms and fingers of the hand, or on the soles of the feet. There can also be blisters in the throat, or on or above the tonsils. Adults can also be affected. The rash, which can appear several days after high temperature and painful sore throat, can be itchy and painful, especially on the hands/fingers and bottom of feet."

It should really be called Coxsuckie!!

The Other Foot-in-Mouth Disease

First day of my 2-week vacation and I come down with a 101.8 degree fever, mouth sore, and sore throat.

Today I woke up hoping it would be better, but I'm still sweating enough to fill a small swimming pool, must have caught something from the kiddos in pediatrics. Couldn't make it to my longitudinal clerkship in radiation oncology, but it's probably better not to give a virus to cancer patients getting chemotherapy. Stumbled into Student Health Services (SHS) this afternoon with a fever of 102.6 F, sore throat, apthous ulcer, and slightly bleeding gums. Since I just completed my pediatrics clerkship, my differential included strep throat and hand-foot-and-mouth disease (Coxsackie virus A).

As a kid, I remember getting HFMD with my siblings, and how I thought that it was called "Foot in Mouth Disease," and felt confused because that was supposed to mean something else...

Rapid strep test was negative (but you would still order a culture if your suspicions were strong), and the doctor said it was probably HFMD. The disease lasts 7-10 days (good use of vacation, eh?), and includes fever, sore throat, oral ulcers, and itchy vesicles on your hands and feet. Not all presentations have the full hand-foot-mouth thing.

My fever has been running pretty high these past 3 days, and i've been doing some reading on the internet to see if tylenol vs. motrin (ibuprofen) is better as a fever reducers. Some studies say ibuprofen, some say alternating both drugs works best.

Heal Thyself

Came down with a 101.7 F fever last night...must have caught something from the kiddos. I sat on the couch for a good 20 minutes before I realized, "Hey, I could be taking an antipyretic right now." So I took Tylenol, but at the clinic we always give feverish kids ibuprofen, I wonder which one works better for fevers. Another useful thing that I learned in peds is that fevers burn off a lot of water, so you have to rehydrate mucho -- and that dehydrated kids will decompensate a lot faster and with less warning than adults do.

Woke up this morning with a fever of 101.8 F...Arghhh.

My First Peds Patient in WBN

Baby Sierra (with permission)

Cancer Stem Cell Symposium

Recently found out that I missed a cancer stem cell symposium at UCSF...bummer.

http://cancer.ucsf.edu/symposium2008/

Education > Contraception

On adolescents: "An increase in the number of years of schooling for a woman delays the age at which a woman marries and has her first child."

Seriously?

What about men?

Smegma

Attendings throw around the word "smegma" occasionally in clinic, and I assumed that it was a slang term for secretory accumulations of "schtuff," but apparently it's an actual scientific term. Mmm, gross!

From Wikipedia:
"Smegma, a transliteration of the Greek word σμήγμα for sebum, is a combination of exfoliated (shed) epithelial cells, transudated skin oils, and moisture, and can accumulate under the foreskin of males and within the vulva of females. It has a characteristic strong odor. Smegma is common to all mammals, male and female. Mycobacterium smegmatis is the characteristic bacterium involved in smegma production, and is generally thought to form smegma from epidermal secretions."

Anti-Babies

Intern: "Baby M and Baby M2 are the anti-babies...don't put them together or they'll explode."