My neuro ICU patient is currently suffering from MRSA bacteremia and endocarditis, with mycotic aneurysms in her brain causing intracranial hemorrhages. She is an IV drug user with hepatitis C and she's 30 years old.
After seeing many patients with a history of IV drug use, a staggering proportion of patients have hepatitis C, HIV, or both. Many patients have infections from dirty needles, like my patient.
Kids, just say no to drugs. But please, do NOT INJECT DRUGS. It's possibly the worst imaginable method of ingesting substances for tons of reasons (outlined below), but it also happens to give people the quickest and most intense effect (partly because it increases bioavailability by bypassing the gut). It's impressive to me that much of the morbidity arising from IV drug use (IVDU) arises from using dirty needles...
- Hepatitis C - very common
- HIV - pretty common
- MRSA, infections, etc
- higher risk of overdose
- nerve/artery damage
Never use needles. Stay away from drugs. Can you tell that I'm venting?
Wednesday, April 01, 2009
Sunday, March 29, 2009
Psych!
"Third year sucks," an intern once told me in the middle of third year.
"Really? Why?" I said (wow, way to go, Stephanie).
"Because you're constantly changing into different clinics and doing different roles and working with new people with no idea how to think or what to expect until you get the hang of it after a few days and then you're shoved into a totally new setting with a different set of practices. And the whole time that you're struggling, everyone around you is critically judging you."
Never really considered that, but it's a good synopsis of why third year can be challenging. The other aspect not really mentioned is that third year can be hard because there is a huge lack of personal free time and a sense of social isolation compared to the first two years of medical school. But it's not all bad news, ladies and gents.
Once you get the hang of third year, however, it can be exciting and fun! Imagine going to a chocolate salon and sampling every bite of chocolate. That was fun last week, until I got really nauseous.
Third year is like a cultural safari where you can study different tribes, adopt their customs, and learn how they think and what their values are. For someone who is adventurous and flexible, resourceful and resilient, third year is like a grueling backpacking trip through the Amazon where the locals are concurrently evaluating whether or not you should be allowed to go traveling. But the best part is that you don't have to travel very far at all...in fact, you tend to stay in one building for 13 hours per day.
Another interesting group that you get enormous exposure to is your patients. I have always suspected this before, but the strength of any medical training (and thus medical school) is heavily based upon both the skills of the residents AND the diversity of your patient population. Pick a medical school based on geography and the patient population that you get exposure to, because that will shape your training as a doctor. At UCSF, we are enormously privileged to have several settings (VA, Moffitt, SFGH, CPMC, Fresno) that gives us a wide range of patients from all walks of life....young/old, rich/poor, urban/rural, etc/etc. Working at SFGH has been an amazing experience, because it is the only hospital in the city that serves the uninsured, the only trauma center in SF, and the cradle of HIV/AIDS healthcare. It is estimated that up to 25% of the patients at SFGH are HIV+ and SFGH is home to Ward 86, one of the most renowned HIV clinics in the country. Going to medical school in SF allows you the unbelievable privilege of working with a large HIV+ population in SF and gives you insight and medical training that cannot be replicated, and I never TRULY appreciated this until third year.
Okay, I've totally digressed again. All of this was a prelude to a short reflection on my time on inpatient psychiatry at SFGH. It was an excellent experience, and I learned so much about how to interview psychiatric patients (be nonjudgmental, ask questions like Columbo) and how to think/adminster psychiatric medications. In fact, the inspiration for this posting was a recent UCSF news tidbit on how the drug company Eli Lilly is trying to market a new combo drug (olanzapine and prozac) for treatment-resistant depression. Psych is so incredibly interesting, and I predict big advances in the next 50-100 years as we learn more about the pathophysiology of schizophrenia, bipolar, depression.
Oops, gotta go.
"Really? Why?" I said (wow, way to go, Stephanie).
"Because you're constantly changing into different clinics and doing different roles and working with new people with no idea how to think or what to expect until you get the hang of it after a few days and then you're shoved into a totally new setting with a different set of practices. And the whole time that you're struggling, everyone around you is critically judging you."
Never really considered that, but it's a good synopsis of why third year can be challenging. The other aspect not really mentioned is that third year can be hard because there is a huge lack of personal free time and a sense of social isolation compared to the first two years of medical school. But it's not all bad news, ladies and gents.
Once you get the hang of third year, however, it can be exciting and fun! Imagine going to a chocolate salon and sampling every bite of chocolate. That was fun last week, until I got really nauseous.
Third year is like a cultural safari where you can study different tribes, adopt their customs, and learn how they think and what their values are. For someone who is adventurous and flexible, resourceful and resilient, third year is like a grueling backpacking trip through the Amazon where the locals are concurrently evaluating whether or not you should be allowed to go traveling. But the best part is that you don't have to travel very far at all...in fact, you tend to stay in one building for 13 hours per day.
Another interesting group that you get enormous exposure to is your patients. I have always suspected this before, but the strength of any medical training (and thus medical school) is heavily based upon both the skills of the residents AND the diversity of your patient population. Pick a medical school based on geography and the patient population that you get exposure to, because that will shape your training as a doctor. At UCSF, we are enormously privileged to have several settings (VA, Moffitt, SFGH, CPMC, Fresno) that gives us a wide range of patients from all walks of life....young/old, rich/poor, urban/rural, etc/etc. Working at SFGH has been an amazing experience, because it is the only hospital in the city that serves the uninsured, the only trauma center in SF, and the cradle of HIV/AIDS healthcare. It is estimated that up to 25% of the patients at SFGH are HIV+ and SFGH is home to Ward 86, one of the most renowned HIV clinics in the country. Going to medical school in SF allows you the unbelievable privilege of working with a large HIV+ population in SF and gives you insight and medical training that cannot be replicated, and I never TRULY appreciated this until third year.
Okay, I've totally digressed again. All of this was a prelude to a short reflection on my time on inpatient psychiatry at SFGH. It was an excellent experience, and I learned so much about how to interview psychiatric patients (be nonjudgmental, ask questions like Columbo) and how to think/adminster psychiatric medications. In fact, the inspiration for this posting was a recent UCSF news tidbit on how the drug company Eli Lilly is trying to market a new combo drug (olanzapine and prozac) for treatment-resistant depression. Psych is so incredibly interesting, and I predict big advances in the next 50-100 years as we learn more about the pathophysiology of schizophrenia, bipolar, depression.
Oops, gotta go.
Monday, March 16, 2009
hey, i got my stuff back
Believe it or not...but I got a call from a medical classmate letting me know that my stolen tote bag was dropped off "by a homeless guy" at the Moffitt ED. Most of my stuff was still there (!) including:
- psychiatry case files book
- medical student ID
- stethoscope
- reflex hammer
- key
- pager
- two notebooks
- chapstick
- umbrella
The only things missing that i can tell so far were a cliff bar, the battery from my pager, and a pack of 50 cards for 1-800 quit tobacco. Found objects include a BART card and a flyer for a tattoo parlor.
Not sure what to make of this...maybe the man who smashed my car window realized that he stole a bag from a painfully dorky medical student and took pity on me?
- psychiatry case files book
- medical student ID
- stethoscope
- reflex hammer
- key
- pager
- two notebooks
- chapstick
- umbrella
The only things missing that i can tell so far were a cliff bar, the battery from my pager, and a pack of 50 cards for 1-800 quit tobacco. Found objects include a BART card and a flyer for a tattoo parlor.
Not sure what to make of this...maybe the man who smashed my car window realized that he stole a bag from a painfully dorky medical student and took pity on me?
Thursday, March 12, 2009
boosts
Last night my car window was broken and my book bag taken as I was eating dinner in SOMA. Bummer. Like any curious medical student, I started almost compulsively googling some background reading and found that these car burglaries or "smash and grab" crimes (known as "boosts") are way too common in San Francisco, with an average of 41 incidents per day in the city!
Many medical students have experienced car burglaries even in the Sunset, which is relatively safe, and some have had their cars stolen. It's like owning a bicycle in college....it WILL get stolen! Accepting these crimes as a fact of life is frustrating.
Interestingly, after a campaign to crack down on car burglaries, the police reported that "the team has arrested 34 people, according to department spokesman Sgt. Steve Mannina, which has contributed to a 22 percent drop in incidents reported between October of this year and October 2006."
"By arresting one person, we prevent at least 10 to 20 [break-ins] per week,” Lazar said. “One person doesn’t break into just one car. They move on and target more.”
This week, my car window got broken and I lost all of my psychiatry materials.
Last week, a psychiatric patient escaped from the hospital under my supervision...but he came back six hours later to "get his stuff back"!
Sigh.
Many medical students have experienced car burglaries even in the Sunset, which is relatively safe, and some have had their cars stolen. It's like owning a bicycle in college....it WILL get stolen! Accepting these crimes as a fact of life is frustrating.
Interestingly, after a campaign to crack down on car burglaries, the police reported that "the team has arrested 34 people, according to department spokesman Sgt. Steve Mannina, which has contributed to a 22 percent drop in incidents reported between October of this year and October 2006."
"By arresting one person, we prevent at least 10 to 20 [break-ins] per week,” Lazar said. “One person doesn’t break into just one car. They move on and target more.”
This week, my car window got broken and I lost all of my psychiatry materials.
Last week, a psychiatric patient escaped from the hospital under my supervision...but he came back six hours later to "get his stuff back"!
Sigh.
Thursday, February 19, 2009
Mnemonic for EKG Lead Placement
Today in anesthesiology, I helped out with the setup for a patient undergoing a whipple procedure for pancreatic cancer. the surgery lasted all day (roughly 8-5pm) and was pretty complex, plus there was a really amazing resected specimen (part of the pancreas, duodenum, with a huge yellow globular tumor). slices of the tumor were sent to a tissue bank and the rest was sent to pathology. but i digress.
after the whipple man was well underway, i tagged along and observed four IVF procedures in which eggs were being harvested from hormonally primed women. then i bounced back to the OR to help set up 2 more patients for a D&C and TVH.
slowly, i am starting to learn how to think like an anesthesiologist. also, i am starting to figure out the myriad of procedures that have to be done in a hurry. during the IVF procedures, it was amazing to think about how marvelous noninvasive inventions like the EKG, pulse oximeter, and even an O2 nasal cannula with CO2 monitors can improve patient safety without harming the patient at all. anesthesia itself has always amazed me...how can a person go to sleep, have their abdomen exposed, have a tumor resected with their plumbing all reconnected...and wake up with minimal pain (thanks to an epidural), alive and kicking? the miracle of anesthesia. amen.
oh wait, i forgot about the title of this post.
so the EKG leads in the OR have 5 leads. on the left side, the resident taught me the mnemonic "smoke over fire," meaning that the red lead is below the black lead (and the brown lead is in between, pretend it's wood if it makes you feel better). on the right side, the green lead is below the white lead, so I have decided to make my own mnemonic: "snow falling on cedars." okay, okay, I know that the biggest criticism of my MSP lessons (based on comments in Evalue) was that I was heavy on the mnemonics, but there are oodles of things in medicine that don't have any intrinsic meaning...like why the white lead has to be white...and why i am spending time typing this ramble when I should be sleeping....zzzz...
after the whipple man was well underway, i tagged along and observed four IVF procedures in which eggs were being harvested from hormonally primed women. then i bounced back to the OR to help set up 2 more patients for a D&C and TVH.
slowly, i am starting to learn how to think like an anesthesiologist. also, i am starting to figure out the myriad of procedures that have to be done in a hurry. during the IVF procedures, it was amazing to think about how marvelous noninvasive inventions like the EKG, pulse oximeter, and even an O2 nasal cannula with CO2 monitors can improve patient safety without harming the patient at all. anesthesia itself has always amazed me...how can a person go to sleep, have their abdomen exposed, have a tumor resected with their plumbing all reconnected...and wake up with minimal pain (thanks to an epidural), alive and kicking? the miracle of anesthesia. amen.
oh wait, i forgot about the title of this post.
so the EKG leads in the OR have 5 leads. on the left side, the resident taught me the mnemonic "smoke over fire," meaning that the red lead is below the black lead (and the brown lead is in between, pretend it's wood if it makes you feel better). on the right side, the green lead is below the white lead, so I have decided to make my own mnemonic: "snow falling on cedars." okay, okay, I know that the biggest criticism of my MSP lessons (based on comments in Evalue) was that I was heavy on the mnemonics, but there are oodles of things in medicine that don't have any intrinsic meaning...like why the white lead has to be white...and why i am spending time typing this ramble when I should be sleeping....zzzz...
Wednesday, February 18, 2009
anesthesiology
Currently on a 2-week anesthesiology rotation at mount zion, and it's pretty cool so far. During grand rounds this morning, I got the impression that anesthesiologists seem happier than surgeons...! There's a lot of cool procedures (i got to put in an LMA today) and different medications to use, and there's a great emphasis on thinking through the patient's physiology.
Wednesday, February 11, 2009
family planning
Visiting the Family Planning Clinic in Fresno, California, was an important part of our Ob/Gyn rotation and of our medical education. Although most students have mixed feelings about elective abortions, the general consensus appears to be that most students are pro-choice, but would never be able to personally perform abortions. How can there be such a contradiction? It is almost impossible to be neutral or apathetic about the issue of abortion, because everyone has deeply held personal beliefs, personal experiences, and cultural or religious backgrounds that influence how we feel and act.
The doctor working at the Family Planning Clinic was extremely cordial and eager to teach medical students. He encouraged us to ask questions and made efforts to have us observe several procedures. After the embryos were extracted, the doctor had the samples placed in dishes of saline so that we could observe the villi, gestational sac, and parts of a 14-week embryo.
There were several moments during the visit when I was very grateful for the opportunity to visit the Family Planning Clinic to observe an important process that even doctors and hospitals will not openly acknowledge. It also made me aware of how difficult it is to be a woman with an unwanted pregnancy with few options, and how the stigma of abortion can be still be so potent. Overall, the experience strengthened my conviction that legalizing abortions is crucial to women’s health and well-being, because so many women would lose their lives to infection, hemorrhage, and dangerous procedures if safe, effective, and confidential medical procedures were unavailable.
Admittedly, there were also a few moments when I experienced twinges of sadness. Gazing into the saline dish, we could see the gestational sac and 2-centimeter body of the 14-week embryo. The embryo’s head had been ripped apart during the vacuum process, but we could still discern the legs, spine, and arms down to the tiny fingers. When we found the embryo head, the two small eyes seemed to be staring at us with a sad confusion that mirrored my own unresolved feelings.
The doctor working at the Family Planning Clinic was extremely cordial and eager to teach medical students. He encouraged us to ask questions and made efforts to have us observe several procedures. After the embryos were extracted, the doctor had the samples placed in dishes of saline so that we could observe the villi, gestational sac, and parts of a 14-week embryo.
There were several moments during the visit when I was very grateful for the opportunity to visit the Family Planning Clinic to observe an important process that even doctors and hospitals will not openly acknowledge. It also made me aware of how difficult it is to be a woman with an unwanted pregnancy with few options, and how the stigma of abortion can be still be so potent. Overall, the experience strengthened my conviction that legalizing abortions is crucial to women’s health and well-being, because so many women would lose their lives to infection, hemorrhage, and dangerous procedures if safe, effective, and confidential medical procedures were unavailable.
Admittedly, there were also a few moments when I experienced twinges of sadness. Gazing into the saline dish, we could see the gestational sac and 2-centimeter body of the 14-week embryo. The embryo’s head had been ripped apart during the vacuum process, but we could still discern the legs, spine, and arms down to the tiny fingers. When we found the embryo head, the two small eyes seemed to be staring at us with a sad confusion that mirrored my own unresolved feelings.
Wednesday, February 04, 2009
My intellectual mother, part 2
Chatting with my 13 y/o brother....
Jeremy: Mom is too mad to talk right now
me: whoa...why is she mad ?
Jeremy: The book she read was the worst book she ever read
me: HAHAHA
Jeremy: The series was called the dreamers
In the end, they went in the past and killed the enemy
Leaving all the books before useless
Jeremy: Mom is too mad to talk right now
me: whoa...why is she mad ?
Jeremy: The book she read was the worst book she ever read
me: HAHAHA
Jeremy: The series was called the dreamers
In the end, they went in the past and killed the enemy
Leaving all the books before useless
Tuesday, January 27, 2009
Tip #3: Pregnant? Go See a Doctor ASAP.
Pregnant women of the world, please see a doctor AS SOON AS you think that you might be pregnant. Not only can you get a second pregnancy test, but you can start your prenatal care early. Fetuses need healthcare too, but the most important thing might be the first sonogram to estimate the age of the fetus. Combined with knowledge of your exact LMP (the first day of your last period), doctors can make better decisions about your healthcare...everything from deciding when you might need an induction to whether your fetus is growing normally.
I always wondered by doctors get very persnickety and anal about "dating" the pregnancy, but now realize that it is a fundamental and often underestimated part of the process.
I always wondered by doctors get very persnickety and anal about "dating" the pregnancy, but now realize that it is a fundamental and often underestimated part of the process.
respect
I often enjoy David Brooks' columns in the NYT, here is a particular quote of a quote for today:
"In 2005, Ryne Sandberg was inducted into the baseball Hall of Fame. Heclo cites his speech as an example of how people talk when they are defined by their devotion to an institution:
'I was in awe every time I walked onto the field. That’s respect. I was taught you never, ever disrespect your opponents or your teammates or your organization or your manager and never, ever your uniform. You make a great play, act like you’ve done it before; get a big hit, look for the third base coach and get ready to run the bases.'”
However, I disagree with Brooks' assertion that we must return to a culture more reliant upon institutional thinking. I am still a big believer in the philosophy of a liberal education, as Brooks points out:
"A few years ago, a faculty committee at Harvard produced a report on the purpose of education. “The aim of a liberal education” the report declared, “is to unsettle presumptions, to defamiliarize the familiar, to reveal what is going on beneath and behind appearances, to disorient young people and to help them to find ways to reorient themselves.”
The report implied an entire way of living. Individuals should learn to think for themselves. They should be skeptical of pre-existing arrangements. They should break free from the way they were raised, examine life from the outside and discover their own values."
Whether we devote ourselves to individualistic "thinking" or institutional "thinking" is not even the point; both labels describe certain automatic behaviors. We need to be capable of thinking (and I say this in italics) in a consciously unbiased manner instead of blindly following our own needs or conforming to the demands of society.
"In 2005, Ryne Sandberg was inducted into the baseball Hall of Fame. Heclo cites his speech as an example of how people talk when they are defined by their devotion to an institution:
'I was in awe every time I walked onto the field. That’s respect. I was taught you never, ever disrespect your opponents or your teammates or your organization or your manager and never, ever your uniform. You make a great play, act like you’ve done it before; get a big hit, look for the third base coach and get ready to run the bases.'”
However, I disagree with Brooks' assertion that we must return to a culture more reliant upon institutional thinking. I am still a big believer in the philosophy of a liberal education, as Brooks points out:
"A few years ago, a faculty committee at Harvard produced a report on the purpose of education. “The aim of a liberal education” the report declared, “is to unsettle presumptions, to defamiliarize the familiar, to reveal what is going on beneath and behind appearances, to disorient young people and to help them to find ways to reorient themselves.”
The report implied an entire way of living. Individuals should learn to think for themselves. They should be skeptical of pre-existing arrangements. They should break free from the way they were raised, examine life from the outside and discover their own values."
Whether we devote ourselves to individualistic "thinking" or institutional "thinking" is not even the point; both labels describe certain automatic behaviors. We need to be capable of thinking (and I say this in italics) in a consciously unbiased manner instead of blindly following our own needs or conforming to the demands of society.
Monday, January 26, 2009
Saturday, January 24, 2009
When I Grow Up
The favorite questions between classmates during this season are: 1) Are you taking a year off? and 2) Do you know what you might go into?
No. And no.
Throughout medical school, I always assumed that the right field would seem immediately and obviously perfect for me. Maybe it would be when I diagnosed my first ear infection in a 2-year-old in Pediatrics. Maybe it would be when I first saw an open abdomen under the bright lights in an OR during Surgery. But somehow, working on the theory that finding a medical profession can be as easy as love at first sight has...well...turned out to be harder than imagined.
Writing has always been a way for me to process emotions and explain decisions. But during third year, writing has been difficult due to time constraints, privacy issues, and my inability to sit down and ponder the journey that will be my life.
Stay tuned for future angst.
No. And no.
Throughout medical school, I always assumed that the right field would seem immediately and obviously perfect for me. Maybe it would be when I diagnosed my first ear infection in a 2-year-old in Pediatrics. Maybe it would be when I first saw an open abdomen under the bright lights in an OR during Surgery. But somehow, working on the theory that finding a medical profession can be as easy as love at first sight has...well...turned out to be harder than imagined.
Writing has always been a way for me to process emotions and explain decisions. But during third year, writing has been difficult due to time constraints, privacy issues, and my inability to sit down and ponder the journey that will be my life.
Stay tuned for future angst.
Wednesday, January 14, 2009
Fresno, CA
Fresno is an inland city located in California's Central Valley approximately midway between San Francisco and Los Angeles. In many ways, Fresno is very different from San Francisco...the median income for a household in Fresno is $32,236 vs. $57,833 in San Francisco according to wiki. There is a larger population of Hispanic and minority patients, and most of the Asian patients in Fresno are the legendary Hmong. (Legendary because Hmong culture is featured extensively in our required reading during medical school as part of lessons in cultural sensitivity, but rarely seen in San Francisco). In Ob-Gyn, our female patients tend to be younger, healthier, poorer, and less educated than patients probably seen at other hospitals in the Bay Area. A fair amount of patients are illiterate. Many are immigrants from other countries. Learning medicine in a non-academic center has been new and refreshing for me, and I have been able to practice my medical Spanish. I had wanted to do obgyn in Fresno because 1) it seemed like a good idea to do an away rotation to see new settings; 2) Fresno has one of the highest birth rates in CA; 3) I've never been to Fresno; 4) I wanted to practice my Spanish.
I haven't spoken much Spanish since college, and have been amazed again at how beautiful the language can be. Honestly, Spanish is more expressive and beautiful than English or Mandarin...and this is coming from a pseudo-Asian American English major. There are so many shades of meaning, and interesting quirks to think about...like how the term for giving birth is "dar la luz" (literally: give light), or why someone can be "estar muerto" (dead) when the verb "estar" implies a temporary state. Or even why someone can be "ser joven" (young) when "ser" usually implies a permanent state. Don't get me wrong, my Spanish is still fairly poor.
Another interesting thing about Fresno is the lifestyle...the buildings are spread out, there are gazillions of chain stores like Target, Starbucks, Costco, and plenty of parking and free high quality food at the hospital. The people in Fresno tend to be more open, friendly, less pretentious and more humble. :)
Monday, January 12, 2009
Tip #2: Wipe from Front to Back
Ladies, avoid getting UTI's by wiping from front to back (if you know what I mean).
Interesting NYT article on abortions in the NYC Dominican community: http://www.nytimes.com/2009/01/05/nyregion/05abortion.html?pagewanted=2&fta=y
ObGyn is fun! I enjoy working in the clinic and seeing different aspects of female reproductive health. Today I saw a few colposcopies for cervical dysplasia and worked up a case of bilateral breast pain. In the past week, there have been a few endometrial biopsies, some PID, a MRSA abscess, lots of prenatal appointments, and lots of birth control appointments. :)
Interesting NYT article on abortions in the NYC Dominican community: http://www.nytimes.com/2009/01/05/nyregion/05abortion.html?pagewanted=2&fta=y
ObGyn is fun! I enjoy working in the clinic and seeing different aspects of female reproductive health. Today I saw a few colposcopies for cervical dysplasia and worked up a case of bilateral breast pain. In the past week, there have been a few endometrial biopsies, some PID, a MRSA abscess, lots of prenatal appointments, and lots of birth control appointments. :)
Wednesday, January 07, 2009
Ladies, Keep Track of Your Period
Current in Fresno on my ob-gyn rotation. Fresno is a cool town, and medical students get free housing! So far, I like how ob-gyn is such a great mix of medicine and surgery.
Public Service Announcement: Ladies, PLEASE KEEP TRACK OF THE FIRST DAY OF YOUR PERIOD. In clinic, less than 25% of women know the date of their last menstrual period (LMP). This is just sad and pathetic, because obviously it's not hard to keep track of your period using a calendar, but rather indicates that medical professionals suck at teaching patients how take charge of their health. This will also come in handy not only if you're pregnant, but also if you show up at the Emergency Room with appendicitis...they will want to know your LMP.
Don't worry about anything more than the FIRST DAY of your period.
Public Service Announcement: Ladies, PLEASE KEEP TRACK OF THE FIRST DAY OF YOUR PERIOD. In clinic, less than 25% of women know the date of their last menstrual period (LMP). This is just sad and pathetic, because obviously it's not hard to keep track of your period using a calendar, but rather indicates that medical professionals suck at teaching patients how take charge of their health. This will also come in handy not only if you're pregnant, but also if you show up at the Emergency Room with appendicitis...they will want to know your LMP.
Don't worry about anything more than the FIRST DAY of your period.
Saturday, January 03, 2009
Raise Your Kids in Arcadia, CA
Sorry again for the lack of posts...surgery was busy and full of dramatic stories to be related soon. A belated Merry Christmas and Happy New Year! :)
Also just wanted to let everyone know that my hometown of Arcadia, CA was named the best place in California to raise your kids in 2009 accordinging to Business Week magazine! And the Rose Queen in the 2009 Pasadena Rose Parade is an Arcadia High School student! :)
See links: http://images.businessweek.com/ss/08/11/1110_best_places_for_kids/6.htm
Kid-Friendly and Cost-Friendly
By Prashant Gopal
Welcome to BusinessWeek's second annual roundup of the best places to raise your kids.
This year we are going state by state. Once again working with OnBoard Informatics, a New York-based provider of real estate analysis, we selected towns with at least 50,000 residents and a median family income between $40,000 and $100,000. We then narrowed the list of towns using the following weighted criteria: school performance; number of schools; household expenditures; crime rates; air quality; job growth; family income; museums, parks, theaters, and other amenities; and diversity. We weighted school performance and safety most heavily, but also gave strong weight to amenities and affordability.
Bear in mind with this list, the organizing principle was affordability. While the median household income varies by state, we purposely weighted the results to prevent pricing out most readers. That's why, for example, Greenwich, Conn., with its good private schools, low crime, and abundance of cultural amenities, was left out. It simply costs too much to live there.
Of course, there are other places that are great for kids which did not make this list. In many states the competition was extremely close. Moreover, we looked for communities that scored well across the board. So, while there might be places that offer more culture, better schools, etc., other factors such as crime or a high cost of living knocked them down.
Also just wanted to let everyone know that my hometown of Arcadia, CA was named the best place in California to raise your kids in 2009 accordinging to Business Week magazine! And the Rose Queen in the 2009 Pasadena Rose Parade is an Arcadia High School student! :)
See links: http://images.businessweek.com/ss/08/11/1110_best_places_for_kids/6.htm
Kid-Friendly and Cost-Friendly
By Prashant Gopal
Welcome to BusinessWeek's second annual roundup of the best places to raise your kids.
This year we are going state by state. Once again working with OnBoard Informatics, a New York-based provider of real estate analysis, we selected towns with at least 50,000 residents and a median family income between $40,000 and $100,000. We then narrowed the list of towns using the following weighted criteria: school performance; number of schools; household expenditures; crime rates; air quality; job growth; family income; museums, parks, theaters, and other amenities; and diversity. We weighted school performance and safety most heavily, but also gave strong weight to amenities and affordability.
Bear in mind with this list, the organizing principle was affordability. While the median household income varies by state, we purposely weighted the results to prevent pricing out most readers. That's why, for example, Greenwich, Conn., with its good private schools, low crime, and abundance of cultural amenities, was left out. It simply costs too much to live there.
Of course, there are other places that are great for kids which did not make this list. In many states the competition was extremely close. Moreover, we looked for communities that scored well across the board. So, while there might be places that offer more culture, better schools, etc., other factors such as crime or a high cost of living knocked them down.
Saturday, November 15, 2008
Surgery. 'Nuff Said.
Sorry for the lack of posts...I fell off the blogging bandwagon for a few weeks.
Currently, I just finished week 3/8 of Surgery at Mt. Zion/Parnassus. MZ is UCSF's cancer center, and I love being on the surgical oncology White service (the Gold service at MZ does colorectal cases). White surgeries include GI malignancies (whipple's, etc), liver resections, and melanoma.
Surgical oncology seems like a great field, there's a lot of satisfaction to be gained from whacking out a tumor.
P.S. It seems like a bad dream...how did Prop 8 AND Prop 2 BOTH pass? Since when do chickens enjoy advances in rights...while humans do not?
Tuesday, October 28, 2008
SAVE GENERAL HOSPITAL
San Francisco voters, please vote YES on Prop A to make San Francisco General Hospital earthquake-friendly.
SELECT trial halted!
As a prostate cancer/oncology geek, I have to let you know that the huge trial examining whether selenium + Vitamin E prevents prostate cancer (results were due in 2013) was closed permanently yesterday!
Researchers found that there was a small but significant increase among vitamin E users to develop prostate cancer, and a small but significant increase in the incidence of diabetes among selenium users.
Juicy oncology gossip!
Discuss.
Researchers found that there was a small but significant increase among vitamin E users to develop prostate cancer, and a small but significant increase in the incidence of diabetes among selenium users.
Juicy oncology gossip!
Discuss.
Tuesday, October 21, 2008
Intersession 2 and a Really Nice Weekend
Big Sur from the Lucia Lodge restaurant porchbest fish and chips ever
The MS3's are midway through Intersession 2, a week-long break between 3rd and 4th block. It's interesting that even though I had more free time during Family Medicine, I actually ended up blogging less. During Intersession, the students engage in a variety of touchy-feely small groups and lectures about medical ethics and professionalism. It's actually a good time to unwind and reflect on how we are changing on our journey to becoming doctors.
Last weekend after the Family Medicine exam was also extremely nice. To start, I spent an hour walking around Lake Merced by myself before sunset, which is something that I wanted to do for six weeks after glimpsing the beautiful lake through a window at the Janet Pomeroy Center (a fantastic center for children and adults with disabilities that FCM introduced me to via a community project). Lake Merced is beautiful; there are so many areas of the city that I haven't explored yet (the SF Zoo is nearby too).
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