Saturday, June 19, 2010

OB-GYN part 1

It seems fitting that a specialty which refers to itself with a five letter abbreviation is one that is chock full of abbreviations, to the point that our syllabus was annotated with a glossary. I imagine this is some subconcious throw-back to the days when physicians spoke in latin both to impress their patients and to conceal their thoughts. Here's a sample:

CC: VB for 2hr
HPI: HC is a 38 yo G4P3103 at 37w5d c/o spontaneous VB this afternoon after waking from a nap. She denies any LOF, d/c, and has postive FM. Pt denies pain, no h/a, dizziness, RUQ pain, or VC. Pt only c/o BRB with dime sized clots. Denies any dysuria, pyuria, hematuria, no n/v/d.

Gyn Hx:
Pap-no hx of abnl pap
STI: neg trich, GC, CT, HIV.
Sx: LTCS for FTP

G1: 2001 IOL for dates at 41, F 6#7
G2: 2003 SVD at 33 F 4#1
G3: 2005 LTCS a 38 for FTP F 6#9
G4: current, pt desires TOLAC.

Med Hx: none
Rx: PNV and Fe
Allergies: NKDA
BrCA: mother, maternal aunt, MGM,
DM: mother, MGF

Pt is 38 G4P3103 c/o VB.
1. U/S
2. FFN, CBC,
3. consider MFM consult.

For the medical purists out there, I know that this is an incomplete H &P and that the assessment and plan are incomplete, but I'm illustrating a point. Here is a prose version:

HC is a 38 year old female with a history of 4 pregnancies, 3 deliveries, 2 term and one premature. She has a complaint of vaginal bleeding. She denies any loss of fluid, vaginal discharge (i.e. purulent discharge), and has felt fetal movement. Patient does not complain of a headache, right upper quadrant abdominal tenderness or vision changes.

Gynecological history:
patient has never had an abnormal pap smear
-no sexually transmitted infections like gonorrhea, chlamydia, trichomonas, or human immunodeficiency virus.
-Her only procedure was a low transverse cesarean section
Obstetrical history:
-G= pregnancy
SVD= spontaneous vaginal delivery
IOL = induction of labor
x#y= lbs and oz
TOLAC= trial of labor after c-section

Family history:
MGM= maternal grandmother
CAD: coronary artery disease
DM: diabetes mellitus.
BrCa: breast cancer

NKDA: no known drug allergies
FFN: fetal fibronectin a test than can help predict the probablility of labor or rupture of fetal membranes.
MFM: maternal fetal medicine: high risk OB doctors.
U/S: ultrasound.

A lot of these abbreviations are very standard, but the OB specific ones can be challenging, especially since they can be interpreted multiple ways i.e. VB could mean vaginal birth, or vaginal bleeding. Mostly there has been a movement towards the standardization of abbreviations in medicine as well as a decrease in their use overall, but OB is a lone holdout.

Thursday, June 17, 2010

My Portable Fomite

I wear a short white coat that I loathe. I have had it since my first day of medical school and have worn it nearly 6 days a week for the last calendar year. Sometimes I'm better at washing it than others. It has some ring around the collar, numerous ink stains in the breast pocket, and two pockets that are in the process of being torn off, and stained cuffs. It weighs between 6 and 7 pounds.
Breast pocket: 1 cracked cheap-o school logo pen.
1 stolen Bic pen.
pocket lint.
Maxwell's pocket guide.
2007 Tarascon's Pharmacopia
1 pen light.
2 ID badges in a semi-opaque holder.
1 monofilament in badge holder.

Left inner pocket:
2009 Sanford Guide to Antimicrobial therapy
Pocket Medicine 3rd edition.
2 old H&P pages with notes.

Left outer pocket:
1 Littman Cardio 3 stethoscope with freebie Army light attached in the likely event that the penlight craps out.

Right inner pocket:
1 FACTS card (little card that I have to get signed periodically during a rotation)
1 gestational age wheel
1 old tongue depressor still in wrapper
2 procedure cards (similar to FACTS card)
2 scholarly papers
4 old H&P's
1 bandaid in wrapper.

Right outer pocket:
study book du jour, in this case Case Files for OB-GYN
2 current H&P's
1 more scholarly paper
1 page of notes from lecture
Sometimes a reflex hammer and tuning forks, depending on how likely I think it is that I'll do a neuro exam (usually these stay safely in my bag or even more safely in my locker 7 miles from the hospital).

Sleeves: miscellaneous dirt, MRSA, VRE, cruddies.

This little gem is my friend for another year, after which I can swap it for a longer version. After I graduate I am going to dowse this one in kerosene and set it on fire, both for sanitataion and catharsis.


Gunner loves cars, and he has recently taken to driving them around on little "tracks". He uses anything that makes for a good road, including the circle on a See 'n Say, the straps on Spiff's school bag, and the tiny little loop on the base of a stacking toy. He's actually pretty creative. It has made me want to buy a new toy for him, a race track or road, something that would probably cost $20-70 that we shouldn't spend on a toy.

Today, my awesome friend, Maggie, helped me make this:
If you can't tell, it's a cuddly little felt town with roads for driving little cars around on, complete with red fire station, blue police station, gray library, pond w/ park benches, and a gazebo in some lucky person's backyard (lower left). I'll call it Gunneropolis. He loves it. I love it. It was fun to make, and it cost about $3.

Thanks, Maggie! Drive on, Gunner!


Okay, two things before I tell my story:
1. I recently got out some toys for Gunner that I had kept hidden for a while. It is a set of pretend food and dishes. I got them for him for Christmas, and I hid them for a while because I was tired of picking them up off the floor.

2. Gunner loves helping me when I cook and bake. His job is to dump cupfuls and spoonfuls of ingredients into a bowl. He is always right there by my side when I make cookies, dumping in the salt and baking powder. Sometimes he doesn't get the dumping action quite right and gets a facefull of flour, to his great dismay, and my great entertainment! Of course, he enjoys the perk at the end of mixing of licking the beaters.

Alright, on to my story. I made dinner rolls the other day, and as usual, he was right by my side on a kitchen chair, helping me out. As I was rolling out and shaping the dough, with my rolling pin and pizza cutter, he gasped, climbed off the chair, and ran out of the kitchen. I thought he was just tired of baking or just excited to play with his long-lost toys. Then he returned with this:
I gave him his own little piece of dough to cut. Man, I stinkin' love watching him figure things out!

Saturday, June 12, 2010

Potty Talk

Let me begin this little discussion by stating that I have no intention of potty training my son for a long while, so I'm not really looking for actual potty training advice at this time. That being said...

Gunner has been very interested in the potty lately. He plays "Pretend Potty" by having us help him sit on the potty and go through the motions with him. He runs to the potty after doing some business in his diaper to show us that he knows relatively what it's all about. He also runs up to me after I have done my business on the potty to help me pull up my pants. (Is this too much information? I don't know since I have forgotten what it's like to have any privacy.)

The other day, Gunner and I had a 10-minute conversation about the potty. He initiated this discussion by pointing at the potty, turning around, scooting his little tushy up to it, and the swinging a leg up, like he was saying, "I'm going to sit on this thing, now." So I helped him on, he sat there for a few seconds, and then hopped off. Then he sat on the floor with me and told me lots of baby-babbled stuff about the potty. Then he stood up, backed up to the toilet, swung his leg up, and sat back down on it. He continued this routine for several rounds. The whole thing was very endearing.

He is very obviously interested in the potty. I would like to fuel his interest and keep him excited about the potty, without actually potty training him yet. We have talked about getting him his own little potty, but a friend suggested getting a toddler-sized seat that connects right to the actual toilet seat instead.

So I am wondering what people's opinions and experiences are with their little ones. How did you fuel any existing interest? What devices/products did you use? And where do I find these gems?

Thursday, June 03, 2010


Wowzah, it's been hard to think of something to blog about lately. It's the end of 3rd year, and I'm really feeling it. My patience is low, my creativity is almost nonexistent, and I can hardly wait the two weeks for Spiff to be done with his OB/GYN rotation which marks the end of 3rd year and the beginning of a two-week vacation!!! I feel like a kid who just can't quite wait for Christmas. Maybe I should make a paper chain.

Before this turns into a total whine session, I'll write about some of the things we've been up to.

Spiff participated in his first triathlon a few weeks ago. It was a mini-tri, with a 200 yard swim, 9 mile bike ride, and 2 mile run. He said that the pool was very warm and the bike/run route was very hilly, and it was hot and sunny. But he had a good time and finished in 52 minutes, which put him at 5th in his 20-29 age group. Not bad for a first try!

I am amazed at how grown-up Gunner is these days. He is becoming so independent, and he knows what a big kid he is. He knows his body parts, he loves reading with us, and he loves, loves, loves being outside. He is also coming up with a whole bunch of new words. My favorite new ones:
Larli (Charlotte...his very best friend in the whole world)
Gah gahn (all gone)
Lellow (yellow)
Gaing (again)
Mmbomeh or Bubby (bummy/bum/tushy)

Our primary class is going well. Thank you for all of your fabulous suggestions! We have some great kids in our class, and I've actually been enjoying it. The 4-5 year olds are a whole lot different than the 2-3 year old nursery kids. The main differences are their capacity to color for a long period of time, and the fact that they want to tell us all kinds of stories. They ask over and over again if they can tell us something, and if we tell them to wait (for the sake of some kind of continuity in the lesson), they completely tune us out while they hold onto their thought. They wait for a pause in the lesson and then say, "NOW can I tell you something?"

Their stories are cute but hard to listen to. They ramble, and there is hardly ever a point. One time last week, we tried to wrap up a little girl's story by saying, "Alright, thank you." And she yelled at us, "I'm Not Finished Yet!!!"

Okay! Sorry to offend. Go right on and finish. We're all ears.

My favorite quote of the class so far:
Spiff asked, "Why should we obey our parents?"
One kid responded, "So we can get stickers."

Anyway, we're one day closer to the end of 3rd year. I can't believe Spiff is almost a 4th year! I'm going to go make my paper chain now.